Renal 99mTc-DMSA pharmacokinetics in pediatric patients.

99mTc-DMSA is one of the most commonly used pediatric nuclear medicine imaging agents. Nevertheless, there are no pharmacokinetic (PK) models for 99mTc-DMSA in children, and currently available pediatric dose estimates for 99mTc-DMSA use pediatric S values with PK data derived from adults. Furthermore, the adult PK data were collected in the mid-70's using quantification techniques and instrumentation available at the time. Using pediatric imaging data for DMSA, we have obtained kinetic parameters for DMSA that differ from those applicable to adults. METHODS: We obtained patient data from a retrospective re-evaluation of clinically collected pediatric SPECT images of 99mTc-DMSA in 54 pediatric patients from Boston's Children Hospital (BCH), ranging in age from 1 to 16 years old. These were supplemented by prospective data from twenty-three pediatric patients (age range: 4 months to 6 years old). RESULTS: In pediatric patients, the plateau phase in fractional kidney uptake occurs at a fractional uptake value closer to 0.3 than the value of 0.5 reported by the International Commission on Radiological Protection (ICRP) for adult patients. This leads to a 27% lower time-integrated activity coefficient in pediatric patients than in adults. Over the age range examined, no age dependency in uptake fraction at the clinical imaging time was observed. Female pediatric patients had a 17% higher fractional kidney uptake at the clinical imaging time than males (P < 0.001). CONCLUSIONS: Pediatric 99mTc-DMSA kinetics differ from those reported for adults and should be considered in pediatric patient dosimetry. Alternatively, the differences obtained in this study could reflect improved quantification methods and the need to re-examine DMSA kinetics in adults.

Dose Estimation in Pediatric Nuclear Medicine.

The practice of nuclear medicine in children is well established for imaging practically all physiologic systems but particularly in the fields of oncology, neurology, urology, and orthopedics. Pediatric nuclear medicine yields images of physiologic and molecular processes that can provide essential diagnostic information to the clinician. However, nuclear medicine involves the administration of radiopharmaceuticals that expose the patient to ionizing radiation and children are thought to be at a higher risk for adverse effects from radiation exposure than adults. Therefore it may be considered prudent to take extra care to optimize the radiation dose associated with pediatric nuclear medicine. This requires a solid understanding of the dosimetry associated with the administration of radiopharmaceuticals in children. Models for estimating the internal radiation dose from radiopharmaceuticals have been developed by the Medical Internal Radiation Dosimetry Committee of the Society of Nuclear Medicine and Molecular Imaging and other groups. But to use these models accurately in children, better pharmacokinetic data for the radiopharmaceuticals and anatomical models specifically for children need to be developed. The use of CT in the context of hybrid imaging has also increased significantly in the past 15 years, and thus CT dosimetry as it applies to children needs to be better understood. The concept of effective dose has been used to compare different practices involving radiation on a dosimetric level, but this approach may not be appropriate when applied to a population of children of different ages as the radiosensitivity weights utilized in the calculation of effective dose are not specific to children and may vary as a function of age on an organ-by-organ bias. As these gaps in knowledge of dosimetry and radiation risk as they apply to children are filled, more accurate models can be developed that allow for better approaches to dose optimization. In turn, this will lead to an overall improvement in the practice of pediatric nuclear medicine by providing excellent diagnostic image quality at the lowest radiation dose possible.

Faculty Readiness for Oral Health Integration into Health Care Professional Education: A Pilot Study.

PURPOSE: Despite mounting evidence of the oral-systemic link, oral health is often treated as a separate entity in health care professional education and training. Faculty attitudes and levels of knowledge and skills related to oral health have been cited as barriers to integration, though no research has reported health care faculty's oral health knowledge and skills or attitudes towards oral health curricular integration. The aim of this study was to assess the oral health knowledge, skills, and attitudes of interdisciplinary health care faculty at a large, metropolitan university. METHODS: A 25-item, web-based survey was distributed to 350 faculty members across nine academic health care programs during the 2013-2014 academic year. RESULTS: A response rate of 13% (n=45) was achieved. Findings indicated overall positive faculty attitudes towards oral health integration, but significant gaps in faculty oral health knowledge and oral health clinical skills. A one-way ANOVA analysis revealed statistically significant differences in oral health clinical skills between faculty of different disciplines. CONCLUSION: This study is the first to assess health care faculty's oral health knowledge and skills and their attitudes towards oral health curricular integration. Findings highlight potential areas for faculty development, education, and training in oral health.

The newborn butterfly project: a shortened treatment protocol for ear molding.

BACKGROUND: Secondary to circulating maternal estrogens, a baby's ear cartilage is unusually plastic during the first few weeks of life, providing an opportunity to correct ear deformities by molding. If molding is initiated during the first days of life with a more rigid molding system than previously described in the literature, the authors hypothesized that treatment time would be reduced and the correction rate would increase. METHODS: An interdisciplinary team identified and assessed all infants born with ear deformities at New York-Presbyterian Hospital/Weill Cornell Medical Center. The authors conducted a prospective, institutional review board-approved study on the first consecutive 100 infants identified. Parents were surveyed initially, immediately after treatment, and at 6 and 12 months. RESULTS: One hundred fifty-eight ears in 96 patients underwent ear molding using the EarWell Infant Ear Correction System. Eighty-two percent of the children had the device placed in the newborn nursery and 95 percent had it placed before 2 weeks of life. Average treatment time was 14 days, and 96 percent of the deformities were corrected. Complications were limited to mild pressure ulcerations. Ninety-nine percent of parents stated that they would have the procedure repeated. CONCLUSIONS: The molding period can be reduced from 6 to 8 weeks to 2 weeks by initiating molding during the first weeks of life and using a more secure and rigid device. Through an interdisciplinary approach, the authors were able to identify patients and to correct the deformity earlier and faster than has been previously published, eliminating the need for surgical correction in many children. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.