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Introduction
Clinical presentation
Clin. aproach to ivestig. and menag. of UTI
Cortical scintigraphy in urinary tract infection
Cystigraphy in urinary tract infection
Vesicourethral reflux (VUR)
The grading systems for vesicourethral eflux
Detection of vesicourethral reflux
Micturating cystourethrography (MCUG)
Radionucleotide cystography (RNC)
Direct radionuclide cystography (DRC)
Indirect radionuclide cystography (IRC)
Dynamic renal scintigraphy in UTI
Practical problems in pediatric nucl.med.
Preparation
Dose schedule
Injection
Imobilisation/ sedation
Conclusion

6. PRACTICAL PROBLEMS IN PAEDIATRIC NUCLEAR MEDICINE

Performing effective nuclear medicine procedures in the paediatric population requires certain modifications of techniques used when studying adull patienl [16]. A visit to the nuclear medicine department can be upsetting experience for both the child and parents and several modifications and factors must be taken into account to obtain good quality scan and to minimize their anxiety.

6.1. PREPARATION

Good practice includes full preparation of the child and parent for investigation [5]. Providing information concerning the procedure is one of the first conditions to obtain the cooperation of the patient and to relieve his/her anxiety. The referring physician gives ihe parents the first information. However, parents are emotionally involved and therefore often unable to absorb this information and to organize their thoughts at that moment. It is recommended to give an information leaflet about procedure. They are then more capable to prepare the child for the planned procedure. However, additional explanation to the child is needed once it arrives in the department [17]. The attitude of every member of the department must be positive , reassuring and sympathetic: this includes the reception staff as well as professionals [5]. They should be adapted to the age of children, be direct and honest, and include what the child may feel, see and hear [17]. Patience, common sense, imagination and flexibility are desirable personal qualities which will assure a favourable atmosphere. It is important that everybody involved really enjoys working with children and feels at ease with them. Children should feel that every effort has been made to make premises comfortable as well [18].The stress of the surroundings can be decreased by making the typical hospital environment of the department more comforting, cheerlul and familiar.

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