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A review of paediatric administered radiopharmaceutical activities to determine compliance with prescription guidelines

Bibbo, Giovanni; Sigalas, Victoria; Kirkwood, Ian

Nuclear Medicine Communications: March 2018 - Volume 39 - Issue 3 - p 205–212
doi: 10.1097/MNM.0000000000000800

Objective Attempts are underway to standardize paediatric administered activities, but equally important is knowing the actual activities administered to patients. In this work, paediatric administered activities are reviewed to determine compliance with the institution-prescribed guidelines.

Patients and methods Paediatric administered activities for common studies at our institution, August 2011 to January 2017, have been analysed to determine their deviations from the set guideline tolerance of 10% from prescribed activities.

Results The results for technetium-99m hydroxy diphosphonate (99mTc-HDP), technetium-99m mercaptoacetyl triglycine (99mTc-MAG3) and technetium-99m dimercaptosuccinic acid (99mTc-DMSA), are presented here. 99mTc-MAG3 mean activities were close to the tolerance guideline at 10.3% SD. For 99mTc-HDP and 99mTc-DMSA, the prescribed guidelines were reviewed and reduced in May 2014 and September 2015, respectively. SDs for these studies over the two acquisition periods were different (8.9 and 6.6%, respectively, for 99mTc-HDP and 11.8 and 14.2%, respectively, for 99mTc-DMSA).

The administered activities (dispensed minus residual activities) to patients depend on prescribed activities and dispensing and injecting techniques. Deviations from the prescribed activities are primarily because of issues related to residual activities, particularly with small activities prescribed in young patients. Small activities in small volumes make residual activities significant. The skill and experience of the nuclear medicine staff are essential in minimizing deviations from prescribed activities.

Conclusion It is important to measure residual to accurately determine the administered activities. If precautions are taken with dispensing and injecting techniques, it is possible to administer activities close to 10% of the prescribed activities. The regular review of the administered activities is essential to ensure that patients are not unnecessarily irradiated.

Department of Nuclear Medicine, SA Medical Imaging, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia

Correspondence to Giovanni Bibbo, PhD, Department of Nuclear Medicine, SA Medical Imaging, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, 5006 SA, Australia Tel: +61 881 616 640; fax: +61 881 616 969; e-mail:

Received September 28, 2017

Received in revised form December 14, 2017

Accepted January 2, 2018

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