Impact of COVID-19 on nuclear medicine in the UK

Myocardial Perfusion SPECT and ATTR imaging 2021 in Germany: Results of the 9th Survey

AIM

This paper presents the results of the 9th survey of myocardial perfusion SPECT (MPS) from the reporting year 2021.

METHODS

218 questionnaires (131 practices (PR), 58 hospitals (HO), 29 university hospitals (UH)) were evaluated. Results of the last survey 2018 are set in squared brackets.

RESULTS

MPS data from a total of 133,057 [145,930] patients (-8.8%) with 131,868 [143,707] stress and 106,546 [121,899] rest MPS were analysed. A comparison with official data revealed that 54% all MPS were recorded. From 2018 to 2021, official data showed a every year an increase in MPS numbers. On average, 610 [502] MPS patients (+22%) were examined in each department. 74% [69%] of the responders reported an increase or no changes in their MPS patient numbers. Ambulatory care cardiologists represented as always, the mayor referral group (68% [69%]). For the first time, pharmacological stress was more frequently applied than ergometry (42% [51]). Regadenoson was mostly used. The use of the different protocols remained nearly unchanged. Two-day protocols were predominantly applied (49% [48%]). A shift from multi-headed cameras (58% [72%]) to SPECT-CT systems (24% [17%]) was found. Attenuation correction was performed in 33% [26%] of all MPS. 88% [86%] of all stress, 88% [87%] of all rest and 87% [83%] of all stress and rest MPS were acquired as gated SPECT. 72% [67%] of all departments performed scoring by default. The number of departments without scoring decreased to 13% [16%].

CONCLUSIONS

The MPS Study 2021 shows that the long-term positive development of MPS imaging in Germany is continuing. The COVID-19 pandemia did not change this trend. The procedural and technical details of MPS imaging reveal a high level of guideline conformity.

Myocardial perfusion SPECT in Germany from 2012 to 2021: insights into development and quality indicators

PURPOSE

This paper summarises the results of 4 national surveys on the numbers, utilisation and technique of myocardial perfusion SPECT (MPS) from 2012 to 2021.

METHODS

A one-page questionnaire for information on MPS in 2012, 2015, 2018 and 2021 was sent to German centres practising nuclear medicine. To check for representativeness, the numbers obtained were related to official annual data and furthermore to the numbers of invasive coronary angiography procedures (ICA).

RESULTS

MPS examinations increased by > 40% from 2012 to 2021 and showed a centralisation with increasing MPS per centre. In 2020, a mild impact of the COVID-19 pandemic could be observed in the form of only a slight MPS increase, which was compensated in the following year. Outpatient care cardiologists represent the most important referrer (70%). Mostly, 2-day protocols were used. One-day protocols and stress-only protocols showed insignificant changes. The use of exercise stress decreased steadily. In 2021, exercise stress was replaced by pharmacological stress as the most frequent stress modality. Camera systems showed a shift to more SPECT-CT systems. The use of gated SPECT increased to almost 90%. Quantitative scoring showed an increasing acceptance. The ratio of invasive coronary angiographies (ICA) to MPS was between 3.9 and 4.5. A significant proportion of ICA in the context of CCS (chronic coronary syndrome) was performed without prior testing for ischaemia.

CONCLUSION

The 2012 to 2021 MPS surveys reveal a continuously growing number of examinations with only a mild temporary effect of the COVID-19 pandemic and a centralisation with increasing numbers per centre. Performance and technical data reveal a high-grade adherence of MPS practice to the current ESC guideline. A large potential of non-invasive diagnostics remains for the future.

The Impact of COVID-19 on Nuclear Medicine in Europe

The COVID-19 pandemic has profoundly changed hospital activities, including nuclear medicine (NM) practice. This review aimed to determine and describe the impact of COVID-19 on NM in Europe and critically discuss actions and strategies applied to face the pandemic. A literature search for relevant articles was performed on PubMed, covering COVID-19 studies published up until January 21, 2021. The findings were summarized according to general and specific activities within the NM departments. The pandemic strongly challenged NM departments: a reduction in the workforce has been experienced in almost every center in Europe due to personnel diagnosed with COVID-19 and other reasons related to the coronavirus. NM departments introduced procedures to limit COVID-19 transmission, including environmental and personal hygiene, social distancing, rescheduling of non-high-priority procedures, the correct use of personal protective equipment, and prompt identification of suspect COVID-19 cases. A proportion of the departments experienced a delay in radiopharmaceuticals supply or technical assistance during the pandemic. Furthermore, the pandemic resulted in a significant reduction of diagnostic and therapeutic NM procedures, as well as a reduced level of care for patients affected by diseases other than COVID-19, such as cancer or acute cardiovascular disease. Telemedicine services have been set up to maintain medical assistance for patients. COVID-19 pandemic has reshaped human work resources, patient's diagnostic and therapeutic management, operative models, radiopharmaceutical supplies, teaching, training and research of NM departments. Limits of availability of resources emerged. Nonetheless, we have to provide continuity in care, especially for fragile patients, maintaining infection control measures. Challenges that have been faced should reshape our vision and get us prepared for the future.

Impact of the COVID-19 Pandemic on Radiology in Inpatient and Outpatient Care in Germany: A Nationwide Survey Regarding the First and Second Wave

OBJECTIVES

To find out the opinion of radiological inpatient and outpatient medical staff regarding the measures taken in relation to the COVID-19 pandemic during the first and second waves and to identify the measures that are still perceived as needing improvement.

MATERIALS AND METHODS

We conducted an anonymous online survey among more than 10 000 radiologists/technicians in Germany from January 5 to January 31, 2021. A total of 862 responses (head physicians, n = 225 [inpatient doctors, n = 138; outpatient doctors, n = 84; N/A, n = 3]; radiologic personnel, n = 637 [inpatient doctor, n = 303; outpatient doctor, n = 50; inpatient technician, n = 217; outpatient technician, n = 26; N/A, n = 41]) were received. Questions of approximation, yes/no questions, and Likert scales were used.

RESULTS

During the first/second wave, 70 % (86/123)/43 % (45/104) of inpatient and 26 % (17/66)/10 % (5/52) of outpatient head physicians agreed that they received financial support from the authorities but the majority rated the financial support as insufficient. During the first and second wave, 33 % (8/24) and 80 % (16/20) of outpatient technicians agreed that they were adequately provided with personal protective equipment. The perceived lack of personal protective equipment improved for all participants during the second wave. Inpatient [outpatient] technicians perceived an increased workload in the first and second wave: 72 % (142/198) [79 % (19/24)] and 84 % (146/174) [80 % (16/20)].

CONCLUSION

Technicians seem increasingly negatively affected by the COVID-19 pandemic in Germany. Financial support by the competent authorities seems to be in need of improvement.

KEY POINTS

· The accessibility of personal protective equipment resources improved in the second wave.. · In particular, radiology technicians seem increasingly negatively affected by the COVID-19 pandemic.. · Financial and consulting support from the government could be improved..

CITATION FORMAT

· Bernatz S, Afat S, Othman AE et al. Impact of the COVID-19 Pandemic on Radiology in Inpatient and Outpatient Care in Germany: A Nationwide Survey Regarding the First and Second Wave. Fortschr Röntgenstr 2022; 194: 70 - 82.

COVID-19 Pandemic: What Have We Learned and What to Expect in the Future?

The COVID-19 pandemic resulted in an unprecedented and unexpected challenge for societies and healthcare systems, including nuclear medicine providers. This article summarizes the major events imposed on nuclear medicine by COVID-19 from a global perspective, focuses on the major lessons learned regarding attitude, medical procedures, organizational implications and strategical considerations, and then discusses what to expect (and how to prepare) for the future. While the look back to what has happened is clearly evidence based, the look ahead and the conclusions drawn require the disclaimer of only representing the personal opinion and prediction of the authors. The COVID-19 pandemic relentlessly revealed deficiencies on an organizational, systematic and leadership level in nuclear medicine and beyond. Crisis gives us the opportunity to learn and furthermore perpare for the future. The authors’ take home messages include the recommendation to focus on developing a culture of responsibility and ownership as opposed to blame, strengthening teams and communication, adapting existing structures based on the lessons learned during COVID-19, as well as establishing an environment of active decision making, prioritizing proposal of solutions rather than simply stating problems, incentivizing support and collaboration, not opposition.

[Impact of COVID-19 on Nuclear Medicine Procedures in Germany 2020 - Results of a National Survey]

INTRODUCTION

 The COVID-19 pandemic imposed an unimaginable challenge to the healthcare systems worldwide. This online survey captured the impact of the COVID-19 pandemic on nuclear medicine services in Germany comparing 2020 to 2019.

MATERIALS AND METHODS

 A web-based questionnaire was developed to record the 2020 numbers of nuclear medicine procedures and, in particular, the change compared with 2019. The changes in nuclear medicine diagnostics and therapy were queried, as well as the extent to which "Coronavirus SARS-CoV-2" recommendations provided by the DGN were implemented.

RESULTS

 91 complete responses were recorded and evaluated. This corresponds to about 20 % of all German nuclear medicine facilities. Nuclear medicine diagnostic tests showed a decrease in scintigraphies for thyroid (15.9 %), bone (8.8 %), lung (7.6 %), sentinel lymph nodes (5.5 %), and myocardium (1.4 %) with small increases in PET/CT examinations (1.2 %) compared with 2019. Among nuclear medicine therapies, reductions were highest for benign indications (benign thyroid 13.3 %, RSO 7.7 %), while changes from 2019 were less pronounced for malignant indications (PRRT: + 2.2 %, PSMA: + 7.4 %, SIRT: -5.9 %, and RJT for thyroid carcinoma -2.4 %). The DGN recommendations for action were fully or partially applied in 90 %.

CONCLUSIONS

 The initial significant reduction in nuclear medicine procedures in the first three weeks of the COVID-19 pandemic did not continue, but there was no compensation of the previously not performed services. The decrease in diagnostics and therapy procedures of benign diseases was particularly severe.