Report of a nationwide survey on actual administered radioactivities of radiopharmaceuticals for diagnostic reference levels in Japan

Abstract

ObjectiveThe optimization of medical exposure is one of the major issues regarding radiation protection in the world, and The International Committee of Radiological Protection and the International Atomic Energy Agency recommend establishing diagnostic reference levels (DRLs) as tools for dose optimization. Therefore, the development of DRLs based on the latest survey has been required for nuclear medicine-related societies and organizations. This prompted us to conduct a nationwide survey on the actual administered radioactivity to adults for the purpose of developing DRLs in nuclear medicine.MethodsA nationwide survey was conducted from November 25, 2014 to January 16, 2015. The questionnaire was sent to all of the 1249 nuclear medicine facilities in Japan, and the responses were collected on a website using an answered form.ResultsResponses were obtained from 516 facilities, for a response rate of 41 %. 75th percentile of 99mTc-MDP and 99mTc-HMDP: bone scintigraphy, 99mTc-HM-PAO, 99mTc-ECD and 123I-IMP: cerebral blood flow scintigraphy, 99mTc-Tetrofosmin, 99mTc-MIBI and 201Tl-Cl; myocardial perfusion scintigraphy and 18F-FDG: oncology PET (in-house-produced or delivery) in representative diagnostic nuclear medicine scans were 932, 937, 763, 775, 200, 831, 818, 180, 235 and 252, respectively. More than 90 % of the facilities were within the range of 50 % from the median of these survey results in representative diagnostic nuclear medicine facilities in Japan. Responses of the administered radioactivities recommended by the package insert, texts and guidelines such as 740 MBq (99mTc-MDP and 99mTc-HMDP: bone scintigraphy), 740 MBq (99mTc-ECD and 99mTc-HM-PAO: cerebral blood flow scintigraphy) and 740 MBq (99mTc-Tetrofosmin and 99mTc-MIBI: myocardial perfusion scintigraphy), etc. were numerous. The administered activity of many radiopharmaceuticals of bone scintigraphy (99mTc-MDP and 99mTc-HMDP), cerebral blood flow scintigraphy (99mTc-HM-PAO) and myocardial perfusion scintigraphy (99mTc-Tetrofosmin and 99mTc-MIBI), etc. were within the range of the EU DRLs and almost none of the administered radioactivity in Japan exceeded the upper limit of SNMMI standard administered radioactivity.ConclusionsThis survey indicated that the administered radioactivity in diagnostic nuclear medicine in Japan had been in the convergence zone and nuclear medicine facilities in Japan show a strong tendency to adhere to the texts and guidelines. Furthermore, the administered radioactivities in Japan were within the range of variation of the EU and the SNMMI administered radioactivities.

Diagnostic reference levels for 18F‐FDG whole body PET/CT procedures: Results from a survey of 12 centres in Australia and New Zealand

“…Compromises on image quality may be offset by increasing scan duration. Internationally, the reported AU QLD/WA DRL study and the proposed NZ NDRL study were within the range of previously published values (200–500 MBq) (Table ) . However, the reported AU QLD/WA DRL and the proposed NZ NDRL are higher than the France published NDRL based on TOF technology, which was 260 MBq .…”

“…Published articles reported 18 F‐FDG PET/CT DRL values for the administered activity or CT used for AC and anatomical localization purposes, with few authors reporting both radiation doses . PET/CT DRLs from both radiation sources should be reported to provide suitable guidelines for professionals .…”

“…Clinical facilities with a median emergent dose that is higher than the national 75 th percentile dose should consider methods of optimizing their clinical imaging protocols to minimize the radiation doses delivered to the patients. 10 Published articles reported 18 F-FDG PET/CT DRL values for the administered activity [11][12][13][14][15][16][17][18][19] or CT 20,21 used for AC and anatomical localization purposes, with few authors reporting both radiation doses. 6,22 PET/CT DRLs from both radiation sources should be reported to provide suitable guidelines for professionals.…”

Determining and updating PET/CT and SPECT/CT diagnostic reference levels: A systematic review

“…The establishment of DRLs for PET/CT and SPECT/CT imaging is an essential step in recognising variations between radiation doses delivered to the patient using a diverse range of equipment and changing protocols (14) . The existing PET/CT and SPECT/CT, PET, SPECT, and CT component methods are prone to some limitations due to diverse methods implemented for population selection, different reporting methods, the impact of new imaging technology, and reporting effective dose (E) from both the A and CT (15,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) . The purpose of this systematic review is to determine the variations in reported NDRL methodology and values for adult PET/CT and SPECT/CT procedures.…”

Highlights of articles published in annals of nuclear medicine 2016

“…Watanabe and colleagues reported on a national survey of the actual administered radioactivity to adults for a variety of single-photon radiotracers as well as for FDG (59). The nationwide survey was conducted for nearly 2 months from November 25, 2014 to January 16, 2015 and was sent to 1249 nuclear medicine facilities in Japan.…”