Extravasation of radiopharmaceuticals - a study of its frequency and estimation of absorbed doses in diagnosis and therapy

In all injection procedures exists a risk for extravasation. For radiopharmaceuticals, the absorbed dose at the injection site can be high because of high activity concentrations. In radionuclide therapy (RNT), this can cause deterministic effects such as tissue necrosis. To estimate the risk for extravasation, we studied various injection techniques at two nuclear medicine clinics. The frequency and magnitude of extravasations was studied in randomly selected patients. Clinic A used peripheral venous cathethers (PVC), and clinic B used direct injections with injection needles (IN). At clinic A 203 patients were investigated and at clinic B 90. All of these patients were injected with either 99mTc-DTPA, 99mTc-MAA, 99mTc-MDP or pertechnetate. Both arms were imaged with a scintillation camera as soon as possible after the injection. In the case of an extravasation, the retention time at the injection site was determined with multiple imaging, together with volume estimates. The results for PVC injected patients showed one complete extravasation. We also found that in 8% of these patients the remaining activity at the injection site was up to 2%. For the IN injected patients there was none with complete extravasation. However, in 33% of these patients the remaining activity was up to 18%.more » The locally absorbed doses in these diagnostically investigated patients were estimated with the MIRD formalism to be up to 0.1 Sv (10 rem). Transforming these results to the RNT, the absorbed doses can be up to 1000 times higher. In addition to the calculated absorbed doses, radionuclides localizing to the cell nucleus could enhance the effects.« less