Kiser Jackson W, Benefield Thad, Lattanze Ronald K, Ryan Kelley A, Crowley James
Carilion Clinic, Roanoke, VA.
University of North Carolina, Chapel Hill, NC.
JCO Oncol Pract. 2020 Jul;16(7):e636-e640. doi: 10.1200/JOP.19.00302. Epub 2020 Feb 11.
Accurate administration of radiotracer dose is essential to positron emission tomography (PET) image quality and quantification. Misadministration (infiltration) of the dose can affect PET/computed tomography results and lead to unnecessary or inappropriate treatments and procedures. Quality control efforts ensure accuracy of the administered dose; however, they fail to ensure complete delivery of the dose into the patient's circulation. We used new technology to assess and improve infiltration rates and evaluate sustainability.
Injection quality was measured, improved, and sustained during our participation in a multicenter quality improvement project using Define, Measure, Analyze, Improve, Control methodology. Five technologists monitored injection quality in the Measure and Improve phases. After seven new technologists joined the team in the Control phase, infiltration rates were recalculated, controlling for technologist- and patient-level correlations, and comparisons were made between these two groups of technologists.
In the Measure phase, five technologists monitored 263 injections (13.3% infiltration rate). Nonantecubital fossa injections had a higher probability of infiltration than antecubital fossa injections. After implementing a quality improvement plan (QIP), the same technologists monitored 278 injections in the Improve phase (2.9% infiltration rate). The 78% decrease in infiltration rate was significant ( < .001) as was the decrease in nonantecubital fossa infiltrations ( = .0025). In the Control phase, 12 technologists monitored 1,240 injections (3.1% infiltration rate). The seven new technologists had significantly higher rates of infiltration ( = .017).
A QIP can significantly improve and sustain injection quality; however, ongoing monitoring is needed as new technologists join the team.
准确给予放射性示踪剂剂量对于正电子发射断层扫描（PET）图像质量和定量分析至关重要。剂量误投（渗漏）会影响PET/计算机断层扫描结果，并导致不必要或不适当的治疗和程序。质量控制措施可确保给予剂量的准确性；然而，它们无法确保剂量完全输送到患者的循环系统中。我们使用新技术来评估和提高渗漏率，并评估可持续性。
在我们参与的一个多中心质量改进项目中，采用定义、测量、分析、改进、控制方法来测量、改进和维持注射质量。五名技术人员在测量和改进阶段监测注射质量。在控制阶段，七名新的技术人员加入团队后，重新计算渗漏率，控制技术人员和患者层面的相关性，并对这两组技术人员进行比较。
在测量阶段，五名技术人员监测了263次注射（渗漏率为13.3%）。非肘前窝注射比肘前窝注射有更高的渗漏概率。实施质量改进计划（QIP）后，同样的技术人员在改进阶段监测了278次注射（渗漏率为2.9%）。渗漏率下降78%具有显著性（<0.001），非肘前窝渗漏的下降也具有显著性（=0.0025）。在控制阶段，12名技术人员监测了1240次注射（渗漏率为3.1%）。七名新的技术人员的渗漏率显著更高（=0.017）。
质量改进计划（QIP）可以显著提高并维持注射质量；然而，随着新的技术人员加入团队，需要持续进行监测。
