Standardization of pediatric nuclear medicine administered radiopharmaceutical activities: the SNMMI/EANM Joint Working Group

Nuclear medicine is a unique and valuable method that contributes to the diagnosis and assessment of many diseases in children. It is generally accepted that radiation exposures to children undergoing diagnostic nuclear medicine studies and the resulting risks are low. However, due to the lack of pediatric guidelines there has been a rather wide variation of pediatric radiopharmaceutical administered activities. As a result, pediatric radiation exposures have also varied over a broad range. Some practices have been able to obtain useful results with administered activities in the lowest ranges while other centers and practices have used considerably larger administered activities. This was dramatically highlighted by surveys of nuclear medicine departments in North America and beyond. Efforts in Europe and North America have resulted in the development and publication of pediatric guidelines. These were initially developed separately utilizing different models, but more recently were joined through harmonization activities; the two sets of guidelines are now further aligned. Dissemination of these guidelines is an ongoing activity. We believe that adhering to these standards can help assure that the most appropriate administered activity is employed. Along with this goal, it is essential that the image quality and their diagnostic value be assured. Beyond the application of the recent guidelines, radiation exposures in children can be reduced further by optimizing use, updating protocols, applying advanced image processing and potentially developing and introducing advanced imaging systems. Further improvements will likely result from increased communication and cooperation by several nuclear medicine organizations in addition to the dissemination of updated information to the clinic.