RT Journal Article
SR Electronic
T1 Findings from Quality Improvement Initiatives to Assess and Improve PET/CT FDG Injection Infiltration Rates in Multiple Centers
JF Journal of Nuclear Medicine Technology
JO J. Nucl. Med. Technol.
FD Society of Nuclear Medicine
SP jnmt.119.228098
DO 10.2967/jnmt.119.228098
A1 Terence Z. Wong
A1 Thad Benefield
A1 Shane C. Masters
A1 Jackson W. Kiser
A1 James R. Crowley
A1 Dustin Osborne
A1 Osama Mawlawi
A1 James Barnwell
A1 Pawan Gupta
A1 Akiva Mintz
A1 Kelley A. Ryan, kryan@luce
A1 Steven R. Perrin
A1 Ronald K. Lattanze
A1 David W. Townsend
YR 2019
UL http://tech.snmjournals.org/content/early/2019/06/06/jnmt.119.228098.abstract
AB PET/CT radiotracer infiltrations are not uncommon and often outside imaging fields of view. Infiltrations can negatively impact image quality and quantification, and can adversely affect patient management. Until recently, there has not been a simple way to routinely practice PET radiopharmaceutical administration quality control/quality assurance (QC/QA). Our objectives were to quantify infiltration rates, determine associative factors for infiltrations, and to assess if rates could be reduced and sustained at multiple centers. Methods: A Design, Measure, Analyze, Improve, Control quality improvement (QI) methodology requiring novel technology was used to try to improve PET/CT injection quality. Teams were educated on the importance of quality injections. Baseline infiltration rates were measured, center-specific associative factors were analyzed, team meetings were held, improvement plans were established and executed, and rates remeasured. To ensure injection quality gains were retained, real-time feedback and ongoing monitoring were used. Sustainability was assessed. Results: Seven centers and 56 technologists provided data on 5,541 injections. The centers’ aggregated baseline infiltration rate was 6.2% (range 2% - 16%). Based on their specific associative factors, four centers developed improvement plans and reduced their aggregated infiltration rate from 8.9% to 4.6% (P < 0.0001). On-going injection monitoring showed sustainability. Significant center- and technologist-level infiltration rate variation was found (P < 0.0001 and P = 0.0020). Conclusion: A QI approach with new technology can help centers measure infiltration rates, determine associative factors, implement interventions, and improve/sustain injection quality. Since PET/CT images help guide patient management, monitoring and improving radiotracer injection quality is important.