Novel Method to Detect and Characterize 18F-FDG Infiltration at the Injection Site: A Single-Institution Experience

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FIGURE 1.
(Top) Sensors placed on injection arm and contralateral control arm. (Bottom) Lara device consists of 2 scintillation sensors, 2 pads, a reader, and a docking station.
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FIGURE 2.
Time–activity curves from sensor recordings in 3 subjects. (Top) Example of ideal injection in right antecubital fossa. Sensor results drop immediately to reference arm level. (Middle) Example of moderate infiltration with injection in left wrist. Sensor results do not drop immediately to reference arm level. (Bottom) Example of severe infiltration with injection in right antecubital fossa. Sensor results never fall to reference arm level. Red line = reference arm level; red arrow = injection site; black line = sensor result; blue arrow = drop in sensor result.

TABLE 1

Results for Each of the Initial 40 Patients

	Physician reporting		Sensor reporting
Patient no.	Infiltration present?	Would SUV be affected?	Infiltration present?	Additional characterization?
1	No		Yes, minor	Yes
2	No		No	No
3	Site not in FOV		Yes, moderate	Yes
4	No		No	No
5	Yes, minor	Not likely	Yes, minor	No
6	No		Yes, minor	Yes
7	Yes, minor	Not likely	Yes, moderate	Yes
8	No		No	No
9	Site not in FOV		Yes, minor	Yes
10	Yes, moderate	Not likely	Yes, moderate	No
11	No		No	No
12	Site not in FOV		No	Yes
13	Yes, moderate	Not likely	Yes, minor	Yes
14	Yes, minor	Not likely	Yes, minor	No
15	Yes, significant	Very likely	Yes, significant	No
16	No		No	No
17	Yes, moderate	Not likely	Yes, moderate	No
18	Site not in FOV		No	Yes
19	Yes, moderate	Possibly likely	Yes, moderate	No
20	Yes, minor	Not likely	Yes, minor	No
21	Yes, minor	Not likely	Yes, minor	No
22	No		No	No
23	No		No	No
24	No		No	No
25	No		No	No
26^*	No		Yes, minor	Yes
27	Yes, moderate	Not likely	Yes, minor	Yes
28	No		Yes, minor	Yes
29	No		No	No
30	No		No	No
31	Yes	Not likely	Yes, minor	No
32	No		No	No
33	Yes, minor	Not likely	Yes, minor	No
34	Yes, minor	Not likely	Yes, minor	No
35	Yes, minor	Not likely	Yes, minor	No
36	No		No	No
37	No		No	No
38	No		No	No
39	Yes, minor		Yes, minor	Yes
40	No		No	No

↵* Injection was in right forearm and within FOV; no injection problems were evident.
FOV = field of view.

TABLE 2

Results Classified by Infiltration Extent Before Modifications Were Made

Infiltration extent	Physician reporting	Sensor reporting	Reconciliation
Minor	9	16	Sensor and physician reporting agreed on 8 minor infiltrations, but sensor classified 1 additional as out of the FOV; sensor found mild infiltration in 5 cases where physician found no infiltration and in 2 cases where physician found moderate infiltration
Moderate	5	5	Sensor and physician reporting agreed on 3 moderate infiltrations; sensor found moderate infiltration in 1 case where physician found the injection site to be out of the FOV and in 1 case where physician found minor infiltration
Significant	1	1	Sensor and physician reporting agreed on 1 significant infiltration
Infiltration rate	38%	55%

TABLE 3

Results Classified by Infiltration Extent After Modifications Were Made

Infiltration extent	Physician reporting	Sensor reporting	Reconciliation
Minor	13	2	Of 13 infiltrations classified as minor on physician reporting, 12 were so minor that sensor did not count them, and sensor agreed that 1 was minor; 1 infiltration classified as moderate on physician reporting was classified as minor on sensor reporting
Moderate	3	2	Of 3 infiltrations classified as moderate on physician reporting, sensor reporting agreed with two
Significant	1	0
Infiltration rate	25%	6%