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