TY - JOUR
T1 - Quality Improvement Initiatives to Assess and Improve PET/CT Injection Infiltration Rates at Multiple Centers
AU - Wong, Terence Z.
AU - Benefield, Thad
AU - Masters, Shane
AU - Kiser, Jackson W.
AU - Crowley, James
AU - Osborne, Dustin
AU - Mawlawi, Osama
AU - Barnwell, James
AU - Gupta, Pawan
AU - Mintz, Akiva
AU - Ryan, Kelley A.
AU - Perrin, Steven R.
AU - Lattanze, Ronald K.
AU - Townsend, David W.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - PET/CT radiotracer infiltration is not uncommon and is often outside the imaging field of view. Infiltration can negatively affect image quality, image quantification, and patient management. Until recently, there has not been a simple way to routinely practice PET radiopharmaceutical administration quality control and quality assurance. Our objectives were to quantify infiltration rates, determine associative factors for infiltration, and assess whether rates could be reduced at multiple centers and then sustained. Methods: A "design, measure, analyze, improve, and control" quality improvement 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 that 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%). On the basis of their specific associative factors, 4 centers developed improvement plans and reduced their aggregated infiltration rate from 8.9% to 4.6% (P < 0.0001). Ongoing injection monitoring showed sustainability. Significant variation was found in center- and technologist-level infiltration rates (P < 0.0001 and P = 0.0020, respectively). Conclusion: A quality improvement approach with new technology can help centers measure infiltration rates, determine associative factors, implement interventions, and improve and sustain injection quality. Because PET/CT images help guide patient management, the monitoring and improvement of radiotracer injection quality are important.
AB - PET/CT radiotracer infiltration is not uncommon and is often outside the imaging field of view. Infiltration can negatively affect image quality, image quantification, and patient management. Until recently, there has not been a simple way to routinely practice PET radiopharmaceutical administration quality control and quality assurance. Our objectives were to quantify infiltration rates, determine associative factors for infiltration, and assess whether rates could be reduced at multiple centers and then sustained. Methods: A "design, measure, analyze, improve, and control" quality improvement 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 that 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%). On the basis of their specific associative factors, 4 centers developed improvement plans and reduced their aggregated infiltration rate from 8.9% to 4.6% (P < 0.0001). Ongoing injection monitoring showed sustainability. Significant variation was found in center- and technologist-level infiltration rates (P < 0.0001 and P = 0.0020, respectively). Conclusion: A quality improvement approach with new technology can help centers measure infiltration rates, determine associative factors, implement interventions, and improve and sustain injection quality. Because PET/CT images help guide patient management, the monitoring and improvement of radiotracer injection quality are important.
KW - FDG
KW - PET/CT
KW - extravasation
KW - infiltration
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85075960263&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075960263&partnerID=8YFLogxK
U2 - 10.2967/jnmt.119.228098
DO - 10.2967/jnmt.119.228098
M3 - Article
C2 - 31182666
SN - 0091-4916
VL - 47
SP - 326
EP - 331
JO - Journal of nuclear medicine technology
JF - Journal of nuclear medicine technology
IS - 4
ER -