Establishment of National Diagnostic Reference Levels for Administered Activity in Diagnostic Nuclear Medicine in Thailand

Dutsadee Suttho

doi:10.2967/jnmt.123.266836

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TABLE 1.

National Survey Results for Thailand

Organ system and protocol	Radiopharmaceutical	Patients (n)	M/F (n)	Age (y)	Weight (kg)	Activity (MBq)	Modality
Skeletal/marrow	^99mTc-MDP	2,284	882/1,402	59.29 ± 15.83	59.27 ± 13.51	720.39 ± 98.79	SPECT
Cardiovascular
MUGA	^99mTc-RBC	317	16/301	53.61 ± 10.87	58.62 ± 10.48	752.21 ± 90.65	SPECT, SPECT/CT
MPI MIBI
Rest	^99mTc-MIBI	205	97/108	66.33 ± 10.91	62.78 ± 15.75	421.06 ± 204.61	SPECT, SPECT/CT
Stress		211	97/114	65.92 ± 11.24	62.11 ± 14.0	719.28 ± 303.40	SPECT, SPECT/CT
MPI ²⁰¹Tl	²⁰¹Tl-chloride	40	30/10	68.28 ± 9.82	62.99 ± 15.56	97.68 ± 25.16	SPECT, SPECT/CT
Pulmonary
Perfusion	^99mTc-MAA	40	15/25	64.09 ± 14.02	59.41 ± 13.56	227.55 ± 74.00	SPECT, SPECT/CT
Ventilation	^99mTc-DTPA aerosol	24	12/11	62.65 ± 11.05	66.65 ± 13.71	916.49 ± 190.18	SPECT, SPECT/CT
	^99mTc-Technegas^*					662.30 ± 139.49	SPECT, SPECT/CT
Gastrointestinal
Protein losing	^99mTc-HSA	15	5/10	51.16 ± 13.91	55.48 ± 8.34	609.02 ± 186.48	SPECT, SPECT/CT
Hepatobiliary	^99mTc-IDA	12	8/4	64.59 ± 21.65	67.32 ± 16.60	237.17 ± 66.97	SPECT, SPECT/CT
Esophagus	^99mTc-phytate	20	3/17	51.5 ± 11.43	54.56 ± 8.94	31.45 ± 1.11	SPECT
Gastric emptying	^99mTc-phytate (solid meal)	22	7/15	51.52 ± 19.79	58.28 ± 6.52	38.85 ± 5.92	SPECT
GI bleeding	^99mTc-RBC	13	9/4	64.82 ± 14.91	56.64 ± 8.42	490.99 ± 199.06	SPECT, SPECT/CT
Hemangiomas	^99mTc-pertechnetate	10	3/7	50.49 ± 20.64	57.79 ± 6.71	214.97 ± 91.02	SPECT, SPECT/CT
Genitourinary	^99mTc-MAG3	99	58/42	47.76 ± 15.51	61.42 ± 13.41	134.31 ± 75.85	SPECT
	^99mTc-DTPA	49	25/24	49.98 ± 16.06	63.98 ± 15.94	156.51 ± 136.53	SPECT
Oncology	¹³¹I-sodium iodide	99	14/85	46.42 ± 13.68	63.83 ± 14.24	95.83 ± 33.67	SPECT, SPECT/CT
	¹³¹I-MIBG	21	5/16	48.25 ± 15.98	61.29 ± 13.49	44.77 ± 9.25	SPECT, SPECT/CT
	⁶⁷Ga-citrate	35	4/2	28.98 ± 11.81	55.0 ± 10.31	158.73 ± 22.57	SPECT, SPECT/CT
	^99mTc-MIBI	29	8/22	49.02 ± 16.54	62.62 ± 13.87	731.49 ± 78.07	SPECT, SPECT/CT
	¹⁸F-FDG	196	92/104	59.63 ± 14.80	59.84 ± 11.98	324.12 ± 83.62	PET/CT
	¹⁸F-PSMA	15	15/0	68.64 ± 5.14	62.74 ± 0.61	242.72 ± 22.57	PET/CT
	⁶⁸Ga-PSMA	17	17/0	70.62 ± 10.54	70.03 ± 10.58	187.96 ± 44.03	PET/CT
Lymphatic	^99mTc-dextran	20	3/17	57.49 ± 12.09	76.62 ± 22.61	96.20 ± 24.79	SPECT
	^99mTc-nanocolloid	31	0/31	58.07 ± 12.23	NA	16.65 ± 10.73	SPECT, SPECT/CT
Endocrine
Thyroid	^99mTc-pertechnetate	332	54/278	49.22 ± 15.33	60.77 ± 12.43	120.25 ± 39.22	SPECT
	¹³¹I-sodium iodide	201	28/173	47.33 ± 14.66	61.32 ± 13.25	122.10 ± 82.88	SPECT
Parathyroid	^99mTc-pertechnetate	72	29/43	51.46 ± 15.75	57.99 ± 13.81	155.03 ± 117.66	SPECT, SPECT/CT
	^99mTc-MIBI	106	42/64	51.96 ± 15.60	58.33 ± 14.54	709.29 ± 121.73	SPECT, SPECT/CT
Nervous system	¹⁸F-FDG	18	9/9	71.66 ± 10.72	56.58 ± 8.26	251.23 ± 35.52	PET/CT
Infection/ inflammation	⁶⁷Ga-citrate	8	5/3	46.87 ± 17.41	43.03 ± 8.39	186.85 ± 19.98	SPECT/CT
	^99mTc-SC-WBC	9	5/4	67.55 ± 14.04	48.0	728.90 ± 71.78	SPECT

↵* Cyclomedica.
MDP = methylene diphosphonate; MUGA = multigated acquisition; RBC = red blood cells; MPI = myocardial perfusion imaging; MIBI = methoxyisobutylisonitrile; MAA = macroaggregated albumin; DTPA = diethylenetriaminepentaacetic acid; HSA = human serum albumin; IDA = iminodiacetic acid; GI = gastrointestinal; MAG3 = mercaptoacetyltriglycine; NA = not applicable; PSMA = prostate-specific membrane antigen; SC-WBC = sulfur colloid white blood cells.
Age, weight, and activity are expressed as mean ± SD.

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TABLE 2.

NDRLs for Most Common Procedures in Thailand

			Percentile of dose distribution
Organ system and protocol	Radiopharmaceutical	Mean activity ± SD (MBq)	25th	50th	75th	Mean	NDRL (MBq)
Skeletal/marrow	^99mTc-MDP	720.39 ± 98.79	680.80	747.03	773.30	720.39	773.3
Cardiovascular
MUGA	^99mTc-RBC	752.21 ± 90.65	715.58	740.00	795.50	752.21	795.5
MPI MIBI
Rest	^99mTc-MIBI	421.06 ± 204.61	273.80	310.80	658.60	421.06	658.6
Stress	^99mTc-MIBI	719.28 ± 303.40	305.25	740.00	947.2	719.28	947.2
MPI ²⁰¹Tl	²⁰¹Tl-chloride	97.68 ± 25.16	92.50	99.90	115.81	97.68	115.81
Pulmonary
Perfusion	^99mTc-MAA	227.55 ± 74.00	185.00	214.60	240.5	227.55	240.5
Ventilation	^99mTc-DTPA aerosol	916.49 ± 190.18	784.4	888.00	1110	916.49	1110
	^99mTc-Technegas^*	662.30 ± 139.49	545.38	678.58	752.95	662.30	752.95
Gastrointestinal
Protein losing	^99mTc-HSA	609.02 ± 186.48	408.48	632.70	723.35	609.02	723.35
Hepatobiliary	^99mTc-IDA	237.17 ± 66.97	195.36	214.23	235.69	237.17	235.69
Esophagus	^99mTc-phytate (esophagus)	31.45 ± 1.11	30.71	31.45	31.45	31.45	31.45
Gastric emptying	^99mTc-phytate (solid meal)	38.85 ± 5.92	37.37	39.22	40.7	38.85	40.7
GI bleeding	^99mTc-RBC	490.99 ± 199.06	307.84	451.77	677.1	488.40	677.1
Hemangiomas	^99mTc-pertechnetate	214.97 ± 91.02	185.00	185.00	186.48	214.97	186.48
Genitourinary	^99mTc-MAG3	134.31 ± 75.85	108.41	118.40	134.31	134.41	134.31
	^99mTc-DTPA	156.51 ± 136.53	66.60	185.00	185	156.51	185
Oncology	¹³¹I-sodium iodide	95.83 ± 33.67	74.00	74.00	111	95.83	111
	¹³¹I-MIBG	44.77 ± 9.25	38.48	42.55	46.62	44.77	46.62
	⁶⁷Ga-citrate	158.73 ± 22.57	144.30	144.67	174.64	158.73	174.64
	^99mTc-MIBI	731.49 ± 78.07	740.00	754.80	784.4	731.49	784.4
	¹⁸F-FDG	324.12 ± 83.62	268.62	320.42	376.29	324.12	376.29
	¹⁸F-PSMA	242.72 ± 22.57	223.48	237.91	263.81	242.72	263.81
	⁶⁸Ga-PSMA	187.96 ± 44.03	150.59	190.55	209.05	187.96	209.05
Lymphatic	^99mTc-dextran	96.20 ± 24.79	79.18	90.65	103.6	96.20	103.6
	^99mTc-nanocolloid	16.65 ± 10.73	14.80	14.80	14.8	16.65	14.8
Endocrine
Thyroid	^99mTc-pertechnetate	120.25 ± 39.22	91.02	109.52	140.6	120.25	140.6
	¹³¹I-sodium iodide	122.1 ± 82.88	74.00	111.00	185	122.10	185
Parathyroid	^99mTc-pertechnetate	155.03 ± 117.66	106.19	130.98	166.5	155.03	166.5
	^99mTc-MIBI	709.29 ± 121.73	604.58	740.00	794.76	709.29	794.76
Nervous system	¹⁸F-FDG	251.23 ± 35.52	223.48	251.23	268.25	251.23	268.25
Infection/inflammation	⁶⁷Ga-citrate	186.85 ± 19.98	49.58	186.11	192.4	186.85	192.4
	^99mTc-SC-WBC	728.9 ± 71.78	736.3	740.00	765.9	728.9	765.9

↵* Cyclomedica.
MDP = methylene diphosphonate; MUGA = multigated acquisition; RBC = red blood cells; MPI = myocardial perfusion imaging; MIBI = methoxyisobutylisonitrile; MAA = macroaggregated albumin; DTPA = diethylenetriaminepentaacetic acid; HSA = human serum albumin; IDA = iminodiacetic acid; GI = gastrointestinal; MAG3 = mercaptoacetyltriglycine; PSMA = prostate-specific membrane antigen; SC-WBC = sulfur colloid white blood cells.

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TABLE 3.

NDRLs for Thailand Compared with Other Countries

Organ system and protocol	Radiopharmaceutical	Thailand	Japan	Korea	Australia	Kuwait	U.K.	United States	European Union
Skeletal/marrow	^99mTc-MDP	773.3	950	925	920	944	600	848–1,185	500–1,110
Cardiovascular
MUGA	^99mTc-RBC	795.5	—	740	1,030	740	800	916–1,301	600–1,000
MPI MIBI
Rest	^99mTc-MIBI	658.6	900	555	620	976	800	519–1,153	560
Stress		947.2	1,200	1,110	1,520	976	800	945–1,402	1,100
MPI ²⁰¹Tl	²⁰¹Tl-chloride	115.81	180	111	120	—	80	—	75–150
Pulmonary (perfusion)	^99mTc-MAA	240.5	260	222	240	217.5	100	147–226	100–296
Gastrointestinal
Hepatobiliary	^99mTc-IDA	235.69	—	370	210	—	150	—	—
Gastric emptying	^99mTc-phytate (solid meal)	40.7	—	111	44	37	12	31–50	150–540
Genitourinary	^99mTc-MAG3	134.31	400	500	305	370	100	283–379	100–370
	^99mTc-DTPA	185	400	555	500	90	300	407–587	—
Oncology	¹³¹I-sodium iodide	111	—	185	185	—	400	—	90–400
	¹⁸F-FDG	376.29	240	370	310	230	400	461–710	200–400
Endocrine
Thyroid	^99mTc-pertechnetate	140.6	300	217	215	185	80	—	75–222
	¹³¹I-sodium iodide	185	—	185	185	200	400	—	90–400
Parathyroid	^99mTc-MIBI	794.76	800	740	900	900	900	—	400–900
Nervous system	¹⁸F-FDG	268.25	240	370	250	231	250	—	—
Infection/inflammation	^99mTc-SC-WBC	765.9	—	888	800	892.5	200	—	300–600

MDP = methylene diphosphonate; MUGA = multigated acquisition; RBC = red blood cells; MPI = myocardial perfusion imaging; MIBI = methoxyisobutylisonitrile; MAA = macroaggregated albumin; IDA = iminodiacetic acid; MAG3 = mercaptoacetyltriglycine; SC-WBC = sulfur colloid white blood cells.
Data are megabecquerels.