{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T18:07:34Z","timestamp":1780337254738,"version":"3.54.1"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["Ricerca Corrente Annual Program 2026"],"award-info":[{"award-number":["Ricerca Corrente Annual Program 2026"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ministero della Salute, 5perMille year 2020","award":["5M-2020-23682114"],"award-info":[{"award-number":["5M-2020-23682114"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Radiopharmaceutical extravasation\u2014when injected activity remains in soft tissue rather than entering the bloodstream\u2014can compromise quantification in positron emission tomography\/computed tomography (PET\/CT) and, in therapeutic settings, deliver high local radiation doses. These effects may lead to inaccurate Standardized Uptake Value (SUV) measurements, potential misdiagnosis, repeat examinations, and to avoid patient risk. We assessed a simple, real-time approach for detecting extravasation during administration to enable immediate management and quantitative correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Real-time monitoring with portable gamma detectors was applied to 885 diagnostic PET examinations (\n                      <jats:sup>18<\/jats:sup>\n                      F-FDG,\n                      <jats:sup>68<\/jats:sup>\n                      Ga-DOTATOC\/TATE,\n                      <jats:sup>68<\/jats:sup>\n                      Ga-PSMA-11) and 15 administrations of\n                      <jats:sup>177<\/jats:sup>\n                      Lu-DOTATATE therapy. In the diagnostic cohort, 53 extravasation events were identified and confirmed on PET images. Analysis of dose-rate\u2013time curves yielded practical thresholds for extravasation detection: \u0394p\n                      <jats:sup>in<\/jats:sup>\n                      <jats:sub>nor<\/jats:sub>\n                      = 0.30 and \u0394R\n                      <jats:sub>t<\/jats:sub>\n                      \u2009=\u2009388 \u00b5Sv\/h. A statistically significant association was observed between SUV correction factors and specific curve parameters, enabling prospective adjustment of SUV before image interpretation. In the therapeutic cohort, one extravasation was observed, with an estimated absorbed self-dose of 11.6 Gy to the affected region. The monitoring enabled timely intervention that limited unnecessary exposure and workflow disruption. Feasibility analyses indicated that, for diagnostic procedures, a single detector can be sufficient for reliable extravasation identification and for deriving SUV correction factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A real-time, detector-based strategy can identify radiopharmaceutical extravasation during injection, support immediate mitigation, and preserve diagnostic accuracy by allowing early SUV correction. In therapeutic applications, it can reduce risk by prompting management of rare but consequential events. The operational simplicity, low cost, and effectiveness demonstrated across both diagnostic and therapeutic scenarios support integration of this approach into routine clinical practice, with the added practicality that a single detector appears adequate for diagnostic workflows.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0350116","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:28:44Z","timestamp":1780334924000},"page":"e0350116","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-time detection of extravasation events of diagnostic and therapeutic radiopharmaceuticals in oncology"],"prefix":"10.1371","volume":"21","author":[{"given":"Noemi","family":"Cucurachi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Fioroni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3302-4351","authenticated-orcid":true,"given":"Elisa","family":"Grassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Panico","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2615-381X","authenticated-orcid":true,"given":"Laura","family":"Verzellesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Botti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Fraternali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Roncali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rexhep","family":"Durmo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelina","family":"Filice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Iori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"issue":"2","key":"pone.0350116.ref001","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s00259-014-2961-x","article-title":"FDG PET\/CT: EANM procedure guidelines for tumour imaging: version 2.0","volume":"42","author":"R Boellaard","year":"2015","journal-title":"Eur J Nucl Med Mol Imaging"},{"issue":"5","key":"pone.0350116.ref002","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/HP.0b013e3182092732","article-title":"Comparison of two different types of LiF:Mg,Cu,P thermoluminescent dosimeters for detection of beta rays (beta-TLDs) from 90Sr\/90Y, 85Kr and 147Pm sources","volume":"100","author":"E Grassi","year":"2011","journal-title":"Health Phys"},{"issue":"10","key":"pone.0350116.ref003","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1097\/MNM.0b013e328349fd60","article-title":"Personnel exposure in labelling and administration of (177)Lu-DOTA-D-Phe1-Tyr3-octreotide","volume":"32","author":"R Sghedoni","year":"2011","journal-title":"Nucl Med Commun"},{"issue":"2","key":"pone.0350116.ref004","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1097\/MNM.0b013e328318effb","article-title":"Radiation protection in 90Y-labelled DOTA-D-Phe1-Tyr3-octreotide preparations","volume":"30","author":"E Grassi","year":"2009","journal-title":"Nucl Med Commun"},{"issue":"3","key":"pone.0350116.ref005","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/NAN.0000000000000100","article-title":"Accepted but unacceptable: peripheral IV catheter failure","volume":"38","author":"RE Helm","year":"2015","journal-title":"J Infus Nurs"},{"issue":"8","key":"pone.0350116.ref006","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/01.NAJ.0000282299.03441.c7","article-title":"Infiltration and extravasation","volume":"107","author":"L Hadaway","year":"2007","journal-title":"Am J Nurs"},{"issue":"7","key":"pone.0350116.ref007","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1007\/s00259-017-3675-7","article-title":"Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review","volume":"44","author":"J van der Pol","year":"2017","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"pone.0350116.ref008","article-title":"Standards for PET image acquisition and quantitative data analysis","author":"R Boellaard","year":"2009","journal-title":"J Nucl Med"},{"key":"pone.0350116.ref009","article-title":"Impact of FDG extravasation on SUV measurements in clinical PET\/CT. 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