subcutaneous extravasation of sr-89: usefulness of bremsstrahlung imaging in confirming sr-89 extravasation and in the decision making for the choice of treatment strategies for local radiation injuries caused by sr-89 extravasation

a male patient in his 20s presented at our clinic with pain caused by bone metastases of the primitive neuroectodermal tumor, and sr-89 was administrated to palliate the pain. after receiving the injection, the patient complained of a slight burning pain at the catheterized area. slight reddening and small circular swelling (diameter, 0.5 cm) were observed at the catheterized area. sr-89 extravasation was suspected. to estimate the amount of subcutaneous sr-89 leakage, bremsstrahlung imaging was immediately performed. we speculated that the skin-absorbed dose from the subcutaneous sr-89 leakage was 1.78 gy. the mildest clinical sign of local radiation injury was erythema. the received dose was higher than 3 gy, and the time of onset was from 2 to 3 weeks. in our patient, local radiation injuries (lris) did not occur. though requiring further verification, subsequent bremsstrahlung imaging and estimation of the skin-absorbed dose from the subcutaneous sr-89 leakage are useful in confirming sr-89 extravasation and in the decision making for the choice of treatment strategies for lris caused by sr-89 extravasation.