title: Administered Activities in Pediatric Nuclear Medicine and the Impact of the 2010 North American Consensus Guidelines on General Hospitals in the United States.
abstract: We sought to describe the practice of pediatric nuclear medicine at general hospitals in the United States and to assess the impact of dose awareness campaigns such as Image Gently.
  
  
  
  A web-based survey was developed that requested information regarding hospital type, whether the hospital practices pediatric nuclear medicine, and the hospital's method for determining the administered activity for children. The survey invitation was emailed to a sample of general hospitals with more than 300 beds, excluding dedicated pediatric, veterans, psychiatric, and rehabilitation hospitals. Data were collected for 5 procedures performed on children: (99m)Tc-methylene diphosphate (MDP) bone scans, (99m)Tc-mercaptoacetyltriglycine (MAG3) renograms, (99m)Tc-dimercaptosuccinic acid (DMSA) renal cortical scans, (99m)Tc-based hepatobiliary scans, and (18)F-FDG PET scans. The sites reported dosage by weight (MBq/kg), minimum and maximum dosages, and the activities that they would administer to 2 hypothetical patients: a 5-y-old boy (20 kg, 110 cm tall) and a 10-y-old girl (30 kg, 140 cm tall).
  
  
  
  The invitation was delivered to 196 sites, with 121 (61.7%) responding. Eighty-two hospitals (67.8%) performed nuclear medicine on children. All sites scaled administered activity for children, mostly by body weight. Also, 82.4% of sites indicated they were familiar with Image Gently, 57.1% were familiar with the 2010 North American consensus guidelines for children, and 54.9% altered their protocols because of the guidelines. The median value for parameters defined by the guidelines was equal to the guideline-recommended value for all procedures. More than 50% of the sites-particularly those familiar with the guidelines-were compliant with the guidelines regarding both the acquisition parameters and the administered activities for the 2 hypothetical patients. However, there remained a wide variation in practice, sometimes by more than a factor of 10, for sites not familiar with the guidelines.
  
  
  
  Image Gently and the North American guidelines have had a substantial impact on pediatric nuclear medicine practice in the United States. However, a wide variation in practice still exists, particularly for sites not familiar with the guidelines. Further promotion and dissemination of the guidelines and best practice are still necessary.
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts frederic.fahey@childrens.harvard.edu.
authors.forename: Frederic H
authors.initials: FH
authors.lastname: Fahey
authors.affiliation: Program for Patient Safety and Quality, Center for Patient Safety and Quality Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sonja I
authors.initials: SI
authors.lastname: Ziniel
authors.affiliation: Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts; and.
authors.forename: Dacie
authors.initials: D
authors.lastname: Manion
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Amanda
authors.initials: A
authors.lastname: Baker
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: S Ted
authors.initials: ST
authors.lastname: Treves
mesh_terms: D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006769:Hospitals, General / Q000592:standards / Q000706:statistics & numerical data*; D009683:Nuclear Medicine / Q000592:standards*; D010372:Pediatrics / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D014055:Tomography, Emission-Computed / Q000592:standards* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: Image Gently; North American guidelines; pediatric nuclear medicine; radiopharmaceutical dosing