• Mandell GA, Eggli DF, Gilday DL, Heyman S, Leonard JC, Miller JH, Nadel HR, Piepsz A, Treves ST. Procedure guideline for radionuclide cystography in children, 3.0. Reston (VA): Society of Nuclear Medicine; 2003 Jan 25. 6 p. [7 references]

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine. Procedure guideline for radionuclide cystography in children, 2.0. Reston (VA): Society of Nuclear Medicine; 1999 Feb. 18 p. (Society of Nuclear Medicine procedure guidelines; no. 2.0).

• Vesicoureteral reflux
• Urinary tract infection
• Bladder dysfunction (e.g., neurogenic bladder)

Diagnosis
Evaluation

Nuclear Medicine
Pediatrics
Radiology
Urology

Allied Health Personnel
Physicians

To assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of radionuclide cystography (RNC) in children

Children with suspected or documented vesicoureteral reflux

Radionuclide cystography

Sensitivity of radionuclide cystography (RNC) for detection of vesicoureteral reflux

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Literature searches were performed. In addition, references known to experts and references from the nuclear medicine community were considered.

Not stated

Not stated

Not applicable

Review

Not stated

Expert Consensus

Drafts of the guideline were submitted to members of the Guideline Development subcommittee (methodologists) and the Task Force (subject experts). These reviewers indicated on a line-by-line basis any suggestions or recommendations for the revision of the guideline. The percentage of agreement for all reviewers was calculated for each revision and compiled by the Society of Nuclear Medicine (SNM) central office. It is expected that the percentage of agreement will increase with each revision.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

When the Task Force and Guideline Development Subcommittee completed their edits, draft procedure guidelines were distributed to the Society of Nuclear Medicine (SNM) Sample Review Group for comment. (The SNM Sample Review Group is a cross-section of approximately 100 nuclear medicine practitioners representing every field of specialization).

The guideline was approved by the SNM Commission on Health Care Policy, the Board of Directors, and the House of Delegates.

The updated guideline was approved January 25, 2003.

Background Information and Definitions

Urinary tract infection is a common problem in the pediatric population. The signs and symptoms are nonspecific, particularly in the younger child. The role of vesicoureteral reflux in the pathogenesis of pyelonephritis is incompletely understood. Approximately 40% of patients with upper urinary tract infection have vesicoureteral reflux. Urinary tract infection, unrecognized and inadequately treated, can lead to hypertension and chronic renal failure.

1. Radionuclide cystography (RNC) is a method to evaluate for vesicoureteral reflux, which results in significantly less gonadal radiation when compared with conventional radiographic technique (voiding cystourethrogram [VCUG]). In addition, radionuclide cystography has a sensitivity for detection of vesicoureteral reflux equal to that of VCUG. Radionuclide cystography does not provide the same anatomic detail as a VCUG.
2. Direct radionuclide cystography (DRC) requires catheterization of the bladder and instillation of radionuclide and fluid for maximum distension of the bladder, allowing imaging during filling, voiding and after voiding.
3. Indirect radionuclide cystography (IRC) does not require bladder catheterization but does require the intravenous injection of the radiopharmaceutical for evaluation of renal function, urine drainage, and detection of vesicoureteral reflux.

Common Indications

1. Initial evaluation of females with urinary tract infection for reflux
2. Diagnosis of familial reflux
3. Evaluation of vesicoureteral reflux after medical management
4. Assessment of the results of antireflux surgery
5. Serial evaluation of bladder dysfunction (e.g. neurogenic bladder) for reflux

Procedure

The detailed procedure recommendations in the guideline address the following areas: patient preparation; information pertinent to performing the procedure (i.e., important data that the physician should have about the patient at the time the exam is performed and interpreted); precautions; information regarding the radiopharmaceutical (i.e., ranges of administered activity, organ receiving the largest radiation dose, effective dose), image acquisition; interventions; processing; interpretation/reporting; quality control, and sources of error.

None provided

The type of evidence supporting the recommendations is not specifically stated.

The intent of the procedure guideline is to describe radionuclide cystography in children, in order to maximize the diagnostic information obtained in the study while minimizing the resources that are expended.

There is a small risk of catheter-induced infection.

• The Society of Nuclear Medicine has written and approved guidelines to promote the cost-effective use of high quality nuclear medicine procedures. These generic recommendations cannot be applied to all patients in all practice settings. The guidelines should not be deemed inclusive of all proper procedures or exclusive of other procedures reasonably directed to obtaining the same results. The spectrum of patients seen in a specialized practice setting may be quite different than the spectrum of patients seen in a more general practice setting. The appropriateness of a procedure will depend in part on the prevalence of disease in the patient population. In addition, the resources available to care for patients may vary greatly from one medical facility to another. For these reasons, guidelines cannot be rigidly applied.
• Advances in medicine occur at a rapid rate. The date of a guideline should always be considered in determining its current applicability.

An implementation strategy was not provided.

Getting Better
Living with Illness

Effectiveness

• Mandell GA, Eggli DF, Gilday DL, Heyman S, Leonard JC, Miller JH, Nadel HR, Piepsz A, Treves ST. Procedure guideline for radionuclide cystography in children, 3.0. Reston (VA): Society of Nuclear Medicine; 2003 Jan 25. 6 p. [7 references]

Not applicable: The guideline was not adapted from another source.

1999 Feb (revised 2003 Jan 25)

Society of Nuclear Medicine, Inc - Medical Specialty Society

Society of Nuclear Medicine (SNM)

Task Force

Authors: Gerald A. Mandell, MD (DuPont Hospital for Children, Wilmington, DE); Douglas F. Eggli, MD (Pennsylvania State University/Milton S. Hershey Medical Center, Hershey, PA); David L. Gilday, MD (Hospital for Sick Children, Toronto, Ontario, Canada); Sydney Heyman, MD (Children's Hospital of Philadelphia, Philadelphia, PA); Joe C. Leonard, MD (Oklahoma Children's Memorial Hospital, Oklahoma City, OK); John H. Miller, MD (Children's Hospital Los Angeles, Los Angeles, CA); Helen R. Nadel, MD (Children's Hospital, British Columbia, Vancouver, Canada); Amy Piepsz, MD (CHU St. Pierre, Department of Radioisotopes, Brussels, Belgium); and S. Ted Treves, MD (Children's Hospital, Boston, MA)

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine. Procedure guideline for radionuclide cystography in children, 2.0. Reston (VA): Society of Nuclear Medicine; 1999 Feb. 18 p. (Society of Nuclear Medicine procedure guidelines; no. 2.0).

None available

This summary was completed by ECRI on July 20, 1999. It was verified by the guideline developer as of August 5, 1999. This NGC summary was updated by ECRI on April 14, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.