Updated Statement: COVID-19 and Ventilation/Perfusion (V/Q) Lung Studies

September 3, 2020

On March 19, 2020, SNMMI released a statement responding to concerns regarding ventilation/perfusion (V/Q) lung scans and, specifically, the inherent risk of spread of COVID-19 to patients and staff related to the ventilation portion of this study. At that time, many institutions opted not to perform ventilation studies. When lung perfusion images are normal, the perfusion scan alone essentially rules out acute pulmonary embolism, and no further studies are needed. When lung perfusion images show a high-probability appearance in the setting of a normal chest radiograph, this also provides helpful information. However, there are cases in which perfusion-only images are indeterminate and a ventilation study may be felt to be clinically necessary to make a definitive interpretation, with recognition of the need for diagnostic accuracy given the potential risks of anticoagulation in this population. In addition, ventilation images provide important information about airway patency and obstructive lung disease that may help to explain symptoms.

Since the time of the original statement, the COVID-19 pandemic has evolved differently in various regions of the world, and questions have arisen as to the safety of resuming performance of the ventilation study.  

There remain unknowns about the transmissibility of COVID-19 using ventilation systems. In some situations, it may remain appropriate not to perform ventilation studies. These situations may include when institutions or practices are in regions where there is a high or increasing number of COVID-19 cases or where there is inadequate access to COVID-19 testing.

The goal of this updated statement is to recognize that in some regions and clinical situations, a ventilation study may be felt to be clinically necessary to help diagnose lung disease, including vascular and airway disease. In these settings, performance of ventilation studies may be considered, with local and institutional COVID-19 policies and procedures for aerosol-generating and non-aerosolizing procedures serving as the primary source of guidance. The following considerations, which typically are included in facility policies and procedures, should be reviewed prior to performing ventilation studies:

  1. In general, patients should have documentation of a negative COVID-19 polymerase chain reaction (PCR) test; however, in some cases, local policies or regulations may be different.
  2. Technologists should wear appropriate personal protective equipment (PPE) when performing ventilation studies, according to local policies for the performance of aerosol-generating and non-aerosolizing procedures.
  3. Airflow in the room in which the ventilation studies are performed should be evaluated, which may help determine the required time for room turnover after the performance of a ventilation study.
  4. The availability and feasibility of administering ventilation agents—including FDA-approved agents such as 99mTc-DTPA and 133Xe gas and other non-FDA-approved agents, including but not limited to 99mTc-labeled ultra-fine carbon particles (e.g., Technegas™)—should be considered for performance of the ventilation study.
  5. It is recommended to engage local infection control groups for guidance and to help evaluate facilities, equipment and staff PPE use for performing ventilation studies.
  6. The approach to performing a ventilation scan in relation to the perfusion scan (i.e., ventilation then perfusion vs. perfusion then ventilation) should be considered on a case-by-case basis, according to the clinical indication and in consultation with the referring physician. 

SNMMI will continue to monitor the COVID-19 pandemic and provide updated information whenever possible.

Nuclear Medicine–Specific Information

NOTE: See next tab for recent articles on nuclear medicine and COVID-19.


COVID Forum

Nuclear Medicine Used for COVID
  • Radioimmunotherapy may help treat COVID-19 (June 16) 
    Monopar Therapeutics and NorthStar Medical Radioisotopes have announced a collaboration to develop potential radioimmunotherapeutics to treat severe COVID-19.

Nuclear Medicine Webinars
SNMMI COVID-19 Industry Partners Satellite Symposium Webinars
Nuclear Medicine Guidelines
COVID-Related Advocacy
Radioisotope Supply
Ventilation/Perfusion (V/Q) Studies

The Journal of Nuclear Medicine (JNM) 

Oncology-inspired treatment options for COVID-19  (Ahead of print)
NagaVaraKishore Pillarsetty, Lukas Carter, Jason S. Lewis, and Thomas Reiner

Low Dose Radiation to COVID-19 Patients to Ease the Disease Course and Reduce the Need of Intensive Care  (Ahead of print)Poul Flemming Høilund-Carlsen, Poul-Erik Braad, Oke Gerke, Kasper Karmark Iversen, and Werner Vach

Guidance and best practices for reestablishment of non-emergent care in nuclear cardiology laboratories during the coronavirus disease 2019 (COVID-19) pandemic: An information statement from ASNC, IAEA, and SNMMI (October 2020)Hicham Skali, Venkatesh L. Murthy, Diana Paez, Elisa M. Choi, Felix Y.J. Keng, McGhie A. Iain, Mouaz Al-Mallah, Roxana Campisi, Timothy M. Bateman, Ignasi Carrio, Rob Beanlands, Dennis A. Calnon, Vasken Dilsizian, Maurizio Dondi, Alessia Gimelli, Robert Pagnanelli, Donna M. Polk, Prem Soman, Andrew J. Einstein, Sharmila Dorbala, and Randall C. Thompson

Global Impact of COVID-19 on Nuclear Medicine Departments: An International Survey in April 2020  (September 2020)
Lutz S. Freudenberg, Diana Paez, Francesco Giammarile, Juliano Julio Cerci, Moshe Modiselle, Thomas N.B. Pascual, Noura El-Haj, Pilar Orellana, Ignasi Carrio, Stefano Fanti, Cristina Sebastiao Matushita, Yaroslav Pynda, and Ken Herrmann

The Impact of COVID‐19 on the Health‐Care Workforce: From Heroes to Zeroes? (August 2020)
Johannes Czernin

Peptide Receptor Radionuclide Therapy (PRRT) During the COVID-19 Pandemic: Are There Any Concerns?  (August 2020Lisa Bodei, Emily K. Bergsland, Wouter K. de Herder, Diego Ferone, Rodney J. Hicks, Thomas A. Hope, Jolanta A. Kunikowska, Marianne Pavel, Diane L Reidy-Lagunes, Jens Siveke, Jonathan R. Strosberg, Ulf Dittmer and Ken Herrmann

Overcoming the COVID-19 Crisis and Planning for the Future (August 2020)
Steven H LoGiudice, Allison Liebhaber, and Heiko Schöder

COVID-19 and Pulmonary Embolism: Diagnostic Imaging Trends (August 2020) 
Sedighe Karimzadeh, Akshay Raut, and Huy Nguyen Tien

Guidance and Best Practices for Nuclear Cardiology Laboratories During the Coronavirus Disease 2019 (COVID-19) Pandemic: An Information Statement from ASNC and SNMMI (June 2020)
Hicham Skali, Venkatesh L. Murthy, Mouaz H. Al-Mallah, Tim M. Bateman, Rob Beanlands, Nathan Better, Dennis A. Calnon, Vasken Dilsizian, Alessia Gimelli, Robert Pagnanelli, Donna M. Polk, Prem Soman, Randall C. Thompson, Andrew J. Einstein, and Sharmila Dorbala

Yttrium-90 Radioembolization: Telemedicine During the COVID-19 Outbreak, Opportunity for Prime Time (June 2020)
Lawrence Han Hwee Quek, Anbalagan Kannivelu, and Uei Pua

The role of Nuclear Medicine for COVID-19 – Time to Act Now (June 2020)
Freimut D Juengling, Antonio Maldonado, Frank Wuest, and Thomas Hellmut Schindler

Dr. Li Wenliang and the Time of COVID-19 (May 2020)
Johannes Czernin

Nuclear Medicine Operations in the Times of COVID-19: Strategies, Precautions and Experiences (May 2020)
Johannes Czernin, Stefano Fanti, Philipp T. Meyer, Martin Allen-Auerbach, Marcus Hacker, Mike Sathekge, Rodney Hicks, Andrew M. Scott, Jun HatazawaMijin Yun, Heiko Schöder, Peter Bartensteinand Ken Herrmann

Incidental Findings Suggestive of COVID-19 in Asymptomatic Patients Undergoing Nuclear Medicine Procedures in a High Prevalence Region (May 2020)
Domenico Albano, Francesco Bertagna, Mattia Bertolia, Giovanni Bosio, Silvia Lucchini, Federica Motta, Maria Beatrice Panarotto, Alessia Peli, Luca Camoni, Frank M. Bengel, and Raffaele Giubbini

Diagnostic Evaluation of Pulmonary Embolism During the COVID-19 Pandemic (May 2020)
Lionel S. Zuckier, Renée M. Moadel, Linda B. Haramati, and Leonard Freeman 


Journal of Nuclear Medicine Technology (JNMT)
 

Nuclear Medicine Clinical Practice in the United States During the COVID-19 Era and Beyond (September 2020)
Gail A. McFarland and Sara G. Johnson

Post–COVID-19 New Normal for Molecular Imaging Departments: A United Kingdom Perspective (September 2020)
Jessica Williams, Emma Meadows, and Manrita Singh

Post–COVID-19 New Normal for Nuclear Medicine Practice: An Australasian Perspective (September 2020) 
Geoff Currie

Coronavirus (COVID-19) Pandemic: What Nuclear Medicine Departments Should Know (June 2020) 
Gopinath Gnanasegaran, Hian Liang Huang, Jessica Williams, and Jamshed Bomanji

From One Technologist to Another – COVID-19 Questions Answered (June 2020) 
Dmitry D. Beyder, Mark H. Crosthwaite, James Crowley, Lyndsi M. Hay, Kimberly Kerrylin Jackson, Nancy McDonald, Lynne T. Roy, Tricia Peters, and Nikki Wenzel-Lamb

Divide and Conquer: Strategies to Manage a Nuclear Medicine Department during COVID‐19 (June 2020)
Wei Y Tham, Aaron KT Tong, Kelvin SH Loke, Liyi Chio, Gabriel KY Lim, Xin Y Seah, David CE Ng, Sean XX Yan, Winnie WC Lam

Uptake

Lung Scintigraphy in the Era of COVID-19 and Chronic Thromboembolic Pulmonary Hypertension (May 8)
J. Anthony Parker, MD, PhD, and Kevin J. Donohoe, MD

Other Nuclear Medicine Journals

Added value of 18F-FDG PET/CT in a SARS-CoV-2-infected complex case with persistent fever (May 16, ahead of print)
Christel H. Kamani, Mario Jreige, Martin Pappon, Arnaud Fischbacher, Olivier Borens, Pierre Monney, Marie Nicod Lalonde, Niklaus Schaefer, and John O. Prior 

Key elements of preparedness for pandemic coronavirus disease 2019 (COVID-19) in nuclear medicine units (April 21 ahead of print)
Majid Assadi, Ali Gholamrezanezhad, Narges Jokar, Mohsen Keshavarz, Maria Picchio, Ettore Seregni, Emilio Bombardieri, and Arturo Chiti

Training and Certification

American Association of Physicists in Medicine

  • All AAPM in-person meetings, plans for AAPM funded travel and meetings of other groups at HQ are to be canceled through April 30, 2020. Find more information here.
  • Update for graduate program directors regarding recent developments in graduate medical physics education in response to the COVID-19 pandemic. (March 18)

American Board of Medical Specialties (ABMS)

  • ABMS reaffirms support for physicians to focus their priorities on patients, families, and the communities they serve. (March 26)

American Board of Nuclear Medicine (ABNM)

American Board of Radiology 

American Board of Science in Nuclear Medicine

  • The ABSNM currently plans to give the General and Specialty Examinations as scheduled on June 12, 2020 in New Orleans, Louisiana. See more updates here.

American Registry of Radiologic Technologists (ARRT)

  • ARRT COVID-19 Update: ARRT is closely monitoring the COVID-19 pandemic and how it could affect students and RTs. RTs who have questions related to their postprimary eligibility pathway requirements, renewals, CQR, or other issues should log on to their online accounts first to see if they’ve received an update specific to their concerns.  

American Society of Radiologic Technologists (ASRT)

JRCNMT

  • The JRCNMT is closely monitoring the latest information regarding the COVID-19 virus and considering its potential impact on programs and site visits. Find information here.

Nuclear Medicine Technology Certification Board (NMTCB)


Resources for Residents

Resources for Students

Government Resources

World Health Organization (WHO)

Centers for Disease Control and Prevention (CDC)

Centers for Medicare and Medicaid Services (CMS)

Department of Defense

Department of Health and Human Services (HHS) Office for Civil Rights (OCR)

Food and Drug Administration (FDA)

National Academy of Medicine (NAM)

National Cancer Institute (NCI)

National Institutes of Health (NIH)

National Science Foundation

Nuclear Regulatory Commission

Other Resources

American College of Physicians

American College of Radiology

American Medical Association

Association of American Medical Colleges

COVID-19 Data Websites

DOTmed

ECRI

Elsevier Novel Coronavirus Information Center

European Association of Nuclear Medicine (EANM)

International Atomic Energy Agency (IAEA)

MIM Software

  • During the pandemic, MIM Software is making free licenses available to its users so they can work from home. Request a license.

North American Neuroendocrine Tumor Society (NANETS)

Radiological Society of North America (RSNA)


Sterilizing Masks for Reuse

These articles may be helpful if you need to stretch your supply of respirators. See also ECRI video above and CDC article under Government Resources tab. Please note: Several of these articles are preprints and have not yet been peer reviewed. Accordingly, they are provided for informational purposes only and should not be used to guide clinical practice.



SNMMI National Office Status

All in-person events sponsored by the society, including the SNMMI Board of Directors meeting, are now held virtually. With our extensive experience in hosting webinars and online meetings, we are confident that these virtual functions will prove both effective and engaging, furthering our goal of improving human health through nuclear medicine, molecular imaging and radionuclide therapy.

We have taken appropriate precautions to keep our leadership and staff safe. We have cancelled all non-essential travel and limited in-person meetings. Staff are working remotely, and the society remains 100% operational and ready to serve you. This means you can still access any and all online services and call or email with membership and customer service related inquiries.



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Please contact us with any issues or questions at covidhelp@snmmi.org, and we will do everything within our power to assist.