Nuclear medicine physicians at Mount Sinai Hospital discuss the challenges they experienced during the peak of COVID-19 and how they adapted their roles to address it.
Nuclear medicine physicians break down COVID-19 game plan at SNMMI
July 15, 2020
by John R. Fischer, Senior Reporter
Prior to the pandemic, Dr. Anthony Hafez saw, on average, one nuclear scan a week that showed a patient’s cancer progressing. But that all changed when COVID-19 hit, as scan volumes dropped off, nonessential exams were delayed, and only urgent cases were seen.
“I remember one day specifically,” the incoming chief resident in nuclear medicine at Mount Sinai Hospital in New York recounted in a virtual special session at the 2020 Society of Nuclear Medicine and Molecular Imaging conference. “We were reading PET/CTs, about 15 or 16 scans. Every single one of them had progression of disease.”
Not only did caseloads change, but exam protocols also changed in order to mitigate risk of spreading infection. To address the situation, the nuclear medicine physicians at Mount Sinai adopted a number of new policies, including the elimination of lung ventilation scanning to eliminate risk of exposure from aerosolized secretions.
“We used chest X-rays as the triaging method,” said Dr. Munir Ghesani, chief of nuclear medicine and vice chair of radiology at Mount Sinai. “We required the most recent chest X-ray. If the chest X-ray was clear, we did not hesitate in adopting the provision-only policy. If the chest X-ray was abnormal, then we went deeper into it, including looking at the infiltrate, whether that infiltrate was ground glass or a more solid geographic consolidation, especially in the lower lobes, which would create more significant problems with assessment using lung scans performed under provision only. For those, we had one-on-one discussion with the clinicians.”
The nuclear medicine department also implemented infection controls to be followed after seeing a patient; scheduled appointments to promote low census; staggered shifts to reduce contact among individuals; modified procedures requiring the removal of patient face masks when non-urgent care resumed; and removed unnecessary items or equipment from rooms that increased the potential for surface contamination.
Another change was the use of telemedicine, which was implemented to conduct virtual visits to continue radioactive iodine therapy and peptide receptor radionuclide therapy for patients, and to allow radiologists to work from home so as to reduce the number of people in reading rooms. Radiologists were given a list of requirements for what their computers needed to read scans at home.
Technologists also would not enter the reading room, instead calling in to request images to be reviewed. The department coordinated with others to ensure COVID information from medical records and radiology information systems for relevant patients were exported to nuclear medicine procedure requests.
“This appeared as an alert on the requisitions, which then allowed the technologist to act promptly and efficiently,” said Dr. Maria DaCosta, supervisor in nuclear medicine at Mount Sinai.
She adds that a staff wellness program was set up with mental health support; childcare resources; complimentary hotel accommodations, parking, meals and transportation; on-site wellness rooms for staff; and reductions in staff work weeks to four days.
A phased approach has also been put in place to reintroduce outpatient imaging procedures from hospital clinics and practices and the external provider community. In addition, the hospital and nuclear medicine department are both planning a “transformation” back to full operations pre-COVID.
“This is a significant milestone and signs of progress,” said DaCosta. “Despite great hope, things will not be the same as before the pandemic. We cannot expect to go back to the way things were but to move to the future with a new normal. How that will work and look is still evolving. This pandemic has reinforced all these required changes throughout the world. By considering what changes are necessary and planning for them, nuclear medicine will be better positioned to address patient and community needs and thrive in what will be a new world.”
“I remember one day specifically,” the incoming chief resident in nuclear medicine at Mount Sinai Hospital in New York recounted in a virtual special session at the 2020 Society of Nuclear Medicine and Molecular Imaging conference. “We were reading PET/CTs, about 15 or 16 scans. Every single one of them had progression of disease.”
Not only did caseloads change, but exam protocols also changed in order to mitigate risk of spreading infection. To address the situation, the nuclear medicine physicians at Mount Sinai adopted a number of new policies, including the elimination of lung ventilation scanning to eliminate risk of exposure from aerosolized secretions.
“We used chest X-rays as the triaging method,” said Dr. Munir Ghesani, chief of nuclear medicine and vice chair of radiology at Mount Sinai. “We required the most recent chest X-ray. If the chest X-ray was clear, we did not hesitate in adopting the provision-only policy. If the chest X-ray was abnormal, then we went deeper into it, including looking at the infiltrate, whether that infiltrate was ground glass or a more solid geographic consolidation, especially in the lower lobes, which would create more significant problems with assessment using lung scans performed under provision only. For those, we had one-on-one discussion with the clinicians.”
The nuclear medicine department also implemented infection controls to be followed after seeing a patient; scheduled appointments to promote low census; staggered shifts to reduce contact among individuals; modified procedures requiring the removal of patient face masks when non-urgent care resumed; and removed unnecessary items or equipment from rooms that increased the potential for surface contamination.
Another change was the use of telemedicine, which was implemented to conduct virtual visits to continue radioactive iodine therapy and peptide receptor radionuclide therapy for patients, and to allow radiologists to work from home so as to reduce the number of people in reading rooms. Radiologists were given a list of requirements for what their computers needed to read scans at home.
Technologists also would not enter the reading room, instead calling in to request images to be reviewed. The department coordinated with others to ensure COVID information from medical records and radiology information systems for relevant patients were exported to nuclear medicine procedure requests.
“This appeared as an alert on the requisitions, which then allowed the technologist to act promptly and efficiently,” said Dr. Maria DaCosta, supervisor in nuclear medicine at Mount Sinai.
She adds that a staff wellness program was set up with mental health support; childcare resources; complimentary hotel accommodations, parking, meals and transportation; on-site wellness rooms for staff; and reductions in staff work weeks to four days.
A phased approach has also been put in place to reintroduce outpatient imaging procedures from hospital clinics and practices and the external provider community. In addition, the hospital and nuclear medicine department are both planning a “transformation” back to full operations pre-COVID.
“This is a significant milestone and signs of progress,” said DaCosta. “Despite great hope, things will not be the same as before the pandemic. We cannot expect to go back to the way things were but to move to the future with a new normal. How that will work and look is still evolving. This pandemic has reinforced all these required changes throughout the world. By considering what changes are necessary and planning for them, nuclear medicine will be better positioned to address patient and community needs and thrive in what will be a new world.”