Quality improvement using new technology to assess and reduce FDG PET/CT radiotracer infiltrations.

Abstract

313 Background: The reported aggregated PET/CT 18F-FDG radiotracer injection infiltration rate from 3 centers in 6 studies is 15.2% (425 infiltrations/2804 patients). Infiltrations can negatively affect cancer patient staging, therapy assessment, treatment planning, and can lead to unnecessary invasive procedures and patient radiation exposure. The radiotracer dose is essential to PET image quality and quantification. Efforts are made to ensure the exact dose administered is used to create the patient image; but, no measures ensure the administered dose completely enters the patient circulation. Our objective was to use new technology (Lara, Lucerno Dynamics) to assess our infiltration rate, determine potential causes, reduce our rate, and assess results sustainability. Methods: Our IRB determined the project did not meet the definition of research as defined by 45 CFR 46.102(d) and classified the initiative as “quality improvement”. In Phase 1, our PET/CT center monitored the injection process. Lara data were analyzed (SAS Enterprise Miner, v. 14.1 and v.9.4) and identified potential contributing factors. We then implemented a quality improvement plan to address these factors. In Phase 2 we remeasured our infiltration rate. After Phase 2, we assessed our rate over an extended period. Results: Lara added 30 seconds to patient imaging. In Phase 1, 263 injections were monitored, and 35 infiltrations were identified (13.3%). Five technologists’ rates ranged from 8%-19%. Patients less than 145lbs with non-antecubital fossa injection sites were highly associated with infiltrations. In Phase 2, 278 injections were monitored, and 8 infiltrations were identified (2.9%), a 78% decrease (p < 0.0001). The same technologists’ rates ranged from 0%-4%. Eight technologists performed the next 504 injections and six were infiltrated (1.2%). Conclusions: Our findings supported published PET/CT infiltration rates. Using new technology provided technologists with feedback on injections and lead to significant and sustainable improvements quickly, with minimal patient/procedure disruption. Infiltrations are a quality and safety issue. As a result, the injection process requires ongoing monitoring.