Dose Reduction in Pediatric Nuclear Medicine

Children are more prone than adults to the deleterious effects of ionizing radiation due to increased tissue sensitivity and significantly longer life span enabling allowing the late expression of malignancies.
Reducing radiation exposure in accordance with the ALARA principle is of paramount importance. The following measures can be taken to achieve this goal:
• Screening study requests judiciously, approving only those in which nuclear medicine provides the best diagnostic information and those in which equivalent information cannot be obtained by other imaging modalities without ionizing radiation.
• Strict adherence to international guidelines (EANM or SNMMI) on administered radiopharmaceutical activities in children
• Reducing the CT dose in hybrid PET/CT and SPECT/CT studies by customizing the acquisition parameters using pediatric CT protocols. Modern CTs utilizing iterative reconstruction can also contribute to a significant reduction in the CT dose.
• Lowering the radiopharmaceutical dose by using modern highly sensitive PET and SPECT cameras that can maintain image quality with up to half the recommended radiopharmaceutical activities. (SPECT cameras equipped with solid state crystals- CZT, and new digital PET cameras)
• Processing studies with resolution recovery software that improves image resolution with standard doses or maintains image quality with up to 50% reduction in administered activities.
• Performing pediatric PET studies with PET/MRI cameras. PET/MRI reduces the effective dose by 2 mechanisms: The obvious one is lack of ionizing radiation from the MR. The other mechanism is the prolonged acquisition time dictated by the MRI component in simultaneous acquisition scanners. Prolonged acquisition allows a significant reduction in the administered radiopharmaceutical activities.