Updated Ventilation and Perfusion Study COVID-19 Guidance

New guidance from the Society of Nuclear Medicine & Molecular Imaging (SNMMI) has been released to guide providers to safely perform ventilation and perfusion lung scans during the continuing COVID-19 outbreak.

Initial guidance from SNMMI released at the advent of the outbreak instructed providers to review the policies of their local healthcare facilities before conducting these exams, as well as confirm the patient’s COVID-19 status. The organization has now released updated guidance that reflects how the virus has continued to morph.

“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,” SNMMI said in a Sept. 3 statement. “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.”

In its statement, the organization outlined six considerations for providers before they conduct these exams:

• Patients should have documentation of a negative RT-PCR test for COVID-19 (though some local policies may differ).
• Technologists must wear appropriate personal protective equipment (PPE) with ventilation studies.
• Ventilation room airflow should be evaluated prior to any studies to determine the time needed for room turnover after a ventilation study.
• Consider the availability and feasibility of administering ventilation agents, including Food & Drug Administration (FDA)-approved agents (^99mTc-DTPA, ¹³³Xe gas) and other non-FDA-approved agents (^99mTc-labeled ultra-fine carbon particles), prior to ventilation study performance.
• Engage local infection control groups for guidance and help in evaluating facilities, equipment, and staff PPE use before performing ventilation studies.
• Consider whether to perform a ventilation-then-perfusion study or perfusion-then-ventilation study on a case-by-case basis. Base the decision on the clinical indication and consultation with the referring physician.