Global Nuclear Medicine Community Shares COVID-19 Strategies and Experiences

April 1, 2020

In an effort to provide safer working environments for nuclear medicine professionals and their patients, clinics across five continents have shared their approaches to containing the spread of COVID-19 in a series of editorials, published ahead of print in The Journal of Nuclear Medicine. This compilation of strategies, experiences and precautions is intended to support nuclear medicine clinics as they make decisions regarding patient care.

Dr. Li Wenliang and the Time of COVID-19

Johannes Czernin

• Nuclear medicine clinics are usually very safe, low-risk, low-stress environments. This has changed now as each patient can be infected, and staff members can be asymptomatic carriers or become symptomatic while providing services. 
  
  

Imaging Clinic Operations in the Times of COVID-19: Strategies, Precautions and Experiences

Johannes Czernin, Stefano Fanti, Philipp T. Meyer, Martin Allen-Auerbach, Marcus Hacker, Mike Sathekge, Rodney Hicks, Andrew M. Scott, Jun Hatazawa, Mijin Yun, Heiko Schöder, Peter Bartenstein, and Ken Herrmann

• An overview of different approaches from leading nuclear medicine experts for containing the spread of the COVID-19 virus to help support your decision making.
  
  

Incidental Findings Suggestive of COVID-19 in Asymptomatic Patients Undergoing Nuclear Medicine Procedures in a High Prevalence Region

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

• For patients undergoing essential nuclear medicine procedures, incidental findings can suggest signs of COVID-19.
  
  

Diagnostic Evaluation of Pulmonary Embolism During the COVID-19 Pandemic 

Lionel S. Zuckier, Renée M. Moadel, Linda B. Haramati, and Leonard Freeman 

• Recommendations for ventilation/perfusion scintigraphy during the COVID-19 pandemic. 

NEW:
Guidance and Best Practices for Nuclear Cardiology Laboratories during the Coronavirus Disease 2019 (COVID-19) Pandemic: An Information Statement from ASNC and SNMMI [Preprint]

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

• In this Information Statement, SNMMI and the American Society of Nuclear Cardiology (ASNC) address the practice of nuclear cardiology in the setting of the current COVID-19 pandemic, reflecting the perspectives of diverse practices across the United States and worldwide.

From the SNMMI and SNMMI-TS Presidents: New COVID-19 Resources for Members (April 3)

A Message from the SNMMI-TS President (March 31)

From the SNMMI President: SNMMI Announces COVID-19 Resource Center (March 27)

From the SNMMI President: SNMMI: Standing with You Against COVID-19 (March 19)

From the SNMMI President: Mo-99 Supply Chain Update (March 16)

Nuclear Medicine–Specific Information

Physician Access to PPE

• SNMMI Encourages Legislators To Ensure Accessibility to PPE (3-26-20) SNMMI joined other diagnostic imaging societies in calling on the president of the United States to ensure an adequate supply of personal protective equipment.

Ventilation/Perfusion (V/Q) Studies

• COVID-19 and Ventilation/Perfusion (V/Q) Lung Studies — SNMMI statement regarding ventilation/perfusion (V/Q) lung scans and the risk inherent in the V/Q scan for spread of COVID-19 to patients and staff alike. 

Radioisotope Supply

• New: NMEu: COVID-19 and the Global Supply of Isotopes (March 30) — Mo-99 supply interrupted by cessation of international flights by South Africa; ANSTO has resumed production. 
• Communication from the NMEu Emergency Response Team (March 24) — Production, processing and transportation are moving forward; some concerns about access to international flights.
• SNMMI Letter to Dutch Ministries—Mo-99 Supply  (March 23) —SNMMI requests the Dutch Ministry of Infrastructure and Water Works to allow the airline KLM to carry radioactive material during the COVID-19 crisis to help ensure a reliable supply of Mo-99. 
• Mo-99 Supply Update (March 16) — SNMMI President Vasken Dilsizian, MD, released a statement addressing how the COVID-19 pandemic may affect the supply of Mo-99. 

From The Journal of Nuclear Medicine (JNM) 

Dr. Li Wenliang and the Time of COVID-19

Johannes Czernin

• Nuclear medicine clinics are usually very safe, low-risk, low-stress environments. This has changed now as each patient can be infected, and staff members can be asymptomatic carriers or become symptomatic while providing services. 

Imaging Clinic Operations in the Times of COVID-19: Strategies, Precautions and Experiences

Johannes Czernin, Stefano Fanti, Philipp T. Meyer, Martin Allen-Auerbach, Marcus Hacker, Mike Sathekge, Rodney Hicks, Andrew M. Scott, Jun Hatazawa, Mijin Yun, Heiko Schöder, Peter Bartenstein, and Ken Herrmann

• An overview of different approaches from leading nuclear medicine experts for containing the spread of the COVID-19 virus to help support your decision making.
  

Incidental Findings Suggestive of COVID-19 in Asymptomatic Patients Undergoing Nuclear Medicine Procedures in a High Prevalence Region

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

• For patients undergoing essential nuclear medicine procedures, incidental findings can suggest signs of COVID-19.

Diagnostic Evaluation of Pulmonary Embolism During the COVID-19 Pandemic 

Lionel S. Zuckier, Renée M. Moadel, Linda B. Haramati, and Leonard Freeman 

• Recommendations for ventilation/perfusion scintigraphy during the COVID-19 pandemic. 

Government Resources

World Health Organization (WHO)

• Coronavirus Disease Technical Guidance
• Advice on the use of masks
• Considerations for stopping laboratory activities
• Considerations for stopping clinical research activities

Centers for Disease Control and Prevention (CDC)

• Information for Healthcare Professionals
• Healthcare Infection Prevention and Control FAQs (PPE guidance for healthcare workers — April 1) New
• Interim Infection Prevention Guidelines (March 19, 2020)
• Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States(Feb. 29, 2020)
• Resources for Clinics and Healthcare Facilities
• Prepare to Care for COVID-19: Get Your Practice Ready
• Healthcare Supply of Personal Protective Equipment
• Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19)
• Sequence for Putting On Personal Protective Equipment

Centers for Medicare and Medicaid Services (CMS)

• CMS relief for providers participating in quality reporting programs
• CMS Releases Recommendations on Non-Essential Medical Procedures During COVID-19 Response (March 18, 2020)
• CMS Coronavirus Response

Department of Defense

• COVID-19 FAQs for Grant Applicants and Recipients (Version 2, March 25, 2020)

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

• Notification of Enforcement Discretion for Telehealth

Food and Drug Administration (FDA)

• FDA Coronavirus Disease 2019
• FDA Guidance on Clinical Trials
• FDA: Guidance to Increase Availability of Ventilators

National Academy of Medicine (NAM)

• Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2

National Cancer Institute (NCI) New

• Coronavirus: Guidance for Cancer Researchers

National Institutes of Health (NIH)

• NIH Coronavirus Disease 2019 Center
• NIH Guidance on Grants, Operations During COVID-19 Response
• Information for NIH Applicants and Recipients of NIH Funding

National Science Foundation

• Impact on Existing Deadline Dates (NSF) 
• FAQs About COVID-19 for NSF Proposers and Awardees

Other Resources

American College of Physicians New

• Coronavirus Disease 2019 (COVID-19): Information for Internists

American Medical Association

• A Physician’s Guide to COVID-19
• COVID-19 Resource Center for Physicians

Association of American Medical Colleges

• AAMC Guidance on Medical Students' Clinical Participation

COVID-19 Data Websites

• live — Live global data about COVID-19
• COVID-19 in the US and Canada (includes state and county-level data)

ECRI

• COVID-19 and Medical Devices: Safe Respirator Usage When Supplies Are Short New

Elsevier Novel Coronavirus Information Center

• Free health and medical research on COVID-19

European Association of Nuclear Medicine (EANM)

• COVID-19 Information Centre

MIM Software

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

References Related to Sterilizing Masks for Reuse New

These articles may be helpful if you need to stretch your supply of respirators. See also ECRI video above. 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.

• N95 Filtering Facepiece Respirator Ultraviolet Germicidal Irradiation (UVGI) Process for Decontamination and Reuse
  John J Lowe, Katie D Paladino, Jerald D Farke, Kathleen Boulter, Kelly Cawcutt, Mark Emodi, Shawn Gibbs, Richard Hankins, Lauren Hinkle, Terry Micheels, Shelly Schwedhelm, Angela Vasa, Michael Wadman, Suzanne Watson, and Mark E Rupp
  
  

• Evaluation of Five Decontamination Methods for Filtering Facepiece Respirators
  Dennis J. Viscusi, Michael S. Bergman, Benjamin C. Eimer, Ronald E. Shaffer
  
  

• What are good ways to address the shortage of face masks by anesthesiologists?
  Amy Price, DPhil (Oxon) and Larry Chu, MD, on behalf of the Stanford AIM Lab and Learnly COVID-19 Evidence Service
  
  

• Stability of SARS-CoV-2 in different environmental conditions
  Alex Chin, Julie Chu, Mahen Perera, Kenrie Hui, Hui-Ling Yen, Michael Chan, Malik Peiris, Leo Poon
  
  

• UV Sterilization of Personal Protective Equipment with Idle Laboratory Biosafety Cabinets During the COVID-19 Pandemic
  Theory Division, Cleveland Clinic Lerner Research Institute, Kyle J Card, Dena Crozier, Andrew Dhawan, Mina Dinh, Emily Dolson, Nathan Farrokhian, Vishhvaan Gopalakrishnan, Emily Ho, Eshan S King, Nikhil Krishnan, Gleb Kuzmin, Jeff Maltas, Julia Pelesko, Jessica A Scarborough, Jacob G Scott, Geoff Sedor, Davis T Weaver

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)

• NM Program Directors: COVID-19 Impact on Nuclear Medicine Training Programs (March 25, 2020)
• Diplomates: COVID-19 and Adjustments to CertLink (March 24, 2020)
• NM Program Directors: Modification of ABNM Leave Policy for COVID-19 (March 12, 2020)

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)

• COVID-19 Resources for Radiologic Technologists and Students: ASRT is closely monitoring the COVID-19 situation. ASRT is providing resources to help radiologic technologists and students adapt to this challenge.

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)

• Information from NMTCB for certified technologists, NMT educators, students, and exam applicants.

Resources for Residents

• ACGME Information for Residents and Fellows

2020 Annual Meeting Status

Much like you, the SNMMI leadership has been closely following the rapidly evolving COVID-19 situation—monitoring the latest recommendations provided by the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to help address its inevitable impact on the nuclear medicine and molecular imaging community.

We are aware that many of your organizations now have temporary travel policies in place to best protect the health of your patients, as well as yours and that of your staff. Given the importance of your work, we are pleased to hear of this quick response being implemented to help limit any outbreak at your institutions, as well as limiting exposure to any patient populations.

We also understand that because of the critical work you do, providing you with unparalleled learning opportunities to examine the latest research and clinical applications helping transform medicine and improve lives remains essential.

So, despite these uncertainties we are currently planning to hold the SNMMI 2020 Annual Meeting as scheduled, June 13-16 in New Orleans. We are also exploring multiple alternate scenarios that will allow us to move forward with producing a positive, enriching Annual Meeting experience. We recognize the situation remains fluid for families and organizations as healthcare officials and governments continue to work to contain this outbreak and we will continue to adjust, as needed.

Public safety is of the utmost importance and SNMMI will make any and all decisions related to this health crisis with that as our guiding principal. To keep you informed, this page will be updated frequently as new information becomes available.

We thank you for your patience and understanding while we explore the best possible solutions to serve you and the nuclear medicine and molecular imaging community during this challenging time.

Warm Regards,

Vasken Dilsizian, MD
SNMMI President