Nuclear Medicine in the First Year of Life

Abstract

Learning Objectives: On successful completion of this activity, participants should be able to describe, for children less than 1 y old, (1) the wide variety of nuclear medicine indications; (2) the nuclear medicine studies, relative to other imaging methods, that can provide the highest diagnostic yield; (3) how to obtain high-quality nuclear medicine examinations at the lowest radiation exposures; (4) how growth and development affect the appearance, and therefore the interpretation, of nuclear medicine images; and (5) special care needed, such as patient preparation, immobilization, distraction techniques, environment, sedation or general anesthesia, imaging techniques, image processing, and presentation of results.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNM designates each JNM continuing education article for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity.For CE credit, participants can access this activity through the SNM Web site (http://www.snm.org/ce_online) through June 2012.Nuclear medicine has an important role in the care of newborns and children less than 1 y old. Patients in this age group present with a spectrum of diseases different from those of older children or adults. These patients can benefit from the full range of nuclear medicine studies. In these young children, nuclear medicine studies are more likely to be used to evaluate a wide range of congenital conditions but also can be helpful for evaluating acquired conditions such as infection, cancer, and trauma. This review first will cover the general aspects of nuclear medicine practice with these patients, including the special considerations that can help achieve successful diagnostic imaging. These topics will include clinical indications, imaging technology, instrumentation, software, positioning and immobilization, sedation, local and general anesthesia, radiopharmaceutical doses, radiation risk, and dose reduction. The review then will discuss the specific nuclear medicine studies that typically are obtained in patients in this age group. With extra care and attention to the special needs of this population, nuclear medicine departments can successfully study patients less than 1 y old.

Detection of salivary aspiration using radionuclide salivagram SPECT/CT in patients with COPD exacerbation: a preliminary study

“…VFSS can be used to directly evaluate the oropharyngeal and esophageal phases of swallowing. However, it has significant false-negative results in predicting those who will progress to have aspiration pneumonia (20), and it uses a greater radiation dose (1.23 mSv), which limits the ability to perform frequent follow-up examinations (21). FEES can be performed at the bedside and does not expose the patient to radiation; however, it is invasive and difficult to perform (18).…”

Assessment of radiation dose in nuclear cardiovascular imaging using realistic computational models

“…It was observed that the highest absorbed dose to critical organs is delivered to the testes, kidney, thyroid, and heart wall for 201 Tl; gall bladder wall, kidney, salivary glands, liver, uterus, colon wall, and urinary bladder wall for Tc-furifosmin; heart wall, liver, and urinary bladder wall for 123 I-BMIPP; the UB wall and uterus for 11 C (realistic maximum model); the liver, urinary bladder wall, and kidney for 13 N-ammonia; the liver, spleen, thyroid, and testes for 15 O-water; the kidney, heart wall, and liver for 18 F-flurpiridaz; the heart wall and urinary bladder wall for 18 F-FDG; the urinary bladder wall and thyroid for 18 F-LMI1195; and uterus, kidney, and lung for 82 Rb. Figure 6 shows the absorbed dose from considered radiotracers for the heart wall, UB wall, kidney, and liver for the newborn, 1-, 5-, 10-, 15-yr-old female, and the adult male and female models.…”

“…11 However, the exposure of pediatric patients to ionizing radiation during nuclear cardiology procedures is a matter of concern. 12,13 With the same absolute level of radiation dose, children may experience greater stochastic effects from ionizing radiation than adults because they have a proportionally higher percentage of T I. Organ masses of computational phantoms.…”

International Guidelines for Pediatric Radiopharmaceutical Administered Activities

“…It follows that the resultant radiation exposure to children undergoing nuclear medicine examinations also has varied quite broadly. Higher amounts of activity may not result in improved diagnostic sensitivity or accuracy, and low doses that do not permit an adequate examination should be considered unnecessary radiation exposure and therefore avoided (1).…”

“…Individual practitioners may use a lower administered activity if their equipment or software permits them to do so (12)(13)(14). Under special circumstances, higher administered activities may be required in certain patients under the direction of the nuclear medicine physician (1,15).…”