Recognizing the artifacts and minimizing untoward effects caused by failed or complicated radiopharmaceutical injections

Learning Objectives To illustrate the findings related to failed or complicated radiopharmaceutical injections by presenting a collection of cases exemplifying different agents, injection routes, and nuclear studies. To present a systematic approach to these cases, including recognition of risk factors, morbidity, management and preventive measures.

Imaging artifacts are possible sources of error which should be identified promptly when interpreting studies. Infiltration of an intravenous injection is not infrequent. Radiopharmaceutical infiltration can be a source of artifacts and unusual findings with which nuclear medicine physicians and radiologists should become familiar. This educational exhibit will exemplify numerous unusual findings related to failed or complicated injections in many nuclear medicine studies including: FDG PET, bone scintigraphy, cardiac nuclear studies, lymphoscintigraphy and a case of therapeutic dose extravasation of I-131 MIBG. The radiopharmaceuticals involved in the cases presented include: single photon emitters, positron emitter, and therapeutic agents. Routes of administration and infiltration or extravasation include: intravenous, subcutaneous and intrarterial. Radiopharmaceutical extravasation can also represent a mimic, an exemplifying case of a cutaneous hemangioma mimicking intrarterial injection of In-111 capromab will be presented. Although nuclear medicine studies are in general safe, potential radiation effects should be considered as a harmful outcome and should be prevented. Timely recognition of the potential patient morbidity is part of our clinical responsibility. The management of radiopharmaceutical extravasation will be presented including an implemented preventive protocol for intravenous therapeutic doses. The regulatory reporting requirements of radiopharmaceutical dose infiltration will also be addressed. Standarization of nomenclature differentiating infiltration from extravasation will be discussed