title: Beyond current guidelines: reduction in minimum administered radiopharmaceutical activity with preserved diagnostic image quality in pediatric hepatobiliary scintigraphy.
abstract: OBJECTIVE
  To determine if the minimum administered radiopharmaceutical activity for hepatobiliary scintigraphy can be reduced while preserving diagnostic image quality using enhanced planar processing (EPP).
  
  
  METHODS
  A total of 40 infants between 10 and 270 days old (body mass 2.2 - 6.5 kg) had hepatobiliary scintigraphy during the period 2004 - 2010 following the intravenous administration of either (99m)Tc-mebrofenin (18 patients) or (99m)Tc-disofenin (22 patients). Due to the small size of these patients, they all received the minimum administered activity of 18.5 MBq consistent with the North American Consensus Guidelines. Six nuclear medicine physicians subjectively graded the acceptability of the image quality for clinical interpretation using a four-point scale (not acceptable, fair, good, excellent). Each physician independently graded seven image sets including the original study (full activity) and simulated reduced activity studies using binomial subsampling (50% of full activity, 25% of full activity and activity reduced by weight), with and without EPP.
  
  
  RESULTS
  For full-activity studies, 98% were deemed acceptable by the six physicians for clinical interpretation. The percentages of acceptable 50% reduced activity studies with and without EPP were not significantly different from the percentage of acceptable full-activity studies (P = 0.193 and P = 0.998, respectively). The percentage of acceptable 25% reduced activity studies without EPP was significantly different from the percentage of acceptable full-activity studies (P < 0.001); however, this difference vanished when EPP was applied (P = 0.482). The activity reduced by weight ranged from 1.85 to 4.81 MBq (10% to 26% of full dose) and the percentages of acceptable studies with and without EPP were significantly different from the percentage of acceptable full-activity studies (P < 0.001 and P = 0.02, respectively).
  
  
  CONCLUSIONS
  Clinically interpretable hepatobiliary scintigraphy images can be obtained in infants when the minimum administered activity is substantially reduced. Without EPP, clinically acceptable images may be produced with a reduction of 50%, and with EPP, a reduction of 75% or more may be possible.
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA, frederic.fahey@childrens.harvard.edu.
authors.forename: Frederic
authors.initials: F
authors.lastname: Fahey
authors.forename: Katherine
authors.initials: K
authors.lastname: Zukotynski
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Robert
authors.initials: R
authors.lastname: Markelewicz
authors.forename: Anthony
authors.initials: A
authors.lastname: Falone
authors.forename: Marie
authors.initials: M
authors.lastname: Vitello
authors.forename: Xinhua
authors.initials: X
authors.lastname: Cao
authors.forename: Frederick
authors.initials: F
authors.lastname: Grant
authors.forename: Laura
authors.initials: L
authors.lastname: Drubach
authors.forename: A Hans
authors.initials: AH
authors.lastname: Vija
authors.forename: Manojeet
authors.initials: M
authors.lastname: Bhattacharya
authors.forename: Xinhong
authors.initials: X
authors.lastname: Ding
authors.forename: Zvi
authors.initials: Z
authors.lastname: Bar-Sever
authors.forename: Michael
authors.initials: M
authors.lastname: Gelfand
authors.forename: S Ted
authors.initials: ST
authors.lastname: Treves
mesh_terms: D000814:Aniline Compounds; D001659:Biliary Tract / Q000000981:diagnostic imaging*; D005260:Female; D005998:Glycine; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007098:Imino Acids / Q000008:administration & dosage*; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000000981:diagnostic imaging*; D008297:Male; D015609:Organotechnetium Compounds / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D011829:Radiation Dosage; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D019785:Technetium Tc 99m Disofenin / Q000008:administration & dosage*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods* / Q000592:standards
chemical_list: D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D019785:Technetium Tc 99m Disofenin; D005998:Glycine
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