Paediatric Nuclear Medicine :Paediatric Nuclear Medicine TkMarshel R.T.(R)(N)(CT)(MR)(NCT)(PET) Chief Pediatric NM Technologist The Cleveland Clinic Children’s Hospital, Cleveland, Ohio


Language :Language Use terms kids can understand Jelco, catheter, EMLA, radioisotope are OUT Straw, tube, Magic Cream, Sparkle Juice are IN Mental age appropriate


Topical Anaesthetics :Topical Anaesthetics EMLA cream or patches applied one hour prior to injection Usually applied to four sites Removes the ‘OUCH’ factor


Injection Technique :Injection Technique Adults – inject directly into vein Kids – insert a Jelco and inject through a line Allows for saline flush Eliminates chance of extravascular injection of radioisotope


Sedation/F.F./G.A. :Sedation/F.F./G.A. 0 – 6 months – Fast and Feed technique 6 – 36 months (under 20kg) – sedation with oral chloral hydrate All others – General Anaesthetic


Oral Sedation :Oral Sedation


Restraint :Restraint


Distraction Techniques :Distraction Techniques


Just for Kids :Just for Kids Use EMLA cream Adjust the dose according to weight Use restraint, sedation and distraction Talk to the Parents Be Patient!!!


Main Scans Performed :Main Scans Performed Bone Scans - NAI, Primary tumors, osteomyelitis Renal Scans – MAG-3, Direct and Indirect Cystograms, DMSA, Lasix GI Scans – Meckels, GO Reflux, Salivagrams, Biliary for ?atresia MIBG - neuroblastomas


Bone Scans :Bone Scans Use MDP (delayed scans at 90mins) or HDP (delayed scans at 60mins) Adjust dose according to weight Blood pools from pelvis up OR pelvis down Toes are taped internally rotated


Normal Bone Scan :Normal Bone Scan


Non-Accidental Injury :Non-Accidental Injury


Ewing’s Sarcoma :Ewing’s Sarcoma


Osteosarcoma :Osteosarcoma


Osteoid Osteoma :Osteoid Osteoma


Perthes’ Disease – bilateral :Perthes’ Disease – bilateral


Osteomyelitis – R hip :Osteomyelitis – R hip


Osteomyelitis :Osteomyelitis


Shin Splints :Shin Splints


Renal Scans :Renal Scans DMSA ?pyelonephritis, cortical scarring Cystograms direct and indirect ? Reflux disease Mag-3 better quality images with less background activity, lower dose (70MBq max. c.f. DTPA 300MBq max) ?PUJ, VUJ, Reflux Disease, Hydronephrosis


Mag-3 Scan :Mag-3 Scan


Lasix :Lasix


Direct Cystogram :Direct Cystogram


Indirect Cystogram :Indirect Cystogram


DMSA – Cortical Scarring :DMSA – Cortical Scarring


GI Studies :GI Studies Meckels GO Reflux Salivagram


Meckel’s Diverticulum :Meckel’s Diverticulum


GO Reflux with Aspiration :GO Reflux with Aspiration


Salivagram with Aspiration :Salivagram with Aspiration


MIBG - Neuroblastoma :MIBG - Neuroblastoma