Real-Time Detection of Extravasation Events of Diagnostic and Therapeutic Radiopharmaceuticals in oncology

Radiopharmaceutical extravasation can 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 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. Real-time monitoring with portable gamma detectors was applied to diagnostic PET examinations (18F-FDG, 68Ga-DOTATOC, 68Ga-PSMA-11) and a series of administrations of 177Lu-DOTATATE therapy. Extravasation events were observed in both diagnostic cohort and therpeutic cohort. The monitoring enabled timely intervention that limited unnecessary exposure and workflow disruption. 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 PET. 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.