Beyond current guidelines: reduction in minimum administered radiopharmaceutical activity with preserved diagnostic image quality in pediatric hepatobiliary scintigraphy View Full Text


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Article Info

DATE

2014-08-06

AUTHORS

Frederic Fahey, Katherine Zukotynski, David Zurakowski, Robert Markelewicz, Anthony Falone, Marie Vitello, Xinhua Cao, Frederick Grant, Laura Drubach, A. Hans Vija, Manojeet Bhattacharya, Xinhong Ding, Zvi Bar-Sever, Michael Gelfand, S. Ted Treves

ABSTRACT

PurposeTo determine if the minimum administered radiopharmaceutical activity for hepatobiliary scintigraphy can be reduced while preserving diagnostic image quality using enhanced planar processing (EPP).MethodsA 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 99mTc-mebrofenin (18 patients) or 99mTc-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.ResultsFor 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).ConclusionClinically 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. More... »

PAGES

2346-2353

References to SciGraph publications

  • 2008-08-22. The new EANM paediatric dosage card in EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
  • 2001. Multivariate Statistical Modelling Based on Generalized Linear Models in NONE
  • 2014. Pediatric Nuclear Medicine and Molecular Imaging in NONE
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    http://scigraph.springernature.com/pub.10.1007/s00259-014-2860-1

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    http://dx.doi.org/10.1007/s00259-014-2860-1

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    https://app.dimensions.ai/details/publication/pub.1021229908

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/25097073


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    24 schema:description PurposeTo determine if the minimum administered radiopharmaceutical activity for hepatobiliary scintigraphy can be reduced while preserving diagnostic image quality using enhanced planar processing (EPP).MethodsA 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 99mTc-mebrofenin (18 patients) or 99mTc-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.ResultsFor 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).ConclusionClinically 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.
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