Use of a PACS Integrated Injection Monitoring Device to Increase Injection Quality and Infiltration Awareness

Introduction: Infiltration of PET radiopharmaceutical injections can lead to significant changes to quantification and image quality. Because the most common imaging position for patients is with the arms up, the site of infiltration is often not visible in the field of view. It is also possible for infiltrations to resolve during the standard uptake period adding to the difficulty in assessing injection issues. An external detector system (Lara, Lucerno Dynamics, LLC) has been created that enables monitoring of nuclear medicine injections and recently was upgraded to enable PACS integration of monitoring results. In this work, we present whether access to the injection monitoring system integrated with PACS would natively increase our radiology reporting rates of injection quality and suspected compromised injections.

Methods: To prepare a baseline, radiology reports and injection monitoring results were reviewed for 37 PET/CT studies where injection monitoring indicated a compromised injection. Additionally, 230 normal scans were assessed to determine if any comments were made regarding injection quality. Reports were reviewed to assess any mention of PET injecections whether good or compromised as well as how many infiltrations were visible in the PET field of view during imaging. The updated Lara injection monitoring system with PACS integration was acquired. Two of our radiologists were told of the new update and what new information they could expect to see in PACS, which included time activity curves from the monitored injections as well as an injection quality scores with scores of more than 200 indicating some form of injection compromise. Data were collected for 30 days to examine if access to the device improved our reporting from our baseline assessments and whether usage of the device proliferated naturally to other radiologists. No requirement to report results was made for this study nor were additional radiologists trained on the system other than the initial two users.

Results: Baseline assessments indicated that of the 37 infiltrated studies, 69% were visible on PET images but only 11% were documented in radiology reports. None of the 230 reports reviewed with normal injections had any radiologist comments as such. During the 30 day period following the PACS integration updates, 105 injections were monitored with 4 injections during that time having a score that indicated a compromised injection but none severe enough to warrant repeat imaging. Reporting of injection quality for all scans increased to 51%. Reporting of compromised injections increased to 100% with all 4 scans flagged as having some degree of infiltration noted in radiology reports. Additionally, we found that reporting of injection quality naturally spread to two additional radiologists over the 30 day period indicating a natural move towards adoption of the technology and reporting.

Conclusions: Access to injection monitoring with PACS integration can lead to significant increases in radiology reporting of injection quality both to confirm good quality, and to indicate when an injection may have been compromised. $$graphic_56935E19-8DDD-4DD5-9715-C059549A1CD4$$