Considerations about Ventilation and Perfusion Imaging for the Diagnosis of Pulmonary Embolism During the COVID-19 Pandemic

2009 Introduction: A new type of coronavirus, SARS-CoV-2 (Covid 19), was identified in December 2019 in China. The resultant world-wide pandemic turned into one of the biggest challenges in the recent history of medicine. The virus is transmitted via respiratory droplets during close unprotected contact between individuals. Patients with COVID-19 infection are at increased risk of developing pulmonary embolism (PE), which may occur in up to one-third of COVID-19 patients requiring ICU admission. Ventilation Perfusion (V/Q) pulmonary scintigraphy can play a role in the management of patients hospitalized for COVID-19 infection for the diagnosis of embolic complications. However, it has been proposed to omit the ventilation scan and to only perform a perfusion planar scan (or a perfusion SPECT/CT scan) in patients with suspected pulmonary embolism. This was suggested in order to minimize the potential exposure to aerosolized secretions in the nuclear medicine department. However, not performing a ventilation scan is associated with a high risk of false positive results, which can potentially lead to unnecessary anticoagulant therapy and its risks for many patients. At present, the safety of V/Q pulmonary imaging for the diagnosis of pulmonary embolism during the COVID-19 pandemic is unknown and requires further work-up. In this educational abstract we will 1. Review the literature regarding patients with COVID 19 infection who had PE diagnosed using V/Q pulmonary imaging. 2. Discuss the benefits and risks of newly proposed algorithms and methods for the diagnosis of PE in order to minimize the use of ventilation imaging. 3. Discuss possible precautions such as appropriate personal protective equipment for techologists and evaluation of room airflow prior to performing ventilation imaging in order to minimize the risks.