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A Novel Protocol For Global Standardization In Upper Extremity Indocyanine Green (ICG) Lymphography
Berk B. Ozmen, Sonia K. Pandey, Sergey Toshinskiy, Wei F. Chen, Graham Schwarz
Cleveland Clinic Department of Plastic Surgery
2024-02-01
Presenter: Berk B Ozmen
Affidavit:
Yes. All of the work is original work of the authors. Not published anywhere else previously.
Director Name: Graham Schwarz
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Effective imaging of the lymphatic system is paramount for comprehensive diagnosis and targeted treatment of upper extremity lymphedema. With increased adoption of indocyanine green (ICG) lymphography, there is growing need for a standardized protocol to conduct, record and interpret the findings of the procedure in a systematic and reproducible way. This study aims to address these issues with a new protocol.
METHODS: ICG lymphography protocols from our institution and those found in the literature were evaluated. Strengths, limitations and areas for targeted improvement were noted. Using this data along with our institutional learned experience, a novel protocol was developed to ensure systematic static and dynamic image capture as well as synoptic reporting based on upper extremity anatomic region. Immediate and delayed lymphogram image acquisitions were included in the paradigm.
RESULTS: Ten anatomic segments of the upper extremity were defined starting from the volar hand to lateral proximal upper arm. Injection pattern of ICG, amount and timing were delineated. During the immediate scan, dynamic videos are recorded for a 3-minute duration and still images captured at a fixed camera distance. Following a predetermined interval period, a secondary set of still images is collected during the delayed scan phase. The procedure is optimized to fit within a 30-minute office visit.
CONCLUSION: We developed a novel upper extremity ICG lymphography protocol that can be easily implemented. The proposed paradigm enhances efficiency and standardizes reporting in ICG lymphography. It offers a unified language, improving reproducibility and comparability of findings.
