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Annals of Nuclear Medicine
Published in: Annals of Nuclear Medicine 11/2021

01-11-2021 | Original Article

Optimization of injection dose in 18F-FDG PET/CT based on the 2020 national diagnostic reference levels for nuclear medicine in Japan

Authors: Hiroaki Sagara, Kazumasa Inoue, Hideki Yaku, Amon Ohsawa, Takashi Someya, Kaori Yanagisawa, Shuhei Ohashi, Rikuta Ishigaki, Masashi Wakabayashi, Yoshihisa Muramatsu, Hirofumi Fujii

Published in: Annals of Nuclear Medicine | Issue 11/2021

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Abstract

Objective

Recently, the national diagnostic reference levels (DRLs) in Japan were revised as the DRLs 2020, wherein the body weight-based injection dose optimization in positron emission tomography/computed tomography using 18F-fluoro-2-deoxy-D-glucose (18F-FDG PET/CT) was first proposed. We retrospectively investigated the usefulness of this optimization method in improving image quality and reducing radiation dose.

Methods

A total of 1,231 patients were enrolled in this study. A fixed injection dose of 240 MBq was administered to 624 patients, and a dose adjusted to 3.7 MBq/kg body weight was given to 607 patients. The patients with body weight-based injection doses were further divided according to body weight: group 1 (≤ 49 kg), group 2 (50–59 kg), group 3 (60–69 kg), and group 4 (≥ 70 kg). The effective radiation dose of FDG PET was calculated using the conversion factor of 0.019 mSv/MBq, per the International Commission on Radiological Protection publication 106. Image quality was assessed using noise equivalent count density (NECdensity), which was calculated by excluding the counts of the brain and bladder. The usefulness of the injection dose optimization in terms of radiation dose and image quality was analyzed.

Results

The body weight-based injection dose optimization significantly decreased the effective dose by 11%, from 4.54 ± 0.1 mSv to 4.05 ± 0.8 mSv (p < 0.001). Image quality evaluated by NECdensity was also significantly improved by 10%, from 0.39 ± 0.1 to 0.43 ± 0.2 (p < 0.001). In no case did NECdensity deteriorate when the effective dose was decreased. In group 1, the dose decreased by 32%, while there was no significant deterioration in NECdensity (p = 0.054). In group 2, the dose decreased by 17%, and the NECdensity increased significantly (p < 0.01). In group 3, the dose decreased by 3%, and the NECdensity increased significantly (p < 0.01). In group 4, the dose increased by 14%, but there was no significant change in the NECdensity (p = 0.766).

Conclusion

Body weight-based FDG injection dose optimization contributed to not only the reduction of effective dose but also the improvement of image quality in patients weighing between 50 and 69 kg.
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Metadata
Title
Optimization of injection dose in 18F-FDG PET/CT based on the 2020 national diagnostic reference levels for nuclear medicine in Japan
Authors
Hiroaki Sagara
Kazumasa Inoue
Hideki Yaku
Amon Ohsawa
Takashi Someya
Kaori Yanagisawa
Shuhei Ohashi
Rikuta Ishigaki
Masashi Wakabayashi
Yoshihisa Muramatsu
Hirofumi Fujii
Publication date
01-11-2021
Publisher
Springer Singapore
Published in
Annals of Nuclear Medicine / Issue 11/2021
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-021-01656-x

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