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Updated: Jun 19, 2026
Whole-body PET/MRI of Pediatric Patients: The Details That Matter
Published on: December 19, 2017
Weight-based, low-dose pediatric whole-body PET/CT protocols
Adam M Alessio1, Paul E Kinahan, Vivek Manchanda
1Department of Radiology, University of Washington, Old Fisheries Center, Seattle, Washington 98195-7987, USA. aalessio@u.washington.edu
Insights
New low-dose PET/CT protocols for pediatric patients customize imaging based on weight, reducing radiation exposure and cancer risk while maintaining diagnostic quality. These protocols aim to minimize radiation dose for children undergoing PET/CT scans.
Area of Science:
- Medical Imaging
- Nuclear Medicine
- Pediatric Radiology
Background:
- Standard adult PET/CT protocols pose risks for pediatric patients due to higher sensitivity to radiation.
- Minimizing radiation dose in pediatric imaging is crucial while preserving diagnostic accuracy.
Purpose of the Study:
- To develop and evaluate customized, low-dose PET/CT acquisition protocols for pediatric patients.
- To estimate the dosimetry and associated cancer risks of these optimized protocols.
Main Methods:
- Developed weight-based protocols for whole-body (18)F-FDG PET and CT imaging.
- Utilized Broselow-Luten scale for patient categorization.
- Calculated dosimetry and lifetime attributable risk (LAR) of cancer using accepted patient models.
Main Results:
- Proposed protocols yield effective doses from 8.0 to 13.5 mSv, depending on patient weight.
- Radiation dose is reduced by 20%-50% compared to standard protocols.
- Estimated additional LAR of cancer incidence is approximately 3 in 1,000 for females and 2 in 1,000 for males.
Conclusions:
- Developed low-dose PET/CT protocols tailored for 11 pediatric weight categories.
- Protocols provide initial parameters for pediatric PET/CT, balancing dose reduction and image quality.
- Multi-category approach allows for ongoing refinement of dose-reduction strategies.
Unlabelled:
Adult PET/CT acquisition protocols need to be modified for pediatric imaging to minimize the radiation dose while maintaining diagnostic utility. We developed pediatric PET/CT acquisition protocols customized to patient weight and estimated the dosimetry and cancer risk of these low-dose protocols to communicate basic imaging risks.
Methods:
Protocols were developed for whole-body (18)F-FDG imaging of patients in PET mode with a weight-based injected activity (5.3 MBq/kg) and acquisition times (3-5 min/field of view) and for CT for attenuation correction and localization with a weight-based tube current ranging from 10 to 40 mAs. Patients were categorized on the basis of the Broselow-Luten color-coded weight scale. Dosimetry and radiation-induced cancer risk for the PET and CT acquisition in each category were derived from mean patient sizes and the interpolation of factors from accepted patient models.
Results:
Whole-body pediatric PET/CT protocols require the customization of PET-acquisition settings and task-specific selection of CT technique. The proposed weight-based protocols result in an approximate effective dose ranging from 8.0 mSv for a 9-kg patient up to 13.5 mSv for a 63-kg patient. The radiation dose from the proposed protocols is 20%-50% (depending on patient weight), the dose from PET/CT protocols that use a fixed CT technique of 120 mAs and 120 kVp. The approximate, conservative estimate of additional lifetime attributable risk (LAR) of cancer incidence for females using the proposed protocols was approximately 3 in 1,000, with a variation of 18% across patient categories. For males, the additional LAR of cancer incidence was approximately 2 in 1,000, with a variation of 16% across categories.
Conclusion:
Low-dose PET/CT protocols for 11 patient weight categories were developed. The proposed protocols offer an initial set of acquisition parameters for pediatric PET/CT. The use of multiple categories allows for the continued refinement of dose-reduction parameters to minimize dose while maintaining image quality across the range of pediatric patient sizes.
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