PET/CT radiotracer infiltration is not uncommon and is often outside the imaging field of view. Infiltration can negatively affect image quality, image quantification, and patient management. Until recently, there has not been a simple way to routinely practice PET radiopharmaceutical administration quality control and quality assurance. Our objectives were to quantify infiltration rates, determine associative factors for infiltration, and assess whether rates could be reduced at multiple centers and then sustained. Methods: A “design, measure, analyze, improve, and control” quality improvement methodology requiring novel technology was used to try to improve PET/CT injection quality. Teams were educated on the importance of quality injections. Baseline infiltration rates were measured, center-specific associative factors were analyzed, team meetings were held, improvement plans were established and executed, and rates remeasured. To ensure that injection-quality gains were retained, real-time feedback and ongoing monitoring were used. Sustainability was assessed. Results: Seven centers and 56 technologists provided data on 5,541 injections. The centers’ aggregated baseline infiltration rate was 6.2% (range, 2%–16%). On the basis of their specific associative factors, 4 centers developed improvement plans and reduced their aggregated infiltration rate from 8.9% to 4.6% (P < 0.0001). Ongoing injection monitoring showed sustainability. Significant variation was found in center- and technologist-level infiltration rates (P < 0.0001 and P = 0.0020, respectively). Conclusion: A quality improvement approach with new technology can help centers measure infiltration rates, determine associative factors, implement interventions, and improve and sustain injection quality. Because PET/CT images help guide patient management, the monitoring and improvement of radiotracer injection quality are important.
Improper electrocardiogram (ECG) lead placement resulting in suboptimal gating may lead to reduced image quality in cardiac magnetic resonance imaging (CMR). A patientspecific systematic technique for rapid optimization of lead placement may improve CMR image quality. A rapid 3 dimensional image of the thorax was used to guide the realignment of ECG leads relative to the cardiac axis of the patient in forty consecutive adult patients. Using our novel approach and consensus reading of pre- and post-correction ECG traces, seventy-three percent of patients had a qualitative improvement in their ECG tracings, and no patient had a decrease in quality of their ECG tracing following the correction technique. Statistically significant improvement was observed independent of gender, body mass index, and cardiac rhythm. This technique provides an efficient option to improve the quality of the ECG tracing in patients who have a poor quality ECG with standard techniques.
SUMMARY:The physical properties of bioceramics have made them ideal for a variety of prosthetic devices. Their porous structure allows fibrovascular tissue to invade the implant and secure it and provides a surface for muscular attachment. This process has been well-documented in animal studies; however, this case report describes the periodic imaging changes seen in a 67-year-old man following placement of a bioceramic orbital prosthesis. Bioceramics have been used in orthopedic and dental prosthetics for decades 1 ; in 2000, they were adapted to orbital prosthetics. Their aluminum oxide components form a cobblestone-appearing microcrystal structure that produces a lightweight, strong, easy-to-use, simple-tomanufacture, and highly porous implant.2 The pores of the implant allow fibrovascular invasion, which secures it within the orbital socket and provides a scaffold for muscular attachment. This process has been documented in animal studies that correlated changes in postcontrast T1 MR imaging with histologic samples demonstrating fibrovascular ingrowth. [2][3][4][5][6] This report documents similar changes seen in a patient following right-sided enucleation and bioceramic prosthetic implantation. Case ReportA 67-year-old man presented with chronic decreased visual acuity. A pigmented lesion, suspicious for melanoma versus choroidal nevus, was identified in the right eye. The lesion was followed with serial sonography for 9 years until its growth rate precluded the diagnosis of choroidal nevus. He then underwent right enucleation and bioceramic prosthetic implantation. Pathologic specimens confirmed the diagnosis of malignant melanoma. Lumbar punctures and imaging studies failed to demonstrate metastatic disease. Serial MR imaging studies with T1 spin-echo (TR, 400 ms; TE, 15 ms; 3-mm axial sections), T2 turbo spin-echo with fat saturation (TR, 5410 ms; TE, 100 ms; echo train of 21; 3-mm axial sections), and postcontrast T1 spinecho with fat saturation (TR, 675 ms; TE, 15 ms; 3-mm axial sections following administration of gadobenate dimeglumines [MultiHance, 1 mL/5 kg; Bracco, Milan, Italy]) were performed on a 1.5T magnet to evaluate the implant and assess disease recurrence. At 20 months after implantation, he is complication-and disease-free, and the prosthesis is well-incorporated clinically and on follow-up MR imaging (Fig 1). DiscussionFibrovascularization of orbital prosthetics secures them within the orbit and provides a surface for muscular attachment. This integral process has been examined in numerous animal models. These studies uniformly describe central T1 postcontrast enhancement, which coincides with histopathologic evidence of fibrovascularization. [2][3][4][5][6]
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