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Objectives: 1. To recognize the impact of the COVID-19 pandemic to imaging in Nuclear Medicine. 2. To understand the importance of the V/Q study during a pandemic and how to modify the study for the safety of patients and technologists while still providing quality images. 3. Understanding the benefits of perfusion SPECT/CT studies compared to a traditional V/Q study. 4. To provide examples of both positive and negative studies for pulmonary embolism with SPECT/CT. Pulmonary embolism (PE) has been and continues to be a challenging diagnosis especially in the new era of the COVID-19 global pandemic. Challenges of COVID-19 in Nuclear Medicine include contamination, spread of disease, availability of radiotracer, the long exam duration, reliance on patient cooperation, radiation exposure to patients/technologists and diagnostic certainty. In our institution, we followed the SNMMI guidelines of foregoing the ventilation component of a V/Q scan and relying on perfusion only imaging for PE diagnosis. Due to the caution of aerosol spread and difficult system contamination clearance, using Hybrid perfusion Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) imaging for PE is a comparable alternative to the traditional V/Q scan with multiple benefits. This can provide a possible solution to many of the challenges of the current pandemic. SPECT/CT has demonstrated better certainty of identifying perfusion defects compared to planar imaging alone. This essay will retrospectively compare a traditional V/Q scan with perfusion SPECT/CT imaging and evaluate radiation exposure, exam duration and COVID-19 exposure. The total radiation exposure from the traditional V/Q scan is 2.575 mSv compared to 2.63 mSv from the SPECT/CT study. However, other aspects of the study had significantly improved with the SPECT/CT study including total exam duration, technologist exposure time, reliance on patient cooperation, the need for a repeat ventilation and improved accuracy. The benefits of additional anatomical localization of perfusion defects, parenchymal disease and incidental findings are also an advantage that should not be overlooked. Illustrative cases will show both positive and negative perfusion studies for pulmonary emboli. We continue to accrue patients for further analysis.
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