Abstract
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Objectives: The objectives of this educational exhibit are to: 1) Outline the theory and use of Iodine-131 MIBG in the treatment of malignancy, 2) Discuss tumor types relevant to pediatric applications of Iodine-131 MIBG therapy, 3) Review guidelines for facilities and patients as they pertain to pediatric hospitals, and 4) Describe the regulatory elements of handling patients and decedents who have received Iodine-131 MIBG therapy.
Methods: The demand for comprehensive nuclear radiology services is growing in children’s hospitals. At the same time, the vast majority of radiologists providing services at children’s hospitals are pediatric radiologists with only a small subset of radiologists trained in both pediatric and nuclear radiology. As such, children’s hospital radiologists are likely to exhibit deficits in knowledge regarding lesser-utilized nuclear radiology therapeutic approaches. This educational exhibit serves to inform and improve knowledge regarding this important therapy as it relates to pediatric radiology.
Results: Neuroblastoma is one of the most common tumors in children, and it is also a tumor that exhibits a high mortality rate. Most neuroblastomas are MIBG avid which allows for labeled MIBG to be used for both diagnosis and therapy. Iodine-131 MIBG is most commonly utilized in children with high-risk neuroblastoma in combination with one or more other therapies. Additional tumors amenable to therapy include pheochromocytoma and carcinoid tumor. Children’s hospitals without lead-lined facilities who are using labeled MIBG may benefit from utilizing rolling lead shields. Handling of patients following radiopharmaceutical administration is described in NCRP report 155, an update of NCRP 37. Autopsy and cremation are not advised in decedents exhibiting residual radioactivity from therapy.
Conclusions: Iodine-131 MIBG can be used as a diagnostic and therapeutic agent in the treatment of MIBG-avid neuroendocrine tumors. Review of the indications, theory, and guidelines regarding Iodine-131 MIBG is useful for pediatric radiologists in an era of increasing demand for comprehensive nuclear radiology services in children’s hospitals.