PET CT IN PEDIATRIC

MALIGNANCIES

DR.K.M.LAKSHMIPATHY

Consultant Nuclear Scans & Therapy and

CHIEF PET-CT Centre(unit of Dr.KMH)

ADYAR CANCER INSTITUTE-CHENNAI

PET/CT in Pediatric Oncology

Treatment and outcome for pediatric malignancy have improved over the

years and at least 70% are now curable. Keepingthis in view, early diagnosis, staging, restaging and monitoring responseto therapy become important in management.

PET/CT imaging proves

golden for detecting cancer

in children 13. December 2007 02:34PET/CT imaging

exhibits significantly higher sensitivity,

specificity and accuracy than

conventional imaging when it comes to

detecting malignant tumors in children,

Primary concern –

Cancer induction from PET/CT and CT imaging

Patient benefits from PET/CT and CT imaging will

have to be balanced against “the cost of the radiation

burden to the individual patient, and possibly to the

community”

Use of radiation in medicine must do more good

than harm (i.e., The procedure should improve

diagnosis)

Guidelines for the use of PET–CT

in children Nuclear Medicine Communications 2008,

29:418–424

Treatment related indications

Before local therapy, scans should be

considered in: Children who are

candidates for radiotherapy (for conditions

known to be FDG avid),

Hepatoblastoma requiring liver transplant,

Wilms‟ tumour considered for bilateral

renal surgery(to assist nephron sparing),

Stage 3 neuroblastoma after initial

chemotherapy (if further chemotherapy is

being considered to further reduce the

tumors),

PET CT uses in pediatric

malignancies

Mutilating sarcoma surgery.

Treatment response scans should be considered in any

child with:

Hodgkin‟s lymphoma (as per Euro-NET protocol, for

children on and off trial);

Non-Hodgkin‟s lymphoma with poor response on

conventional imaging;

MIBG-negative neuroblastoma;

Langerhans cell histiocytosis;

Soft tissue sarcoma.

Indications contd…..

Residual mass assessment may be

appropriate in:

Hodgkin‟s lymphoma,

Some soft tissue sarcomas,

Neuroblastoma.

Follow-up

Scans for follow-up are only advisable if prompt further

life-saving treatment is planned in the event of relapse/

progression.

Relapse Scans may be considered in any child with confirmed or suspected relapse of above conditions.

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Preparation for PET

CT Before the test, we suggest you talk to your child about what

will happen. For young children, use simple words and explain

only shortly before the test. Also know we recommend

sedation for children under age 5. Also before your

visit, please:

Arrive at least 15 minutes before your child's scheduled

appointment time.

Do not allow food, drink (except water) or chewing gum at

least six hours before your visit - all can interfere with results.

Do allow the child to drink plenty of water.

Dress the child in comfortable clothing, avoiding metal snaps

and zippers - all can interfere with results. After arrival, we

may suggest the child wear a hospital gown.

Keep the child away from strenuous physical exercise 24

hours before your visit.

For older children, bring a book, DVD or toy to play with while

waiting.

If on the day of the test, your child feels feverish, please let us

know.

The total effective dose from each PET/CT study was about five to 13 times the worldwide average effective dose from background radiation over 1 year, which is estimated to be about 2.4 mSv

the effective dose from 18F-FDG PET/CT scanning with a diagnostic CT protocol and an administered FDGactivity of 370 MBq was calculated to be up to 32.18 mSv, and the associated lifetime cancer incidence was estimated to be up to 0.514%

REF:April 2009 Radiology, 251, 166-174.

Whole-Body PET/CT

Scanning: Estimation of

Radiation Dose and Cancer

Risk

Our team

Dr .Kamakshi Memorial

Hospital

CYCLOTRON

IGRT

Thank you