Automated 18F-FDG drug delivery system: Reducing occupational radiation exposure and improving injection accuracy

Objective To compare the injection accuracy, radiation exposure, and surface radiation levels between manual injection and an automated drug delivery system for 2-[¹⁸F]-fluoro-2-deoxy-D-glucose (18F-FDG) administration, and to evaluate the clinical applicability of the automated system.Methods Between December 2024 and January 2025, a total of 504 patients undergoing positron emission tomography and computed tomography (PET/CT) with 18F-FDG injection were enrolled, including 249 in the manual injection group and 255 in the automated injection group. Injection activity, occupational radiation dose to nurses, and ambient dose equivalent rates at 1 cm above operating surfaces (injection table, gloves, and floor) were monitored. A portable radiation detector was positioned 10 cm from the needle tip (to simulate the operator’s hand) and at chest level (to simulate the torso) to record the peak ambient dose equivalent rate during injection.Results The automated drug delivery system demonstrated significantly better performance in terms of injection accuracy, radiation exposure reduction, and contamination control (Z ranged from -3.16 to -19.44, P<0.05). The mean injection activity deviation was 8.01% for manual injection versus 0.83% for automated injection. The average peak ambient dose equivalent rate at the hand position was 2 415 µSv/h for manual injection versus 51.09 µSv/h for automated injection; at the torso position, 1.49 µSv/h versus 0.14 µSv/h, respectively. The highest surface dose rates on the injection table and gloves were 16.11 µSv/h and 15.04 µSv/h for manual injection, compared to 0.39 µSv/h and 0.15 µSv/h for automated injection. The floor remained at background levels in both groups. No surface contamination was detected in the automated group, whereas contamination occurred in the manual group at rates of 7% (injection table) and 3% (gloves).Conclusion The automated 18F-FDG drug delivery system improves injection precision, reduces occupational radiation exposure, and minimizes environmental contamination, offering significant potential for safer and more standardized clinical nuclear medicine practice.