By
Randall L. Bursaw, BSc., RTNM, CNMT ,
Manager, Clinical Sciences - Jubilant Radiopharma
The COVID-19 pandemic has made a significant impact on every aspect of life across the globe. Particularly in the early days of the pandemic when there was very little information available on how to protect people who were at the highest risk of exposure – our front line healthcare workers. In response, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) issued a guidance on March 19, 2020, regarding V/Q lung scans and the inherent risk of the spread of COVID-19 to patients and staff related to the ventilation portion of the study.
As a result, most Nuclear Medicine departments across the U.S. opted not to perform the ventilation portion of the V/Q scan, and in many cases opted not to perform V/Q imaging at all.
As more information became available the SNMMI released an updated statement on September 3, 2020 noting that since March 2020, the COVID-19 pandemic had evolved differently in various regions of the world and, with increased availability of COVID-19 PCR testing, resumption of ventilation studies could be considered in some clinical scenarios. Since then sites have slowly been returning to performing the full V/Q scan.
More recently, on March 28, 2021, the SNMMI revised their statement again understanding that V/Q imaging in its entirety is clinically necessary to help diagnose lung disease, including vascular and airway disease. These guidelines state1:
1. Consideration should be given to a COVID-19 PCR test, depending on local policies or institutional guidelines.
2. When performing ventilation studies, technologists should wear appropriate personal protective equipment (PPE) in accordance with local policies.
3. Airflow of the room in which the ventilation studies are performed should be evaluated, which may help to determine the required time for room turnover after the performance of a ventilation study.
4. The selection of the appropriate agent for the ventilation study should be carefully considered.
5. Local infection control groups should be engaged for guidance and to help evaluate facilities, equipment, and staff PPE necessary to safely perform 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 according to the clinical indication and consultation with the referring physician may be advisable.
Jubilant Radiopharma supports the SNMMI’s most current guidelines and the use of a full V/Q imaging procedure.
There are many criteria to consider for ventilation agents. For planar acquisition Xenon-133 and for planar/SPECT acquisition Tc-99m DTPA and Tc-99m carbon labeled particles provide acceptable results. We also recommend that facilities take into consideration that that there is no 100% closed system. All aerosolized delivery systems, including carbon labeled particles, have the potential for leakage. In fact, a recent study found that 64% of subjects produced significant airborne contamination with carbon labeled particles.2
It is important to utilize best practices when performing advanced functional lung imaging. Proper administration of the ventilation imaging agent is a key factor that can contribute to the reduction of exposure to the COVID-19 virus. We advise sites to contact their nebulizer supplier to understand these proper administration techniques to ensure the safety of their staff and their patients. For more information on these techniques please visit:
MediNuclear Insta/Vent™ Plus
Bidex Venti-Scan™ IV & AeroTech™
Amici Swirler®
References: 1. SNMMI Guidelines 2. C Mayes, Safe practice ventilation technique in lung scanning for pulmonary embolism, Nuclear Medicine Communications 2020, 41:1328–1333