Weight-based, low-dose pediatric whole-body PET/CT protocols.
Adult PET/CT acquisition protocols need to be modified for pediatric imaging to minimize the radiation dose while maintaining diagnostic utility. We developed pediatric PET/CT acquisition protocols customized to patient weight and estimated the dosimetry and cancer risk of these low-dose protocols to communicate basic imaging risks.


METHODS
Protocols were developed for whole-body (18)F-FDG imaging of patients in PET mode with a weight-based injected activity (5.3 MBq/kg) and acquisition times (3-5 min/field of view) and for CT for attenuation correction and localization with a weight-based tube current ranging from 10 to 40 mAs. Patients were categorized on the basis of the Broselow-Luten color-coded weight scale. Dosimetry and radiation-induced cancer risk for the PET and CT acquisition in each category were derived from mean patient sizes and the interpolation of factors from accepted patient models.


RESULTS
Whole-body pediatric PET/CT protocols require the customization of PET-acquisition settings and task-specific selection of CT technique. The proposed weight-based protocols result in an approximate effective dose ranging from 8.0 mSv for a 9-kg patient up to 13.5 mSv for a 63-kg patient. The radiation dose from the proposed protocols is 20%-50% (depending on patient weight), the dose from PET/CT protocols that use a fixed CT technique of 120 mAs and 120 kVp. The approximate, conservative estimate of additional lifetime attributable risk (LAR) of cancer incidence for females using the proposed protocols was approximately 3 in 1,000, with a variation of 18% across patient categories. For males, the additional LAR of cancer incidence was approximately 2 in 1,000, with a variation of 16% across categories.


CONCLUSIONS
Low-dose PET/CT protocols for 11 patient weight categories were developed. The proposed protocols offer an initial set of acquisition parameters for pediatric PET/CT. The use of multiple categories allows for the continued refinement of dose-reduction parameters to minimize dose while maintaining image quality across the range of pediatric patient sizes.
Alessio
Adam M
AM
Department of Radiology, University of Washington, Old Fisheries Center, Seattle, Washington 98195-7987, USA. aalessio@u.washington.edu
Kinahan
Paul E
PE
Manchanda
Vivek
V
Ghioni
Victor
V
Aldape
Lisa
L
Parisi
Marguerite T
MT
D000293:Adolescent; D000328:Adult; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009381:Neoplasms, Radiation-Induced; D049268:Positron-Emission Tomography / Q000379:methods*; D011829:Radiation Dosage; D011874:Radiometry; D012306:Risk; D014057:Tomography, X-Ray Computed / Q000379:methods*; D051598:Whole Body Imaging / Q000379:methods*