A Novel Protocol for Global Standardization in Upper Extremity Indocyanine Green Lymphography

ABSTRACT: Effective imaging of the lymphatic system is crucial for accurate diagnosis and targeted treatment of upper extremity lymphedema. The increasing adoption of indocyanine green (ICG) lymphography highlights the need for a standardized protocol to conduct, record, and interpret the findings in a systematic and reproducible manner. We present a novel upper extremity ICG lymphography protocol that addresses these issues. The protocol provides detailed guidelines for patient positioning, imaging setup, ICG preparation and injection, anatomical segmentation of the upper extremity, dynamic and delayed scanning, and patient exercise during the interval period. The upper extremity is systematically divided into 10 distinct anatomical regions to facilitate a standardized approach to image capture and reporting. Dynamic scans involve video recording and still image capture of each segment as the ICG dye traverses through, while delayed scans capture still images of each segment in a specified order. This comprehensive protocol ensures consistency across patients and institutions, enhances efficiency, and provides a unified language for ICG lymphography, improving reproducibility and comparability of findings. The protocol is adaptable to different clinical settings and can improve the diagnosis and management of upper extremity lymphedema.