Appropriate use criteria for nuclear medicine in the evaluation and treatment of differentiated thyroid cancer

Nuclear medicine is an essential tool in the delivery of highquality medical care, going beyond simple anatomic imaging to the use of physiologic processes for both imaging and therapy. One of the first uses of nuclear medicine techniques occurred in the 1930s to demonstrate the physiology of radioiodine uptake by using the concentration of radioiodine in the thyroid, followed by the use of radioiodine for the treatment of hyperthyroidism and thyroid carcinoma in the 1940s. These investigations began a new era in the management of thyroid disease with nuclear imaging techniques and 131I radioiodine therapy (1). Although management has evolved since the 1940s, the basic principles have remained, including the use of radiopharmaceuticals to identify and localize disease, radioiodine 123I and 131I to test for iodine avidity, and radioiodine 131I for radioiodine therapy. These appropriate use criteria (AUC) (2) have been developed to describe the appropriate use of radiopharmaceuticals for diagnosis and therapy in patients with differentiated thyroid cancer (DTC). It is hoped that through these recommendations, nuclear medicine techniques will be used to benefit patients with DTC in the most cost-effective manner.