Abstract
PET/CT radiotracer infiltration is not uncommon and is often outside the imaging field of view. Infiltration can negatively affect image quality, image quantification, and patient management. Until recently, there has not been a simple way to routinely practice PET radiopharmaceutical administration quality control and quality assurance. Our objectives were to quantify infiltration rates, determine associative factors for infiltration, and assess whether rates could be reduced at multiple centers and then sustained. Methods: A “design, measure, analyze, improve, and control” quality improvement methodology requiring novel technology was used to try to improve PET/CT injection quality. Teams were educated on the importance of quality injections. Baseline infiltration rates were measured, center-specific associative factors were analyzed, team meetings were held, improvement plans were established and executed, and rates remeasured. To ensure that injection-quality gains were retained, real-time feedback and ongoing monitoring were used. Sustainability was assessed. Results: Seven centers and 56 technologists provided data on 5,541 injections. The centers’ aggregated baseline infiltration rate was 6.2% (range, 2%–16%). On the basis of their specific associative factors, 4 centers developed improvement plans and reduced their aggregated infiltration rate from 8.9% to 4.6% (P < 0.0001). Ongoing injection monitoring showed sustainability. Significant variation was found in center- and technologist-level infiltration rates (P < 0.0001 and P = 0.0020, respectively). Conclusion: A quality improvement approach with new technology can help centers measure infiltration rates, determine associative factors, implement interventions, and improve and sustain injection quality. Because PET/CT images help guide patient management, the monitoring and improvement of radiotracer injection quality are important.
Highlights
An estimated 3 million PET/CT procedures were performed in the United States in 2017, with over 90% being for oncology care and approximately 10% for assessing myocardial perfusion, neurologic function, and other physiologic processes [1,2]
Our hypotheses were that a quality improvement (QI) approach could measure infiltration rates for patients undergoing PET/CT examinations across multiple centers, determine associative factors that may contribute to infiltration, and measure the reduction in rates of infiltration
Because QI approaches have led to high-quality results for chemotherapy and contrast-CT injections [6,7] in patient populations such as those undergoing PET/CT radiotracer injections, we believed that following a QI process for PET/CT could lead to similar results
Summary
An estimated 3 million PET/CT procedures were performed in the United States in 2017, with over 90% being for oncology care and approximately 10% for assessing myocardial perfusion, neurologic function, and other physiologic processes [1,2]. Complete delivery of an intravenous bolus of radiotracer is important to the accuracy and reproducibility of imaging [3] and to patient treatment [4]. A radiotracer infiltration prevents a bolus delivery of the entire dose. During PET/CT image interpretation, the injection site is often outside the imaging field of view [8]. Detection is further hindered when the injection site is within the imaging field of view but the infiltration. Our hypotheses were that a quality improvement (QI) approach could measure infiltration rates for patients undergoing PET/CT examinations across multiple centers, determine associative factors that may contribute to infiltration, and measure the reduction in rates of infiltration
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