An International Survey of the Practice of Pediatric Nuclear Medicine: A Report of the First Nuclear Medicine Global Initiative

Objectives To characterize the practice of pediatric nuclear medicine around the world, particularly the amount of radioactivity administered to children.

Methods In 2012, the Nuclear Medicine Global Initiative (NMGI) was formed consisting of 13 international organizations involved in nuclear medicine (Asia Oceanic Federation of NM and Biology, Australian/New Zealand SNM, Canadian Association of NM, Chinese SNM, EANM, IAEA, Japanese SNM, Korean SNM, ALASBMN, SNM of India, SNMMI, South African SNM, World Federation of NM and Biology). The basic goals of the NMGI were to promote human health by advancing the field of nuclear medicine and molecular imaging, encourage global collaboration in education, and harmonize procedure guidelines and other policies that ultimately lead to improvements in quality and safety in the field throughout the world. For its first project, the NMGI decided to consider the issues involved in the standardization of administered activities in pediatric nuclear medicine. A survey was developed as part of the first Nuclear Medicine Global Initiative (NMGI) project on the standardization of pediatric nuclear medicine. The survey inquired about the nature of the responding hospital and the number of nuclear medicine procedures they performed in children. Sites provided data regarding the top 5 pediatric imaging procedures performed by a facility, the guideline that was being followed (if any), and either the typical patient administered activity or the method of adjusting the administered activity for individual patients. The survey asked for details of administered activity based on the usual operating protocols rather than a collection of details for actual patients. The survey included questions about the gamma camera used for imaging, whether SPECT imaging was mostly performed, and whether SPECT/CT imaging was sometimes performed. It inquired about administered activities for a hypothetical 5-year-old boy (20 kg and 110 cm tall) and a 10-year-old girl (30 kg and 140 cm tall). For facilities performing PET/CT imaging, the survey asked questions about administered activity for whole body pediatric FDG imaging and details on CT acquisition for PET. The web-based survey was developed using SurveyMonkey®, and was available only in English as was preferred by all NMGI participating organizations. Participation was by invitation from the NMGI and organizations. Each organization managed the participation of their members or the people they were representing.

Results The survey was open for approximately 1 month. There were 313 entries received from 29 different countries with 98 entries from Japan. The responders were organized into 7 regions: Asia (not including Japan), Australia/New Zealand, EANM (member nations of the EANM), Japan, Latin America, North America and South Africa. The 3 most common procedures were bone scans using Tc-99m, radionuclide renograms using Tc-99m,and renal cortical imaging using Tc-99m DMSA although this varied by region. The survey shows wide variations in the suggested administered activity for the hypothetical patients, both within and among regions. However, those regions with current guidelines of administered activity in children (North America, EANM and Japanese SNM) tended to be consistent with their own guidelines. This was especially true for North America and Japan.

Conclusions Although those regions with current guidelines tended to have less variability in the administered activity, a wide variation still exists within and among regions. Countries and regions that do not currently have pediatric guidelines should either develop their own or officially adopt currently existing guidelines. The authors would like to thank the NMGI organizations and participants for their input and support with this project. Also, we thank the sites that completed the survey for their contributions to this investigation.