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COVID-19 Pandemic: Technical Guidance for Nuclear Medicine Departments
COVID-19 PANDEMIC: TECHNICAL GUIDANCE FOR
NUCLEAR MEDICINE DEPARTMENTS
AFGHANISTANALBANIAALGERIAANGOLAANTIGUA AND BARBUDAARGENTINAARMENIAAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBOLIVIA, PLURINATIONAL
STATE OFBOSNIA AND HERZEGOVINABOTSWANABRAZILBRUNEI DARUSSALAMBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCANADACENTRAL AFRICAN
REPUBLICCHADCHILECHINACOLOMBIACONGOCOSTA RICACÔTE D’IVOIRECROATIACUBACYPRUSCZECH REPUBLICDEMOCRATIC REPUBLIC
OF THE CONGODENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADORERITREAESTONIAESWATINIETHIOPIAFIJIFINLANDFRANCEGABONGEORGIA
GERMANYGHANAGREECEGRENADAGUATEMALAGUYANAHAITIHOLY SEEHONDURASHUNGARYICELANDINDIAINDONESIAIRAN, ISLAMIC REPUBLIC OF IRAQIRELANDISRAELITALYJAMAICAJAPANJORDANKAZAKHSTANKENYAKOREA, REPUBLIC OFKUWAITKYRGYZSTANLAO PEOPLE’S DEMOCRATIC
REPUBLICLATVIALEBANONLESOTHOLIBERIALIBYALIECHTENSTEINLITHUANIALUXEMBOURGMADAGASCARMALAWIMALAYSIAMALIMALTAMARSHALL ISLANDSMAURITANIAMAURITIUSMEXICOMONACOMONGOLIAMONTENEGROMOROCCOMOZAMBIQUEMYANMARNAMIBIANEPALNETHERLANDSNEW ZEALANDNICARAGUANIGERNIGERIANORTH MACEDONIANORWAYOMAN
PAKISTANPALAUPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPOLANDPORTUGALQATARREPUBLIC OF MOLDOVAROMANIARUSSIAN FEDERATIONRWANDASAINT LUCIASAINT VINCENT AND
THE GRENADINESSAN MARINOSAUDI ARABIASENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAKIASLOVENIASOUTH AFRICASPAINSRI LANKASUDANSWEDENSWITZERLANDSYRIAN ARAB REPUBLICTAJIKISTANTHAILANDTOGOTRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOM OF
GREAT BRITAIN AND NORTHERN IRELAND
UNITED REPUBLICOF TANZANIA
UNITED STATES OF AMERICAURUGUAYUZBEKISTANVANUATUVENEZUELA, BOLIVARIAN
REPUBLIC OF VIET NAMYEMENZAMBIAZIMBABWE
The following States are Members of the International Atomic Energy Agency:
The Agency’s Statute was approved on 23 October 1956 by the Conference on the Statute of the IAEA held at United Nations Headquarters, New York; it entered into force on 29 July 1957. The Headquarters of the Agency are situated in Vienna. Its principal objective is “to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world’’.
COVID-19 PANDEMIC: TECHNICAL GUIDANCE FOR
NUCLEAR MEDICINE DEPARTMENTS
ENDORSED BY THE EUROPEAN ASSOCIATION OF NUCLEAR MEDICINE,
THE INTERNATIONAL SOCIETY OF RADIOGRAPHERS AND RADIOLOGICAL TECHNOLOGISTS AND THE WORLD FEDERATION OF NUCLEAR MEDICINE AND BIOLOGY
INTERNATIONAL ATOMIC ENERGY AGENCYVIENNA, 2020
COPYRIGHT NOTICE
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For further information on this publication, please contact:
Nuclear Medicine and Diagnostic Imaging SectionInternational Atomic Energy Agency
Vienna International CentrePO Box 100
1400 Vienna, AustriaEmail: [email protected]
COVID-19 PANDEMIC: TECHNICAL GUIDANCE FOR NUCLEAR MEDICINE DEPARTMENTSIAEA, VIENNA, 2020
IAEA/COV/19-1
© IAEA, 2020
Printed by the IAEA in AustriaJuly 2020
FOREWORD
In January 2020, researchers isolated a new type of coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), associated with cases of atypical pneumonia. The name of the novel virus was chosen to reflect its similarities to another coronavirus, the SARS coronavirus (SARS-CoV), which was identified in 2002 and infected over 8000 people in 29 different countries and territories, with over 700 deaths globally between 2002 and 2004. The outbreak lasted about 8 months; however, additional SARS cases were reported until May 2004.
Today, SARS-CoV-2 and the disease it causes, coronavirus disease or COVID-19, have become the subjects of intense study in the scientific community. Within a short time, hundreds of publications have been published on the virus; its transmission, detection and diagnosis; possible complications; and treatment alternatives. While this research indicates that most people with COVID-19 will experience only mild to moderate respiratory symptoms, older people and those with underlying medical problems such as cardiovascular disease, diabetes, chronic respiratory disease and cancer are more likely to develop more serious respiratory symptoms such as shortness of breath, difficulty breathing and fluid in their lungs or may present with multisystem manifestations of a COVID-19 infection caused by a combination of specific host defence responses with associated inflammatory activity, and microvascular involvement with the propensity to develop blood clots. Patients with severe or critical conditions require immediate medical care, often in an intensive care unit. They may experience respiratory failure, septic shock and organ failure, and some may die.
The human to human transmission of COVID-19 poses challenges to health care providers. In view of the hazards that health care workers are exposed to every day, this publication aims to provide guidance to nuclear medicine departments on adjusting standard operating procedures so that they can continue to provide essential services while protecting staff, patients and the public and preventing further spread of the virus.
The present publication expands on editorials by the IAEA and a team of international experts in the European Journal of Nuclear Medicine and Molecular Imaging entitled “COVID-19 pandemic: Guidance for nuclear medicine departments”, published in April 2020, and “Nuclear medicine services after COVID-19: Gearing up back to normality”, published in May 2020. It provides detailed information for nuclear medicine departments on operating during the COVID-19 pandemic. The guidance included here can also be applied in any outbreak with human to human transmission.
This publication was prepared by the IAEA. It has been endorsed by the European Association of Nuclear Medicine (EANM), the International Society of Radiographers and Radiological Technologists (ISRRT) and the World Federation of Nuclear Medicine and Biology (WFNMB).
The IAEA is grateful to all those who contributed to the drafting and review of this publication, to the experts who participated in the three webinars organized by the IAEA in March, April and May 2020 to provide guidance to nuclear medicine departments during the COVID-19 pandemic, and to the co-authors of the editorials on the topic. The webinars and editorials established the foundation for the guidance in this publication. The IAEA wishes to acknowledge the contributions of M. Perez of the World Health Organization (WHO) and the support of the EANM, ISRRT and WFNMB. The IAEA officers responsible for this publication were N. El-Haj, F. Giammarile, P. Orellana and D. Paez of the Division of Human Health.
EDITORIAL NOTE
This publication has been prepared from the original material as submitted by the contributors and has not been edited by the editorial staff of the IAEA. The views expressed remain the responsibility of the contributors and do not necessarily represent the views of the IAEA or its Member States.
Neither the IAEA nor its Member States assume any responsibility for consequences which may arise from the use of this publication. This publication does not address questions of responsibility, legal or otherwise, for acts or omissions on the part of any person.
The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities and institutions or of the delimitation of their boundaries.
The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA. Security related terms are to be understood as defined in the publication in which they appear, or in the guidance that the publication supports. Otherwise, words are used with their commonly understood meanings.
An appendix is considered to form an integral part of the publication. Material in an appendix has the same status as the body text. Annexes are used to provide practical examples or additional information or explanation. Annexes are not integral parts of the main text.
The IAEA has no responsibility for the persistence or accuracy of URLs for external or third party Internet web sites referred to in this publication and does not guarantee that any content on such web sites is, or will remain, accurate or appropriate.
CONTENTS 1. INTRODUCTION .............................................................................................................. 1
1.1. BACKGROUND ......................................................................................................... 1
1.2. OBJECTIVE ................................................................................................................ 1
1.3. SCOPE ......................................................................................................................... 2
1.4. STRUCTURE .............................................................................................................. 2
2. NUCLEAR MEDICINE DEPARTMENTS DURING THE COVID-19 OUTBREAK ... 3
2.1. GENERAL PRINCIPLES ........................................................................................... 3
2.2. GOVERNANCE .......................................................................................................... 4
2.3. ESSENTIAL SERVICES ............................................................................................ 5
2.4. PATIENT FLOW ........................................................................................................ 7
3. PROTECTION OF NUCLEAR MEDICINE STAFF ..................................................... 14
3.1. INTRODUCTION ..................................................................................................... 14
3.2. PERSONAL PROTECTIVE EQUIPMENT ............................................................. 14
3.3. CLASSIFICATION OF WORKING AREAS AND RELATED PROCEDURES .. 18
3.4. CONSIDERATION FOR PREGNANT HEALTHCARE WORKERS DURING THE OUTBREAK ............................................................................................................... 18
4. CONCLUSION ................................................................................................................ 19
Appendix I. ............................................................................................................................... 22
Appendix II. ............................................................................................................................. 24
REFERENCES ......................................................................................................................... 25
BIBLIOGRAPHY .................................................................................................................... 28
ANNEX .................................................................................................................................... 29
CHECK LISTS ................................................................................................................. 29
List of contributors to drafting and review ............................................................................... 50
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1. INTRODUCTION 1.1. BACKGROUND
The world is currently going through an unprecedented health crisis. On 31 December, 2019, the World Health Organization (WHO) office in China was informed of the existence of cases of atypical pneumonia of unknown ethology in the City of Wuhan, Hubei Province in China. More than 40 cases of pneumonia occurred between 31 December and 3 January. On 7 January 2020, scientists in China identified a coronavirus, previously unknown, as the cause of the pneumonias. The virus was isolated, from the lower respiratory tract samples of several patients. On 12 January 2020 the genome sequence of the new coronavirus was identified as the 2019-nCoV/SARS-CoV-2 causing the disease COVID-19.
The newly identified virus is part of the betacoronavirus family. A type of virus that is known for its ability to infect humans and has been associated with recent outbreaks of diseases such as Severe Acute Respiratory Syndrome (SARS) or the Middle East Respiratory Syndrome (MERS). It is known that betacoronaviruses can infect human hosts through the angiotensin-converting enzyme 2 (ACE-2), a membrane-bound protein that it is mainly expressed in vascular endothelial cells, the renal tubular epithelium, epithelium of the small intestine and cardiovascular tissue.
By 30 January 2020, 18 countries outside of China had reported cases of COVID-19. On 11 March, the WHO declared COVID-19 a pandemic.
The human to human transmission of COVID-19 represents a challenge for health care providers. It has been demonstrated that one infected person can transmit the virus 2 or 3 people. The main mechanism of transmission is through contact with droplets and fomites from an infected person that is produced when coughing, speaking or breathing. It is suspected that COVID-19 droplets can also be airborne which poses an additional risk for health care workers. Asymptomatic patients infected with COVID-19 can also transmit the virus. 1.2. OBJECTIVE
The objective of this publication is to advise nuclear medicine departments on the importance of adjusting their standard operation procedures to continue providing their essential services, while protecting their staff, patients and the public and subsequently preventing further spread of the virus.
This publication is focused on the infection prevention and control measures that have to be taken into consideration while executing all the steps needed to perform nuclear medicine diagnostic or therapeutic procedures, and provides detailed guidance on the adjustment of all the steps involved in the delivery of nuclear medicine services, from scheduling to reporting, during the COVID-19 pandemic. While many institutions will have their own guidelines for clinicians and imaging experts to follow, these recommendations are meant to support nuclear medicine departments interested in developing or refining such policies, in addition to the existing ones.
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1.3. SCOPE
As with other imaging departments, the nuclear medicine technologists, nurses and healthcare assistants are generally the most at risk for exposure to COVID-19.
Infection exposure in nuclear medicine departments can occur in the waiting area, during patient registration, recording of history, clinical examination, transportation and imaging examination. Therefore, it is important to identify individuals who may pose an exposure risk to others and take the appropriate precautions to prevent contact and droplet infection transmission. This publication provides guidance for the safe practice of nuclear medicine to prevent COVID-19 infection transmission through the consecutive steps of a patient journey in the unit. This guidance could be also useful for other similar scenarios of public health emergencies from infectious diseases.
As this situation is shifting rapidly, the information contained within this document is likely to evolve. It is therefore advisable that healthcare providers keep informed regarding future updates from the relevant organizations and professional societies on strategies for protecting patients and health workforce from COVID-19 infection, while deciding on the optimal timing of outpatient and inpatient exams. 1.4. STRUCTURE
The chapters are structured for workers in nuclear medicine departments. The first part of the document includes all the measures that should be adopted in the present crisis. After a short outline regarding general measures, a description of Personal Protective Equipment (PPE) is addressed, followed by the classification of working areas, the measures to adopt during patient arrival, waiting area, nuclear medicine exams, and the protections of nuclear medicine staff. Incidental pulmonary findings in patients at risk of COVID-19 exposure are described and finally, the optimization of nuclear medicine devices is discussed. This part is completed by a conclusion with a list of key points.
The second part of the document is presented as an appendix summarizing check lists for nuclear medicine frontline staff such as Nuclear Medicine Radiographers/Technologist or nurses who will have the most potential close contact with infected patients.
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2. NUCLEAR MEDICINE DEPARTMENTS DURING THE COVID-19 OUTBREAK 2.1. GENERAL PRINCIPLES
The first step of the process involving preventive measures for COVID-19 disease is to identify basic operations [1–11]. The World Health Organization (WHO) has published an Operational Guidance on COVID-19 for maintaining essential health services during an outbreak, which includes six main processes that could be extrapolated to nuclear medicine facilities (table 1). TABLE 1: OPERATIONAL PROCESSES
OPERATIONAL PROCESSES (ADAPTED FROM [5])
I. Establish simplified purpose-designed governance and coordination mechanisms a. Establish a COVID-19 Incident Management Team; b. Designate a focal point.
II. Identify context-relevant essential services a. Reallocate financial and material resources; b. Mobilize additional resources.
III. Optimize service delivery settings and platforms a. Develop a contingency and business continuity plan.
IV. Establish effective patient flow (screening, triage, and targeted referral) at all levels.
V. Rapid redistribution of health workforce capacity, including reassignment of tasks a. Apply same precautions and screening tests that apply to patients; b. Stay home if feeling unwell or there is suspicion of COVID-19 infection; c. Consider segregating staff into teams; d. Consider re-training of staff to cover other positions within the department; e. All necessary personal protective equipment available must always be made
available for staff at all working sites; f. Consider providing staff transportation and, if necessary, staff accommodation; g. Ensure environmental services staff are appropriately trained and protected; h. Establish periodic virtual staff meetings to update on the local status of the pandemic
and to enquire about their well-being; i. Facilitate psychological consultation for staff.
VI. Identify mechanisms to maintain the availability of essential equipment and supplies a. Identify mechanisms to maintain the availability of essential equipment and supplies; b. List required supplies and all possible suppliers and distribution channels.
Nuclear Medicine services should be flexible and adapt, considering the stage of the
epidemic in the population they serve. Several general principles have been suggested by international organizations with key goals to minimize disease transmission, protect healthcare workers, preserve healthcare system functioning and, ultimately reduce morbidity and mortality [1-5]. Consideration is needed for the adoption of appropriate personal and institutional infection control practices tailored to the overall situation, as well as to the different areas of workplace and different levels of risks among the patients.
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Specifically, these general principles include:
(i) Distancing: Distancing should include both the patient waiting room as well as work areas for staff. Adopt international guidelines for social distancing at least 1m (three feet) and adapt best practice to local or national guidelines [8, 12–19];
(ii) Hand Hygiene: Practising hand hygiene is one of the most effective way to removing germs from yourself and preventing the spread of germs to other as well as surfaces. Understanding when you should perform hand hygiene will be key in preventing the spread of COVID-19. Incorporating best practice protocols should include hand hygiene with either soap and water or, if not readily available, with hand sanitizer that contains at least 60% alcohol. This should be performed before and after contact with a patient;
(iii)Rescheduling non-urgent procedures: Practitioners should work closely with referring physicians to define the appropriateness and timing of each study on a case by case basis, considering the local epidemiology of COVID-19 and local institutional guidelines for practice, until effective measures are in place to provide a full nuclear medicine service to all patients in a safe environment for patients and staff;
(iv) Ensuring supplies are available: Leadership will need to ensure enough Personal Protective Equipment (PPE) is made available for staff. Centralizing PPE supplies and allocating based on clinical priority needs can help ensure that PPE will remain available for the evolving pandemic. Storing PPE in a secure location can also help prevent theft;
(v) Promoting use of telehealth.
2.2. GOVERNANCE
It is important to set up at the departmental level a special infection emergency management team. The essential role of this team will be to implement infection containment and control procedures, according to local recommendations that allow the continuation of imaging examinations of those patients with suspected, probable and / or confirmed infection1 and to prevent intradepartmental spreading of infection. Infection prevention and control measures, such as reconfiguration of department areas, personal protection, and anti-infection training of all staff, as well as standardized procedures including contact minimization for examinations and timely disinfection of examination rooms should be implemented properly.
1 According to WHO definition, “a suspected case is a patient with acute respiratory illness AND a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset; or a patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case in the last 14 days prior to symptom onset; or a patient with severe acute respiratory illness AND requiring hospitalization AND in the absence of an alternative diagnosis that fully explains the clinical presentation. A probable case is a suspect case for whom the result of the test for the COVID-19 virus is reported as “inconclusive” by the laboratory OR a suspect case for whom testing could not be performed for any reason. A confirmed case is a person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms” [6].
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2.3. ESSENTIAL SERVICES 2.3.1. Critical activities
The considerations for critical nuclear medicine services during the COVID-19 pandemic are the
following (table 2): (a) Review hospital’s license for authorized users and radiopharmaceuticals to ensure that
facilities have appropriate radiopharmaceuticals and authorized users needed to perform appropriate tests needed. If needed, apply for emergency amendment to your license to allow for isotopes to be delivered appropriately;
(b) During crisis, radiopharmaceuticals supply should be confirmed as there may be some disruption;
(c) If multiple facilities are available, designate one facility for symptomatic / unconfirmed / confirmed COVID-19 only patients. Also, if possible, designate a portable gamma camera for the COVID-19 floor in hospital and when possible leave in unit;
(d) The exams should be prioritized, in discussion with the referring clinician, according to the impact of the result in the patient’s history (table 2).
(i) Non-essential nuclear medicine studies should be postponed; (ii) Urgent studies must be performed whenever clinically appropriate to expedite the
management of outpatients, as well as assess and dispose of inpatients and emergency department patients;
(iii) The guiding principle that imaging is appropriate if it leads to short term change in patient management, should be used [9].
(e) Lung Scan: (i) Consider not performing ventilation scans and only performing perfusion imaging as
part of procedures with hybrid Single Photon Emission Computed Tomography (SPECT) Computed Tomography (CT), if available;
(ii) If current chest radiograph or lung CT demonstrates lung opacification, patients should be referred for alternative testing;
(iii)If the lungs are clear, the patient should proceed to perfusion scintigraphy, using either planar or tomographic imaging.
(f) Cardiac scan: (i) Cardiac Positron Emission Tomography (PET) if available may be preferred for rapid
throughput and to help minimize time spent by the patient in the laboratory; (ii) Exercise stress testing should be generally avoided.
(g) Therapeutic Nuclear Medicine: (i) Each patient needs to be assessed on an individual basis; (ii) Radioiodine therapy appointments for benign Hyperthyroidism may have to cease, since
they are in the main, non-urgent, and would pose radiation protection issues should they be admitted to intensive care. However, consideration should be given to giving the treatment to those patients who are unable to tolerate anti-thyroid medications, or those who have other severe comorbid issues, whereby a delay in treatment would cause more harm than good;
(iii)Administration of radioiodine ablation therapy to thyroid cancer patients needs careful consideration. Thyroid Cancer guidance should be followed for actions to be taken for
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low, medium and high-risk patients in terms of delay of treatment and measures to be taken should the decision be made to go ahead with treatment;
(iv) Lu177-DOTATOC/PSMA for patients with neuroendocrine tumours or prostate cancer, respectively, will need to be reviewed in light of local risk assessments/guidelines. However, since these patients could be considered at risk due to possible marrow depletion post procedure, it may be safer to defer treatment for a few months. Each patient should be reviewed in his/her own clinical and local contexts;
(v) Radium-223 dichloride can be administered as an outpatient procedure, provided the patients do not have comorbidities that would put them at high risk due to low immunity.
TABLE 2. CLASSIFICATION OF EXAMS (NO Tc-GENERATOR SHORTAGE)
Priority 1 To be maintained as scheduled
Priority 2 Consider postponing
Priority 3 Can be postponed
Oncology Bone scan (oncology) Bone scan (non-oncology) Sentinel lymph nodes Lymphoscintigraphy F-18 FDG cancer: diagnosis, evaluation of therapy and relapse
FDG follow-up
Octreotide/ Ga68-DOTATATE new cancer diagnosis, evaluation of therapy and relapse
Octreotide/ Ga-68-DOTATATE follow-up
F-18-choline/ Ga-68-PSMA new cancer
F-18-choline/ Ga-68-PSMA follow-up
mIBG Cardiology MUGA (oncology) MUGA cardiac MPS in order to discard significant coronary disease
MPS routine mIBG (heart)
General NM F-18 FDG infection Labelled White Blood Cell Labelled Platelet GI bleeding / Meckel Diverticulum Scan
Thyroid
DTPA scan for GFR MAG3 Parathyroid Scan DMSA scan for Acute Pyelonephritis HIDA Lung perfusion Lung VQ SPECT and PET for neurological
diseases Therapy Y-90 SIRT Lu-177 DOTATATE Ra-223 I-131
Table based on consensus only. Responsibility lies with each Nuclear Medicine Department to ensure their written policy adheres to that outlined by National Public Health Guidance or recommendations in their respective countries and institutions. Each case should be analysed individually, ideally with the referring physician. 2.3.2. Optimization of nuclear medicine devices
In case of a difficult situation, when the institution requires and when appropriate, the CT
part of hybrid SPECT or PET systems should be used for CT diagnostic scans, if the CT component fulfils diagnostic procedures (i.e. over 16 slices) [3–6, 20, 21].
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2.3.3. Shortage of supplies
A possible shortage in Tc-99m generator should also be considered (table 3). TABLE 3. CLASSIFICATION OF EXAMS (Tc-GENERATOR SHORTAGE)
Essential exams Consider replacement Oncology Bone scan (oncology) NaF-18 Sentinel Lymph Node n.a. Octreotide Ga68-DOTATATE (when available) Cardiology MUGA (oncology) n.a. MPS acute chest pain Rb-82 (when available) General NM White labelled cell F18FDG GI bleed / Meckel Diverticulum Scan n.a. DTPA scan for GFR n.a. Lung perfusion n.a.
The proposed limitations indicated in table 2 and 3 do not advocate a total ban of any of the
included procedures, but are suggestions for a short-term delay of some nuclear medicine procedures in selected patients, when temporary logistics around handling the COVID-19 epidemic dictate the streamlining of a nuclear medicine service. Thus, this approach does not suggest or imply a delay of any specific procedure as such, but it rather allows all essential nuclear medicine procedures to be performed uninterruptedly, while departments can put effective measures in place to again provide a full nuclear medicine service to all patients in a safe environment for patients and staff, adhering to local and national rules. 2.4. PATIENT FLOW 2.4.1. Introduction
When faced with major public health emergencies from infectious diseases, such as the
current COVID-19 outbreak, infection prevention and control procedures should commence at the outpatient clinic. A notice at the reception desk for outpatients to self-declare would be helpful for this purpose: When visiting [Name of Nuclear Medicine department] please remember that we are a diagnostic imaging unit, not an infectious disease control location. If you have symptoms of the virus or have been in contact with a person at-risk, please let our staff know at check-in.
WHO criteria should be adopted to categorize patients as either suspected, probable or diagnosed with COVID-19. Due to the incubation time the probability of contagion should always be considered [22-24]. Healthcare workers should recognize the symptoms of COVID-19 infection, including fever, dry cough, fatigue and dyspnoea. However, since there are asymptomatic carriers of the virus, when the patient arrives at the unit, the patient’s epidemiological history and temperature measurement should be taken (Figs 1 and 2).
Patients must wear masks throughout his/her visit in the department and during the imaging procedure according to national or international guidelines. Immunocompromised patients (e.g. oncology patients) should be separated from other patients, and have separate personnel attending to them for their testing.
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FIG. 1. Healthcare Facilities Measures. The image illustrates the measures recommended by WHO regarding patient management in a healthcare facility [23].
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FIG. 2. Key measures. The image illustrates key steps to minimize COVID-19 exposure during the patient’s journey in a nuclear medicine department.
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2.4.2. Unit front desk The unit front desk serves as a screening site, with similar screening to that performed at
the hospital front door. The screening questions regarding symptoms and contact with someone suspected to have, or diagnosed with COVID-19, should be asked.
In the case of suspected or confirmed COVID-19 infection, all imaging and related procedures that are not urgent must be postponed until the patient has recovered with no more risk of being contagious. For time-sensitive procedures, ensure that the patients wear an appropriate mask and that a clean sheet is placed over the patients when traveling to the imaging department. Patients must be placed in a separate waiting area and the appropriate consultations with the relevant infectious disease team should be sought, according to local indications.
The following measures should be considered:
(a) Before the test: (i) Call patients to verify health status (Screening Checklist).
(b) Arrival at the Nuclear Medicine Department: (i) Reception staff behind a glass or plastic screen;
(ii) Distancing; (iii) Hygiene.
(c) Reception area: (i) Display information announcements, indicating possible symptoms;
(ii) Display posters to promote handwashing and proper respiratory hygiene measures. (d) Upon arrival:
(i) Patients are asked to declare (Screening Checklist): - Possible exposure to COVID-19; - Symptoms.
(ii) COVID-19 risk status verification: - Measure temperature.
(e) Provide clear instructions: (i) Only one caregiver per person;
(ii) Minimize permanence of patients in the department. (f) Screening Checklist:
(i) Have you had a fever? A temperature above 37.3°C (99.14°F)? (ii) Have you had a cough?
(iii) Have you had difficulty breathing? (iv) Have you been unusually tired? (v) Have you had muscle aches?
(vi) Have you had diarrhoea recently? (vii) Is your sense of smell less than usual?
(viii) Is your sense of taste less than usual? (ix) Have you been exposed to any person with the virus in the last 2 weeks? (x) Have you been exposed to any person who has a high risk of getting the virus, in the last
2 weeks?
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2.4.3. Waiting areas The waiting area must have enough space so that waiting patients may sit far enough away
from each other to be in accordance with international guidelines for social distancing of at least 1m (three feet) or in accordance with local or national guidance (if different).
While waiting, ensure that patients always wear masks. All sources of infection must be removed from the waiting room to decrease transmission of virus, including magazines, and disposable cups. Ensure that the waiting area has access to hand washing facilities and tissue boxes and masks are within easy reach and encourage the patients to follow basic hand and respiratory hygiene practices.
In the case of inpatients, injecting of radiopharmaceuticals and the subsequent uptake phase can performed in the patient hospital room, thus decreasing the number of patients in the waiting areas.
2.4.4. Administration of radiopharmaceutical
According to HUANG, H.L., et al., “the nuclear medicine frontline staff such as nuclear
medicine radiographers/technologists or nurses will have the most potential close contact with infected patients. It is therefore crucial that potentially infected patients should be identified prior to this step. Since physical contact is inevitable for cannulation, and therefore a significant amount of time may be spent with the patient, appropriate PPE is always mandatory” [7].
2.4.5. During uptake phase
According to HUANG, H.L., et al., “nuclear medicine scans require an uptake phase
ranging from a few minutes to a few hours. During this time, the patients may be waiting in separate radioactive patient areas (or in uptake bays if waiting for PET). Similar considerations as those for patients in the initial post registration waiting area would then apply for all other procedures. If it is possible, the patients can wait in their cars” [7].
2.4.6. When the patient is scanned and goes home
Regular cleaning of surfaces should be performed using appropriate PPE (as per local
policies and standards), including doorknobs, table surfaces, computer keyboards, telephones and dictation equipment at least daily and, preferably, between users. This can be with locally available wipes or soaps, in keeping with institutional recommendations. Stretcher, treadmill, blood pressure equipment, and infusion pumps should be cleaned after each test and sheets/linen replaced in compliance with local infection control recommendation.
Appropriate environmental cleaning and decontamination of rooms through thorough cleaning of the surfaces by a staff member with appropriate PPE as per local institutional guidelines for droplet disease is essential. Appropriate training of environmental maintenance staff is recommended. After each patient, the room should be appropriately cleaned, closed, and after a delay of 30–60 minutes (based on local practice recommendations) for decontamination and passive air exchange, the imaging room can be reused.
For patients with suspected or confirmed COVID-19, equipment including cameras and beds must be decontaminated between patients, using appropriate PPE (as per local policies and standards), by locally available cleansing agents and as per manufacturer’s recommendations.;
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additionally, air/ventilation system disinfection may be performed per local infectious disease recommendations.
2.4.7. Incidental pulmonary findings
There are an increasing number of reports of CT findings of COVID-19 associated
pneumonia, and recently a short article regarding incidental findings suggestive of COVID-19 seen on CT images acquired on SPECT/ or PET/CT was published [1, 4, 5, 7, 13]. As COVID-19 patients present a spectrum of pulmonary symptoms ranging from normal lungs to acute respiratory distress syndrome, it is essential that nuclear medicine physicians analyse carefully the lung windows on each CT imaging, [3–6].
In case of typical or atypical pulmonary CT findings, especially in case of asymptomatic patients, consultation with a radiologist with thoracic expertise is encouraged. Upon identification of potential cases with the appropriate clinical context of acute illness and contact history, relevant patient management and contact tracing should be instituted, according to local regulations. 2.4.8. Promoting use of telehealth
Decreasing in-person consultation with referring physicians in the reporting room should be considered, as well as implementation by nuclear medicine physician’s use of video or phone for remote patient’s consultation during therapeutic procedures. Practice protocols should include remote reviewing or screen sharing wherever possible and/or telephone discussions when nuclear medicine radiographers /technologists are checking images with physicians. The uses of communication technologies are:
- Teleconsulting prior to scheduling; - Teleconsulting before attending the appointment; - Attend alone (only one caregiver per patient, ideally without risk factors); - Remote reporting (national or local rules should be followed); - Teleconsultation after radionuclide therapies; - Virtual multidisciplinary and staff meetings; - Remote communication channels with referring physicians.
2.4.9. In summary
(a) During the injection and scan:
(i) Aseptic and antiseptic techniques; (ii) Standard radiation protection and optimisation principles;
(iii) Use the appropriate PPE; (iv) Place special attention when removing it; (v) Disinfect devices;
(vi) Thoroughly sanitize hands after each procedure; (vii) Dispose in a container for biosafety waste.
(b) During the scan: (i) Apply all standard radiation protection and optimization principles;
13
(ii) Use the appropriate PPE and ensure that patients and staff wear surgical masks to protect particularly immunocompromised patients;
(iii) Use disposable protective elements for the scanners; (iv) The patient must wear at least a facial mask, depending on the patient’s classification
risk. (c) When the patient is scanned and goes home:
(i) If a COVID-19 patient is scanned, scanners and the room must be disinfected accordingly;
(ii) If the hybrid study involves a CT of the chest, it is imperative to look for incidental COVID-19 findings before the patient is released;
(iii) CT images acquired on SPECT/ or PET/CT scans should be interpreted in the context of possible COVID-19 pulmonary findings, and images should be reviewed before the outpatient is released;
(iv) Avoid in-person image reviews with referring services and use remote reviewing or screen sharing wherever possible and/or telephone discussions.
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3. PROTECTION OF NUCLEAR MEDICINE STAFF 3.1. INTRODUCTION
One of the major concerns is how best to protect the staff of the imaging department, so
they do not become infected and serve as additional vectors spreading the disease. Exposure to infectious organisms is not limited to clinical staff such as physicians, technologists, and nurses; receptionists, cleaning personal and transport and monitoring personnel are also at risk. All practices should minimize the risk of COVID-19 exposure to healthcare workers and patients during the performance of nuclear procedures [4, 5, 6, 25-30]. The following measures always apply in the workplace and throughout the patient journey:
(a) Screen staff, patients and visitors before they enter the department; (b) Minimize non-essential visitors into the department; (c) Record symptoms at the start of the shift; (d) Record patient temperature daily as per local policies and standards; (e) Ensure proper use of personal protective equipment (PPE) for healthcare workers, and if
available for patients (due to concern of asymptomatic transmission of COVID-19), as per local policies and standards;
(f) Patient facing staff in the waiting room and laboratory should always wear a facemask; (g) Maintain strict hand hygiene; (h) Maintain at least 1 meter (3 feet) distance in all patient/staff interactions when possible; (i) Minimize crowding in workplace; (j) Rotating staff schedules for onsite and offsite work; (k) Limit interaction between inpatients and outpatients; (l) When possible consider the possibility of separate imaging teams to handle inpatients and
outpatients; (m) Work remotely whenever feasible; (n) Use of virtual conference tools for meetings and educational conferences; (o) Rotating staff schedules for onsite and offsite work; (p) Training in local infection control recommendations; (q) Senior clinicians and/or management take a more proactive stance to advise staff that they
should not come to work if they are not well; (r) Some units may consider segregating staff into teams so as to reduce the potential of
transmission of virus between healthcare providers causing a catastrophic inability of the department to function.
3.2. PERSONAL PROTECTIVE EQUIPMENT
Healthcare personnel who manage confirmed or suspected COVID-19 patients should wear
the appropriate personal protective equipment. PPE (Fig. 3) consisting of eye protection with goggles or face shield, surgical masks at least (if N95 masks are unavailable), fluid resistant isolation gown and disposable gloves [24].
15
FIG. 3. Imaging measures [27]. The figure illustrates the measures in a nuclear medicine department, including the protection of healthcare workers.
16
3.2.1. Instruction for use Healthcare personnel should learn when to use PPE, which PPE is necessary, how to
properly don, use, and doff PPE in a manner to prevent self-contamination, and the limitations of PPE. Any reusable PPE must be properly cleaned, decontaminated, and maintained after and between uses.
The PPE recommended when caring for a patient with known or suspected COVID-19 includes:
(a) Respirator or facemask:
(i) Put on a facemask before entry into contact with patients or care area; (ii) N95/FFP2/FFP3 medical protective mask or Powered Air Purifying Respirators (PAPR)
or respirators that offer a higher level of protection should be used instead of a facemask when performing an aerosol-generating procedure. Disposable respirators and facemasks should be removed and discarded after exiting the patient’s room or care area and closing the door. Perform hand hygiene after discarding the respirator or facemask.
(b) Eye Protection: (i) Put on eye protection (i.e., goggles or a disposable face shield that covers the front and
sides of the face) upon entry to the patient room or care area. Personal eyeglasses and contact lenses are NOT considered adequate eye protection;
(ii) Remove eye protection before leaving the patient room or care area; (iii)Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to
manufacturer’s reprocessing instructions prior to re-use. Disposable eye protection should be discarded after use. During times of PPE shortages face shields may also be cleaned and disinfected according to the manufacturer’s reprocessing instructions prior to re-use as well.
(c) Gloves: (i) Perform hand hygiene, and put on clean, non-sterile gloves upon entry into the patient
room or care area; (ii) Change gloves if they become torn or heavily contaminated; (iii)Remove and discard gloves when leaving the patient room or care area, and immediately
perform hand hygiene. (d) Gowns:
(i) Put on a clean isolation gown upon entry into the patient room or area. Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room or care area. Disposable gowns should be discarded after use. Cloth gowns should be laundered after each use;
(ii) If there are shortages of gowns, they should be prioritized for:
- aerosol-generating procedures;
- care activities where splashes and sprays are anticipated;
- high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of healthcare workers. Examples include:
Dressing; Bathing/showering; Transferring; Providing hygiene;
17
Changing linens; Changing briefs or assisting with toileting; Device care or use; Wound care.
(iii)During times of limited access to respirators or facemasks, facilities could consider having healthcare workers remove only gloves and gowns (if used) and perform hand hygiene between patients with the same diagnosis (e.g., confirmed COVID-19) while continuing to wear the same eye protection and respirator or facemask (i.e., extended use). Risk of transmission from eye protection and facemasks during extended use is expected to be very low:
- Healthcare workers must take care not to touch their eye protection and respirator or facemask;
- Eye protection and the respirator or facemask should be removed, and hand hygiene performed if they become damaged or soiled and when leaving the unit.
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3.3. CLASSIFICATION OF WORKING AREAS AND RELATED PROCEDURES
According to Zhang et al., “due to the shortage of medical supplies, some institutions adopted district management and hierarchical protection where the entire department is divided into a contaminated area, a mixed zone, a transition zone and a clean area” [30]. Hierarchical protection refers to the different levels of protection measures taken in areas with different degrees of infection risk.
If possible, classify the zones in your unit, and if there are more than one SPECT and PET scanner in a hospital, only one of them should be assigned to suspected cases.
According to Zhang et al., “the first level protection area refers to the area where healthcare workers are engaged in the general diagnosis and treatment activities in ordinary clinics and wards. Healthcare workers here need to wear disposable work caps, medical surgical masks and work clothes. Patients are forbidden to enter the unit clean area, which refers to the diagnostic room, which contains the workstations physicians use for interpretation, and storage room for medical supplies, as contamination of these areas will spread the virus to many parts of the medical centre” [30]. According to Zhang et al. [30], in case patients are suspected of infection, the procedures are the following:
a) “The examination room (SPECT or PET) is isolated and used to examine patients suspected of being infected with the COVID-19 virus.
b) The passage area from the clinic where the temperature is measured to the examination room is defined as the contaminated area.
c) Healthcare workers performing medical activities in these areas must comply with the secondary protection standards defined locally or internationally.
d) Healthcare workers who have close contact with suspected or confirmed patients must adhere to strict medical protection, which includes:
(i) Wearing disposable work caps; (ii) Wearing protective glasses or face masks (antifog type); (iii)Wearing medical protective masks (N95); (iv) Wearing protective clothing or isolation clothing; (v) Wearing disposable latex gloves (double layered); (vi) Wearing disposable shoe covers; (vii) Strictly implementing good hand hygiene”.
3.4. CONSIDERATION FOR PREGNANT HEALTHCARE WORKERS DURING THE
OUTBREAK
(a) Pregnant healthcare workers should not provide direct patient care to suspected or confirmed COVID-19 positive patients;
(b) Pregnant healthcare workers must wear a surgical mask at work throughout the duration of their shift.
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4. CONCLUSION
An adequately prepared nuclear medicine department can properly deal with COVID-19 outbreak, despite challenges and emergency (Fig. 4). The experience of preparing for this virus will help improve readiness and response in case of a new outbreak in the future.
In summary, the considerations for critical nuclear medicine services during the COVID-19
pandemic, suggested by Huang et.al. [7] and Choi et.al. [21], are the following:
(a) Robust screening process for outpatients in line with hospital policy should be in place. Screen patients and visitors for symptoms of acute respiratory illness (e.g., fever, cough, difficulty breathing) or gastrointestinal symptoms and coronavirus exposure in the last 2 weeks before entering one’s healthcare facility;
(b) Limit points of entry to the facility; (c) Develop clear escalation pathway to ensure cases are identified in a timely manner; (d) Training for all healthcare workers (identifying and handling COVID-19 patients; hygiene
procedures; disinfection procedures) to ensure maximum compliance and vigilance; (e) Display posters to promote hand washing and good respiratory hygiene measures within the
department. Combine this with other communication measures such as briefings at meetings and information on the intranet to promote handwashing;
(f) All camera gantries, blood pressure cuffs, surfaces (desks & tables) and image viewing station mice and keyboards should be wiped with disinfectant regularly and after every contact with suspected patients;
(g) Place sanitizing hand rub dispensers in prominent places around the workplace. Make sure these dispensers are regularly refilled;
(h) Environmental services staff members who clean all departmental areas during and out of work hours must be specifically trained for professional cleaning of potentially contaminated surfaces after each high-risk patient contact;
(i) Communicate and promote the message to staff to stay at home even if they have just mild symptoms of COVID-19;
(j) Develop a contingency and business continuity plan if one of your staff becomes sick with COVID-19;
(k) Social distancing — keeping at least 1 meter (3 feet) between individuals in waiting rooms and workspaces and adapt best practice to local or national guidelines;
(l) Encourage sick employees to stay home. Personnel who develop respiratory symptoms (e.g., cough, shortness of breath) or unexplained fever should be instructed not to report to work;
(m) Ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies. Make contingency plans for increased absenteeism;
(n) Ensure healthcare workers has hand hygiene best practices. If soap and water are not readily available, use of a hand sanitizer that contains at least 60% alcohol;
(o) Consider standard contact and droplet precautions for patients and healthcare workers as per institutional infection prevention and control protocols;
(p) Prioritize essential procedures (i.e. oncology, cardiology), postpone other activities until effective measures are in place to provide a full nuclear medicine service to all patients in a safe environment for patients and staff;
20
(q) Increase scheduling intervals or appointment times to allow adequate time to clean equipment as needed;
(r) Use telemedicine technologies when possible and isolated workstations to allow for reading and interpretation, thereby allowing for social distancing to limit staff exposure;
(s) Assign a team member to monitor and incorporate regular updates from appropriate national and local jurisdictions.
21
FIG. 4. Nuclear Medicine Workflow. The image represents a general patient chart in nuclear medicine.
22
Appendix I. ADVICE ON THE USE OF PPE EQUIPMENT – DONNING AND DOFFING (REMOVAL AND DISPOSAL)
I.1. DONNING OF PERSONAL PROTECTIVE EQUIPMENT (PPE) COVID-19 ( Fig. 5)
(a) Perform Hand Hygiene (b) Put on long sleeve fluid resistant gown (c) Put on N95/FFP2/FFP3 or PAPR (If Nuclear Medicine Radiographer/Technologist wears
glasses take off until FFP is secured in place- put glasses back on) (d) Place Face mask (if reuses N 95 mask face serves as barrier) or googles in place (If
N95/FFP2/FFP3 put surgical mask over your N95/FFP2/FFP3) (The facial mask should be put on first, then head/hair cover that covers all hair and both ears)
(e) Clean hands with antibacterial liquid before putting on gloves and put on non-sterile Nitrile gloves (be sure gloves cover cuffs of gown)
(f) You may now enter patient room
I.2. DOFFING REMOVAL AND DISPOSAL OF PERSONAL PROTECTIVE EQUIPMENT (PPE) COVID-19 – see appendix III
(a) Do not step into clean area when removing PPE (b) Safely remove gloves by first grasping outside of the glove with the opposite gloved hand,
peel off, hold the removed glove in gloved hand peel off glove and throw away (c) Clean hands with hand gel (d) Remove gown slowly undo necktie and waist tie, pull gown away from neck and shoulders
touching the inside of the gown only using a peeling motion as outside of gown is contaminated, roll into bundle discard in garbage. Clean hands with antibacterial solution. between every removal of PPE device/clothing
(e) Remove visor, stand straight reach for elastic strap at back of head, close eyes and lift the strap upward than over the hear using both hands, place visor into clinical waste bin. Clean hands with antibacterial solution.
(f) Step into clear area wearing respirator and now clear hands again with alcohol hand gel (g) If glasses are worn remove glasses and clean with alcohol wipe, don’t put back on until you
have completed doffing and washed your hands. PPE should be removed in controlled area between “infected” and “clean” room. Facemask should be kept on until clean area.
(h) Remove FFP3 respirator without touching the front of the respirator which is contaminated (both hands find bottom strap and bring it up to the top strap, lift both straps over the top of the head, let the respirator fall away from your face and drop into waste bin)
(i) Wash hands with soap and water for 20 seconds with antibacterial solution.
23
FIG.5. Donning and Doffing diagram. The image show put and remove PPE.
24
Appendix II. DECONTAMINATION OF COUCHES AND OTHER EQUIPMENT
Decontamination of reusable non-invasive care equipment should be undertaken after suspected or known contamination. Equipment must be cleaned first, then disinfected. Step 1. Thorough cleaning with water and a neutral detergent, or disposable detergent wipes, to remove substances such as dust, soiling and organic matter, along with a large proportion of micro-organisms. Follow manufacturers’ instructions and use suitable cleaning products in line with local policy. Step 2. Disinfection by use of chemicals to reduce the number of viable micro-organisms to a level that is not harmful to health.
I.1. EQUIPMENT NEEDED
(a) PPE; disposable plastic apron and single-use non-sterile gloves (b) Clean, colour-coded bucket (unless you are using disposable detergent wipes) (c) Colour-coded cloth or disposable detergent wipes (d) Cleaning trolley (e) General purpose detergent or general surface cleaner (unless you are using disposable wipes) (f) Non-abrasive cloth (if you are cleaning a mattress) (g) Disposable disinfectant wipes – for mattress cleaning.
I.2. THE PROCEDURE
(a) Wash your hands, put on an apron and a pair of gloves. (b) If not using disposable wipes, prepare the cleaning solution in the bucket according to the
manufacturer’s guidelines and place the bucket on a cleaning trolley. (c) Raise or lower the couch to a convenient height. (d) If damp dusting, dampen or rinse the cloth in the cleaning solution. If using detergent wipes,
take a wipe from the container. (e) Clean from top to bottom, working downwards to the base and wheels. If damp dusting, turn
the cloth regularly and rinse regularly in the cleaning solution; change the cleaning solution when it becomes soiled. If using wipes, replace when they become dry or soiled.
(f) Take care to clean the edges and undersides of surfaces after cleaning the tops. (g) If cleaning the bed, wipe the impermeable cover clean using an s-shaped motion and non-
abrasive cloth. Change the cleaning solution and cloth when soiled or wipes when soiled or dry. Allow the mattress to dry, then wipe all surfaces with a disinfectant wipe.
(h) When the couch and mattress are dry, replace any items that were removed before cleaning commenced.
(i) Lower or raise the couch to its original position. (j) Dispose of the cloths or wipes and cleaning solution. (k) Clean and dry the bucket according to local policy. (l) Remove the apron and gloves. Wash your hands. (m) Document that cleaning has taken place according to local policy.
25
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ure
Sta
ff b
acku
p in
cas
e of
A&
E-
call
s in
the
emer
genc
y si
tuat
ion.
Sta
ff r
isk
eval
uatio
n (p
regn
ancy
, im
mun
e, m
enta
l hea
lth c
once
rns
etc.
)
Don
PP
E w
ith a
ll a
ppro
pria
te s
teps
– s
ee
appe
ndix
‘A
’
Is
it n
eede
d no
w o
r co
uld
this
be
dela
yed?
Is m
obil
e im
agin
g po
ssib
le?
P
PE d
urin
g tr
ansf
er
to th
e de
part
men
t w
hen
imag
ing
cann
ot b
e pe
rfor
med
m
obil
e
R
emov
e un
nece
ssar
y eq
uipm
ent f
rom
th
e im
agin
g ro
om
C
over
equ
ipm
ent
that
can
not b
e m
oved
with
su
itabl
e pl
asti
c
E
nsur
e in
fect
ion
prev
enti
on m
easu
res
are
empl
oyed
whe
n m
anag
ing
the
imag
ing
room
and
imag
ing
equi
pmen
t. T
his
mus
t be
subj
ect t
o re
gula
r cl
eani
ng c
onsi
sten
t wit
h lo
cal I
PC
gui
danc
e an
d cl
eani
ng s
ched
ules
co
mpl
eted
and
sig
ned
and
date
d.
Du
rin
g
App
ropr
iate
PPE
Em
ploy
“co
ntam
inat
ed a
nd n
on-
cont
amin
ated
tech
nolo
gist
” sc
enar
io
E
nsur
e si
ngle
pat
ient
att
enda
nce
to th
e Im
agin
g de
part
men
t whe
reve
r po
ssib
le
to e
nabl
e fu
rthe
r im
agin
g if
this
is
requ
ired
.
P
PE, c
omfo
rt,
reas
sura
nce
In
fect
ion
cont
rol
and
barr
ier
prec
auti
ons
C
ontr
ol a
cces
s to
imag
ing
room
or
pati
ent
area
dur
ing
mob
ile
Nuc
lear
Med
icin
e
Pos
t p
roce
dure
Rev
iew
of
imag
ing
by N
ucle
ar M
edic
ine
Rad
iogr
aphe
r/ T
echn
olog
ist f
or s
uspi
ciou
s fe
atur
es a
nd o
rgan
ise
addi
tiona
l im
agin
g if
re
quir
ed
A
ppro
pria
te s
taff
’D
offi
ng’
of P
PE
eq
uipm
ent –
see
App
endi
x A
P
PE
dur
ing
pati
ent
tran
sfer
, rap
id r
esul
ts to
gu
ide
man
agem
ent
A
ppro
pria
te
deco
ntam
inat
ion
incl
udin
g ai
r ex
chan
ge
A
ppro
pria
te d
econ
tam
inat
ion
incl
udin
g ai
r ex
chan
ge
30
In a
ddit
ion
to th
is c
heck
list
rem
embe
r th
at te
chno
logi
sts
are
at th
e fr
ont l
ine
of h
ealt
hcar
e se
rvic
e so
you
mus
t fol
low
exi
stin
g gu
idan
ce/p
roto
cols
: A
-1.
Ens
ure
all r
outi
ne in
itia
l key
che
cks
are
perf
orm
ed i.
e. th
e Im
agin
g R
eque
st is
just
ifie
d, s
uita
bly
prot
ocol
led
and
the
pati
ent
iden
tifi
cati
on p
roce
dure
s fo
llow
ed;
A-2
. W
hen
a pa
tient
is s
uspe
cted
or
conf
irm
ed to
hav
e C
OV
ID -
19 u
se b
arri
er n
ursi
ng te
chni
ques
; A
-3.
App
ly s
tand
ard
radi
atio
n pr
otec
tion
and
opt
imis
atio
n pr
inci
ples
; A
-4.
Alw
ays
ensu
re th
e im
age
is d
iagn
osti
c be
fore
leav
ing
pati
ent;
A
-5.
Alw
ays
ensu
re th
e im
age
is r
ecei
ved
and
avai
labl
e in
PA
CS
read
y fo
r re
port
ing;
A
-6.
Cod
e an
d jo
b de
scri
ptio
n m
ust a
lway
s be
mai
ntai
ned;
A
-7.
Sep
arat
e co
ld/b
lue/
clea
n fr
om h
ot/r
ed/c
onta
min
ated
are
as.
A-8
. D
econ
tam
inat
ion
of c
ouch
es a
nd o
ther
equ
ipm
ent i
s de
scri
bed
in A
ppen
dix
B
31
A-2
. T
AB
LE
2. N
UC
LE
AR
ME
DIC
INE
VQ
SC
AN
CH
EC
K L
IST
Con
trol
of
CO
VID
- 19
Ch
eck
Lis
t
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hnol
ogis
ts T
asks
P
atie
nt
C
onsi
der
atio
ns
Equ
ipm
ent
Con
sid
erat
ions
Im
agin
g R
oom
E
nvir
onm
enta
l C
onsi
der
atio
ns
Pre
par
atio
n P
rep
roce
du
re c
onsi
der
atio
n V
Q S
can
for
know
n C
OV
ID-1
9 pa
tient
s •
The
dec
isio
n on
whe
ther
to
proc
eed
wit
h th
e V
Q s
houl
d be
di
scus
sed
wit
h th
e re
ferr
er b
efor
e bo
okin
g.
• M
ost i
n-pa
tien
t ref
erra
ls a
re fo
r VQ
sca
ns a
nd th
ese
coul
d in
clud
e su
spec
ted
or c
onfi
rmed
in-p
atie
nt C
OV
ID-1
9 po
sitiv
e pa
tien
ts
• In
-pat
ient
VQ
s w
ith u
ncer
tain
CO
VID
-19
stat
us a
s po
tent
iall
y po
sitiv
e an
d w
ear
appr
opri
ate
PPE
• V
Q
in
mos
t de
part
men
ts
are
the
preg
nant
pa
tient
s pe
rfor
m
perf
usio
n on
ly s
can
than
che
ck if
nee
d ae
roso
l pro
cedu
re
• E
nsur
e th
at p
atie
nts
and
staf
f us
e th
e ce
ntra
l en
tran
ce a
nd d
o no
t en
ter
the
depa
rtm
ent
wit
hout
pe
rmis
sion
an
d w
itho
ut
spec
ific
rea
son.
• D
o no
t al
low
pat
ient
to
wai
t in
the
wai
ting
roo
m f
or l
ong
peri
ods,
ado
pt i
nter
nati
onal
gui
deli
ne f
or s
ocia
l di
stan
cing
of
at l
east
1 m
(3
feet
) an
d ad
apt
best
pra
ctic
e of
loc
al a
nd
nati
onal
gui
deli
ne.
• C
onfi
rm t
hat
med
ical
exp
osur
e ha
s be
en j
usti
fied
as
urge
nt
acco
rdin
gly
and/
or c
anno
t be
res
ched
uled
.
• E
nsur
e ar
eas
and
equi
pmen
t hav
e be
en a
dequ
atel
y di
sinf
ecte
d-de
cont
amin
ated
.
• D
isin
fect
. Was
h ha
nds.
• D
on P
PE w
ith a
ll a
ppro
pria
te s
teps
– s
ee a
ppen
dix
‘I’.
• B
e su
re t
o w
ear
a N
95/F
FP2
/FF
P3
mas
k w
ith
eye
prot
ecti
on
eith
er g
oggl
es o
r fa
ce m
ask,
gow
n et
c. a
nd s
ingl
e us
e gl
oves
w
hen
rece
ivin
g a
pape
r re
ferr
al,
iden
tify
th
e pa
tien
t an
d co
ntin
ue w
ith
the
proc
edur
e.
C
ontr
olle
d ar
riva
l an
d de
part
ure
of
pati
ents
an
d st
aff
in
the
radi
olog
y de
part
men
t an
d on
ly
usin
g th
e ce
ntra
l en
tran
ce
P
rovi
de
pati
ent
wit
h m
ask
and
glov
es to
wea
r du
ring
the
pro
cedu
re
D
isin
fect
ion/
D
econ
tam
inat
ion
with
th
e us
e of
app
ropr
iate
te
chni
que
and
mea
ns
acco
rdin
g to
H
ospi
tal
Infe
ctio
us
Dis
ease
s C
ontr
ol
Com
mitt
ee
betw
een
pati
ents
de
pend
ing
on
thei
r in
fect
ion
stat
us
G
amm
a C
amer
a,
(im
mob
iliz
atio
n st
raps
, po
sitio
ning
spo
nges
) A
uxil
iary
eq
uipm
ent
(suc
tion
de
vice
, O
xyge
n m
ask)
D
isin
fect
ion-
Dec
onta
min
atio
n w
ith
the
use
of
appr
opri
ate
tech
niqu
e an
d m
eans
of
ar
eas
and
pati
ent
cont
act
surf
aces
ac
cord
ing
to
Hos
pita
l In
fect
ious
D
isea
ses
Con
trol
C
omm
itte
e be
twee
n pa
tient
s de
pend
ing
on
thei
r in
fect
ion
stat
us
(i.e
. as
ympt
omat
ic-
susp
ecte
d-co
nfir
med
C
OV
ID 1
9)
32
T
AB
LE
2. N
UC
LE
AR
ME
DIC
INE
VQ
SC
AN
CH
EC
K L
IST
(con
t.)
C
ontr
ol o
f C
OV
ID-
19 C
hec
k L
ist
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hno
logi
sts
Tas
ks
Pat
ien
t
Con
sid
erat
ions
E
quip
men
t C
onsi
der
atio
ns
Imag
ing
Roo
m
Env
iron
men
tal
Con
sid
erat
ions
Du
rin
g •
Dur
ing
a V
Q L
ung
Scan
tes
t ev
ery
effo
rt s
houl
d be
mad
e to
m
inim
ize
the
num
ber
of s
taff
in c
onta
ct w
ith
the
pati
ent i
mag
ing
in
a C
OV
ID-1
9 po
sitiv
e pa
tien
t is
bes
t pe
rfor
med
usi
ng t
wo
Nuc
lear
M
edic
ine
Rad
iogr
aphe
rs/T
echn
olog
ist
, on
e do
nnin
g fu
ll p
erso
nal
prot
ecti
ve e
quip
men
t m
ask
with
N95
/FFP
2/FF
P3 o
r PA
PR
eye
pr
otec
tion
gog
gles
or f
acem
ask,
flu
id r
esis
tant
gow
n to
atte
nd to
the
patie
nt,
oper
ate
the
scan
ner
,Aer
osol
uni
t an
d th
e ot
her
Nuc
lear
M
edic
ine
Rad
iogr
aphe
r/T
echn
olog
ist
wil
l be
con
side
red
clea
n an
d w
ill o
pera
te in
clud
ing
acqu
isit
ion
and
proc
essi
ng e
quip
men
t .
• T
he u
se o
f a
perf
usio
n on
ly s
can
is u
nlik
ely
to b
e of
any
ben
efit
if
CO
VID
-19
infe
ctio
n is
sus
pect
ed a
s th
e C
oron
avir
us r
espo
nse
alte
rs
MA
A d
istr
ibut
ion.
•
Non
hy
pert
ensi
ve p
atie
nts,
co
nsid
er
incr
easi
ng
the
DR
L
from
20
0MB
q to
300
MB
q to
bri
ng a
bout
rap
id S
PEC
T i
mag
ing
(5m
ins
cp
12
min
s).
It
wou
ld
also
re
duce
th
e ti
me
the
pati
ent
and
acco
mpa
nyin
g w
ard
staf
f ar
e in
the
depa
rtm
ent.
• P
atie
nts
with
pul
mon
ary
hype
rten
sion
sho
uld
only
rec
eive
200
MB
q an
d al
way
s in
ject
ed s
oon
afte
r pr
epar
atio
n of
MA
A t
o re
duce
the
nu
mbe
r of
par
ticl
es (
this
usu
ally
mea
ns in
the
mor
ning
).
• I
f m
ore
than
one
ref
erra
l is
mad
e, t
hese
sho
uld
be b
ooke
d an
d pe
rfor
med
co
nsec
utiv
ely,
al
low
ing
for
suff
icie
nt
room
re
-ci
rcul
atio
ns.
Nat
iona
l gu
idan
ce s
tate
s “A
min
imum
of
20 m
inut
es
i.e.
2 ai
r ch
ange
s, i
n ho
spita
l se
tting
s w
here
the
maj
ority
of
thes
e pr
oced
ures
occ
ur is
con
side
red
prag
mat
ic”
• F
or a
ll o
ther
VQ
sca
ns (i
.e. t
hose
non
-sym
ptom
atic
for C
OV
ID-1
9),
whe
ther
in-p
atie
nt o
r ou
tpat
ient
, the
ope
rato
r sh
ould
wea
r a
surg
ical
m
ask,
glo
ves
and
gow
n.
• U
se d
ispo
sabl
e to
urni
quet
s an
d an
y di
spos
able
was
te f
rom
the
pr
oced
ure
shou
ld b
e ba
gged
in s
uita
ble
was
te b
ags
as re
com
men
ded
by th
e lo
cal h
ospi
tal
• W
hen
perf
orm
ing
a V
Q s
can
on s
uspe
cted
or
conf
irm
ed C
OV
ID-1
9 pa
tient
s, t
he N
M o
pera
tor
of c
hoic
e w
ould
be
thos
e w
ith
no o
ther
m
edic
al c
ondi
tions
.
P
atie
nt c
onti
nues
to w
ear
mas
k an
d gl
oves
•
Gam
ma
Cam
era
and
rem
ote
hand
con
trol
are
co
nsid
ered
co
ntam
inat
ed
so th
ey m
ust b
e us
ed w
ith
glov
es a
nd th
e
• G
amm
a C
amer
a co
uch
is
cove
red
wit
h si
ngle
us
e pa
per
per
pati
ent.
• G
amm
a C
amer
a co
nsol
e ke
yboa
rd,
mou
se
and
expo
sure
pa
d ar
e co
nsid
ered
cle
an s
o th
ey
mus
t be
use
d on
ly b
y th
e cl
ean
Nuc
lear
M
edic
ine
Rad
iogr
aphe
r/
Tec
hnol
ogis
t
33
TA
BL
E 2
. NU
CL
EA
R M
ED
ICIN
E V
Q S
CA
N C
HE
CK
LIS
T (c
ont.)
C
ontr
ol o
f C
OV
ID-
19 C
hec
k
Lis
t
Nuc
lear
Med
icin
e R
adio
grap
her/
Tec
hnol
ogis
ts T
ask
s P
atie
nt
C
onsi
der
atio
ns
Equ
ipm
ent
Con
sid
erat
ions
Im
agin
g R
oom
E
nvir
onm
enta
l C
onsi
der
atio
ns
•
VQ
sca
n m
ay n
ot b
e co
nsid
ered
an
actu
al a
eros
ol. H
owev
er, g
iven
th
e pa
tien
t’s
like
ly s
ympt
oms
(cou
gh),
the
tes
t w
arra
nts
extr
a P
PE
. T
he o
pera
tor
(inj
ecto
r, a
nd m
ask
fitt
er)
shou
ld w
ear
the
full
PP
E –
gl
oves
, ey
e pr
otec
tion
Gog
gles
or
Fac
emas
k, a
nd N
95/F
FP2
/FF
P3
or P
APR
flu
id r
esis
tant
gow
n as
ther
e is
a ti
me
duri
ng th
is te
st w
hen
the
oper
ator
mus
t be
in
clos
e co
ntac
t w
ith
the
pati
ent’
s m
outh
in
orde
r to
fit
the
aero
sol m
ask.
P
regn
ant
Pat
ien
ts
• P
regn
ant p
atie
nts
are
in a
hig
her
risk
cat
egor
y an
d sh
ould
be
in th
e de
part
men
t for
as
shor
t a ti
me
as p
ossi
ble.
• I
f us
ing
Kry
pton
, pro
ceed
wit
h a
dual
ene
rgy
Tc-
MA
A/K
r-ga
s V
Q
to c
ompl
ete
the
test
qui
ckly
.
• O
nly
perf
orm
ven
tila
tion
at th
e sa
me
tim
e if
you
hav
e K
ypto
n-81
m
avai
labl
e. O
ther
ven
tila
tion
agen
ts m
ay n
ot b
e su
itabl
e du
e to
the
ti
me
requ
ired
to
be
w
ith
the
pati
ent,
and
the
unsa
tisf
acto
ry
dist
ribu
tion
due
to li
kely
pat
ient
non
-com
plia
nce
• If
Tec
hneg
as o
r ae
roso
l is
used
fol
low
the
man
ufac
ture
r’s
guid
ance
Gen
eral
pre
cau
tion
s
• C
over
the
gam
ma
cam
era
couc
h w
ith
disp
osab
le p
aper
• R
emov
e gl
oves
and
dis
pose
of
them
in
the
Cli
nica
l W
aste
bin
(y
ello
w h
azar
dous
con
tam
inat
ed w
aste
) in
acc
orda
nce
wit
h th
e re
gula
tion
of
yo
ur
Hos
pita
l W
aste
M
anag
emen
t C
omm
itte
e.
(HW
MC
)
• R
emem
ber,
w
hen
exit
ing
the
gam
ma
cam
era
scan
ner
room
(c
onta
min
ated
are
a) c
loth
ing
may
be
cont
amin
ated
.
• D
on't
take
off
mas
k!
• D
isin
fect
han
ds w
ith
an h
and
sani
tize
r be
fore
you
ent
er th
e (c
lean
ar
ea)
i.e.
bef
ore
touc
hing
the
key
boar
d an
d m
ouse
, th
e co
ntro
l co
nsol
e, p
rinc
iple
s of
jus
tifi
cati
on,
optim
izat
ion,
rad
iatio
n do
se
lim
itatio
n as
w
ell
as
the
Nuc
lear
M
edic
ine
Rad
iogr
aphe
r’s/
Tec
hnol
ogis
t’s
Eth
ical
C
ode
and
RG
/RT
P
rofe
ssio
nal R
ight
s at
all
tim
es.
34
TA
BL
E 2
. NU
CL
EA
R M
ED
ICIN
E V
Q S
CA
N C
HE
CK
LIS
T (c
ont.)
Con
trol
of
CO
VID
- 19
Ch
eck
Lis
t
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hnol
ogis
ts T
asks
P
atie
nt
Con
sid
erat
ions
E
quip
men
t C
onsi
der
atio
ns
Imag
ing
Roo
m
Env
iron
men
tal
Con
sid
erat
ion
s
Pos
t p
roce
dure
•
Whe
n en
teri
ng t
he g
amm
a (d
irty
are
a), w
ear
disp
osab
le g
love
s.
• C
aref
ully
rem
ove
the
used
pap
er c
over
fro
m t
he g
amm
a w
itho
ut
touc
hing
you
r cl
othi
ng a
nd d
ispo
se o
f it
in th
e co
rres
pond
ing
bin
acco
rdin
g to
hos
pita
l po
licy
.
• D
isin
fect
gl
oves
an
d en
sure
de
cont
amin
atio
n-di
sinf
ecti
on
of
Gam
ma
couc
h-ga
ntry
ke
ypad
, an
d su
rfac
es
/ co
ntac
t po
ints
(s
pong
es,
fixi
ng p
ads,
an
d kn
obs)
by
the
use
of
a su
itab
le
disi
nfec
tant
in
ac
cord
ance
to
H
ospi
tal
Infe
ctio
us
Dis
ease
s C
ontr
ol C
omm
itte
e m
anuf
actu
rer’
s in
stru
ctio
ns.
• A
fter
dis
infe
ctio
n/de
cont
amin
atio
n/de
ep c
lean
ing,
the
RG
/RT
m
ust
visu
ally
ins
pect
the
sca
nnin
g ar
ea,
gam
ma
and
auxi
liar
y eq
uipm
ent
wit
hout
rem
ovin
g gl
oves
and
mas
k.
• M
ust
not
rem
ove
your
mas
k ye
t!
• C
aref
ully
rem
ove
your
glo
ves
care
full
y F
IRS
T!
• D
ispo
se o
f th
em i
n th
e C
lini
cal
Was
te b
in (
yell
ow h
azar
dous
co
ntam
inat
ed w
aste
) in
acc
orda
nce
wit
h th
e re
gula
tion
of
your
H
WM
C
• D
isin
fect
ha
nds
imm
edia
tely
as
th
ere
is
dang
er
of
bein
g co
ntam
inat
ed w
itho
ut g
love
s!
• R
emov
e m
ask
care
full
y so
tha
t th
e co
rds
or b
ands
of
the
mas
k do
not
tou
ch t
he f
ace
or m
ucou
s m
embr
anes
of
the
face
(an
d ey
es)
and
disp
ose
of
it
in
the
Cli
nica
l W
aste
bi
n (y
ello
w
haza
rdou
s co
ntam
inat
ed w
aste
) in
acc
orda
nce
wit
h th
e H
WM
C.
D
isin
fect
- W
ash
hand
s w
ell
(aga
in b
ecau
se y
ou t
ouch
ed y
our
mas
k)!
Pat
ient
kee
ps m
ask
and
glov
es o
n •
Sin
gle
use
gam
ma
cam
era
pape
r co
ver
is
rem
oved
an
d de
pose
d of
int
o th
e co
rres
pond
ing
bin
acco
rdin
g to
ho
spit
al
poli
cy.
• D
isin
fect
ion-
Dec
onta
min
atio
n-D
eep
Cle
anin
g by
the
use
of
a su
itab
le
disi
nfec
tant
in
ac
cord
ance
to
H
ospi
tal
Infe
ctio
us
Dis
ease
s C
ontr
ol
Com
mit
tee
Cam
era
man
ufac
ture
r’s
inst
ruct
ions
of:
•
Gam
ma
cam
era,
cam
era
head
s,
rem
ote
hand
co
ntro
l •
keyp
ad
• Im
mob
iliz
atio
n V
elcr
o st
raps
an
d po
siti
onin
g sp
onge
s,
C
amer
a ro
om s
houl
d be
clo
sed,
and
aft
er a
de
lay
of u
p to
2 h
ours
(b
ased
on
lo
cal
prac
tice
re
com
men
dati
on)
the
imag
ing
room
can
be
clea
ned.
For
pa
tien
ts
with
kn
own
acti
ve C
OV
ID-
19
or
thou
ght
to
be
high
-ris
k fo
r C
OV
ID-
19,
betw
een
pati
ents
, eq
uipm
ent
incl
udin
g ca
mer
as,
beds
, an
d an
ythi
ng t
hat
has
been
in
co
ntac
t w
ith
any
patie
nt
and/
or
staf
f sh
ould
be
de
cont
amin
ated
, us
ing
appr
opri
ate
PP
E
(as
per
loca
l po
lici
es a
nd
stan
dard
s),
by
loca
lly
avai
labl
e cl
eans
ing
agen
ts
and
as
per
man
ufac
ture
r’s
reco
mm
enda
tion
s
Dis
infe
ctio
n-D
econ
tam
inat
ion-
Dee
p cl
eani
ng o
f:
S
urfa
ces
desk
s an
d ta
bles
, cha
irs
35
TA
BL
E 2
. NU
CL
EA
R M
ED
ICIN
E V
Q S
CA
N C
HE
CK
LIS
T (c
ont.)
C
ontr
ol o
f C
OV
ID-
19 C
hec
k
Lis
t
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hnol
ogis
ts T
ask
s P
atie
nt
Con
sid
erat
ions
E
qui
pmen
t C
onsi
der
atio
ns
Imag
ing
Roo
m
Env
iron
men
tal
Con
sid
erat
ions
C
amer
as,
imag
ing
view
ing
stat
ions
, K
eybo
ards
and
mic
e be
ds,
stre
tche
r,
shou
ld
be
clea
ned
afte
r ea
ch
test
an
d sh
eets
/lin
en
repl
aced
in
co
mpl
ianc
e w
ith
loca
l in
fect
ion
cont
rol
reco
mm
enda
tion
cont
act
poin
ts
(kno
bs)
by t
he u
se
of
a su
itab
le
disi
nfec
tant
in
ac
cord
ance
to
H
ospi
tal
Infe
ctio
us
Dis
ease
s C
ontr
ol
Att
enti
on
to
the
knob
s,
keyb
oard
s,
cons
ole,
m
ouse
, ph
one,
m
obil
e ph
ones
, pa
gers
, li
ghti
ng s
wit
ches
, as
th
ey
are
also
co
ntam
inat
ed.
36
A-3
. T
AB
LE
3. F
DG
PE
T/C
T (
ON
CO
LO
GY
) S
TU
DY
CH
EC
K L
IST
Con
trol
of
CO
VID
- 19
C
heck
Lis
t N
ucle
ar M
edic
ine
Rad
iogr
aph
er/T
echn
olog
ists
T
ask
s
Pat
ien
t C
onsi
der
atio
ns
Equ
ipm
ent
Con
sid
erat
ions
Im
agin
g R
oom
or
Mob
ile
Imag
ing
En
viro
nmen
tal
Con
sid
erat
ions
P
repa
rati
on
Pre
-pro
cedu
re c
onsi
der
atio
n
• W
ill
the
imag
ing
proc
edur
e ch
ange
pa
tien
t m
anag
emen
t an
d/or
cou
ld
the
proc
edur
e to
be
dela
yed?
• S
elec
t the
pro
toco
l wit
h th
e sh
orte
st
dura
tion
of s
can
tim
e an
d ex
posu
re
to s
taff
•
Rev
iew
pr
ep
and
imag
ing
ques
tion
s,
heig
ht,
curr
ent
wei
ght
virt
ual
visi
t or
te
lehe
alth
(o
r eq
uiva
lent
) eq
uipm
ent
from
th
e pa
tien
t bef
ore
they
com
e to
the
PE
T
CT
lab
orat
ory
and
docu
men
t it
in
the
elec
tron
ic h
ealt
h re
cord
•
Ens
ure
that
pat
ient
s an
d st
aff
use
the
cent
ral
entr
ance
and
do
not
ente
r th
e de
part
men
t w
itho
ut
perm
issi
on a
nd w
itho
ut s
peci
fic
reas
on.
• D
o no
t al
low
pat
ient
s to
wai
t in
th
e w
aiti
ng r
oom
for
long
per
iods
.
• A
dopt
inte
rnat
iona
l gui
deli
nes
for
soci
al d
ista
ncin
g of
at l
east
1 m
(3
feet
) or
ad
apt
best
pr
acti
ce
of
loca
l an
d na
tion
al g
uide
line
.
• C
onfi
rm
that
m
edic
al
expo
sure
ha
s be
en
just
ifie
d as
ur
gent
ac
cord
ingl
y an
d/or
ca
nnot
be
re
sche
dule
d
• In
form
th
e re
ferr
ing
phys
icia
n th
at
the
pati
ent
wou
ld
not
be
allo
wed
to
ente
r th
e de
part
men
t an
d ex
amin
atio
n ro
om
un
less
w
eari
ng t
he a
ppro
pria
te m
ask
in
acco
rdan
ce
wit
h th
e H
ospi
tal
Infe
ctio
us
Dis
ease
s C
omm
itte
e gu
idel
ines
.
C
ontr
olle
d ar
riva
l an
d de
part
ure
of p
atie
nts
and
staf
f in
th
e ra
diol
ogy
depa
rtm
ent
and
only
us
ing
the
cent
ral
entr
ance
P
rovi
de
pati
ent
wit
h m
ask
and
glov
es t
o w
ear
duri
ng t
he p
roce
dure
D
isin
fect
ion:
D
econ
tam
inat
ion
with
the
us
e of
ap
prop
riat
e te
chni
que
and
mea
ns
acco
rdin
g to
H
ospi
tal
Infe
ctio
us
Dis
ease
s C
ontr
ol
Com
mit
tee
betw
een
pati
ents
de
pend
ing
on
thei
r in
fect
ion
stat
us
• P
ET
- C
T
scan
ner
(im
mob
iliz
atio
n st
raps
, po
sitio
ning
spo
nges
)
A
uxili
ary
equi
pmen
t (i
.e.
suct
ion
devi
ce,
Oxy
gen
mas
k)
D
isin
fect
ion
Dec
onta
min
atio
n w
ith t
he
use
of
appr
opri
ate
tech
niqu
e an
d m
eans
of
ar
eas
and
pati
ent
cont
act
surf
aces
ac
cord
ing
to
Hos
pita
l In
fect
ious
D
isea
ses
Con
trol
C
omm
itte
e be
twee
n pa
tien
ts
depe
ndin
g on
th
eir
infe
ctio
n st
atus
.
37
TA
BL
E 3
. FD
G P
ET
/CT
(O
NC
OL
OG
Y)
STU
DY
CH
EC
K L
IST
(con
t.)
Con
trol
of
CO
VID
- 19
C
heck
Lis
t N
ucle
ar M
edic
ine
Rad
iogr
aph
er/T
ech
nol
ogis
ts
Tas
ks
Pat
ient
Con
side
rati
ons
E
quip
men
t C
onsi
der
atio
ns
Im
agin
g R
oom
or
Mob
ile
Imag
ing
Env
iron
men
tal
Con
side
rati
ons
•
Ens
ure
area
s an
d eq
uipm
ent h
ave
been
ad
equa
tely
di
sinf
ecte
d/de
cont
amin
ated
.
• D
isin
fect
. Was
h ha
nds.
• D
on P
PE
with
all
appr
opri
ate
step
s –
see
appe
ndix
‘A
’ •
Be
sure
to
w
ear
a m
ask
N95
/FF
P2/
FF
P3
or
PA
PR
ey
e pr
otec
tion
gog
gles
or
face
shi
eld,
fl
uid
resi
stan
t gow
n et
c. a
nd s
ingl
e us
e gl
oves
w
hen
rece
ivin
g a
pape
r re
ferr
al,
iden
tify
th
e pa
tien
t an
d co
ntin
ue
wit
h th
e pr
oced
ure.
Du
rin
g In
ject
ion
Ph
ase
and
Up
tak
e p
has
e of
FD
G O
nco
logy
PE
T C
T S
tud
y
• D
urin
g In
ject
ion
phas
e an
d up
take
ph
ase
of
FD
G
Onc
olog
y PE
T
CT
ev
ery
effo
rt
shou
ld
be
mad
e to
m
inim
ize
the
num
ber
of
staf
f in
co
ntac
t w
ith
the
pati
ent.
It i
s be
st
prac
tice
to
ha
ve
two
pers
ons,
on
e do
nnin
g P
PE
to
atte
nd t
o th
e pa
tient
, gl
ucos
e m
eter
, sca
les,
FD
G d
ose
afte
r as
say
and
duri
ng
inje
ctio
n to
th
e pa
tien
t an
d th
e ot
her
to o
pera
te t
he
dose
cal
ibra
tor,
FD
G d
ose
befo
re a
nd
duri
ng
assa
y pr
epar
atio
n,
blan
ket
war
mer
an
d P
atie
nt
elec
tron
ic
char
ting
dur
ing
this
por
tion
of th
e te
st
or a
s pe
r lo
cal I
nsti
tutio
nal g
uida
nce
• C
onsi
der
the
Bat
hroo
m c
onta
min
ated
w
hich
th
e pa
tien
t us
es
to
empt
y bl
adde
r bef
ore
the
imag
ing
proc
edur
e
Pat
ient
to w
ear
mas
k an
d us
e ha
nd s
anit
izer
•
PE
T-C
T S
cann
er a
nd G
antr
y co
ntro
ls
are
cons
ider
ed
cont
amin
ated
so
they
mus
t be
us
ed
with
gl
oves
an
d al
l eq
uipm
ent
in
the
inje
ctio
n/up
take
ro
om
is
cons
ider
ed c
onta
min
ated
,
• g
luco
se
met
er,
scal
es
dose
ca
libra
tor
and
equi
pmen
t fo
r in
ject
ing
cons
ider
ed
cont
amin
ated
• C
onsi
der
the
bath
room
and
all
equi
pmen
t in
it
cont
amin
ated
af
ter
pati
ent u
ses
• U
ptak
e ch
air/
tab
le a
nd o
ther
eq
uipm
ent
shou
ld b
e co
vere
d w
ith
sing
le u
se p
aper
• P
ET
-C
T
scan
ner
couc
h is
co
vere
d w
ith s
ingl
e us
e pa
per
per
pati
ent.
38
TA
BL
E 3
. FD
G P
ET
/CT
(O
NC
OL
OG
Y)
STU
DY
CH
EC
K L
IST
(con
t.)
Con
trol
of
CO
VID
- 19
C
heck
Lis
t N
ucle
ar M
edic
ine
Rad
iogr
aph
er/T
echn
olog
ists
Tas
ks
Pat
ien
t C
onsi
der
atio
ns
Equ
ipm
ent
Con
sid
erat
ion
s
Imag
ing
Roo
m o
r M
obile
Im
agin
g E
nvi
ron
men
tal
Con
sid
erat
ion
s
Im
agin
g of
FD
G O
nco
logy
PE
T C
T S
tudy
• D
urin
g P
ET
C
T
Imag
ing
for
FD
G
Onc
olog
y PE
T C
T e
very
eff
ort
shou
ld b
e m
ade
to m
inim
ize
the
num
ber
of s
taff
in
cont
act
with
th
e pa
tien
t im
agin
g in
a
CO
VID
-19
posi
tive
pati
ent
is
best
pe
rfor
med
us
ing
two
nucl
ear
med
icin
e ra
diog
raph
ers/
tech
nolo
gist
,
one
donn
ing
full
pers
onal
pro
tect
ive
equi
pmen
t to
atte
nd
to t
he p
atie
nt, o
pera
te th
e sc
anne
r , a
nd t
he
othe
r nu
clea
r m
edic
ine
radi
ogra
pher
/ te
chno
logi
st w
ill
be c
onsi
dere
d cl
ean
and
wil
l op
erat
e th
e co
ntro
l ro
om e
quip
men
t, in
clud
ing
acqu
isit
ion
and
proc
essi
ng
equi
pmen
t. E
nsur
e th
at t
he
trol
ley
or
stre
tche
r is
re
mov
ed f
rom
the
exa
min
atio
n ro
om
• C
over
the
PE
T -
CT
Sca
nner
cou
ch w
ith
disp
osab
le p
aper
• R
emov
e an
y m
etal
lic
obje
cts
in
the
regi
on o
f in
tere
st f
rom
the
pat
ient
wit
h pa
rtic
ular
car
e (e
spec
iall
y w
hen
it c
omes
to
art
ific
ial
dent
ures
whe
re t
here
is
a ri
sk
of g
etti
ng i
nfec
ted)
. •
Rem
ove
glov
es a
nd d
ispo
se o
f th
em i
n th
e cl
inic
al w
aste
bin
(ye
llow
haz
ardo
us-
cont
amin
ated
was
te)
in a
ccor
danc
e w
ith
the
regu
lati
on
of
your
H
ospi
tal
Was
te
Man
agem
ent
Com
mit
tee.
(H
WM
C).
• R
emem
ber,
w
hen
exit
ing
the
PE
T-C
T
scan
ner
room
(c
onta
min
ated
ar
ea)
clot
hing
may
be
cont
amin
ated
.
• D
on't
take
off
mas
k!
•
PE
T -
CT
Sca
nner
co
nsol
e ke
yboa
rd, m
ouse
an
d ex
posu
re p
ad a
re
cons
ider
ed c
lean
so
they
m
ust b
e us
ed o
nly
by th
e cl
ean
tech
nolo
gist
39
TA
BL
E 3
. FD
G P
ET
/CT
(O
NC
OL
OG
Y)
STU
DY
CH
EC
K L
IST
(con
t.)
Con
trol
of
CO
VID
- 19
C
heck
Lis
t N
ucle
ar M
edic
ine
Rad
iogr
aph
er/T
echn
olog
ists
T
ask
s
Pat
ient
Con
side
rati
ons
E
qui
pm
ent
Con
sid
erat
ion
s
Imag
ing
Roo
m o
r M
obil
e Im
agin
g E
nvi
ronm
enta
l C
onsi
dera
tion
s
Dis
infe
ct
hand
s w
ith
an
hand
sa
niti
zer
befo
re
you
ente
r th
e P
ET
CT
con
sole
ar
ea (
clea
n ar
ea)
i.e.
bef
ore
touc
hing
the
key
boar
d an
d m
ouse
, th
e co
ntro
l co
nsol
e,
prin
cipl
es
of
just
ific
atio
n,
opti
miz
atio
n,
radi
atio
n do
se
lim
itat
ion
as
wel
l as
th
e
Nuc
lear
M
edic
ine
Rad
iogr
aphe
r’s/
T
echn
olog
ist’
s E
thic
al C
ode
Pro
fess
iona
l R
ight
s at
al
l ti
mes
Pos
t pr
oced
ure
•
Whe
n en
teri
ng
the
PE
T C
T
scan
ner
room
(d
irty
ar
ea),
w
ear
disp
osab
le g
love
s.
• C
aref
ully
re
mov
e th
e us
ed
pape
r co
ver
from
the
PE
T C
T
couc
h w
itho
ut t
ouch
ing
your
cl
othi
ng a
nd d
ispo
se o
f it
in
the
corr
espo
ndin
g bi
n ac
cord
ing
to h
ospi
tal
poli
cy.
D
isin
fect
glo
ves,
and
ens
ure
deco
ntam
inat
ion-
disi
nfec
tion
of
P
ET
C
T
couc
h-ga
ntry
ke
ypad
, C
M
inje
ctor
co
ntro
l pa
nel
and
surf
aces
/
cont
act
poin
ts (
spon
ges,
fix
ing
pads
, kn
obs)
by
the
use
of a
sui
tabl
e di
sinf
ecta
nt i
n ac
cord
ance
to
Hos
pita
l In
fect
ious
D
isea
ses
Con
trol
C
omm
itte
e P
ET
C
T
man
ufac
ture
r’s
inst
ruct
ions
.
Pat
ient
kee
ps m
ask
and
glov
es
on
• S
ingl
e us
e P
ET
C
T
couc
h pa
per
cove
r is
re
mov
ed
and
depo
sed
of
into
th
e co
rres
pond
ing
bin
acco
rdin
g to
hos
pita
l po
licy
.
• D
isin
fect
ion-
Dec
onta
min
atio
n-D
eep
Cle
anin
g by
th
e us
e of
a
suit
able
di
sinf
ecta
nt
in
acco
rdan
ce
to
Hos
pita
l In
fect
ious
D
isea
ses
Con
trol
C
omm
itte
e C
amer
a m
anuf
actu
rer’
s in
stru
ctio
ns
of:h
and
cont
rol
area
, P
ET
C
T
couc
h an
d en
tire
ga
ntry
in
side
ga
ntry
an
d ou
tsid
e G
antr
y ke
ypad
Im
mob
iliz
atio
n V
elcr
o st
raps
and
pos
itio
ning
sp
onge
s,
In
ject
ion
and
Upt
ake
room
and
C
amer
a ro
om s
houl
d be
clo
sed,
an
d af
ter
a de
lay
of u
p to
2
hour
s (b
ased
on
loca
l pr
actic
e re
com
men
datio
n) t
he i
mag
ing
room
can
be
clea
ned.
For
pat
ient
s w
ith
know
n ac
tive
C
OV
ID-1
9 or
th
ough
t to
be
hi
gh-r
isk
for
CO
VID
-19,
be
twee
n pa
tien
ts,
equi
pmen
t in
clud
ing
cam
eras
, be
ds,
and
anyt
hing
that
has
bee
n
in c
onta
ct w
ith
any
pati
ent
and/
or
staf
f sh
ould
be
de
cont
amin
ated
, us
ing
appr
opri
ate
PP
E
(as
per
loca
l po
licie
s an
d st
anda
rds)
, by
lo
call
y av
aila
ble
clea
nsin
g ag
ents
an
d as
per
man
ufac
ture
r’s
reco
mm
enda
tion.
40
TA
BL
E 3
. FD
G P
ET
/CT
(O
NC
OL
OG
Y)
STU
DY
CH
EC
K L
IST
(con
t.)
Con
trol
of
CO
VID
- 19
C
heck
Lis
t N
ucle
ar M
edic
ine
Rad
iogr
aphe
r/T
ech
nol
ogis
ts
Tas
ks
Pat
ien
t C
onsi
der
atio
ns
Equ
ipm
ent
Con
side
rati
ons
Im
agin
g R
oom
or
Mob
ile
Imag
ing
En
viro
nmen
tal
Con
side
rati
ons
Aft
er
disi
nfec
tion
/dec
onta
min
atio
n/de
ep
clea
ning
, th
e N
ucle
ar
Med
icin
e R
adio
grap
her/
Tec
hnol
ogis
t m
ust
visu
ally
ins
pect
the
sca
nnin
g ar
ea,
PE
T
CT
sc
anne
r an
d au
xili
ary
equi
pmen
t w
itho
ut
rem
ovin
g gl
oves
and
mas
k.
M
ust
not
rem
ove
your
mas
k ye
t!
C
aref
ully
re
mov
e yo
ur
glov
es
care
full
y F
IRS
T!
• D
ispo
se o
f th
em i
n th
e C
lini
cal
Was
te
bin
(yel
low
ha
zard
ous
cont
amin
ated
w
aste
) in
ac
cord
ance
wit
h th
e re
gula
tion
of
your
HW
MC
• D
isin
fect
ha
nds
imm
edia
tely
as
th
ere
is
dang
er
of
bein
g co
ntam
inat
ed w
itho
ut g
love
s!
• R
emov
e m
ask
care
full
y so
th
at
the
cord
s or
ban
ds o
f th
e m
ask
do
not
touc
h th
e fa
ce
or
muc
ous
mem
bran
es o
f th
e fa
ce (
and
eyes
) an
d di
spos
e of
it
in t
he C
lini
cal
Was
te
bin
(yel
low
ha
zard
ous
cont
amin
ated
w
aste
) in
ac
cord
ance
wit
h th
e H
WM
C.
Dis
infe
ct -
Was
h ha
nds
wel
l (a
gain
be
caus
e yo
u to
uche
d yo
ur m
ask)
!
Dis
infe
ctio
n-D
econ
tam
inat
ion-
Dee
p cl
eani
ng o
f:
• S
urfa
ces
desk
s an
d ta
bles
, ch
airs
• C
amer
as
gant
ries
, im
agin
g vi
ewin
g st
atio
ns,
Key
boar
ds
and
beds
, st
retc
her,
Inj
ecti
on
room
equ
ipm
ent i
n it,
infu
sion
pu
mps
, ba
thro
om
shou
ld
be
clea
ned
afte
r ea
ch
test
an
d sh
eets
/lin
en
repl
aced
in
co
mpl
ianc
e w
ith
loca
l in
fect
ion
cont
rol
reco
mm
enda
tion
• co
ntac
t po
ints
(d
oor
and
cupb
oard
kno
bs)
by t
he u
se
of a
sui
tabl
e di
sinf
ecta
nt i
n ac
cord
ance
to
H
ospi
tal
Infe
ctio
us D
isea
ses
Con
trol
A
tten
tion
to
the
knob
s,
keyb
oard
s, c
onso
le,
mou
se,
phon
e, m
obil
e ph
ones
, pag
ers,
li
ghti
ng s
wit
ches
, as
they
are
al
so c
onta
min
ated
.
41
A-4
. T
AB
LE
4. N
UC
LE
AR
CA
RD
IOL
OG
Y S
TU
DY
CH
EC
K L
IST
Con
trol
of
CO
VID
- 19
C
hec
k L
ist
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hno
logi
st
Tas
ks
Pat
ient
C
onsi
der
atio
ns
Equ
ipm
ent
cons
ider
atio
ns
Im
agin
g R
oom
E
nvir
onm
enta
l C
onsi
der
atio
ns
Pre
para
tion
P
re-p
roce
du
re c
onsi
der
atio
n •
Avo
id e
xerc
ise
nucl
ear
stre
ss t
esti
ng d
ue t
o ri
sk o
f dr
ople
t exp
osur
e
• U
se
phar
mac
olog
ical
N
ucle
ar
stre
ss
test
ing
for
Car
diac
Nuc
lear
Med
icin
e
• Se
lect
the
prot
ocol
wit
h th
e sh
orte
st d
urat
ion
of s
can
time
and
expo
sure
to s
taff
• C
onsi
der
usin
g st
anda
rd d
ose
imag
ing
with
rap
id
imag
ing
prot
ocol
s
• C
onsi
der
stre
ss f
irst
imag
ing
prot
ocol
s
• C
onsi
der
sing
le d
ay im
agin
g pr
otoc
ols
• C
onsi
der
atte
nuat
ion
corr
ecte
d im
agin
g •
Obt
ain
cons
ent
usin
g vi
rtua
l vi
sit
or t
eleh
ealth
(or
eq
uiva
lent
) eq
uipm
ent
from
the
pat
ient
bef
ore
they
co
me
to t
he n
ucle
ar l
abor
ator
y an
d do
cum
ent
it i
n th
e el
ectr
onic
hea
lth r
ecor
d •
Ens
ure
that
pat
ient
s an
d st
aff
use
the
cent
ral
entr
ance
and
do
not
ente
r th
e de
part
men
t w
itho
ut
perm
issi
on a
nd w
itho
ut s
peci
fic
reas
on.
• D
o no
t al
low
pat
ient
to
wai
t in
the
wai
ting
roo
m
for
long
per
iods
, ado
pt in
tern
atio
nal g
uide
line
for
so
cial
dis
tanc
ing
of a
t le
ast
1 m
(3
feet
) or
ada
pt
best
pra
ctic
e of
loc
al a
nd n
atio
nal
guid
elin
e.
• C
onfi
rm th
at m
edic
al e
xpos
ure
has
been
just
ifie
d as
ur
gent
ac
cord
ingl
y an
d/or
ca
nnot
be
re
sche
dule
d
• In
form
the
ref
erri
ng p
hysi
cian
tha
t th
e pa
tien
t w
ould
not
be
allo
wed
to e
nter
the
depa
rtm
ent a
nd
exam
inat
ion
room
unl
ess
wea
ring
the
a
ppro
pria
te
mas
k in
ac
cord
ance
w
ith
the
Hos
pita
l In
fect
ious
D
isea
ses
Com
mit
tee
guid
elin
es.
• E
nsur
e ar
eas
and
equi
pmen
t ha
ve
been
ad
equa
tely
dis
infe
cted
-dec
onta
min
ated
.
• C
ontr
olle
d ar
riva
l an
d de
part
ure
of p
atie
nts
and
staf
f in
the
rad
iolo
gy
depa
rtm
ent
and
only
usi
ng
the
cent
ral
entr
ance
• P
rovi
de p
atie
nt w
ith
mas
k an
d gl
oves
to
wea
r du
ring
th
e pr
oced
ure
• D
isin
fect
ion-
Dec
onta
min
atio
n w
ith
the
use
of a
ppro
pria
te te
chni
que
and
mea
ns a
ccor
ding
to
Hos
pita
l Inf
ecti
ous
Dis
ease
s C
ontr
ol C
omm
itte
e be
twee
n pa
tien
ts d
epen
ding
on
thei
r in
fect
ion
stat
us
• G
amm
a C
amer
a (i
mm
obil
izat
ion
stra
ps,
posi
tioni
ng s
pong
es)
• A
uxili
ary
equi
pmen
t (i.e
. E
CG
, Def
ibri
llat
or, s
uctio
n de
vice
, Oxy
gen
mas
k)
• D
isin
fect
ion-
D
econ
tam
inat
ion
wit
h th
e us
e of
app
ropr
iate
tech
niqu
e an
d m
eans
of
area
s an
d pa
tient
co
ntac
t sur
face
s ac
cord
ing
to
Hos
pita
l Inf
ecti
ous
Dis
ease
s C
ontr
ol C
omm
itte
e be
twee
n pa
tien
ts d
epen
ding
on
thei
r in
fect
ion.
42
TA
BL
E 4
. NU
CL
EA
R C
AR
DIO
LO
GY
ST
UD
Y C
HE
CK
LIS
T (c
ont.)
Con
trol
of
CO
VID
- 19
C
heck
Lis
t
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hnol
ogis
t T
ask
s P
atie
nt
Con
side
rati
ons
E
quip
men
t co
nsid
erat
ion
s
Imag
ing
Roo
m
Env
iron
men
tal
Con
sid
erat
ions
•
Dis
infe
ct. W
ash
hand
s.
• D
on P
PE
wit
h al
l app
ropr
iate
ste
ps –
see
App
endi
x ‘A
’
• B
e su
re t
o w
ear
a N
95/F
FP2
/FF
P3 m
ask
wit
h ey
e pr
otec
tion
eith
er g
oggl
es o
r fa
ce m
ask,
gow
n et
c. a
nd
sing
le u
se g
love
s w
hen
rece
ivin
g a
pape
r re
ferr
al,
iden
tify
the
pat
ient
and
con
tinu
e w
ith
the
proc
edur
e.
Pre
par
atio
n S
tres
s T
est
Por
tion
of
Car
dia
c N
ucl
ear
Stu
dy
Str
ess
Tes
tin
g P
roto
col
• If
exe
rcis
e te
stin
g is
dee
med
nec
essa
ry, p
erso
nnel
sho
uld
use
PP
E a
s in
dica
ted
per
loca
l ins
titu
tiona
l gui
danc
e
• se
lect
ion
min
imiz
e co
ntac
t for
wri
tten
con
sent
(w
ipin
g,
glov
es, d
ispo
sing
pen
s), c
onsi
der
verb
al c
onse
nt, o
r w
ritt
en c
onse
nt w
ith m
inim
ized
con
tact
and
exc
hang
es o
f pa
pers
and
pen
s (e
.g.,
sepa
rate
pen
s, g
love
s), w
ipin
g su
rfac
es b
efor
e an
d af
ter
use
• Ph
arm
acol
ogic
al s
tres
s w
ith
vaso
dila
tors
is p
refe
rred
to
min
imiz
e dr
ople
t exp
osur
e to
exe
rcis
e st
aff
and
min
imiz
e cl
ose
cont
act b
etw
een
staf
f an
d pa
tien
ts.
• R
egad
enos
on m
ay b
e th
e pr
efer
red
stre
ss a
gent
if
avai
labl
e an
d no
t con
trai
ndic
ated
for
the
pati
ent,
sinc
e it
requ
ires
a s
ingl
e 10
sec
ond
infu
sion
, aft
er w
hich
pr
ovid
ers
can
mai
ntai
n di
stan
ce f
rom
the
pati
ent.
For
ad
enos
ine
and
dipy
rida
mol
e st
ress
test
ing,
ext
ra-l
ong
tubi
ng c
an b
e us
ed to
kee
p di
stan
ce b
etw
een
staf
f an
d pa
tient
s
• A
utom
atic
BP
cuf
fs s
houl
d be
con
side
red
• D
urin
g Ph
arm
acol
ogic
al S
tres
s po
rtio
n of
stu
dy o
r ex
erci
se S
tres
s po
rtio
n of
a n
ucle
ar s
tres
s te
st e
very
eff
ort
shou
ld b
e m
ade
to m
inim
ize
the
num
ber
of s
taff
in
cont
act w
ith
the
pati
ent i
s be
st p
ract
ice
to h
ave
two
pers
ons,
one
don
ning
ful
l per
sona
l pro
tect
ive
equi
pmen
t to
atte
nd to
the
pati
ent,
and
the
othe
r to
ope
rate
the
stre
ss
lab
equi
pmen
t dur
ing
this
por
tion
of
the
test
Pat
ient
con
tinu
es to
w
ear
mas
k an
d gl
oves
•
Gam
ma
Cam
era
and
rem
ote
hand
r a
nd G
antr
y co
ntro
ls a
re
cons
ider
ed c
onta
min
ated
so
they
mus
t be
used
wit
h gl
oves
an
d th
e
• G
amm
a C
amer
a co
uch
is
cove
red
with
sin
gle
use
pape
r pe
r pa
tient
. •
Gam
ma
Cam
era
cons
ole
keyb
oard
, mou
se a
nd e
xpos
ure
pad
are
cons
ider
ed c
lean
so
they
mus
t be
used
onl
y by
the
clea
n N
ucle
ar M
edic
ine
Rad
iogr
aphe
r/ T
echn
olog
ist
43
T
AB
LE
4. N
UC
LE
AR
CA
RD
IOL
OG
Y S
TU
DY
CH
EC
K L
IST
(con
t.)
C
ontr
ol o
f C
OV
ID-
19
Che
ck L
ist
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hn
olog
ist
Tas
ks
Pat
ient
C
onsi
der
atio
ns
E
qui
pmen
t co
nsid
erat
ion
s
Imag
ing
Roo
m
Env
iron
men
tal
Con
side
rati
ons
Im
agin
g of
Nu
clea
r M
edic
ine
Car
dia
c S
tres
s te
st
• W
hen
perf
orm
ing
Nuc
lear
med
icin
e Im
agin
g po
rtio
n nu
clea
r m
edic
ine
stre
ss te
st e
very
eff
ort s
houl
d be
mad
e to
min
imiz
e th
e nu
mbe
r of
sta
ff in
con
tact
wit
h th
e pa
tien
t im
agin
g in
a C
OV
ID-1
9 po
siti
ve p
atie
nt b
est
prac
tice
wou
ld b
e to
two
Nuc
lear
Med
icin
e R
adio
grap
hers
/ Tec
hnol
ogis
t , o
ne d
onni
ng f
ull p
erso
nal
prot
ecti
ve e
quip
men
t to
atte
nd to
the
pati
ent,
oper
ate
the
gam
ma
cam
era
and
the
hand
con
trol
, and
the
othe
r N
ucle
ar M
edic
ine
Rad
iogr
aphe
r/T
echn
olog
ist w
ill a
lso
be d
onni
ng a
s w
ell c
onsi
dere
d cl
ean
and
will
att
end
to
the
acqu
isit
ion
and
proc
essi
ng e
quip
men
t.
• E
nsur
e th
at t
he t
roll
ey o
r st
retc
her
is r
emov
ed f
rom
th
e ex
amin
atio
n ro
om
• C
over
the
gam
ma
cam
era
couc
h w
ith
disp
osab
le p
aper
•
Rem
ove
any
met
alli
c ob
ject
s in
the
reg
ion
of i
nter
est
from
the
pat
ient
wit
h pa
rtic
ular
car
e (e
spec
iall
y w
hen
it c
omes
to
arti
fici
al d
entu
res
whe
re t
here
is
a ri
sk o
f ge
ttin
g in
fect
ed).
•
Rem
ove
glov
es a
nd d
ispo
se o
f th
em i
n th
e C
lini
cal
Was
te b
in (
yell
ow h
azar
dous
con
tam
inat
ed w
aste
) in
ac
cord
ance
wit
h th
e re
gula
tion
of
your
Hos
pita
l W
aste
M
anag
emen
t C
omm
itte
e. (
HW
MC
)
• R
emem
ber,
whe
n ex
itin
g th
e ga
mm
a ca
mer
a (c
onta
min
ated
are
a) c
loth
ing
may
be
cont
amin
ated
. •
Don
't ta
ke o
ff m
ask!
• D
isin
fect
han
ds w
ith
an h
and
sani
tize
r be
fore
you
en
ter
the
cons
ole
area
(cl
ean
area
) i.
e. b
efor
e to
uchi
ng
the
keyb
oard
and
mou
se, t
he c
ontr
ol c
onso
le,
prin
cipl
es o
f ju
stif
icat
ion,
opt
imiz
atio
n, r
adia
tion
dos
e li
mita
tion
as w
ell a
s th
e N
ucle
ar M
edic
ine
Rad
iogr
aphe
r’s/
Tec
hnol
ogis
t’s
Eth
ical
Cod
e an
d R
G/R
T
Pro
fess
iona
l Rig
hts
at a
ll ti
mes
.
44
TA
BL
E 4
. NU
CL
EA
R C
AR
DIO
LO
GY
ST
UD
Y C
HE
CK
LIS
T (c
ont.)
Con
trol
of
CO
VID
- 19
C
heck
Lis
t
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hn
olog
ist
Tas
ks
Pat
ient
C
onsi
dera
tion
s
Equ
ipm
ent
con
side
rati
ons
Im
agin
g R
oom
E
nvir
onm
enta
l C
onsi
der
atio
ns
Pos
t pr
oced
ure
•
Whe
n en
teri
ng t
he g
amm
a ro
om (
dirt
y ar
ea),
wea
r di
spos
able
glo
ves.
• C
aref
ully
rem
ove
the
used
pap
er c
over
fro
m t
he
gam
ma
wit
hout
tou
chin
g yo
ur c
loth
ing
and
disp
ose
of
it i
n th
e co
rres
pond
ing
bin
acco
rdin
g to
hos
pita
l po
licy
.
Dis
infe
ct g
love
s an
d en
sure
dec
onta
min
atio
n-di
sinf
ecti
on o
f G
amm
a co
uch-
gant
ry k
eypa
d, C
M
inje
ctor
con
trol
pan
el a
nd s
urfa
ces
/ co
ntac
t po
ints
(s
pong
es, f
ixin
g pa
ds, k
nobs
) by
the
use
of
a su
itab
le
disi
nfec
tant
in
acco
rdan
ce t
o H
ospi
tal
Infe
ctio
us
Dis
ease
s C
ontr
ol C
omm
itte
e C
T m
anuf
actu
rer’
s in
stru
ctio
ns.
A
fter
dis
infe
ctio
n/de
cont
amin
atio
n/de
ep c
lean
ing,
the
R
G/R
T m
ust
visu
ally
ins
pect
the
sca
nnin
g ar
ea,
gam
ma
cam
era
and
auxi
liar
y eq
uipm
ent
wit
hout
re
mov
ing
glov
es a
nd m
ask.
Mus
t no
t re
mov
e yo
ur m
ask
yet!
Car
eful
ly r
emov
e yo
ur g
love
s ca
refu
lly
FIR
ST
!
• D
ispo
se o
f th
em i
n th
e C
lini
cal W
aste
bin
(ye
llow
ha
zard
ous
cont
amin
ated
was
te)
in a
ccor
danc
e w
ith
the
regu
lati
on o
f yo
ur H
WM
C
• D
isin
fect
han
ds i
mm
edia
tely
as
ther
e is
dan
ger
of
bein
g co
ntam
inat
ed w
itho
ut g
love
s!
• R
emov
e m
ask
care
full
y so
tha
t th
e co
rds
or b
ands
of
the
mas
k do
not
tou
ch t
he f
ace
or m
ucou
s m
embr
anes
of
the
fac
e (a
nd e
yes)
and
dis
pose
of
it i
n th
e C
lini
cal
Was
te b
in (
yell
ow h
azar
dous
con
tam
inat
ed w
aste
) in
ac
cord
ance
wit
h th
e H
WM
C.
D
isin
fect
- W
ash
hand
s w
ell
(aga
in b
ecau
se y
ou
touc
hed
your
mas
k)!
Pat
ient
kee
ps m
ask
and
glov
es o
n •
Sin
gle
use
gam
ma
cam
era
couc
h pa
per
cove
r is
re
mov
ed a
nd d
epos
ed o
f in
to t
he c
orre
spon
ding
bin
ac
cord
ing
to h
ospi
tal
poli
cy.
• D
isin
fect
ion-
Dec
onta
min
atio
n-D
eep
Cle
anin
g by
the
use
of
a su
itab
le d
isin
fect
ant
in
acco
rdan
ce t
o H
ospi
tal
Infe
ctio
us D
isea
ses
Con
trol
Com
mit
tee
Cam
era
man
ufac
ture
r’s
inst
ruct
ions
of:
• G
amm
a ca
mer
a, c
amer
a he
ads,
rem
ote
hand
con
trol
a
nd e
ntir
e ga
ntry
in
side
gan
try
and
outs
ide
•Gan
try
keyp
ad
•gen
erat
or c
art
•I
mm
obil
izat
ion
Vel
cro
stra
ps a
nd p
osit
ioni
ng
spon
ges,
•Str
ess
Lab
roo
m a
nd C
amer
a ro
om is
app
ropr
iate
ly c
lean
ed,
shou
ld b
e cl
osed
, and
aft
er a
de
lay
of u
p to
2 h
ours
(ba
sed
on lo
cal p
ract
ice
reco
mm
enda
tion)
the
imag
ing
room
can
be
clea
ned.
•
For
pat
ient
s w
ith k
now
n ac
tive
C
OV
ID-1
9 or
thou
ght t
o be
hi
gh-r
isk
for
CO
VID
-19,
be
twee
n pa
tien
ts, e
quip
men
t in
clud
ing
cam
eras
, bed
s, a
nd
anyt
hing
that
has
bee
n in
co
ntac
t wit
h an
y pa
tien
t and
/or
staf
f
shou
ld b
e de
cont
amin
ated
, us
ing
appr
opri
ate
PPE
(as
per
lo
cal p
olic
ies
and
stan
dard
s),
by lo
call
y av
aila
ble
clea
nsin
g ag
ents
and
as
per
man
ufac
ture
r’s
reco
mm
enda
tions
D
isin
fect
ion-
Dec
onta
min
atio
n-D
eep
clea
ning
of:
• S
urfa
ces
desk
s an
d ta
bles
, ch
airs
• C
amer
as g
antr
ies,
imag
ing
view
ing
stat
ions
, Key
boar
ds
and
mic
e be
ds, s
tret
cher
, tr
eadm
ill,
bloo
d pr
essu
re c
uff
and
equi
pmen
t, an
d in
fusi
on
pum
ps s
houl
d be
cle
aned
aft
er
each
test
and
she
ets/
linen
re
plac
ed in
com
plia
nce
with
lo
cal i
nfec
tion
con
trol
re
com
men
datio
n
45
TA
BL
E 4
. NU
CL
EA
R C
AR
DIO
LO
GY
ST
UD
Y C
HE
CK
LIS
T (c
ont.)
C
ontr
ol o
f C
OV
ID-
19
Che
ck L
ist
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hn
olog
ist
Tas
ks
Pat
ient
C
onsi
dera
tion
s
Equ
ipm
ent
con
sid
erat
ions
Im
agin
g R
oom
E
nvir
onm
enta
l C
onsi
der
atio
ns
• co
ntac
t po
ints
(do
or a
nd
cupb
oard
kno
bs)
by t
he u
se
of a
sui
tabl
e di
sinf
ecta
nt i
n ac
cord
ance
to
Hos
pita
l In
fect
ious
Dis
ease
s C
ontr
ol
Att
enti
on t
o th
e kn
obs,
ke
yboa
rds,
con
sole
, mou
se,
phon
e, m
obil
e ph
ones
, pag
ers,
li
ghti
ng s
wit
ches
, as
they
are
al
so c
onta
min
ated
.
46
A
-5. T
AB
LE
5. P
ET
CT
CA
RD
IAC
ST
RE
SS T
EST
ING
Con
trol
of
CO
VID
- 19
C
heck
Lis
t
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hnol
ogis
t T
ask
s P
atie
nt
Con
sid
erat
ions
E
qu
ipm
ent
cons
ider
atio
ns
Imag
ing
Roo
m
Env
iron
men
tal
Con
sid
erat
ions
P
repa
rati
on
Pre
- p
roce
dure
con
sid
erat
ion
• U
se p
harm
acol
ogic
al N
ucle
ar S
tres
s te
stin
g fo
r C
ardi
ac P
ET
C
T
• S
elec
t the
pro
toco
l with
the
shor
test
dur
atio
n of
sca
n tim
e an
d ex
posu
re to
sta
ff
• C
onsi
der
usin
g st
anda
rd d
ose
imag
ing
with
rap
id i
mag
ing
prot
ocol
s
• C
onsi
der
atte
nuat
ion
corr
ecte
d im
agin
g •
Obt
ain
cons
ent u
sing
vir
tual
vis
it o
r tel
ehea
lth
(or e
quiv
alen
t)
equi
pmen
t fr
om t
he p
atie
nt b
efor
e th
ey c
ome
to t
he n
ucle
ar
labo
rato
ry a
nd d
ocum
ent i
t in
the
elec
tron
ic h
ealt
h re
cord
• E
nsur
e th
at p
atie
nts
and
staf
f us
e th
e ce
ntra
l en
tran
ce a
nd
do
not
ente
r th
e de
part
men
t w
itho
ut
perm
issi
on
and
wit
hout
spe
cifi
c re
ason
.
• D
o no
t al
low
pat
ient
to
wai
t in
the
wai
ting
roo
m f
or l
ong
peri
ods,
ado
pt in
tern
atio
nal g
uide
line
for
soc
ial d
ista
ncin
g of
at
leas
t 1 m
(3
feet
) an
d ad
apt
best
pra
ctic
e of
loca
l an
d na
tion
al g
uide
line
.
• C
onfi
rm th
at m
edic
al e
xpos
ure
has
been
just
ifie
d as
urg
ent
acco
rdin
gly
and/
or c
anno
t be
res
ched
uled
•
Info
rm t
he r
efer
ring
phy
sici
an t
hat
the
pati
ent
wou
ld n
ot
be a
llow
ed t
o en
ter
the
depa
rtm
ent
and
exam
inat
ion
room
un
less
wea
ring
the
app
ropr
iate
mas
k in
acc
orda
nce
wit
h th
e H
ospi
tal
Infe
ctio
us D
isea
ses
Com
mit
tee
guid
elin
es.
• E
nsur
e ar
eas
and
equi
pmen
t ha
ve
been
ad
equa
tely
di
sinf
ecte
d/ d
econ
tam
inat
ed.
• D
isin
fect
. Was
h ha
nds.
• D
on P
PE
with
all
appr
opri
ate
step
s –
see
appe
ndix
‘A
’
• B
e su
re to
wea
r a
N95
/FF
P2/F
FP3
mas
k w
ith e
ye p
rote
ctio
n ei
ther
gog
gles
or
face
mas
k, g
own
etc.
and
sin
gle
use
glov
es
whe
n re
ceiv
ing
a pa
per
refe
rral
, id
enti
fy t
he p
atie
nt a
nd
cont
inue
wit
h th
e pr
oced
ure
• C
ontr
olle
d ar
riva
l an
d de
part
ure
of
pati
ents
an
d st
aff
in
the
radi
olog
y de
part
men
t an
d on
ly
usin
g th
e ce
ntra
l en
tran
ce
• P
rovi
de
pati
ent
wit
h m
ask
and
glov
es
to
wea
r du
ring
th
e pr
oced
ure
• D
isin
fect
ion/
D
econ
tam
inat
ion
wit
h th
e us
e of
app
ropr
iate
tec
hniq
ue
and
mea
ns
acco
rdin
g to
H
ospi
tal
Infe
ctio
us D
isea
ses
Con
trol
Com
mit
tee
betw
een
patie
nts
depe
ndin
g on
the
ir
infe
ctio
n st
atus
•
PE
T-
CT
sc
anne
r (i
mm
obil
izat
ion
stra
ps,
posi
tioni
ng s
pong
es)
• A
uxil
iary
eq
uipm
ent
(i.e
. E
CG
, D
efib
rill
ator
, su
ctio
n de
vice
, Oxy
gen
mas
k)
• D
isin
fect
ion/
D
econ
tam
inat
ion
with
the
use
of
ap
prop
riat
e te
chni
que
and
mea
ns
of
area
s an
d pa
tient
co
ntac
t su
rfac
es a
ccor
ding
to
Hos
pita
l In
fect
ious
D
isea
ses
Con
trol
C
omm
itte
e be
twee
n pa
tien
ts
depe
ndin
g on
th
eir
infe
ctio
n.
47
TA
BL
E 5
. PE
T C
T C
AR
DIA
C S
TR
ES
S T
ES
TIN
G (c
ont.)
Con
trol
of
CO
VID
- 19
C
heck
Lis
t
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hnol
ogis
t T
ask
s P
atie
nt
Con
sid
erat
ions
E
quip
men
t co
nsid
erat
ion
s
Imag
ing
Roo
m
Env
iron
men
tal
Con
sid
erat
ions
D
urin
g S
tres
s T
est
Por
tion
of
PE
T C
T C
ard
iac
S
tres
s T
esti
ng
Pro
toco
l
• se
lect
ion
min
imiz
e co
ntac
t fo
r w
ritt
en
cons
ent
(wip
ing,
gl
oves
, di
spos
ing
pens
), c
onsi
der
verb
al c
onse
nt,
or w
ritt
en
cons
ent
with
min
imiz
ed c
onta
ct a
nd e
xcha
nges
of
pape
rs a
nd
pens
(e.
g., s
epar
ate
pens
, glo
ves)
, wip
ing
surf
aces
bef
ore
and
afte
r us
e
• P
harm
acol
ogic
al
stre
ss
with
va
sodi
lato
rs
is
pref
erre
d to
m
inim
ize
drop
let
expo
sure
to
exer
cise
sta
ff a
nd m
inim
ize
clos
e co
ntac
t bet
wee
n st
aff
and
pati
ents
• R
egad
enos
on m
ay b
e th
e pr
efer
red
stre
ss a
gent
if a
vail
able
and
no
t con
trai
ndic
ated
for
the
pati
ent,
sinc
e it
req
uire
s a
sing
le 1
0 se
cond
inf
usio
n, a
fter
whi
ch p
rovi
ders
can
mai
ntai
n di
stan
ce
from
the
patie
nt.
For
ade
nosi
ne a
nd d
ipyr
idam
ole
stre
ss t
esti
ng,
extr
a-lo
ng
tubi
ng c
an b
e us
ed to
kee
p di
stan
ce b
etw
een
staf
f an
d pa
tient
s
• A
utom
atic
BP
cuf
fs s
houl
d be
con
side
red
• D
urin
g P
harm
acol
ogic
al S
tres
s po
rtio
n of
stu
dy e
very
eff
ort
shou
ld b
e m
ade
to m
inim
ize
the
num
ber
of s
taff
in
cont
act
wit
h th
e pa
tien
t is
bes
t pr
acti
ce t
o ha
ve t
wo
pers
ons,
one
do
nnin
g fu
ll p
erso
nal
prot
ecti
ve e
quip
men
t to
att
end
to t
he
patie
nt,
and
the
othe
r to
ope
rate
the
str
ess
lab
equi
pmen
t du
ring
this
por
tion
of th
e te
st
Ph
arm
acol
ogic
al P
ET
CT
Car
diac
Str
ess
test
• D
urin
g a
Phar
mac
olog
ical
PE
T C
T C
ardi
ac s
tres
s te
st e
very
ef
fort
sho
uld
be m
ade
to m
inim
ize
the
num
ber
of s
taff
in
cont
act
wit
h th
e pa
tien
t im
agin
g in
a C
OV
ID-1
9 po
sitiv
e pa
tient
is
be
st
perf
orm
ed
usin
g tw
o nu
clea
r m
edic
ine
radi
ogra
pher
s/T
echn
olog
ist,
one
donn
ing
full
pe
rson
al
prot
ecti
ve e
quip
men
t to
att
end
to t
he p
atie
nt,
oper
ate
the
scan
ner
, ge
nera
tor
inje
ctio
n ca
rt
and
the
othe
r N
ucle
ar
Med
icin
e R
adio
grap
her/
Tec
hnol
ogis
t wil
l be
cons
ider
ed c
lean
an
d w
ill
oper
ate
the
cont
rol
room
eq
uipm
ent,
incl
udin
g ac
quis
itio
n an
d pr
oces
sing
equ
ipm
ent .
The
per
sona
l ope
ratin
g th
e E
KG
mac
hine
and
inje
ctin
g th
e st
ress
age
nt s
houl
d al
so b
e D
onni
ng in
ful
l per
sona
l pro
tect
ive
equi
pmen
t and
con
side
red
dirt
y as
they
will
als
o be
att
endi
ng to
the
pati
ent a
s w
ell.
• P
atie
nt
cont
inue
s to
w
ear m
ask
and
glov
es
• P
ET
-CT
S
cann
er
hand
co
ntro
l an
d G
antr
y co
ntro
ls
are
cons
ider
ed c
onta
min
ated
so
the
y m
ust
be u
sed
with
gl
oves
and
the
• P
ET
-C
T s
cann
er c
ouch
is
cove
red
wit
h si
ngle
use
pap
er
per
patie
nt.
• P
ET
-C
T
Sca
nner
co
nsol
e ke
yboa
rd,
mou
se
and
expo
sure
pad
are
con
side
red
clea
n so
the
y m
ust
be u
sed
only
by
th
e cl
ean
Nuc
lear
M
edic
ine
Rad
iogr
aphe
r/
Tec
hnol
ogis
t
48
TA
BL
E 5
. PE
T C
T C
AR
DIA
C S
TR
ES
S T
ES
TIN
G (c
ont.)
Con
trol
of
CO
VID
- 19
Ch
eck
L
ist
Nuc
lear
Med
icin
e R
adio
grap
her
/Tec
hnol
ogis
t T
ask
s P
atie
nt
Con
sid
erat
ion
s
Equ
ipm
ent
cons
ider
atio
ns
Im
agin
g R
oom
E
nvi
ronm
enta
l C
onsi
der
atio
ns
•
Ens
ure
that
the
tro
lley
or
stre
tche
r is
rem
oved
fro
m t
he e
xam
inat
ion
room
•
Cov
er t
he P
ET
-C
T S
cann
er c
ouch
wit
h di
spos
able
pap
er
• R
emov
e an
y m
etal
lic
obje
cts
in t
he r
egio
n of
inte
rest
fro
m t
he p
atie
nt
wit
h pa
rtic
ular
car
e (e
spec
iall
y w
hen
it c
omes
to
arti
fici
al d
entu
res
whe
re t
here
is
a ri
sk o
f ge
ttin
g in
fect
ed).
• R
emov
e gl
oves
and
dis
pose
of
them
in
the
Cli
nica
l W
aste
bin
(ye
llow
ha
zard
ous
cont
amin
ated
was
te)
in a
ccor
danc
e w
ith
the
regu
lati
on o
f yo
ur H
ospi
tal
Was
te M
anag
emen
t C
omm
itte
e. (
HW
MC
)
• R
emem
ber,
whe
n ex
itin
g th
e P
ET
-CT
sca
nner
roo
m (
cont
amin
ated
ar
ea)
clot
hing
may
be
cont
amin
ated
.
• D
on't
take
off
mas
k!
• D
isin
fect
han
ds w
ith
an h
and
sani
tize
r be
fore
you
ent
er t
he P
ET
CT
co
nsol
e ar
ea (
clea
n ar
ea)
i.e.
bef
ore
touc
hing
the
keyb
oard
and
mou
se,
the
cont
rol
cons
ole,
pri
ncip
les
of j
usti
fica
tion,
opt
imiz
atio
n, r
adia
tion
dose
li
mit
atio
n as
w
ell
as
the
Nuc
lear
M
edic
ine
Rad
iogr
aphe
r’s/
T
echn
olog
ist’
s E
thic
al C
ode
and
RG
/RT
Pro
fess
iona
l Rig
hts
at a
ll ti
mes
.
Pos
t pr
oced
ure
• W
hen
ente
ring
the
PE
T C
T s
cann
er r
oom
(di
rty
area
), w
ear
disp
osab
le
glov
es.
• C
aref
ully
rem
ove
the
used
pap
er c
over
fro
m N
95/F
FP
2/F
FP
3 or
PA
PR
th
e P
ET
CT
cou
ch w
itho
ut t
ouch
ing
your
clo
thin
g an
d di
spos
e of
it
in
the
corr
espo
ndin
g bi
n ac
cord
ing
to h
ospi
tal
poli
cy.
D
isin
fect
glo
ves
and
ensu
re d
econ
tam
inat
ion-
disi
nfec
tion
of
the
PE
T
CT
cou
ch-g
antr
y ke
ypad
, co
ntro
l pa
nel
and
surf
aces
/ c
onta
ct p
oint
s (s
pong
es,
fixi
ng p
ads,
kno
bs)
by t
he u
se o
f a
suit
able
dis
infe
ctan
t in
ac
cord
ance
to
Hos
pita
l In
fect
ious
Dis
ease
s C
ontr
ol C
omm
itte
e C
T
man
ufac
ture
r’s
inst
ruct
ions
.
Aft
er d
isin
fect
ion/
deco
ntam
inat
ion/
deep
cle
anin
g, t
he R
G/R
T m
ust
visu
ally
ins
pect
the
sca
nnin
g ar
ea,
PE
T C
T s
cann
er a
nd a
uxil
iary
eq
uipm
ent
wit
hout
rem
ovin
g gl
oves
and
mas
k.
M
ust
not
rem
ove
your
mas
k ye
t!
C
aref
ully
rem
ove
your
glo
ves
care
full
y F
IRS
T!
Pat
ient
kee
ps m
ask
and
glov
es o
n •
Sin
gle
use
PE
T
CT
co
uch
pape
r co
ver
is r
emov
ed a
nd
depo
sed
of
into
th
e co
rres
pond
ing
bin
acco
rdin
g to
hos
pita
l pol
icy.
•
Dis
infe
ctio
n-D
econ
tam
inat
ion-
Dee
p C
lean
ing
by
the
use
of
a su
itab
le
disi
nfec
tant
in
ac
cord
ance
to
H
ospi
tal
Infe
ctio
us D
isea
ses
Con
trol
C
omm
itte
e C
amer
a m
anuf
actu
rer’
s in
stru
ctio
ns
of:
• C
amer
a ro
om s
houl
d be
clo
sed,
an
d af
ter a
del
ay o
f up
to 2
hou
rs
(bas
ed
on
loca
l pr
acti
ce
reco
mm
enda
tion)
th
e im
agin
g ro
om c
an b
e cl
eane
d.
• F
or p
atie
nts
wit
h kn
own
activ
e C
OV
ID-1
9 or
th
ough
t to
be
hi
gh-r
isk
for
CO
VID
-19,
be
twee
n pa
tien
ts,
equi
pmen
t in
clud
ing
cam
eras
, be
ds,
and
anyt
hing
that
has
bee
n in
con
tact
w
ith
any
pati
ent
and/
or
staf
f sh
ould
be
de
cont
amin
ated
, us
ing
appr
opri
ate
PP
E (
as p
er
loca
l pol
icie
s an
d st
anda
rds)
, by
49
TA
BL
E 5
. PE
T C
T C
AR
DIA
C S
TR
ES
S T
ES
TIN
G (c
ont.)
Con
trol
of
CO
VID
- 19
C
heck
Lis
t N
ucle
ar M
edic
ine
Rad
iogr
aphe
r/T
ech
nol
ogis
t T
ask
s
Pat
ient
C
onsi
der
atio
ns
Equ
ipm
ent
cons
ider
atio
ns
Imag
ing
Roo
m
Env
iron
men
tal
Con
sid
erat
ion
s
•
Dis
pose
of
th
em
in
the
Cli
nica
l W
aste
bi
n (y
ello
w
haza
rdou
s co
ntam
inat
ed
was
te)
in a
ccor
danc
e w
ith
the
regu
lati
on o
f yo
ur H
WM
C
• D
isin
fect
han
ds i
mm
edia
tely
as
the
re i
s da
nger
of
bein
g co
ntam
inat
ed
wit
hout
gl
oves
!
• R
emov
e m
ask
care
full
y so
th
at t
he c
ords
or
band
s of
the
m
ask
do n
ot to
uch
the
face
or
muc
ous
mem
bran
es
of
the
face
(an
d ey
es)
and
disp
ose
of it
in th
e C
lini
cal W
aste
bin
(y
ello
w
haza
rdou
s co
ntam
inat
ed
was
te)
in
acco
rdan
ce w
ith
the
HW
MC
. D
isin
fect
- W
ash
hand
s w
ell
(aga
in b
ecau
se y
ou t
ouch
ed
your
mas
k)!
P
ET
CT
cou
ch c
ontr
ol h
andl
e an
d en
tire
gan
try
insi
de g
antr
y an
d ou
tsid
e •G
antr
y ke
ypad
•g
ener
ator
car
t
•Im
mob
iliz
atio
n V
elcr
o st
raps
an
d po
siti
onin
g sp
onge
s,
by l
ocal
ly a
vaila
ble
clea
nsin
g ag
ents
an
d as
pe
r m
anuf
actu
rer’
s re
com
men
dati
ons
• D
isin
fect
ion-
Dec
onta
min
atio
n-D
eep
clea
ning
of:
• S
urfa
ces
desk
s an
d ta
bles
, ch
airs
• C
amer
as
gant
ries
, im
agin
g vi
ewin
g st
atio
ns,
Key
boar
ds
and
mic
e be
ds,
stre
tche
r,
trea
dmil
l, bl
ood
pres
sure
cuf
f an
d eq
uipm
ent,
and
infu
sion
pu
mps
sho
uld
be c
lean
ed a
fter
ea
ch
test
an
d sh
eets
/lin
en
repl
aced
in
co
mpl
ianc
e w
ith
loca
l in
fect
ion
cont
rol
reco
mm
enda
tion
• co
ntac
t po
ints
(d
oor
and
cupb
oard
kno
bs)
by t
he u
se
of a
sui
tabl
e di
sinf
ecta
nt i
n ac
cord
ance
to
H
ospi
tal
Infe
ctio
us D
isea
ses
Con
trol
A
tten
tion
to
the
knob
s,
keyb
oard
s, c
onso
le, m
ouse
, ph
one,
mob
ile
phon
es, p
ager
s,
ligh
ting
sw
itch
es, a
s th
ey a
re
also
con
tam
inat
ed.
50
List of contributors to drafting and review
Angel, P. International Atomic Energy Agency, Austria Bom, H. Chonnam National University, Korea and World Federation of Nuclear
Medicine and Biology Bucheli Pabon, JC. International Atomic Energy Agency, Austria Dondi, M. International Atomic Energy Agency, Austria El-Haj, N. International Atomic Energy Agency, Austria Estrada, E. International Atomic Energy Agency, Austria Fanti, S. University of Bologna, Italy and European Association of Nuclear
Medicine, Austria Giammarile, F. International Atomic Energy Agency, Austria Lee, D.S. Seoul National University College of Medicine, Korea and World
Federation of Nuclear Medicine and Biology Newman, D. International Society of Radiographers and Radiological Technologists,
United States of America Orellana P. International Atomic Energy Agency, Austria Paez, D. International Atomic Energy Agency, Austria Pellet, O. International Atomic Energy Agency, Austria Perez, M. World Health Organization, Switzerland Prior, J. University of Lausanne, Switzerland and World Federation of Nuclear
Medicine and Biology Scott, A. University of Melbourne, Australia and World Federation of Nuclear
Medicine and Biology
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@ No. 26
20-01949E
INTERNATIONAL ATOMIC ENERGY AGENCYVIENNA
20-0
1949
E