Radiopharmaceutical Extravasation: Pragmatic Radiation Protection

Abstract Inadvertent injection of a radiopharmaceutical agent into a patient's arm tissue instead of into the appropriate blood vessel can cause the injection to infiltrate underlying tissue and produce a potentially substantial, localized irradiation to the patient's arm and skin tissue. When this type of misadministration occurs, called an extravasation, it should be recognized, mitigated, and monitored for patient health and safety. Immediate symptoms of radiopharmaceutical extravasation may include swelling, edema, pain, or numbness in the vicinity of the extravasation site; inflammation; and drainage from the site. Some infiltrations may go unnoticed until later. Pragmatic elements of radiation safety include imaging to assess the geometry, volume, and anatomic distribution of activity, collection of tissue count-rate data over retention times, calibration against known activity levels, and dosimetry to help clinicians determine whether an extravasation is severe and whether the patient should be followed for adverse tissue reactions.