Applying Image Gently SM and Image Wisely SM in nuclear medicine.

Although computed tomography (CT) scan radiation dose has drawn much attention, radiation dose from nuclear medicine procedures should not be overlooked. An estimated 19.7 million nuclear medicine procedures are done annually in the United States, with patient radiation dose comparable to that from CT scans. Nuclear medicine departments should implement Image Gently SM and Image Wisely SM recommendations to reduce nuclear medicine patient radiation dose. Pediatric administered radiopharmaceutical doses should be compared with the North American Consensus Guidelines for Administered Radiopharmaceutical Activities in Children and Adolescents, and adult doses should be compared with national and international standards. In a 2011 patient quality and safety initiative at Gundersen Lutheran Health System, 24 pediatric protocols and 52 adult protocols were compared with standards. Doses not comparable to the recommended values were adjusted accordingly and the resultant image quality evaluated. Additional steps to reduce patient radiation dose include decision support to reduce inappropriate ordering, technique optimization for the CT portion of single-photon emission computed tomography/computed tomography and positron emission tomography/computed tomography scans, use of vendor's dose reduction camera and software technology, use of shorter lived radiopharmaceuticals, and "right sizing" patient doses by weight.