Review of three common Cardiogen Rb-82 Infusion System injection methods and their impact on clinical volume and image counts.

Abstract

In the wake of the FDA recall, many clinics have had to reduce their exam volumes to meet the new generator volume usage requirements. This is a review of three common infusion methods and how those methods affect patient dose, generator volume usage, image counts, and generator volume limits. Methods: Three common configurations of the Cardiogen Rb-82 Infusion system settings, Standard 50mL, Volume Limiting, and Bolus Method, were tested to determine how they affect patient dose, generator volume, and image counts. Each injection configuration was tested daily for the duration of 3 consecutive generators by injecting into separate vials. Each injection configuration was also infused into a beaker and imaged to determine the impact of image counts for each method. The total estimated volumes for multiple exam and QA clinical situations were simulated to observe the use of each method and the new FDA volume alert and expirations limits. Results: Vial tests confirm that the Bolus method uses the least amount of volume per infusion and stays the most consistent throughout the life of the generator. The Bolus method also produces a lower patient dose after ~10 days of use. The beaker tests in the scanner showed the Standard 50mL method produced the greatest number of total counts for the flow and uptake images. Based on the estimated total volume simulations, the Bolus Method allows for the most exams over the life of the generator while staying within the new FDA limits. Conclusion: All three methods for augmenting the Rb-82 Cardiogen Infusion system will produce different outcomes for patient dose, image counts, and total generator volume use. The Standard 50mL method will assure the maximum amount of counts available for imaging throughout the life of the generator. The Bolus method will provide a consistent and predictable amount of volume use. The Volume Limiting method falls somewhere in the middle of volume predictability and count preservation.