Safety injections of nuclear medicine radiotracers: towards a new modality for a real-time detection of extravasation events and 18F-FDG SUV data correction
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Published:2023-05-23
Issue:1
Volume:10
Page:
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ISSN:2197-7364
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Container-title:EJNMMI Physics
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language:en
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Short-container-title:EJNMMI Phys
Author:
Iori Mauro, Grassi Elisa, Piergallini Lorenzo, Meglioli Greta, Botti Andrea, Sceni Giada, Cucurachi NoemiORCID, Verzellesi Laura, Finocchiaro Domenico, Versari Annibale, Fraboni Beatrice, Fioroni Federica
Abstract
Abstract
Background
18F-FDG PET/CT imaging allows to study oncological patients and their relative diagnosis through the standardised uptake value (SUV) evaluation. During radiopharmaceutical injection, an extravasation event may occur, making the SUV value less accurate and possibly leading to severe tissue damage. The study aimed to propose a new technique to monitor and manage these events, to provide an early evaluation and correction to the estimated SUV value through a SUV correction coefficient.
Methods
A cohort of 70 patients undergoing 18F- FDG PET/CT examinations was enrolled. Two portable detectors were secured on the patients' arms. The dose-rate (DR) time curves on the injected DRin and contralateral DRcon arm were acquired during the first 10 min of injection. Such data were processed to calculate the parameters ΔpinNOR = (DRinmax- DRinmean)/DRinmax and ΔRt = (DRin(t) − DRcon(t)), where DRinmax is the maximum DR value, DRinmean is the average DR value in the injected arm. OLINDA software allowed dosimetric estimation of the dose in the extravasation region. The estimated residual activity in the extravasation site allowed the evaluation of the SUV's correction value and to define an SUV correction coefficient.
Results
Four cases of extravasations were identified for which ΔRt [(390 ± 26) µSv/h], while ΔRt [(150 ± 22) µSv/h] for abnormal and ΔRt [(24 ± 11) µSv/h] for normal cases. The ΔpinNOR showed an average value of (0.44 ± 0.05) for extravasation cases and an average value of (0.91 ± 0.06) and (0.77 ± 0.23) in normal and abnormal classes, respectively. The percentage of SUV reduction (SUV%CR) ranges between 0.3% and 6%. The calculated self-tissue dose values range from 0.027 to 0.573 Gy, according to the segmentation modality. A similar correlation between the inverse of ΔpinNOR and the normalised ΔRt with the SUV correction coefficient was found.
Conclusions
The proposed metrics allowed to characterised the extravasation events in the first few minutes after the injection, providing an early SUV correction when necessary. We also assume that the characterisation of the DR-time curve of the injection arm is sufficient for the detection of extravasation events. Further validation of these hypotheses and key metrics is recommended in larger cohorts.
Publisher
Springer Science and Business Media LLC
Subject
Radiology, Nuclear Medicine and imaging,Instrumentation,Biomedical Engineering,Radiation
Reference26 articles.
1. Commission E. SAMIRA: strategic agenda for medical ionising radiation applications. Brussels: European Commission; 2021. 2. Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, Verzijlbergen FJ, Barrington SF, Pike LC, Weber WA, Stroobants S, Delbeke D, Donohoe KJ, Holbrook S, Graham MM, Testanera G, Hoekstra OS, Zijlstra J, Visser E, Hoekstra CJ, Pruim J, Willemsen A, Arends B, Kotzerke J, Bockisch A, Beyer T, Chiti A, Krause BJ. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imag. 2015;42(2):328–54. https://doi.org/10.1007/s00259-014-2961-x. 3. Grassi E, Sghedoni R, Piccagli V, Fioroni F, Borasi G, Iori M. Comparison of two different types of LiF:Mg, Cu, P thermoluminescent dosimeters for detection of beta rays (beta-TLDs) from 90Sr/90Y, 85Kr and 147Pm sources. Health Phys. 2011;100(5):515–22. https://doi.org/10.1097/HP.0b013e3182092732. 4. Sghedoni R, Grassi E, Fioroni F, Asti M, Piccagli V, Versari A, Iori M. Personnel exposure in labelling and administration of (177)Lu-DOTA-D-Phe1-Tyr3-octreotide. Nucl Med Commun. 2011;32(10):947–53. https://doi.org/10.1097/MNM.0b013e328349fd60. 5. Grassi E, Sghedoni R, Asti M, Fioroni F, Salvo D, Borasi G. Radiation protection in 90Y-labelled DOTA-D-Phe1-Tyr3-octreotide preparations. Nucl Med Commun. 2009;30(2):176–82. https://doi.org/10.1097/MNM.0b013e328318effb.
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