Radiation dose optimization and dosimetry in pediatric nuclear medicine: Current concepts and future directions.
Authors
Affiliations (4)
Affiliations (4)
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan.
- Nuclear Medicine Research Infrastructure (NuMeRI) NPC, Pretoria, 0084, South Africa; Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, 0001, South Africa.
- Department of Nuclear Medicine, Radiotherapy and Nuclear Medicine Hospital, Bab Al-Muadham, 10047, Baghdad, Iraq.
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan. Electronic address: [email protected].
Abstract
Pediatric nuclear medicine plays an essential role in the diagnosis and treatment of a wide range of oncologic and non-oncologic diseases while requiring particular attention to radiation safety because of children's greater radiosensitivity, ongoing growth, and longer life expectancy. Over the past decade, substantial advances in quantitative imaging, detector technology, hybrid imaging, computational dosimetry, and theranostics have transformed radiation management from standardized activity administration toward increasingly individualized approaches. This review summarizes the biological basis of radiation risk in children, fundamental principles of internal dosimetry, and the unique anatomical and physiological factors influencing radiation dose estimation in pediatric patients. Current international recommendations for pediatric administered activities are discussed alongside practical strategies for radiation dose optimization across common nuclear medicine procedures and hybrid PET/CT and SPECT/CT imaging. The review further examines the growing role of quantitative PET and SPECT, patient-specific dosimetry, voxel-based dose calculation, Monte Carlo simulation, and advanced computational phantoms in improving absorbed-dose estimation and supporting personalized imaging and radionuclide therapy. Emerging applications of artificial intelligence, including image reconstruction, automated organ segmentation, predictive dosimetry, and low-count imaging, are also highlighted. Finally, current challenges, radiation protection principles, and future directions are discussed, emphasizing the transition toward precision pediatric nuclear medicine. Continued technological innovation, standardized quantitative methodologies, and prospective pediatric validation studies will be essential to optimize radiation safety while maximizing the diagnostic and therapeutic benefits of molecular imaging and theranostics in children.