title: Dose Optimization of the Administered Activity in Pediatric Bone Scintigraphy: Validation of the North American Consensus Guidelines.
abstract: The 2010 North American Consensus Guidelines (NACG) for pediatric administered doses and the European Association of Nuclear Medicine (EANM) Dosage Card guidelines recommend lower activities than those administered at our institution. We compared the quality of the lower-activity images with the higher-activity images to determine whether the reduction in counts affects overall image quality.
  
  
  METHODS
  Twenty patients presenting to our pediatric radiology department for bone scintigraphy were evaluated. Their mean weight was 20 kg. The patients were referred for oncologic (n = 10), infectious/inflammatory (n = 5), and pain (n = 5) evaluation. Dynamic anterior and posterior images were acquired for 5 min for each patient. Data were subsampled to represent different administered activities corresponding to the activities recommended by the NACG and the EANM Dosage Card. Images were evaluated twice, first for diagnostic quality and then for acceptability for daily clinical use.
  
  
  RESULTS
  There was no statistically significant difference in the diagnostic quality of the images from any of the 3 protocols. Pathologic uptake was correctly identified independent of the administered activity, although there was a single false-positive result for an EANM image. When images were subjectively evaluated as acceptable for daily clinical use, there was a slight preference for the higher-activity images over the NACG (P = 0.04).
  
  
  CONCLUSIONS
  The recommended administered activities of the NACG produce images of diagnostic quality while reducing patient radiation exposure.
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee karen.ayres@vanderbilt.edu.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Ayres
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Spottswood
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee.
authors.forename: Dominique
authors.initials: D
authors.lastname: Delbeke
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee.
authors.forename: Ronald
authors.initials: R
authors.lastname: Price
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Hodges
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee.
authors.forename: William H
authors.initials: WH
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D001847:Bone Diseases / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage*; D019983:Guideline Adherence; D006801:Humans; D007089:Image Enhancement / Q000592:standards; D007223:Infant; D008297:Male; D008495:Medical Oncology / Q000592:standards*; D009656:North America; D010372:Pediatrics / Q000592:standards*; D049268:Positron-Emission Tomography / Q000592:standards*; D017410:Practice Guidelines as Topic; D011829:Radiation Dosage; D011835:Radiation Protection / Q000592:standards; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013714:Tennessee
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: North American Consensus Guidelines; dose reduction; pediatric bone scintigraphy