Effects of Image Gently and the North American guidelines: administered activities in children at 13 North American pediatric hospitals

Abstract

The goal of this investigation was to assess the impact of the publication of the 2010 North American guidelines on the practice of nuclear medicine in children at 13 dedicated pediatric institutions within the United States and Canada by comparing results of similar surveys from 2007 and 2013.

Methods: In 2013, a follow-up survey was performed of the original 13 dedicated pediatric institutions initially surveyed in 2007. Both surveys inquired about the administered activities for 16 nuclear medicine procedures commonly performed on children. The administered activity per body mass, the maximum activity, and the minimum activity for patients for each procedure were requested from each site. For each parameter the minimum and maximum reported values, as well as the median and the mean, were tabulated. The mean difference in the mean between 2007 and 2013 was calculated, as well as the 95% confidence intervals for the mean administered activity per body mass for both years. The factor of variation used with the previous survey for each parameter was calculated by taking the ratio of the maximum and minimum reported values. For the 8 procedures addressed in the 2010 North American guidelines, the percentage of institutions that were compliant (defined as within 20%) for each parameter were noted for both surveys. Institutions were asked whether they were familiar with "Image Gently," the North American guidelines, and the "Go with the Guidelines" campaign and whether they adjusted their administered activities on the basis of these guidelines.

Results: In general, the 13 pediatric institutions have reduced their administered activities in children, particularly for those procedures addressed by the 2010 North American guidelines. The average variability in the activity per body mass and the minimum activity as measured by the factor of variation were substantially reduced by 9.7% (from 3.1 to 2.8) and 24% (from 10.0 to 7.6). The average variability of the maximum activity was increased by 6.1% (from 3.3 to 3.5), but the increase was mostly due to some sites reducing their limits while others maintained their previous values. For the 8 procedures addressed by the guidelines, half or more of the institutions were compliant (within 20%) with the associated parameters in 66% of the cases. Ten of the 13 institutions reported that they adjusted their administered activities according to the North American guidelines.

Conclusion: The publication of these guidelines and the associated public relations program appear to have had a positive effect with regard to both dose optimization and procedure standardization in pediatric nuclear medicine.

Keywords: Image Gently; North American guidelines; children; pediatric nuclear medicine; pediatric radiopharmaceutical dosing.