Dosing & Timing Chart

ICG Dosing and Timing for Pediatric Fluorescence-Guided Surgery

Indocyanine green (ICG) fluorescence imaging is increasingly used in pediatric surgery to visualize anatomy, assess tissue perfusion, and guide intraoperative decision-making. When combined with near-infrared imaging systems, ICG allows surgeons to evaluate blood flow, identify lymphatic pathways, and improve anatomical visualization during a wide range of pediatric procedures.

This pediatric dosing chart provides guidance on recommended ICG administration in children, including weight-based dosing, dilution protocols, injection techniques, and timing of administration for different surgical applications such as perfusion assessment, biliary visualization, tumor detection, and sentinel lymph node mapping.

Angiography & Perfusion Assessment

Skin and soft tissue
Intestinal perfusion
Organ ischemia

Purpose:	Visualize blood flow to area of interest
Injection Type:	#Intravenous
Typical dilution:	<25 kg: 0.5 mg/ml >25 kg: 2.5 mg/ml
Usual dosage (amount):	<25 kg: 0.1 mg/kg >25 kg: 5 mg (2 ml)
Real time, as desired
First ICG detection	Within seconds
ICG duration:	Minutes
Notes:	Speed of uptake in first few seconds can be important. Can be redosed if needed.

Extrahepatic Biliary Tree

Cholecystectomy
Choledochal cyst
Portoenterostomy

Purpose:	Bile duct identification
Injection type	#Intravenous
Typical dilution	<25 kg: 0.5 mg/ml >25 kg: 2.5 mg/ml
Usual dosage (amount)	<25 kg: 0.1 mg/kg >25 kg: 5 mg (2 ml)
Injection time	Between 45 minutes and 2 hours prior to induction
First ICG detection	With exposure of hepatocystic triangle
ICG duration	Hours
Notes	Time in advance decreases liver background signal to allow focus on ducts.

Liver Tumor

Hepatoblastoma

Purpose	Tumor visualization and margin assessment
Injection type	#Intravenous
Typical dilution	2.5 mg/ml
Usual dosage (amount)	0.5 mg/kg
Injection time	72 to 96 hours prior to surgery
First ICG detection	As needed
ICG duration	Stable during surgery
Notes	Tumors remain fluorescent after normal liver has fully excreted the dye.

Sarcomas & Other Tumors

Ewing Sarcoma
Osteosarcoma
Rhabdomyosarcoma
Sacrococcygeal Teratoma

Purpose	Tumor visualization and margin assessment
Injection type	#Intravenous
Typical dilution	2.5 mg/ml
Usual dosage (amount)	4 mg/kg
Injection time	24 hours prior to surgery
First ICG detection	As needed
ICG duration	Stable during surgery
Notes	Variable per tumor biology and pretreatment necrosis. Relies on enhanced permeability and retention effect.

Pulmonary Metastasectomy

Hepatoblastoma
Wilms tumor
Sarcomas

Purpose	Metastasis identification
Injection type	#Intravenous
Typical dilution	2.5 mg/ml
Usual dosage (amount)	0.5 mg/kg if liver primary; 4 mg/kg all others
Injection time	24 hours prior to surgery
First ICG detection	As needed
ICG duration	Stable during surgery
Notes	Can be missed if deeper than 1 cm in lung parenchyma.

SLN Biopsy

Melanoma
Rhabdomyosarcoma

Purpose	Identification of SLN
Injection type	4-quadrant dermal (skin lesions) or subcutaneous (other tumors)
Typical dilution	1.25 mg/ml
Usual dosage (amount)	1.25 mg (1 ml) per quadrant
Injection time	At start of procedure
First ICG detection	5-10 minutes in expected nodal basin
ICG duration	Stable during surgery
Notes	Can be paired with radiotracer.

ICG, indocyanine green; SLN, sentinel lymph node
#All intravenous administrations should be followed by routine saline flush. This is particularly important if visualization is anticipated to be immediate.
*2.5 mg/ml is standard dilution from lyophilized ICG. For 0.5 mg/ml, mix 2 ml standard dilution with 8 ml sterile water. For 1.25 mg/ml mix even parts standard dilution and sterile water.
**For children >25kg if weight based is desired for angiography or cholangiography: Weight (kg)/27 = # mL of standard dilution 2.5mg/mL; corresponds to 0.09mg/kg.

DISCLAIMERS

The above dosage and timing information have been collated from worldwide surgeons expert in these procedures and is based on their recommendations
All intravenous administrations should be followed by routine saline flush, this is particularly important if visualization is anticipated to be immediate
All dosages have been adjusted to the U.S. recommended dilution of 25mg of ICG in 10mL of sterile water.
Approval for listed indications may vary according to country.