Determinants of incomplete nuclear medicine examinations following radiopharmaceutical administration: A mixed-methods clinical audit at a tertiary hospital in Saudi Arabia

Objective To identify the prevalence and clinical determinants of incomplete nuclear medicine (NM) examinations following radiopharmaceutical administration, and to assess their impact on nuclear medicine practice efficiency and radiopharmaceutical utilization at a tertiary hospital in Saudi Arabia. Methods A mixed-methods clinical audit was conducted using records of NM examinations performed at a tertiary hospital in Saudi Arabia. Quantitative analysis included a retrospective review of 122 NM cases in which radiopharmaceuticals were administered but imaging was not completed between 2007 and 2024. Qualitative analysis involved semi-structured interviews with seven NM technologists to provide contextual insights into factors contributing to scan incompletion. Reasons for incompletion were categorized, and associations with demographic variables (gender and patient status) were assessed using chi-square analysis. Thematic analysis was applied to interpret technologist perspectives. Results Incomplete NM examinations were classified into ten categories, with no-show events being the most frequent cause (52.45%), followed by health-related interruptions (19.67%) and patient refusal (11.47%). Myocardial perfusion imaging accounted for the largest proportion of incomplete examinations (49.18%). Male sex (p = 0.0003) and outpatient status (p < 0.00001) were significantly associated with reasons for scan incompletion. Qualitative findings identified fasting intolerance, fear of radiation, and logistical delays as key contributors to scan incompletion. Conclusion Incomplete NM examinations following radiopharmaceutical administration result from identifiable behavioral, procedural, and operational factors that affect nuclear medicine workflow efficiency and radiopharmaceutical resource utilization. Targeted interventions, including patient education, risk-based pre-scan triage, and optimized scheduling, may improve scan completion and reduce unnecessary radiopharmaceutical waste. Multi-center studies are warranted to evaluate the generalizability of these findings across Gulf Cooperation Council healthcare systems.