Article Figures & Data
Figures
- FIGURE 1.
Flowchart illustrating sampling of hospitals and survey response rate. NM = nuclear medicine.
- FIGURE 2.
Box plots of administered activities for 2 hypothetical patients (5-y-old boy, 20 kg, 110 cm tall, and 10-y-old girl, 30 kg, 140 cm tall) for 99mTc-MDP bone scans (A and B), 99mTc-MAG3 renograms (C and D), 99mTc-DMSA renal cortical scans (E and F), 99mTc-HIDA derivative hepatobiliary scans (G and H), and 18F-FDG torso PET scans (I and J). For each panel, median is shown by cross-hairs and tick to right of vertical axis, box represents 25th and 75th percentiles, whiskers represent 10th and 90th percentiles, and values outside whiskers are shown as dots. Guideline-recommended value for these patients is shown in red. Range of activities recommended for 18F-FDG PET is shown by red hatching.
Tables
- TABLE 1
Characteristics of All 121 Sites and the Subset of 82 Sites Performing Pediatric Nuclear Medicine
All 121 Subset of 82 Characteristic n Data n Data Location of hospital Total 119 81 Rural (population, <30,000) 3 2.5% 2 2.5% Suburban (population, 30,000–500,000) 57 47.9% 39 48.2% Urban (population, >500,000) 59 49.6% 40 49.4% Hospital type Total 121 82 Community hospital, nonteaching 27 22.3% 12 14.6% Community hospital, teaching 62 51.3% 45 54.9% Large academic hospital 31 25.6% 24 29.3% Government-affiliated hospital 1 0.8% 1 1.2% Affiliated with medical school? Total 120 82 No 58 48.3% 38 46.3% Yes 62 51.7% 44 53.7% Residents in hospital? Total 116 81 No 30 25.9% 17 21.0% Yes 86 74.1% 64 79.0% Medical students in hospital? Total 115 81 No 28 24.4% 17 21.0% Yes 87 76.6% 64 79.0% No. of physicians in nuclear medicine department Total 121 7.1 (11.46) 82 7.9 (10.87) No. of nuclear technologists in nuclear medicine department Total 101 8.0 (5.73) 79 8.4 (5.86) No. of nuclear medicine studies annually Total 101 79 <3,000 21 20.8% 14 17.7% 3,000–6,000 55 54.5% 45 57.0% 6,000 25 24.8% 20 25.3% Nuclear medicine studies on children performed at hospital? Total 104 No 21 20.2% — — Yes 83 79.8% — — No. of nuclear medicine studies on children annually Total 72 189.0 (389.39) 71 191.5 (391.57) Familiarity with doses recommended by 2010 guidelines? Total 49 No — — 21 42.9% Yes — — 28 57.1% Familiarity with Image Gently or “Go with the Guidelines”? Total 51 No — — 9 17.7% Yes — — 42 82.3% Any imaging protocol altered because of guidelines? Total 51 No — — 23 45.1% Yes — — 28 54.9% n indicates number of respondents, and data are expressed as percentage or as mean followed by SD in parentheses.
- TABLE 2
Use and Patterns of Use for Radiopharmaceutical Agents in 5 Commonly Performed Pediatric Procedures
Agent Percentage of the 82 sites Single 99mTc-MDP 86.6% 99mTc-MAG3 68.3% 99mTc-DMSA 59.8% 99mTc-HIDAs 39.0% 18F-FDG 30.5% Combination All 5 16.9% 4 of 5 23.4% 3 of 5 19.5% 2 or less of 5 40.3% - TABLE 3
Radiopharmaceutical Dosage per Kilogram of Body Weight, According to Familiarity of Site with 2010 Guidelines
Dosage* Familiar with guidelines? n Minimum Mean SD Median Maximum Factor of variation (max/min) Guideline-recommended dosage* Respondents following guideline ± 20% 99mTc-MDP Total 39 5.18 (0.14) 11.08 (0.30) 7.32 (0.20) 9.25 (0.25) 41.63 (1.13) 8.04 9.25 (0.25) 84.6% No 10 5.18 (0.14) 12.75 (0.34) 10.30 (0.28) 10.36 (0.28) 41.63 (1.13) 8.04 80.0% Yes 24 6.29 (0.17) 9.02 (0.24) 0.82 (0.02) 9.25 (0.25) 10.36 (0.28) 1.65 95.8% 99mTc-MAG3 Total 34 2.59 (0.07) 6.33 (0.17) 6.73 (0.18) 5.55 (0.15) 41.63 (1.13) 16.07 5.55 (0.15) 58.8% No 8 2.59 (0.07) 10.85 (0.29) 13.41 (0.36) 5.18 (0.14) 41.63 (1.13) 16.07 50.0% Yes 24 3.70 (0.10) 4.83 (0.13) 0.90 (0.02) 5.55 (0.15) 5.55 (0.15) 1.50 62.5% 99mTc-DMSA Total 28 1.11 (0.03) 2.02 (0.05) 0.56 (0.02) 1.85 (0.05) 3.70 (0.10) 3.33 1.85 (0.05) 78.6% No 6 1.85 (0.05) 2.41 (0.07) 0.73 (0.02) 2.22 (0.06) 3.70 (0.10) 2.00 50.0% Yes 21 1.11 (0.03) 1.92 (0.05) 0.48 (0.01) 1.85 (0.05) 3.70 (0.10) 3.33 85.7% 99mTc-HIDAs Total 21 1.48 (0.04) 4.14 (0.11) 4.62 (0.12) 1.85 (0.05) 18.50 (0.50) 12.50 1.85 (0.05) 61.9% No 6 1.85 (0.05) 6.00 (0.16) 4.96 (0.13) 3.93 (0.11) 14.80 (0.40) 8.00 16.7% Yes 14 1.48 (0.04) 3.54 (0.10) 4.57 (0.12) 1.85 (0.05) 18.50 (0.50) 12.50 78.6% 18F-FDG Total 18 2.22 (0.06) 4.97 (0.13) 1.87 (0.05) 4.44 (0.12) 10.58 (0.29) 4.77 3.7–5.18 (0.10–0.14) 77.8% No 3 3.70 (0.10) 4.81 (0.13) 0.98 (0.03) 5.18 (0.14) 5.55 (0.15) 1.50 100.0% Yes 13 2.22 (0.06) 4.35 (0.12) 1.00 (0.03) 4.44 (0.12) 6.29 (0.17) 2.83 84.6% ↵* Units of measurement are megabecquerels per kilogram (MBq/kg) followed by millicuries per kilogram (mCi/kg) in parentheses.
n indicates number of respondents. In some cases, numbers answering “no” and “yes” do not equal total number because not all sites indicated whether they are familiar with 2010 guidelines.
- TABLE 4
Minimum and Maximum Radiopharmaceutical Dosages in Smaller and Larger Patients, Respectively, According to Familiarity of Site with 2010 Guidelines
Dosage* Familiar with guidelines? n Minimum Mean SD Median Maximum Factor of variation (max/min) Guideline-recommended dosage* Respondents following guideline ± 20% Minimum dose in smaller patients 99mTc-MDP Total 35 18.50 (0.50) 51.27 (1.39) 35.07 (0.95) 37.00 (1.00) 185.00 (5.00) 10.00 37.00 (1.00) 71.4% No 9 37.00 (1.00) 71.94 (1.94) 39.73 (1.07) 74.00 (2.00) 148.00 (4.00) 4.00 44.4% Yes 21 18.50 (0.50) 39.64 (1.07) 12.11 (0.33) 37.00 (1.00) 74.00 (2.00) 4.00 85.7% 99mTc-MAG3 Total 39 18.50 (0.50) 37.47 (1.01) 15.00 (0.41) 37.00 (1.00) 111.00 (3.00) 6.00 — — No 9 18.50 (0.50) 32.89 (0.89) 8.16 (0.22) 37.00 (1.00) 37.00 (1.00) 2.00 Yes 26 18.50 (0.50) 37.71 (1.02) 16.11 (0.44) 37.00 (1.00) 111.00 (3.00) 6.00 99mTc-DMSA Total 33 18.50 (0.50) 32.07 (0.87) 26.63 (0.72) 18.50 (0.50) 111.00 (3.00) 6.00 18.5 (0.50) 63.6% No 10 18.50 (0.50) 35.15 (0.95) 28.19 (0.76) 27.75 (0.75) 111.00 (3.00) 6.00 50.0% Yes 22 18.50 (0.50) 30.44 (0.82) 27.04 (0.73) 18.50 (0.50) 111.00 (3.00) 6.00 72.7% 99mTc-HIDAs Total 22 18.50 (0.50) 28.59 (0.77) 13.66 (0.37) 18.50 (0.50) 74.00 (2.00) 4.00 18.5 (0.50) 54.6% No 7 18.50 (0.50) 29.07 (0.79) 9.89 (0.27) 37.00 (1.00) 37.00 (1.00) 2.00 42.9% Yes 14 18.50 (0.50) 27.75 (0.75) 15.81 (0.43) 18.50 (0.50) 74.00 (2.00) 4.00 64.3% 18F-FDG Total 16 18.50 (0.50) 63.59 (1.72) 72.75 (1.97) 37.00 (1.00) 296.00 (8.00) 16.00 37.00 (1.00) 75.0% No 2 37.00 (1.00) 166.5 (4.50) 183.14 (4.95) 166.50 (4.50) 296.00 (8.00) 8.00 50.0% Yes 13 18.50 (0.50) 49.81 (1.35) 42.31 (1.14) 37.00 (1.00) 185.00 (5.00) 10.00 76.9% Maximum dose in larger patients 99mTc-MDP Total 50 444.00 (12.00) 788.92 (21.32) 152.01 (4.11) 740.00 (20.00) 1110.00 (30.00) 2.50 — — No 16 444.00 (12.00) 797.81 (21.56) 136.43 (3.69) 740.00 (20.00) 925.00 (25.00) 2.08 Yes 26 444.00 (12.00) 770.04 (20.81) 172.96 (4.67) 740.00 (20.00) 1,110.00 (30.00) 2.50 99mTc-MAG3 Total 42 111.00 (3.00) 266.05 (7.19) 115.64 (3.13) 240.50 (6.50) 555.00 (15.00) 5.00 — — No 11 148.00 (4.00) 299.36 (8.09) 99.91 (2.70) 370.00 (10.00) 370.00 (10.00) 2.50 Yes 27 111.00 (3.00) 246.67 (6.67) 119.23 (3.22) 185.00 (5.00) 555.00 (15.00) 5.00 99mTc-DMSA Total 35 74.00 (2.00) 178.68 (4.83) 54.74 (1.48) 185.00 (5.00) 370.00 (10.00) 5.00 — — No 11 74.00 (2.00) 164.82 (4.45) 44.90 (1.21) 185.00 (5.00) 222.00 (6.00) 3.00 Yes 22 74.00 (2.00) 183.35 (4.96) 60.63 (1.64) 185.00 (5.00) 370.00 (10.00) 5.00 99mTc-HIDAs Total 26 111.00 (3.00) 186.45 (5.04) 43.40 (1.17) 185.00 (5.00) 296.00 (8.00) 2.67 — — No 8 148.00 (4.00) 194.25 (5.25) 43.10 (1.16) 185.00 (5.00) 296.00 (8.00) 2.00 Yes 15 129.50 (3.50) 180.12 (4.87) 33.06 (0.89) 185.00 (5.00) 259.00 (7.00) 2.00 18F-FDG Total 20 185.00 (5.00) 407.74 (11.02) 137.33 (3.71) 370.00 (10.00) 666.00 (18.00) 3.60 — — No 5 370.00 (10.00) 458.80 (12.40) 92.87 (2.51) 444.00 (12.00) 555.00 (15.00) 1.50 Yes 14 185.00 (5.00) 378.99 (10.24) 146.11 (3.95) 370.00 (10.00) 666.00 (18.00) 3.60 ↵* Units of measurement are megabecquerels (MBq) followed by millicuries (mCi) in parentheses.
n indicates number of respondents. In some cases, numbers answering “no” and “yes” do not equal total number because not all sites indicated whether they are familiar with 2010 guidelines.
- TABLE 5
Reported Dosages for the 2 Hypothetical Patients According to Familiarity of Site with 2010 Guidelines
Respondents (n) Respondents following guideline ± 20% Agent Total Yes No Total Yes No Guideline-recommended dosage* Boy 99mTc-MDP 50 26 18 66.0% 88.5% 38.9% 185.0 (5) 99mTc-MAG3 42 27 12 45.2% 55.6% 25.0% 111.0 (3) 99mTc-DMSA 37 23 12 54.1% 69.6% 25.0% 37.0 (1) 99mTc-HIDAs 27 15 10 48.2% 73.3% 10.0% 37.0 (1) 18F-FDG 20 14 5 70.0% 78.6% 60.0% 74.0–103.6 (2.0–2.8) Girl 99mTc-MDP 50 26 18 50.0% 84.6% 44.4% 277.5 (7.5) 99mTc-MAG3 43 27 12 45.2% 55.6% 25.0% 166.5 (4.5) 99mTc-DMSA 37 23 12 51.4% 65.2% 33.3% 55.5 (1.5) 99mTc-HIDAs 27 15 10 40.7% 73.3% 10.0% 55.5 (1.5) 18F-FDG 20 14 5 70.0% 85.7% 60.0% 111.0–155.4 (3.0–4.2) ↵* Units of measurement are megabecquerels (MBq) followed by millicuries (mCi) in parentheses.
The hypothetical patients are a 5-y-old, 20-kg, 110-cm boy and a 10-y-old, 30-kg, 140-cm girl.
Supplemental Data
Files in this Data Supplement:
