Nuclear Medicine Extravasations: Patients Have a Right to Know

Nuclear medicine has contributed to extraordinary progress in the diagnosis and treatment of cancer and other diseases. And the best is yet to come. Over the next decade, new treatments will emerge that promise to positively revolutionize cancer care.

Unfortunately, all this progress is severely hampered by the fact that a simple and preventable error – nuclear medicine injection extravasation – can potentially harm the patient. Worse, the patient may never even know that extravasation has occurred because currently there is no requirement that a patient be notified.

What is extravasation?

A nuclear medicine injection extravasation occurs when the needle misses the vein, and a radio-pharmaceutical is accidentally injected into a patient’s skin or soft tissue. Three medical societies recently announced that extravasations happen frequently, and it is estimated that an extravasation occurs on an average of once every 56 seconds in the U.S. 

Extravasations and harm to patients

Nuclear medicine extravasations can affect the quality and quantification of images that help diagnose, stage, and assess cancer and many other diseases, as well as leave radiation in the tissue. In high dosages, extravasation can lead to skin and tissue damage months, even years, after injection.

Are extravasations preventable?

Yes. In the past, it was believed that extravasations were unavoidable. However, that is simply not the case. In fact, as the Chief of Molecular Imaging at the Carilion Clinic in Roanoke, VA, I am proud to note that our clinic has reduced its extravasation rate by 85 percent since 2016. How? Through a combination of simple monitoring and technology advances. The resulting benefit to patients is twofold: reduced unnecessary exposure to radiation, and increased quality of imaging procedures. 

What can be done at the national level to address extravasations?

Since 1980, nuclear medicine providers have been required to report any unintentional, significant radiation exposure to the U.S. Nuclear Regulatory Commission (NRC). However, a loophole excludes extravasations. The NRC is now considering a petition (Docket: NRC-2020-0141) that would eliminate the loophole, an action that I support. 

By requiring extravasations to be reported, nuclear medicine providers across the U.S. will be encouraged to deploy quality control measures to drive down the number of cases. The NRC will also be armed with data that help identify underlying reasons behind extravasations, which will lead to fewer such cases in the future. 

Summary: Putting patients first

By failing to report extravasations, we are failing patients. Medical evidence is clear: extravasations can be harmful – but they are also avoidable. 

Cancer patients are literally in the fight for their lives. Closing this regulatory loophole will help arm patients with vital information about their own diagnosis and treatment journey. Patients deserve transparency and should be able to trust their health care team. Let’s take action to help build on that trust. 

Jackson W. Kiser is Chief of Molecular Imaging at Carilion Clinic in Roanoke, VA.

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