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Recent advances in pediatric nuclear medicine
1Department of Nuclear Medicine, AZ VUB, Brussels, Belgium.
Insights
Pediatric nuclear medicine can often avoid sedation by addressing children's anxiety. This review covers methods for renal clearance, gastroesophageal reflux scintigraphy, and brain SPECT applications in children.
Area of Science:
- Pediatric Nuclear Medicine
- Child Psychology in Medical Procedures
Background:
- Child anxiety significantly impacts pediatric nuclear medicine procedures, often necessitating sedation.
- Factors contributing to anxiety include past negative experiences, unfamiliar environments, and perceived loss of parental protection.
Purpose of the Study:
- To review controversial topics in pediatric nuclear medicine.
- To discuss methods for measuring renal clearance in children.
- To compare gastroesophageal reflux scintigraphy with pH metry and evaluate pediatric brain SPECT applications.
Main Methods:
- Review of existing literature on pediatric nuclear medicine.
- Analysis of various renal clearance measurement techniques (non-radioisotopic, radioisotopic, blood sample algorithms, gamma-camera methods).
- Comparison of scintigraphy and pH metry for gastroesophageal reflux detection.
Main Results:
- Sedation can frequently be avoided by considering the child's emotional state and optimizing the environment.
- Numerous methods exist for pediatric renal clearance assessment.
- Gastroesophageal reflux scintigraphy, despite advantages, has limited acceptance; its comparison with pH metry is crucial.
Conclusions:
- Addressing children's emotional needs is key to successful pediatric nuclear medicine without sedation.
- A comprehensive understanding of diverse renal clearance methods is necessary.
- Further evaluation of scintigraphy and ongoing development of brain SPECT are important for pediatric applications.
Abstract:
This review is devoted to some controversial topics in the field of pediatric nuclear medicine. In most cases, drug sedation can be avoided and the nuclear medicine procedure can be successfully achieved simply by taking the emotional life of the child into account. Factors such as past negative experiences (painful procedures, hospitalizations), unfamiliar environment (frightening examination room), physical aggressions related to the nuclear medicine procedure (intravenous injections, cystography), and the feeling of loss of parents' protection all contribute to the child's anxiety. People in charge of pediatric procedures should be adequately trained to be aware of these factors and to create the best environmental conditions to avoid unnecessarily frightening the child. Methods for measuring renal clearance in children are numerous. It is my aim to review the different methods proposed in the literature, including the nonradioisotopic methods, the reference radioisotopic methods, the various simplified algorithms using blood samples, and the gamma-camera methods. Gastroesophageal reflux scintigraphy is a well-established procedure for the detection of gastro-esophageal reflux in children. However, despite the numerous advantages of this technique, it has not gained wide acceptance in the field of pediatric gastroenterology. This review focuses mainly on the comparison between scintigraphy and pH metry. Finally, the applications of 99m technetium-hexamethylpropylenamine brain single photon emission computer tomography in the field of pediatric neurology are still under development; this part of the review is an attempt to summarize the real contribution of this technique.