Extravasation of a Therapeutic Dose of ¹³¹I-Metaiodobenzylguanidine: Prevention, Dosimetry, and Mitigation

Abstract

After the extravasation of a therapeutic dose of ¹³¹I-metaiodobenzylguanidine that produced a radiation burn to a patient's forearm, we instituted a catheter placement verification protocol. Methods: Before therapy infusion, proper placement is verified by administering 37 MBq of ^99mTc-pertechnetate through the catheter, and monitoring activity at the administration site and on the contralateral extremity. A dosimetric model describing both high-rate and low-rate dose components was developed and predicted that the basal epidermal layer received a radiation dose consistent with the observed moist desquamation radiation skin toxicity. Results: No extravasation incidents have occurred since the verification procedure was instituted. Conclusion: To protect against radiation injury from extravasation of therapeutic radionuclides, test administration of a small ^99mTc dose with probe monitoring of comparable sites in both upper extremities appears to be an effective preventive measure.