title: Report of a nationwide survey on actual administered radioactivities of radiopharmaceuticals for diagnostic reference levels in Japan.
abstract: OBJECTIVE
  The optimization of medical exposure is one of the major issues regarding radiation protection in the world, and The International Committee of Radiological Protection and the International Atomic Energy Agency recommend establishing diagnostic reference levels (DRLs) as tools for dose optimization. Therefore, the development of DRLs based on the latest survey has been required for nuclear medicine-related societies and organizations. This prompted us to conduct a nationwide survey on the actual administered radioactivity to adults for the purpose of developing DRLs in nuclear medicine.
  
  
  METHODS
  A nationwide survey was conducted from November 25, 2014 to January 16, 2015. The questionnaire was sent to all of the 1249 nuclear medicine facilities in Japan, and the responses were collected on a website using an answered form.
  
  
  RESULTS
  Responses were obtained from 516 facilities, for a response rate of 41 %. 75th percentile of (99m)Tc-MDP and (99m)Tc-HMDP: bone scintigraphy, (99m)Tc-HM-PAO, (99m)Tc-ECD and (123)I-IMP: cerebral blood flow scintigraphy, (99m)Tc-Tetrofosmin, (99m)Tc-MIBI and (201)Tl-Cl; myocardial perfusion scintigraphy and (18)F-FDG: oncology PET (in-house-produced or delivery) in representative diagnostic nuclear medicine scans were 932, 937, 763, 775, 200, 831, 818, 180, 235 and 252, respectively. More than 90 % of the facilities were within the range of 50 % from the median of these survey results in representative diagnostic nuclear medicine facilities in Japan. Responses of the administered radioactivities recommended by the package insert, texts and guidelines such as 740 MBq ((99m)Tc-MDP and (99m)Tc-HMDP: bone scintigraphy), 740 MBq ((99m)Tc-ECD and (99m)Tc-HM-PAO: cerebral blood flow scintigraphy) and 740 MBq ((99m)Tc-Tetrofosmin and (99m)Tc-MIBI: myocardial perfusion scintigraphy), etc. were numerous. The administered activity of many radiopharmaceuticals of bone scintigraphy ((99m)Tc-MDP and (99m)Tc-HMDP), cerebral blood flow scintigraphy ((99m)Tc-HM-PAO) and myocardial perfusion scintigraphy ((99m)Tc-Tetrofosmin and (99m)Tc-MIBI), etc. were within the range of the EU DRLs and almost none of the administered radioactivity in Japan exceeded the upper limit of SNMMI standard administered radioactivity.
  
  
  CONCLUSIONS
  This survey indicated that the administered radioactivity in diagnostic nuclear medicine in Japan had been in the convergence zone and nuclear medicine facilities in Japan show a strong tendency to adhere to the texts and guidelines. Furthermore, the administered radioactivities in Japan were within the range of variation of the EU and the SNMMI administered radioactivities.
authors.affiliation: Department of Radiological Technology, Japan Labour Health and Welfare Organization Yokohama Rosai Hospital, 3211, Kozukue, Kohoku, Yokohama, Kanagawa, 222-0036, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Radiology, Kindai University Faculty of Medicine, Ohnohigashi 377-2, Osakasayama, Osaka, 589-8511, Japan. ishii@med.kindai.ac.jp.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Institute of Advanced Clinical Medicine, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hosono
authors.affiliation: Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Imabayashi
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Women's Medical University, Kawada-cho 8-1, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Abe
authors.affiliation: Division of Nuclear Medicine, Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Inubushi
authors.affiliation: Department of Radiological Technology, Kyoto College of Medical Science, 1-3 Oyamahigashimachi Sonobe-cho Nantan, Kyoto, 622-0041, Japan.
authors.forename: Kazuko
authors.initials: K
authors.lastname: Ohno
authors.affiliation: Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Magata
authors.affiliation: Department of Radiology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0013, Japan.
authors.forename: Kinya
authors.initials: K
authors.lastname: Ono
authors.affiliation: Department of Radiology, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Kikuchi
authors.affiliation: Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Wagatsuma
authors.affiliation: Department of Radiology, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Takase
authors.affiliation: Department of Radiological Technology, Faculty of Health Sciences, Nihon Institute of Medical Science, 1276, Shimogawara, Moroyama-machi, Iruma-gun, Saitama, 350-0435, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Nuclear Medicine Technology, Gunma Prefectural College of Health Sciences, 323-1 Kamioki-cho, Maebashi, Gunma, 371-0052, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D003952:Diagnostic Imaging / Q000592:standards*; D006801:Humans; D007564:Japan; D011851:Radioactivity; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000737:chemistry*; D012015:Reference Standards; D012955:Societies, Medical; D011795:Surveys and Questionnaires
chemical_list: D019275:Radiopharmaceuticals
keywords: Diagnostic reference level; Optimization of dose; Radioactivity; Radiopharmaceutical; Survey