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Research ArticleQuality & Practice Management
Open Access

Quality Improvement Initiatives to Assess and Improve PET/CT Injection Infiltration Rates at Multiple Centers

Terence Z. Wong, Thad Benefield, Shane Masters, Jackson W. Kiser, James Crowley, Dustin Osborne, Osama Mawlawi, James Barnwell, Pawan Gupta, Akiva Mintz, Kelley A. Ryan, Steven R. Perrin, Ronald K. Lattanze and David W. Townsend
Journal of Nuclear Medicine Technology December 2019, 47 (4) 326-331; DOI: https://doi.org/10.2967/jnmt.119.228098
Terence Z. Wong
1Duke University, Durham, North Carolina
2University of North Carolina, Chapel Hill, North Carolina
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Thad Benefield
2University of North Carolina, Chapel Hill, North Carolina
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Shane Masters
3Wake Forest Baptist Medical Center, Winston Salem, North Carolina
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Jackson W. Kiser
4Carilion Clinic, Roanoke, Virginia
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James Crowley
4Carilion Clinic, Roanoke, Virginia
CNMT
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Dustin Osborne
5Radiology/Molecular Imaging and Translational Research, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
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Osama Mawlawi
6Department of Imaging Physics, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
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James Barnwell
7Wake Radiology, Raleigh, North Carolina
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Pawan Gupta
8Division of Nuclear Medicine, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA Health, Los Angeles, California
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Akiva Mintz
9Columbia University Medical Center, New York, New York
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Kelley A. Ryan
10Lucerno Dynamics, LLC, Cary, North Carolina; and
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Steven R. Perrin
10Lucerno Dynamics, LLC, Cary, North Carolina; and
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Ronald K. Lattanze
10Lucerno Dynamics, LLC, Cary, North Carolina; and
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David W. Townsend
11A*STAR-NUS Clinical Imaging Research Centre, Singapore
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    FIGURE 1.

    Lara system consists of 2 scintillation sensors, 2 pads, reader, and docking station. Sensors are placed on injection arm and contralateral arm. Time–activity curve is provided after data upload.

Tables

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    TABLE 1

    Unadjusted Measure-Phase Infiltration Rates

    CenterRate
    A13.3%
    B15.7%
    C12.8%
    D2.1%
    E3.2%
    F2.7%
    G1.9%
    • Centers’ volumes are not included to ensure center anonymity.

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    TABLE 2

    Unadjusted Measure- and Improve-Phase Infiltration Rates

    CenterMeasure-phase rateSEImprove-phase rateSEChange
    A13.3%2.1%2.9%1.0%−78%
    B15.7%4.0%6.0%2.6%−62%
    C12.8%1.5%8.7%1.3%−32%
    D2.1%0.6%1.9%0.6%−10%
    • Centers’ volumes are not included to help ensure individual center anonymity.

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    TABLE 3

    Associative Factor Analysis for Binary Infiltration Outcome: Significant Associations

    Effect (all data, all phases)P
    Hand/wrist/forearm injections are associated with higher predicted probability of infiltration than is antecubital fossa injection<0.0001
    Radiotracer dose is positively associated with infiltration<0.0001
    Weight is negatively associated with infiltration<0.0001
    Flush volume is negatively associated with infiltration<0.0001
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    TABLE 4

    Sustainability at 3 Centers (Control Phase) Using Aggregated Rates

    PhaseAdjusted 3-center aggregated infiltration rateNumber of injectionsSE95% CI
    Measure12.1%8152.4%8.2, 17.5
    Improve6.2%8301.4%3.9, 9.5
    Control5.2%1,7631.1%3.5, 7.8
    • CI = confidence interval.

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Journal of Nuclear Medicine Technology: 47 (4)
Journal of Nuclear Medicine Technology
Vol. 47, Issue 4
December 1, 2019
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Quality Improvement Initiatives to Assess and Improve PET/CT Injection Infiltration Rates at Multiple Centers
Terence Z. Wong, Thad Benefield, Shane Masters, Jackson W. Kiser, James Crowley, Dustin Osborne, Osama Mawlawi, James Barnwell, Pawan Gupta, Akiva Mintz, Kelley A. Ryan, Steven R. Perrin, Ronald K. Lattanze, David W. Townsend
Journal of Nuclear Medicine Technology Dec 2019, 47 (4) 326-331; DOI: 10.2967/jnmt.119.228098

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Quality Improvement Initiatives to Assess and Improve PET/CT Injection Infiltration Rates at Multiple Centers
Terence Z. Wong, Thad Benefield, Shane Masters, Jackson W. Kiser, James Crowley, Dustin Osborne, Osama Mawlawi, James Barnwell, Pawan Gupta, Akiva Mintz, Kelley A. Ryan, Steven R. Perrin, Ronald K. Lattanze, David W. Townsend
Journal of Nuclear Medicine Technology Dec 2019, 47 (4) 326-331; DOI: 10.2967/jnmt.119.228098
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Keywords

  • quality improvement
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