Real-time scintigraphic assessment of intravenous radium-223 administration for quality control

Radium-223 ((223)Ra) dichloride is an approved intravenous radiotherapy for patients with osseous metastases from castration-resistant prostate cancer (CRPC). In addition to the therapeutic alpha radiation, there is additional (223)Ra radiation generated which produces photons that can be imaged with conventional gamma cameras. No studies have evaluated real-time and quality imaging during intravenous (223)Ra administration to verify systemic circulation and exclude (223)Ra extravasation at the injection site. A retrospective review was performed for fifteen (223)Ra administrations for CRPC patients which were imaged using a large field of view portable gamma camera (LFOVPGC) for the purposes of quality control and patient safety. Dynamic imaging of the chest was performed before, during, and after the (223)Ra administration to verify systemic circulation, per institutional clinical protocol. Before and after (223)Ra administration, a static image was obtained of the intravenous access site. Dynamic imaging of the chest confirmed systemic administration early during the 1-minute injection period for all patients. There were no cases of focal (223)Ra extravasation at the site of intravenous access. These results verify that systemic (223)Ra administrations can be quantified with real-time imaging using an LFOVPGC. This simple approach can confirm and quantify systemic circulation of (223)Ra early during injection and exclude focal extravasation for the purposes of quality control.