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Journal of Nuclear Medicine Vol. 50 No. 10 1570-1578
© 2009 by Society of Nuclear Medicine
doi: 10.2967/jnumed.109.065912

Clinical Investigation

Weight-Based, Low-Dose Pediatric Whole-Body PET/CT Protocols

Adam M. Alessio1,2, Paul E. Kinahan1, Vivek Manchanda1,2, Victor Ghioni2, Lisa Aldape2 and Marguerite T. Parisi1,2

1 Department of Radiology, University of Washington, Seattle, Washington; and 2 Department of Radiology, Seattle Children's Hospital, Seattle, Washington

Correspondence: For correspondence or reprints contact: Adam M. Alessio, Department of Radiology, University of Washington, P.O. Box 357987, Old Fisheries Center, Room 220, 4000 15th Ave., NE, Seattle, WA 98195-7987. E- mail: aalessio{at}u.washington.edu

Adult PET/CT acquisition protocols need to be modified for pediatric imaging to minimize the radiation dose while maintaining diagnostic utility. We developed pediatric PET/CT acquisition protocols customized to patient weight and estimated the dosimetry and cancer risk of these low-dose protocols to communicate basic imaging risks. Methods: Protocols were developed for whole-body 18F-FDG imaging of patients in PET mode with a weight-based injected activity (5.3 MBq/kg) and acquisition times (3–5 min/field of view) and for CT for attenuation correction and localization with a weight-based tube current ranging from 10 to 40 mAs. Patients were categorized on the basis of the Broselow–Luten color-coded weight scale. Dosimetry and radiation-induced cancer risk for the PET and CT acquisition in each category were derived from mean patient sizes and the interpolation of factors from accepted patient models. Results: Whole-body pediatric PET/CT protocols require the customization of PET-acquisition settings and task-specific selection of CT technique. The proposed weight-based protocols result in an approximate effective dose ranging from 8.0 mSv for a 9-kg patient up to 13.5 mSv for a 63-kg patient. The radiation dose from the proposed protocols is 20%–50% (depending on patient weight), the dose from PET/CT protocols that use a fixed CT technique of 120 mAs and 120 kVp. The approximate, conservative estimate of additional lifetime attributable risk (LAR) of cancer incidence for females using the proposed protocols was approximately 3 in 1,000, with a variation of 18% across patient categories. For males, the additional LAR of cancer incidence was approximately 2 in 1,000, with a variation of 16% across categories. Conclusion: Low-dose PET/CT protocols for 11 patient weight categories were developed. The proposed protocols offer an initial set of acquisition parameters for pediatric PET/CT. The use of multiple categories allows for the continued refinement of dose-reduction parameters to minimize dose while maintaining image quality across the range of pediatric patient sizes.

Key Words: pediatric PET/CT • dosimetry • low-dose CT • acquisition protocols

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.


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