Applying Image GentlySM and Image WiselySM in Nuclear Medicine

Abstract

Although computed tomography (CT) scan radiation dose has drawn much attention, radiation dose from nuclear medicine procedures should not be overlooked. An estimated 19.7 million nuclear medicine procedures are done annually in the United States, with patient radiation dose comparable to that from CT scans. Nuclear medicine departments should implement Image Gently SM and Image Wisely SM recommendations to reduce nuclear medicine patient radiation dose. Pediatric administered radiopharmaceutical doses should be compared with the North American Consensus Guidelines for Administered Radiopharmaceutical Activities in Children and Adolescents, and adult doses should be compared with national and international standards. In a 2011 patient quality and safety initiative at Gundersen Lutheran Health System, 24 pediatric protocols and 52 adult protocols were compared with standards. Doses not comparable to the recommended values were adjusted accordingly and the resultant image quality evaluated. Additional steps to reduce patient radiation dose include decision support to reduce inappropriate ordering, technique optimization for the CT portion of single-photon emission computed tomography/computed tomography and positron emission tomography/computed tomography scans, use of vendor's dose reduction camera and software technology, use of shorter lived radiopharmaceuticals, and "right sizing" patient doses by weight.

Use of Radiopharmaceuticals in Diagnostic Nuclear Medicine in the United States

“…The typical administered activity of 99m Tc-MAA was initially 111 MBq (Blahd 1971; Sodee and Early 1975; Neuman et al 1980) but gradually increased to 185 MBq in the 1980s (Mettler et al 1986, 2008a; McAfee 1989; Wagner et al 1995; Kuni and duCret 1997; NCRP 2009; Mettler and Guiberteau 2012; Jafari and Daus 2013). …”

“…The typical administered activity of 198 Au-colloid was 7.4 MBq with range of 5.55–11.1 MBq (Wagner 1968; Silver 1968; Maynard 1969; Early et al 1969; USDHEW, 1970; Blahd 1971; Atkins 1975; Sodee and Early 1972; Kowalsky and Falen 2004; Drozdovitch et al 2014). The typical administered activity of 99m Tc-SC was 74 MBq in the late 1960s (Harper et al 1965; Wagner 1968; Silver 1968; Early et al 1969; Maynard 1969; USDHEW, 1970; Blahd 1971; Atkins 1975), gradually increasing to 185 MBq in the late 1970s (Mettler and Guiberteau 1983, 1998; Mettler et al 1986; Wagner et al 1986, 1995; Royal et al 2003; Jafari and Daus 2013). The typical administered activity of 99m Tc-IDA is 185 MBq (Mettler and Guiberteau 1983; Kowalsky and Falen 2004; Dahnert 2007).…”

“…The typical administered activity of 131 I-iodohippurate was 9.25 MBq (Mettler and Guiberteau 1983, 1998; Mettler et al 1986). Typical administered activities of 99m Tc-DTPA and 99m Tc-GH varied between 370 MBq and 555 MBq; while the typical administered activities of 99m Tc-DMSA and 99m Tc-MAG3 were 185 MBq and 370 MBq, respectively (Enlander et al 1974; USDHEW, 1976; Shanahan and Klingensmith 1981; Robertson 1982; Mettler and Guiberteau 1983, 1998, 2012; Schultz et al 1985; Ziessman et al 1987; Setaro et al 1991; Barbaric 1994; Wagner et al 1995; Mandell et al 1999; Kowalsky and Falen 2004; Dahnert 2007; Mettler et al 2008a; 2008b; NCRP 2009; Jafari and Daus. 2013).…”

“…The typical administered activity of 99m Tl-thallous chloride was 111 MBq (Mettler et al 1986; Saha et al 1992, 1996; NCRP 1996; Mettler and Guiberteau 1998; Bushberg et al 2002; Kowalsky and Falen 2004), which increased in the late 1990s to 148 MBq (Holly et al 2010; Frank et al 2012; Jafari and Daus 2013). The administered activity of 99m Tc-tetrofosmin was 1110 MBq, 1110 MBq of 99m Tc-sestamibi for the one-day protocol and 1480 MBq for the two-day protocol (NCRP 1996; Mettler and Guiberteau 1998, 2012; Kowalsky and Falen 2004; Mettler et al 2008a, 2008b, Strauss et al 2008; Holly et al 2010; Dorbala et al 2013).…”

Using SUV as a Guide to 18F-FDG Dose Reduction

“…Recently, attention has begun to shift to the contribution from radionuclides to the total radiation dose per scan, since some nuclear medicine procedures may yield doses comparable to the effective dose from CT (10). In particular, Alessio et al (8) have suggested a reduction of the positron emitter dose in PET as an alternative to a reduction in CT scanning time in an evaluation based on subjective adequacy and objective lesion detection accuracy by body region.…”