Duration of Breastfeeding Interruption in Nuclear Medicine Procedures

Dhrumil Naik; Hema Merai; Ran Klein; Wanzhen Zeng

doi:10.2967/jnmt.122.264910

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TABLE 1.

Duration of Breastfeeding Interruption (Studies Listed Alphabetically from A to I)

Study	Radiopharmaceutical	Administered dose	Institution guidelines, 2022	SNMMI/EANM procedure guideline (7)^*	Stabin and Breitz (2)	ICRP 106 (8)	Leide- Svegborn (1)^†	ACMUI (9)^‡
Adrenal medulla	¹³¹I-MIBG	37 MBq	Stop	Stop	NA	>3 wk	NA	NA
Adrenal medulla	¹²³I-MIBG	370 MBq	48 h	48 h	48 h	>3 wk	NA	NA
Bone scan	^99mTc-MDP	11 MBq/kg	4 h	4–24 h	0	0	0	24 h
Bone scan PET	¹⁸F-fluoride	185–370 MBq	—	NA	NA	NA	NA	4 h
Bone marrow	^99mTc-SC	555 MBq	4 h	NA	0	0	NA	24 h
Brain perfusion	^99mTc-ECD	555–1,110 MBq	4 h	NA	NA	0	NA	24 h
Brain perfusion	^99mTc-HMPAO	555–1,110 MBq	4 h	NA	NA	0	NA	24 h
Brain amyloid	¹⁸F-florbetapir	370 MBq	—	24 h	NA	NA	NA	NA
Brain amyloid	¹⁸F-flutemetamol	185 MBq	—	24 h	NA	NA	NA	NA
Brain amyloid	¹⁸F-florbetaben	300 MBq	—	24 h	NA	NA	NA	NA
Breast imaging	^99mTc-sestamibi	300–600 MBq	—	0	0	0	NA	24 h
Breast imaging	^99mTc-testrofosmin	300–600 MBq	—	0	NA	0	NA	24 h
Cardiac necrosis	^99mTc-PYP	740 MBq	4 h	NA	0	0	NA	24 h
Cisternography	¹¹¹In-DTPA	18–27.8 MBq	0	NA	NA	NA	NA	NA
Cerebrospinal fluid shuntogram	¹¹¹In-DTPA	28 MBq	0	NA	NA	NA	NA	NA
DaTScan	¹²³I-ioflupane	111–185 MBq	3 d	1–6 d	NA	NA	NA	NA
Brain scan	¹⁸F-FDG	4.9 MBq/kg	12 h	24 h	NA	0	0	4 h
Esophageal transit	^99mTc-SC	40 MBq	4 h	NA	0	0	NA	24 h
¹⁸F-FDG PET (oncology)	¹⁸F-FDG	4.9 MBq/kg	12 h	12 h	NA	0	0	4 h
⁶⁷Ga scan	⁶⁷Ga-citrate	148–333 MBq	Stop	2–4 wk	Stop	>3 wk	NA	28 d
Gastric emptying/transit (liquid)	^99mTc-DTPA	37 MBq	4 h	NA	0	0	NA	24 h
Gastric emptying (solid)	^99mTc-SC	18.5 MBq	4 h	NA	0	0	NA	24 h
Gastrointestinal bleed	^99mTc-RBC in vitro	555–1,110 MBq	4 h	0	0	0	NA	24 h
Heat-damaged RBC scan	^99mTc-RBC in vitro	370 MBq	4 h	NA	0	0	NA	24 h
Hepatic hemangioma	^99mTc-RBC in vitro	750–925 MBq	4 h	NA	0	0	NA	24 h
Hepatobiliary scan	^99mTc-DISIDA	185 MBq	4 h	0	0	0	NA	24 h
Hepatobiliary scan	^99mTc-mebrofenin	185 MBq	4 h	0	NA	NA	NA	24 h
Iodine whole-body imaging	¹³¹I-NaI	185 MBq	Stop	NA	Stop	>3 wk	Stop	Stop
Iodine whole-body imaging	¹²³I-NaI	74–185 MBq	4 d	NA	Stop	>3 wk	NA	3 d

↵* Or publicly available guidance documents.
↵† Recommendation was based on both internal and external radiation exposure.
↵‡ Single 24-h interruption period is recommended for ^99mTc-labeled radiopharmaceuticals to simplify guidance.
MIBG = metaiodobenzylguanidine; NA = data not available; MDP = methyl diphosphonate; 0 = no breastfeeding cessation is necessary; — = not institutional procedure; SC = sulfur colloid; ECD = ethyl cysteinate dimer; HMPAO = hexamethylpropyleneamine oxime; PYP = pyrophosphate; DTPA = diethylenetriaminepentaacetic acid; RBC = red blood cell; DISIDA = diisopropyl iminodiacetic acid.

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TABLE 2.

Duration of Breastfeeding Interruption (Studies Beginning with L)

Study	Radiopharmaceutical	Administered dose (MBq)	Institution guidelines, 2022	SNMMI/EANM procedure guideline (7)^*	Stabin and Breitz (2)	ICRP 106 (8)	Leide- Svegborn (1)^†	ACMUI (9)^‡
Lacrimal gland	^99mTc-pertechnetate	7.4	0	NA	NA	NA	NA	NA
Liver, spleen	^99mTc-SC	200	4 h	NA	0	0	NA	24 h
Lung perfusion	^99mTc-MAA	74–185	12 h	NA	12 h	12 h	12 h	24 h
Lung ventilation	^99mTc-Technegas	18–37	0	NA	NA	0	NA	24 h
Lung ventilation	^99mTc-DTPA aerosol	20–40	—	NA	0	NA	NA	24 h
Lung ventilation	^99mTc-SC aerosol	20–40	—	0	NA	NA	NA	24 h
Lung ventilation	^81mKr gas	40–400	—	0	NA	0	NA	NA
Lung ventilation	¹³³Xe gas	200–750	—	0	NA	0	NA	NA
Lymphoscintigraphy	^99mTc-filtered SC	37	4 h	24 h	0	0	NA	24 h
Lymphoscintigraphy	^99mTc-unfiltered SC	185	4 h	24 h	0	0	NA	24 h
Lymphoscintigraphy	^99mTc-sulphide nanocolloid	3.7−370	—	24 h	NA	NA	NA	24 h
Lymphoscintigraphy	^99mTc-nanocolloidal albumin	3.7–370	—	24 h	NA	NA	NA	24 h
Lymphoscintigraphy	^99mTc-antimony trisulfide	3.7−370	—	24 h	NA	NA	NA	24 h
Lymphoscintigraphy	^99mTc-tilmanocept	3.7−370	—	24 h	NA	NA	NA	24 h
¹⁷⁷Lu-DOTATATE	¹⁷⁷Lu-oxodotreotide	3,700	Stop	2.5 mo	NA	NA	NA	Stop

↵* Or publicly available guidance documents.
↵† Recommendation was based on both internal and external radiation exposure.
↵‡ Single 24-h interruption period is recommended for ^99mTc-labeled radiopharmaceuticals to simplify guidance.
NA = data not available; 0 = no breastfeeding cessation is necessary; SC = sulfur colloid; DTPA = diethylenetriaminepentaacetic acid; — = not institutional procedure.

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TABLE 3.

Duration of Breastfeeding Interruption (Studies Listed Alphabetically from M to S)

Study	Radiopharmaceutical	Administered dose	Institution guidelines, 2022	SNMMI/EANM procedure guideline (7)^*	Stabin and Breitz (2)	ICRP 106 (8)	Leide- Svegborn (1)^†	ACMUI (9)^‡
Meckel diverticulum	^99mTc-pertechnetate	555 MBq	12 h	12 h	4 h	12 h	12 h	24 h
Multigated acquisition	^99mTc-RBC modified in vivo	925 MBq	12 h	24 h	12 h	12 h	0	24 h
Myocardial perfusion (rest + stress)	^99mTc-tetrofosmin	1,184 MBq	4 h	4 h	NA	0	NA	24 h
Myocardial perfusion (rest + stress)	^99mTc-sestamibi	1,184 MBq	4 h	4 h	0	0	0	24 h
Myocardial perfusion	²⁰¹Tl-chloride	111 MBq	4 d	48 h	96 h	48 h	NA	4 d
Myocardial perfusion	⁸²Rb	1,100–1,850 MBq	—	NA	NA	NA	NA	0
Myocardial perfusion	¹³N-ammonia	370–740 MBq	—	NA	NA	0	NA	1 h
Sodium fluoride PET	¹⁸F-NaF	2.22 MBq/kg	0	NA	NA	NA	NA	4 h
Octreotide scan	¹¹¹In-octreotide	111 MBq	0	0	NA	0	NA	6 d
Parathyroid scan	^99mTc-sestamibi	740 MBq	4 h	0	0	0	NA	24 h
Parathyroid scan	^99mTc-tetrofosmin	185–925 MBq	—	0	NA	0	NA	24 h
Parathyroid scan (for dual phase)	^99mTc-pertechnetate	75–150 MBq	—	12 h	4 h	12 h	NA	24 h
Parathyroid scan (for dual tracer)	¹²³I-NaI and ^99mTc-sestamibi	7.5–20 and 740 MBq	4 d	3 wk	Stop	>3 wk	NA	3 d
R to L shunt	^99mTc-MAA	37 MBq	12 h	NA	NA	NA	NA	24 h
Renal cortical	^99mTc-gluceptate	296 MBq	4 h	NA	0	0	NA	24 h
Renal cortical	^99mTc-DMSA	111 MBq	4 h	NA	NA	0	NA	24 h
Renal function	^99mTc-MAG-3	260 MBq	4 h	4 h	0	0	0	24 h
Renal function	^99mTc-DTPA	370 MBq	4 h	12 h	0	0	0	24 h
Renal GFR	^99mTc-DTPA	37 MBq	4 h	NA	0	0	0	24 h
Salivary gland scan	^99mTc-pertechnetate	555 MBq	12 h	NA	4 h	12 h	12 h	24 h
SeHCAT scan	⁷⁵Se-tauroselcholic acid	0.37 MBq	>3 wk	NA	NA	>3 wk	NA	NA
Small-bowel and colon transit	^99mTc-SC	18.5–37 MBq	—	NA	0	0	NA	24 h

↵* Or publicly available guidance documents.
↵† Recommendation was based on both internal and external radiation exposure.
↵‡ Single 24-h interruption period is recommended for ^99mTc-labeled radiopharmaceuticals to simplify guidance.
RBC = red blood cell; 0 = no breastfeeding cessation is necessary; NA = data not available; — = not institutional procedure; DMSA = dimercaptosuccinic acid; MAG = mercaptoacetyltriglycine; DTPA = diethylenetriaminepentaacetic acid; SC = sulfur colloid.

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TABLE 4.

Duration of Breastfeeding Interruption (Studies Listed Alphabetically from T to Z)

Study	Radiopharmaceutical	Administered dose	Institution guidelines, 2022	SNMMI/EANM procedure guideline (7)^*	Stabin and Breitz (2)	ICRP 106 (8)	Leide- Svegborn (1)^†	ACMUI (9)^‡
Thyroid scan	¹²³I-NaI	18.5 MBq	4 d	NA	0	>3 wk	NA	3 d
Thyroid scan	^99mTc-pertechnetate	370 MBq	12 h	NA	4 h	12 h	12 h	24 h
Thyroid uptake	¹³¹I-NaI	0.37 MBq	Stop	NA	Stop	>3 wk	Stop	Stop
Thyroid ablation (hyperthyroidism)	¹³¹I-NaI	185–1,110 MBq	Stop	Stop	Stop	>3 wk	Stop	Stop
Thyroid cancer ablation^§	¹³¹I-NaI	1,100–7,400 MBq	Stop 3 mo prior	Stop	Stop	>3 wk	Stop	Stop
Urea breath test	¹⁴C-urea	0.037 MBq	0	NA	NA	0	NA	NA
WBC scan	¹¹¹In-oxine WBC	10–40 MBq	0	NA	0	0	NA	6 d
WBC scan	^99mTc-HMPAO WBC	370–740 MBq	24 h	NA	48 h	12 h	0	24 h
⁹⁰Y-radiolabeled therapy	⁹⁰Y-ibritumomab tiuxetan	15 MBq/kg	—	Stop	NA	NA	NA	NA

↵* Or publicly available guidance documents.
↵† Recommendation was based on both internal and external radiation exposure.
↵‡ Single 24-h interruption period is recommended for ^99mTc-labeled radiopharmaceuticals to simplify guidance.
↵§ For radioiodine ablation for thyroid cancer, discontinuation of breastfeeding of 3 mo is recommended before therapy to reduce radiation exposure to lactating breast.
NA = data not available; 0 = no breastfeeding cessation is necessary; WBC = white blood cell; HMPAO = hexamethylpropyleneamine oxime; — = not institutional procedure.