Survey of Knowledge, Perceptions, and Adoption of Near-infrared Imaging With Indocyanine Green Findings Among US Lymphedema Therapists

Background: Near-infrared imaging fluorescence using indocyanine green lymphography (NIRF/ICG-L) has emerged as a useful tool in guiding surgical approaches. However, its use in guiding conservative therapy interventions, such as manual lymph drainage (MLD), remains limited. This study aimed to explore the knowledge, perceptions, and adoption of NIRF/ICG-L in the conservative management of lymphedema among US therapists. Methods: An anonymous online survey was distributed via email to US lymphedema therapists in late 2024. Descriptive statistics and χ 2 tests were used to examine knowledge, perceptions, and adoption of ICG-L findings related to conservative therapy interventions. Results: Data from 509 actively practicing lymphedema therapists were analyzed. Nearly half (49.7%) reported no knowledge of NIRF/ICG-L, while 30.2% were somewhat familiar and 20.1% were familiar. Therapists working alone were significantly less likely to have heard of NIRF/ICG-L ( χ 2 = 13.97, P <.01). While 33.9% felt NIRF/ICG-L studies would impact MLD practice, 39% were optimistic but needed more information. Adoption of NIRF/ICG-L findings in MLD practice was reported by 23.8% of respondents, with higher rates in urban settings ( χ 2 = 8.53, P < .05) and among Lymphology Association of North America (LANA)-certified therapists ( χ 2 = 16.33, P < .001). Key barriers included limited knowledge (55.8%), limited access to testing (40.7%), time constraints (10.4%), organizational protocols (5.5%), and loyalty to established methods (3.4%). Conclusion: There is wide variation in knowledge of NIRF/ICG-L among US lymphedema therapists. Although many recognize its potential benefits, adoption may be limited by knowledge and access barriers. Targeted strategies to enhance education and improve testing access may increase its use in conservative lymphedema management.