title: Extravasation of a therapeutic dose of 131I-metaiodobenzylguanidine: prevention, dosimetry, and mitigation.
abstract: After the extravasation of a therapeutic dose of (131)I-metaiodobenzylguanidine that produced a radiation burn to a patient's forearm, we instituted a catheter placement verification protocol.
  
  
  METHODS
  Before therapy infusion, proper placement is verified by administering 37 MBq of (99m)Tc-pertechnetate through the catheter, and monitoring activity at the administration site and on the contralateral extremity. A dosimetric model describing both high-rate and low-rate dose components was developed and predicted that the basal epidermal layer received a radiation dose consistent with the observed moist desquamation radiation skin toxicity.
  
  
  RESULTS
  No extravasation incidents have occurred since the verification procedure was instituted.
  
  
  CONCLUSIONS
  To protect against radiation injury from extravasation of therapeutic radionuclides, test administration of a small (99m)Tc dose with probe monitoring of comparable sites in both upper extremities appears to be an effective preventive measure.
authors.affiliation: Nuclear Medicine Service, Department of Radiology and Imaging Sciences, Veterans Affairs Medical Center, Emory University School of Medicine, Atlanta, Georgia 30033, USA.
authors.forename: Dacian V
authors.initials: DV
authors.lastname: Bonta
authors.forename: Raghuveer K
authors.initials: RK
authors.lastname: Halkar
authors.forename: Naomi
authors.initials: N
authors.lastname: Alazraki
mesh_terms: D019797:3-Iodobenzylguanidine / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D000465:Algorithms; D001610:Beta Particles; D020405:Dermis / Q000098:blood supply; D005119:Extravasation of Diagnostic and Therapeutic Materials; D007262:Infusions, Intravenous; D008962:Models, Theoretical; D017785:Photons; D011874:Radiometry / Q000379:methods; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D012039:Regional Blood Flow / Q000502:physiology; D012867:Skin / Q000098:blood supply / Q000528:radiation effects; D013670:Sodium Pertechnetate Tc 99m / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D013670:Sodium Pertechnetate Tc 99m