Letter from the Editors

Article Outline

• Copyright

This issue of Seminars in Nuclear Medicine—the second devoted to an update of pediatric nuclear medicine—presents a review of older applications as well as some newer areas in which radionuclide methodology has an important role. Oncology is one of the main themes with a wonderful multi-institutional review of the roles of positron emission tomography (PET) and PET/computed tomography (CT). These powerful imaging tools have added a great deal of clinically useful information to the study of a variety of tumors in children. Dr. Barry Shulkin coordinated a superb collaborative effort from Dr. Hossein Jadvar of the University of Southern California, Drs. Leonard Connolly and Fred Fahey of Children’s Hospital Boston, and himself to provide an overview of this important area.

The use of radioiodine to both diagnose and treat differentiated thyroid cancer is the grandparent of our specialty. In fact, the editors would like to chauvinistically and proudly point out that the first use of radioiodine to treat thyroid cancer occurred at New York’s Montefiore Medical Center in the mid 1940s. Dr. Sam Seidlin, a Montefiore endocrinologist, obtained a limited supply of radioiodine from Dr. Robley Evans’ Cyclotron at the Massachusetts Institute of Technology and published his results along with coauthors L.D. Marinelli and Eleanor Oshry in the December 7, 1946 issue of the Journal of the American Medical Association. That was five years to the day after the Pearl Harbor attack that initiated U.S. involvement in the war with Japan and about 16 months after atomic bombs were dropped on Hiroshima and Nagasaki to end World War II. In that era of great concern and fear over nuclear power, Dr. Seidlin’s landmark article showed how nuclear energy could be used peacefully to benefit mankind. In fact, one of the nuclear medicine pioneers, Dr. Marshall Brucer, in a 1978 issue of his legendary Vignettes in Nuclear Medicine, referred to Seidlin’s paper as “the single most important article in the history of nuclear medicine” since it stimulated the U.S. Congress to initiate funding of research in the medical applications of radioisotopes. The excellent review of thyroid cancer therapy by Drs. Parisi and Mankoff underscores both the important similarities and differences between treating children and adults with this most common malignancy. A side note of interest is that one of the physicists working with Dr. Seidlin at Montefiore was Dr. Roslyn Yalow, who went on to win the Nobel Prize for her pioneering work in radioimmunoassay.

Two relatively neglected clinical areas are the roles that nuclear medicine plays in neurology/neurosurgery and cardiology. In another cooperative effort, Drs. Patel, Biassoni, and Borgwardt describe the important contributions that both single-photon emission computed tomography and PET have made in managing children with both epilepsy and brain tumors. Similarly, Dr. Michael Dae shows how radionuclide methodology helps to “provide accurate and reproducible quantitative assessment of the physiologic consequences of structural heart disease.”

Certainly, the bone scan remains an important component of pediatric and of all nuclear medicine practice. Dr. Helen Nadel shares her great experience with us in updating its role in a variety of benign and malignant conditions.

Finally, it is always important to deal with radiation exposure from all of the procedures we perform. Pediatricians, more so than any other physicians, are always concerned with this issue when considering both radiologic and scintigraphic studies in their young patients. Drs. Michael Gelfand and Lisa Lemen deal with these concerns in their review article on this subject. This is a timely review since we are using increasing doses of radionuclides diagnostically and nuclear medicine can no longer claim that the administered radiation is necessarily less than any comparable modality.

Overall, these two issues will serve as a useful reference source for nuclear medicine physicians dealing with a significant pediatric population in their practice.