We read with great interest the recent editorial by Huang et al [1] regarding the unfortunately timely topic of considerations attendant to running a nuclear medicine department in the context of the COVID-19 epidemic, which complements similar work on diagnostic imaging [2] and hospital-wide preparedness [3] As the pandemic has unfolded in a somewhat sequential manner [4], lessons learned in one geographic domain are of great value to physicians who practice in locations that are earlier on the learning curve One area of concern which we did not see covered in the comprehensive treatment relates to performance of ventilation scans, a standard component of ventilation/perfusion studies performed to exclude pulmonary embolus [5] The population of patients who are short-of-breath and considered for pulmonary embolus certainly overlap with individuals who may be suffering effects of COVID-19 infection Beyond standard methods of decontamination, which are relevant to all patients with suspicion of infection [2,6], is there a specific concern that patients performing ventilation studies will expose others to airborne virus by exhalation into the aerosolization system? Do we need to take any additional precautions to minimize airborne distribution of virus, such as requiring technologists to don respiratory mask to protect against airborne virus? Are there any changes in protocol that we can implement to mitigate risk?

COVID-19 in the Nuclear Medicine Department, be prepared for ventilation scans as well!

The world has been profoundly affected by the COVID-19 pandemic; stability is the exception rather than the rule. This is certainly true with respect to provision of medical care. In order to minimize exposure of others to possibly infectious material, procedures with potential to spread patient secretions were limited or proscribed in individuals with suspected or proven COVID-19 infection [1]. In the nuclear medicine arena, ventilation scintigraphy was identified as an “at-risk” procedure [2, 3] due to the potential of secretions to contaminate the exam room atmosphere [4–9]. It is striking to note the number and variety of strategies proposed in the nuclear medicine literature for evaluating pulmonary embolism during the COVID-19 pandemic, indicating determination on the part of nuclear medicine physicians to remain clinically relevant without compromising the safety of staff and patients. It is fascinating to note howmany authors coopted preexisting lung scan strategies that had been previously proposed and generally sidelined in the past [10–15], adopting them as novel solutions to the unusual COVID-19 situation (Table 1). A likely contribution to the wide variety of different approaches is the variation in clinical situations prevalent when and where each method was proposed. As the viral infection waxed and waned across geographical regions, as stocks of supplies were periodically diminished and replenished, and as knowledge was accumulated and refined, it not surprising that the assumptions that inform these different methods would vary, resulting in a spectrum of different responses. Decisions taken to protect patients and staff at a particular locus in time and space were made to the best of each practitioner’s ability, appropriate to that milieu but not necessarily applicable to other places or times under different prevailing conditions. Personally, the experience of working in a hospital in New York City in March and April 2020 was akin to that of working in a battlefield. There was a lack of definitive scientific information regarding the spread and pathogenicity of the virus (not fully resolved to date) [16], there were shortages of personal protective equipment (PPE) [17] and PCR testing materials [18], and the prevalence of virus was astronomical. Upon review, the range of options proffered in the nuclear medicine literature regarding performance of lung scintigraphy during the COVID-19 surge can be grouped to yield 4 conceptually similar approaches which span the full gamut of response, listed below. Several published opinions straddle more than one approach or lack sufficient detail to allow definitive categorization. We have tried to offer examples which clearly illustrate each strategy; the illustrations furnished are not exhaustive.

/pdf/to-everything-there-is-a-season-taxonomy-of-approaches-to-4yfgjnqtk7.pdf

To everything there is a season: taxonomy of approaches to the performance of lung scintigraphy in the era of COVID-19

The main goal of the present study was estimation of an internal contamination of 131I among family members of patients treated with radioactive iodine Thyroid activity measurements of 131I in examined volunteers were performed using a whole-body spectrometer at the institute of nuclear physics, Polish academy of sciences During this research, 20 relatives of patients treated with 131I were examined: eight women and 12 men with an age in the range from 3 to 72 years In the case of nine individuals, the activity of 131I in the thyroid was below the detection limit, but among the remaining 11 individuals, the activity varied from (9 ± 3) Bq up to (1140 ± 295) Bq Subsequently, based on the measurements of thyroid 131I activities, the corresponding doses were assessed The highest estimated effective dose reached 218 μSv, while the thyroid equivalent dose was 24 mSv In addition, the experimental data obtained were statistically analysed together with the results of surveys of the individuals participating in the study by means of correspondence analysis and nonparametric tests: Mann–Whitney, gamma, χ2 and Yule Phi coefficient These analyses revealed relationships between 131I activities in the thyroids of the examined individuals and their housing conditions as well as consumption of meals prepared by the patients

/pdf/131-i-thyroid-activity-and-committed-dose-assessment-among-4wfemaaxy4.pdf

131 I thyroid activity and committed dose assessment among family members of patients treated with radioactive iodine.

Evaluation of the annual occupational effective doses in a SPECT/CT department

Safe Pulmonary Scintigraphy in the Era of COVID-19.

This paper presents the results of measurements of 99mTc activity concentrations in indoor air in a nuclear medicine department and resulting estimated 99mTc intake by medical personnel. 99mTc air activity measurements were conducted at the Nuclear Medicine Department, John Paul II Hospital, Krakow, Poland, during ventilation–perfusion SPECT lung scans. Technetium from the air was collected by means of a mobile aerosol sampler with a Petryanov filter operating at an average flow rate of 10 dm3 min−1. Measured activities ranged from 99 ± 11 to 6.1 ± 0.5 kBq m−3. The resulting daily average intake of 99mTc by medical staff was estimated to be 5.4 kBq, 4.4 kBq, 3.0 kBq and 2.5 kBq, respectively, for male technicians, female technicians, male nurses and female nurses. Corresponding annual effective doses were 1.6 µSv for technicians and 1 µSv for nurses. The highest equivalent dose values were determined for extrathoracic (ET) airways: 5 µSv and 10 µSv for nurses and technicians, respectively. It is concluded that estimated annual absorbed doses are over three orders of magnitude lower than the dose limit established in the Polish Atomic Law Act and in recommendations of the International Commission on Radiological Protection for medical staff.

/pdf/99mtc-activity-concentrations-in-room-air-and-resulting-1uwtd6ct3h.pdf

99mTc activity concentrations in room air and resulting internal contamination of medical personnel during ventilation-perfusion lung scans.

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131 I thyroid activity and committed dose assessment among family members of patients treated with radioactive iodine.

99mTc activity concentrations in room air and resulting internal contamination of medical personnel during ventilation-perfusion lung scans.