Transfer of the site of surgery
The ARSAC notes that they have received a number of queries regarding the transfer of the site of surgery required for the administration of radioactive substances (e.g. sentinel lymph node biopsies) due to Covid-19.
"Where the administration remains at the licenced installation but the surgery is now at a different installation this constitutes a notification against the Employer licence," the ARSAC state.
"These should be submitted as an email to ARSAC@phe.gov.uk to include confirmation of the arrangements for the surgical teams and procedure."
Radioactive substances temporary employer licences
Applications are being accepted for temporary employer licenses by the Administration of Radioactive Substances Advisory Committee (ARSAC).
A short form for employers has been created by the ARSAC to issue licenses to administer radioactive substances.
The licenses are for situations where existing diagnostic NHS services involving the administration of radioactive substances are being temporarily transferred because of the Covid-19 pandemic.
The ARSAC notes that, for transfers of therapeutic services, the support unit should be contacted and any applications to transfer therapy services should be submitted on the full employer licence application form.
“Any transfer of services needs careful consideration and prior risk assessment as there are other regulatory requirements that also need to be satisfied,” the advice states.
“There is no fee for processing applications, and applications will be processed as a matter of urgency.”
For V/Q SPECT procedures, employers do not need to apply to amend their licence to administer an activity greater than the DRL.
However, the administration of an activity greater than the DRL must either be directly justified by the IR(ME)R Practitioner or detailed in a revised emergency protocol that is approved by the IR(ME)R Practitioner.
“Wherever possible, the patient’s best interest should be considered, and individual patient circumstances should be assessed on a case by case basis prior to administration,” the advice states. Further information can be found on BNMS.
ARSAC is continuing to process applications for employer and practitioner licences and research approvals. All applications should be submitted to ARSAC.
All forms are available on the website.
Covid-19 nuclear medicine recovery guidance
With the country preparing to reduce some of the restrictions associated with lockdown, the British Nuclear Medicine Society (BNMS) have released guidance to assist with the reintroduction of services.
The BNMS guidance covers:
- Waiting room capacity and social distancing
- Rationale for booking appointments
- Appointments for radioiodine therapy
- Patient booking process
- Radiopharmaceutical supply
- Cameras
- IT
- PPE and patient contact
- Cleaning
“Hospitals will soon be able to start the process of booking patient appointments currently on their waiting lists. This ‘recovery phase’ needs to be carefully planned as the process is not straightforward,” the guidance states.
“When planning appointments, the significant level of anxiety amongst patients should not be underestimated.”
The document should be read in conjunction with the BNMS guidance for the Covid-19 pandemic and the Royal College of Radiologists Covid-19 interim guidance for restarting elective work.
Further Resources
Journal articles
Nuclear Medicine Departments, be prepared!
Nuclear Medicine and Molecular Imaging Advisory Group member, Rayjanah Allie, has co-authored an editorial in Nuclear Medicine Communications: COVID19 - Nuclear Medicine Departments, be prepared! The editorial provides background information and hints and tips for departments on how to manage at this difficult time.
BNMS Guidance (Posted 3 April 2020)
Information and rescources from the BNMS Covid-19 hub
ARSAC Guidance(Posted 27 March 2020)
The Administration of Radioactive Substances Advisory Committee (ARSAC) has provided the following advice:
For V/Q SPECT procedures, employers do not need to apply to ARSAC to amend their licence to administer an activity greater than the DRL if this is for the purposes of reducing contact and scanning times and this has been approved by the local IR(ME)R Practitioner licence holder.
The administration of an activity greater than the DRL must either be directly justified by the IR(ME)R Practitioner, or detailed in a revised emergency protocol that is approved by the IR(ME)R Practitioner.
FDG PET/CT of COVID-19
Covid 19 is often seen as an incidental finding on PET-CT as peripheral ground glass lesions on the CT and FDG uptake.
Please see the following article based on a case in Wuhan.