Advisory Committee Chair
Emily Caffrey
Advisory Committee Members
Charles Wilson
Remo George
Document Type
Thesis
Date of Award
2024
Degree Name by School
Master of Science (MS) College of Arts and Sciences
Abstract
Extravasations are medical occurrences where an injected or infused pharmaceutical is unintentionally deposited into the soft tissue near the injection site, rather than into the bloodstream. With radiopharmaceuticals, extravasations can result in potentially large radiation doses to skin and tissue. The current rate of extravasations in clinical settings is estimated to be between 3-23%. In the interest of patient safety, a clearer understanding of the dosimetry and differences in extravasation scenarios to simplify dose estimation is needed. Similarly, the NRC is considering modifying regulations to include extravasations as reportable medical events rather than to continue considering them as patient interventions. Numerous papers have applied the Fano Theorem for dose estimations, yet these estimations reveal inconsistencies in the assumptions regarding tissue density, volume, mass, and clearance rates. Dose estimates often indicate that deterministic effects are probable, but these rarely are observed. There is no standard solution for dose calculations for extravasations. To be fully prepared to meet the 24-hour reporting requirements for medical events, a standard must be developed. This research aims to review and compare existing literature to determine the best practices for radiation safety programs’ response to extravasation events. Methods of dose calculations include the use of publicly available software such as IDAC, modified versions of VARSKIN+, Monte-Carlo methods, and use of the Fano Theorem. More work is still needed for accurate determination of the effective half-life of extravasated radiopharmaceuticals and reliably determining the fraction of extravasated material. Extravasation scenarios vary widely and there are questions regarding the regulatory need to determine skin dose versus tissue dose and whether this regulation is truly needed for patient safety if deterministic effects are generally not observed and stochastic effects are not sufficiently studied.
Recommended Citation
Drelich, Michael Richard, "Growing Need for a Standardized Response to Radiopharmaceutical Extravasations" (2024). All ETDs from UAB. 6542.
https://digitalcommons.library.uab.edu/etd-collection/6542