TY - JOUR T1 - Comparison of Four Infusion Methods for Lutathera Peptide Radionuclide Receptor Therapy JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 182 LP - 182 VL - 62 IS - supplement 1 AU - Anne Ellis AU - Susan Lawson AU - Lauren Rybicki AU - ROBERT ACKERMANN AU - Regen Newton AU - Kirk Frey AU - Ka Kit Wong Y1 - 2021/05/01 UR - http://jnm.snmjournals.org/content/62/supplement_1/182.abstract N2 - 182Introduction: Peptide radionuclide receptor therapy (PRRT) for the treatment of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) commenced at our institution in June 2018. The treatment course requires the infusion of Lutathera with concurrent renoprotective amino acid infusion over 4 hours, with a total of 4 cycles given at eight-week intervals. To provide an effective and safe method for the infusion of Lutathera (Lutetium-177 DOTATATE) solution, we identified and tested multiple available infusion methods. Methods: A total of 4 methods for infusion were tested for our PRRT program: 1) gravity method, 2) syringe pump, 3) infusion pump, and 4) peristaltic pump (MOOG Curlin 6000). Each method was performed numerous times, allowing us to evaluate each for: efficiency; residuals; ease of use; radiation safety, including contamination risk and exposure to staff; and patient safety. In the gravity method, saline flows into the Lu-177 vial; as pressure builds up the PRRT is pushed out of the vial. The infusion lasts until an exposure rate of 100-700 cps is measured on a handheld pancake probe GM meter positioned over the vial. For the syringe pump infusion method, the Lutathera was drawn up into a 30cc syringe placed in a lead shield-encased pump. After completion of the Lu-177 infusion, a saline flush is loaded into the Lutathera syringe via a 4-way stopcock. In the infusion pump method, we used an infusion pump and standard tubing to spike the Lu-177 vial. The vial was then hung upside down, the tubing run through the infusion pump, and a bag of saline connected after the pump to flush the tubing line. The peristaltic pump method uses small-bore tubing connected to the Lu-177 vial by a male-male connection attached to a spinal need that reaches the bottom of the vial. The other end of the tubing is attached to the patient. As the peristaltic pump infuses, air is drawn into the vial by a filter needle. Results: We have administered PRRT for 120 patients between June 2018 and November 2020. To date 100 patients have completed PRRT. During these treatments, four infusion methods were used sequentially over time. Residuals of Lutathera were recorded for each of these methods, and we recorded any problems that arose allowing comparison of the methods. With the gravity method, several issues were identified related to leaking of Lutathera at the needle insertion site due to a buildup of pressure in the vial and reduced infusion rates due to loss of pressure in the vial. Several episodes of inadequate delivery of the radiotracer within the recommended timeframe occurred leading us to conclude that this method had the highest contamination risk, difficulty of use, and increased risk to the patient. The average residual was 3.93(±3.38) mCi Lu-177. The syringe pump method was very efficient for the PRRT infusion with low residuals but resulted in increased radiation exposure to staff (due to handling) and was slightly more complicated to use than the peristaltic pump. The average residual for the syringe pump was 2.83(±0.49) mCi Lu-177. The infusion pump method was the most complicated to use and had an increased risk of radiation exposure and contamination. There were incidents of air in the line that were difficult to clear. The infusion pump method resulted in an average residual of 6.10(±13.87) mCi Lu-177. The peristaltic pump was the easiest to use with low residual amounts and the highest safety in regard to staff radiation exposure. The residual amount average for the peristaltic pump was 4.71(±2.41) mCi Lu-177.Conclusion: After performing PRRT to 120 patients and analyzing these four infusion methods, the peristaltic pump is the preferred method. The use of the Curlin pump proved to be the easiest to use, safest, and most efficient method tested with acceptable residuals. ER -