Guidelines and considerations when introducing Axumin imaging within a clinical workflow

3041 Objectives: Axumin (fluciclovine F 18) is a radioactive tracer approved by the FDA in 2016 for positron emission tomography (PET) imaging in men with suspected prostate cancer recurrence based on elevated blood prostate specific antigen (PSA) levels following prior treatment. The University of Tennessee Medical Center has been offering Axumin scans clinically since May 2018. When a new tracer is introduced into the clinical workflow, the technologists need to be well educated. The objective of this abstract is to review all the steps within the workflow and discuss any issues discovered after using Axumin the clinical setting. Methods: A review of PET/CT imaging using Axumin for men with suspected prostate cancer recurrence based on elevated blood prostate specific antigen (PSA) levels following prior treatment was performed. The process of scheduling, patient prep, dose handling, injecting, imaging, and the bio-distribution concerns with Axumin was assessed to determine all the critical elements and time points associated with this workflow. Results: After an assessment of the use and workflow associated with Axumin, six different categories where identified and the critical elements and time points were reviewed. Scheduling & Insurance Getting an Axumin scan approved by insurance and getting them to fit in a clinical workflow can be a challenge. • Two codes are needed for Axumin. 78815 is the correct code for the PET scan and the A code for the Axumin dose is A9588. • If insurance states that a precert is not needed, that does not guarantee the coverage of the dose. Make sure the insurance approves to cover the actual dose. • Axumin scans are only approved for suspected recurrence of prostate cancer due to rising PSA following prior treatment. The reason for exam is extremely important to get insurance to cover. • Due to the scan time of 3-5 min post injection, Axumin scans will need a time slot for the scanner for 45min. Keep this in mind when schedule in between your normal FDG patients who allow for a 60min uptake. Patient Prep There is very little patient prep. • The patient needs to be NPO for 4hrs. • No exercise for at least 24hrs before scan. Dose Handling Axumin is a radioactive compound containing fluorine-18 with a half-life of 109min. • ALARA safety measures need to be used while handling the doses. • Aseptic technique needs to be used when handling and preparing the dose for injection. Dose Injection Guidelines There are specific guidelines to follow when using Axumin. • 10mCi (370MBq) is to be administered as an intravenous bolus injection followed by saline flush while the patient is positioned in the PET/CT scanner. • Injection should always take place in the right arm if possible. If left arm is used, stasis in the left axillary vein could happen and be misread as a metastatic lymph node. Imaging Guidelines Specific imaging parameters are to be followed. • Place patient’s arms above the head if possible and continue with a topogram and CT. • PET imaging should start at 3-5minutes post injection over the pelvis area. Imaging to outside of the recommend times could lead to poor image quality. Contrast of tumor versus normal tissue is the highest at 4-10 minutes post injection. Total imaging time should take around 20-30 minutes. •Time of flight and Iterative reconstructions should be used with a gaussian smoothing filter equal to or less that 5mm if available. Bio-distribution Only 3% of Axumin is excreted in the urine 4 hours post injection. Bladder interference is not a major concern when using Axumin. Conclusions: There are specific guidelines that need to be followed when using Axumin in a clinical workflow. After the assessment of the Axumin workflow for the last few months, some main categories were identified. Within those categories, there are critical elements that need to be practiced and a few recommendation that were learned along the way.