Critique and discussion of “Multicenter evaluation of frequency and impact of activity infiltration in PET imaging, including microscale modeling of skin-absorbed dose”

On May 25, 2023, the Journal of Nuclear Medicine (JNM) published an article ahead-of-print entitled “Multicenter Evaluation of Frequency and Impact of Activity Infiltration in PET Imaging, Including Microscale Modeling of Skin-Absorbed Dose” … There are, however, several problems with the work that raise questions about its conclusions. The methods are not well described, the results contain errors, and the peer-review process for this manuscript appears to have lacked rigor. Full Text

Radiopharmaceutical extravasations: a twenty year mini-review

This mini-review will examine the literature of the last twenty years to summarize the history of radiopharmaceutical extravasations, determine key trends in imaging and therapies, and highlight critical gaps in research that currently exist. Full Text

The decision to reimage following extravasation in diagnostic nuclear medicine

To provide high quality service, nuclear medicine departments as well as the interpreting radiologist physicians should be cognizant of the possible need to repeat studies which have been affected by an extravasation. Full Text

Active monitoring improves radiopharmaceutical administration quality

Our findings suggest that active monitoring and the associated display of results are critical to quality improvement efforts to reduce and sustain radiopharmaceutical extravasation rates. Full Text

Transparency – a patient-centric view on radiopharmaceutical extravasations

From the patient perspective, transparency regarding extravasations is essential to improving care, ensuring radiation protection, reducing health inequities, and untangling the deeply disturbing and irregular relationship between the nuclear medicine community and their regulating body, The U.S. Nuclear Regulatory Commission. Full Text

Extravasation of radiopharmaceuticals: Why report?

Steps can be taken by radiation protection personnel at medical institutions to educate practitioners and staff about extravasations, their risks and what steps can be taken to reduce their occurrence. Further research needs to be performed to better understand the incidence rate, categorization, causes, and methods of prevention. Full text

Practical Tools for Patient-specific Characterization and Dosimetry of Radiopharmaceutical Extravasation

Accurate extravasation dosimetry requires characterization of the event. In this work, we developed three extravasation characterization and dosimetry tools, validated each against published data, and demonstrated their utility in a realistic clinical workflow. Full Text

Development of a classifier for [18F] fluorodeoxyglucose extravasation severity using semi-quantitative readings from topically applied detectors

The topical detector binary classifier, calibrated using quantitative static PET measurements, significantly improves extravasation detection compared to qualitative image analysis. Full Text

Extravasation Reporting Pros and Cons

In 2020 the Health Physics Society (HPS) submitted a public comment, unsupported by science, to the Nuclear Regulatory Commission regarding the reporting of extravasations. In early 2022, the radiation protection journal, Health Physics, provided a forum for discussing the HPS public comment. Lucerno, patients, experts, and HPS members provided written responses to the HPS public comment.

Detection of Excess Presence of 99mTc-MDP Near Injection Site—A Case Report

“This case describes how detection of excess presence of 99mTc-MDP near the injection site enabled the technologist to apply mitigation tactics early in the uptake process. It also suggests that detecting an extravasation or stasis early in the injection process can be important for image interpretation and minimizing radiation dose to tissue.” Full Text

The Scientific and Clinical Case for Reviewing Diagnostic Radiopharmaceutical Extravasation Long-Standing Assumptions

“Our findings suggest that significant extravasations can or have caused patient harm and can irradiate patients’ tissue with doses that exceed medical event reporting limits and deterministic effect thresholds. Therefore, diagnostic radiopharmaceutical injections should be monitored, and dosimetry of extravasated tissue should be performed in certain cases where thresholds are thought to have been exceeded. Process improvement efforts should be implemented to reduce the frequency of extravasation in nuclear medicine.” Full Text

Patient-specific Extravasation Dosimetry Using Uptake Probe Measurements

“With patient radiation safety in mind, we maintain that both diagnostic and therapeutic extravasation events should be identified and characterized. Severe extravasations affect the diagnostic or therapeutic quality of nuclear medicine procedures, and the unintended dose to tissue and skin may eventually be clinically significant. A dedicated radiopharmaceutical injection monitoring system can be used to improve the accuracy of dosimetry and assist in determining the need for patient follow-up.” Full Text