Standardization of administered activities in paediatric nuclear medicine: the EANM perspective

Eur J Nucl Med Mol Imaging (2016) 43:2275–2278 DOI 10.1007/s00259-016-3474-6 EDITORIAL Standardization of administered activities in paediatric nuclear medicine: the EANM perspective Michael Lassmann 1 & Uta Eberlein 1 & Egesta Lopci 2 & Arturo Chiti 2,3 Received: 21 July 2016 / Accepted: 22 July 2016 / Published online: 6 August 2016 # Springer-Verlag Berlin Heidelberg 2016 The nuclear medicine global initiative In the summer of 2012, the Nuclear Medicine Global Initiative (NMGI) was formed with the intention of promoting and maintaining worldwide standards in the practice and science of nuclear medicine and molecular imaging by encouraging global collaboration in education and by harmonizing procedure guidelines and other policies. The endeavour involved the participation of 13 international organizations with direct involvement in nuclear medicine (Table 1). One of the first projects the NMGI decided to pursue was the standardization of administered activities in paediatric nuclear medicine. As a result, a series of two reports (part 1 and part 2) appeared in the Journal of Nuclear Medicine [1, 2]. Part 1 of the report [1] provides a literature review of the role of paediatric nuclear medicine, the current understanding of the carcinogenic risk of radiation as it pertains to the administration of radiopharmaceuticals in children, and the application of dosimetric models in the paediatric population. It is well understood that children are at higher risk of adverse effects from ionizing radiation than adults, and it is therefore prudent to be more cautious when determining the administered activities for studies in children [1]. This can be challenging because the dosimetric models available for use in * Arturo Chiti 1 Department of Nuclear Medicine, University Würzburg, Würzburg, Germany 2 Department of Nuclear Medicine, Humanitas Research Hospital, Milano, Italy 3 Humanitas University, Via A. Manzoni 113, 20089 Rozzano, MI, Italy children and adolescents are not as well established as those for use in adults, particularly with respect to the biodistribution of radiopharmaceuticals, as shown in the framework of the European Union (EU) sponsored project PEDDOSE.NET [3, 4]. Part 1 of the report also provides a variety of educational and informational resources regarding the practice, dosimetry, and radiation risk associated with paediatric nuclear medicine. In addition, the report provides a list of links to many resources that are of clear value to the nuclear medicine practitioner. Part 2 of the report [2] discusses current standards for administered activities in children and adolescents that have been developed by various professional organizations. In addition, an evaluation of the current practice of paediatric nuclear medicine specifically with regard to administered activities, as determined by an international survey of 313 nuclear medicine clinics and centres from 29 countries, is presented. Lastly, the report provides recommendations for a path forward toward global standardization of the administration of radiopharmaceuticals in children. Survey on the current practice of paediatric nuclear medicine: European point of view One of the tasks of the NMGI was to conduct a worldwide survey on the current practice of paediatric nuclear medicine. As described in more detail in part 2 of the NMGI report [2], the survey captured data regarding the top five paediatric imaging procedures, and questions on the technology used and on the activities that would be administered to hypothetical cases at that site. In addition, details on the CT part of hybrid imaging were included. The survey was open for approximately 1 month (21 July 2014 to 19 August 2014). The results to be reported were 2276 Table 1 Initiative Eur J Nucl Med Mol Imaging (2016) 43:2275–2278 Institutions participating in the Nuclear Medicine Global Institution Asia Oceania Federation of Nuclear Medicine and Biology Australian and New Zealand Society of Nuclear Medicine Canadian Association of Nuclear Medicine Chinese Society of Nuclear Medicine European Association of Nuclear Medicine International Atomic Energy Agency Japanese Society of Nuclear Medicine Korean Society of Nuclear Medicine Latin American Association of Societies of Nuclear Medicine and Biology Society of Nuclear Medicine India Society of Nuclear Medicine and Molecular Imaging South African Society of Nuclear Medicine World Federation on Nuclear Medicine and Biology from 313 respondents from 29 different countries, although possible inaccuracies might remain in these entries. Within the member nations of the EANM there were 77 responses. The corresponding distribution is shown in Table 2. This variability in response among countries and regions may limit the accuracy and generalizability of the survey results. Particularly for Europe, the missing or low number of responses from Northern Europe and the UK could have distorted the results. According to the report [2], the five most frequent nuclear medicine procedures in Europe were renograms, bone scans, DMSA scans, MIBG scans, and scans for Table 2 Participating sites Country Number of participating sites Albania Belgium Croatia Czech Republic Denmark Germany Hungary Israel 1 7 1 7 2 4 6 11 Italy Malta Netherlands Portugal Serbia Spain Turkey Total 21 1 7 4 2 1 2 77 Meckel’s diverticulum. For the eight hypothetical cases (99mTc bone scans, 99mTc renograms, 99mTc-DMSA scans, and 18F-FDG scans), at the majority of centres the corresponding values of the EANM paediatric dosage card or lower values would be applied [5–7]. There were, however, some outlier centres where the activities applied were twofold or more higher. With respect to hybrid imaging systems the results are inconclusive [2]. Answers to questions regarding the acquisition of CT in the context of PET/CT were received from 120 of the 313 sites. At 72 % of the sites, automatic exposure control was used for CT acquisitions. However, 9 % of the respondents did not know if this feature was used at their site, and so the percentage of sites where this feature was used may have been higher than 72 %. At about one-third of sites the CT component of PET/CT was acquired in children as a diagnostic scan with administration of contrast agent. A GE PET/CT system was used at about one-third of the sites, a Siemens system at one-third and a Philips system at 20 % [2]. Efforts by the EANM on paediatric dosing The first international effort to harmonize the administered activities in paediatric nuclear medicine initiated by the Paediatric Task Group of the European Association of Nuclear Medicine (EANM) was in the late 1980s. The resulting recommendations (BA radiopharmaceuticals schedule for imaging in paediatrics^) [8] were published and endorsed by the EANM in 1990. The approach of the authors [8] was to calculate the fraction of the administered activity as a function of the body surface area and to translate th (...truncated)