Nuclear Medicine and Oncology in the COVID-19 pandemic era.

The coronavirus disease 2019 (COVID-19) global pandemic poses a significant challenge to the national health systems. Not only China, the first country that experienced the health crisis since last December, but the rest of the world, is facing an unprecedented global health crisis, the most serious crisis in a century, with social and economic impact. However, the most important impact of the new pandemic is the human impact. Till 4th of June 2020, coronavirus SARS-CoV-2, causing COVID-19 disease, has infected more than 65000.000 people and has been responsible for more than 386000 deaths globally. The first priority of public health authorities is to contain and mitigate the spread and infection rate of the coronavirus SARS-CoV-2, distributing the number of infections over time and, if possible, reduce the incidence of the disease (COVID-19) it causes. A critical task for health systems confronted with the spread of the coronavirus is to protect the health of all citizens, so this requires that both diagnosis/testing and appropriate care should be readily available, affordable, and provided in a safe environment. The health care systems of many developed countries failed to demonstrate a satisfactory response to the increased demand for acute care hospital beds, ventilators, emergency services, diagnostics tests, support equipment for their COVID-19 patients, availability of essential medicines, protective equipment for their staff etc. Nuclear Medicine (NM) departments and their staff, in spite of the fact that not being in the front line of the pandemic response, have experienced a dramatic alteration in their daily clinical activity, trying to adapt their clinical routine to the new environment. There are several issued guidance from national and international organizations, trying to help to cope with suspected or verified COVID-19 patients. Patients with cancer are thought to be more susceptible and have higher morbidity and mortality rates from COVID-19 than the general population. In the current article, our aim is to present measures, guidance and thoughts that should be considered for the cancer patients.

[Waste of resources as a result of cancelled or delayed diagnostic imaging of hospitalized patients]. / Resursespild ved manglende aflysning eller forsinkelse af billeddiagnostiske undersøgelser hos indlagte patienter.

INTRODUCTION: When diagnostic imaging is cancelled on short notice or an examination is delayed, the Imaging Department suffers a loss. Based on voluntary reporting of such events, we have estimated the total expenditure involved. MATERIALS AND METHODS: For one year an orderly reported cases in which, when he arrived to fetch an inpatient, the latter was no longer in the ward or was not ready. From this study material we estimated the waste of time for the staff and the total price of cancelled or delayed examinations, spread over various categories. This sum is related to the estimated cost of one preventive measure: letting the orderly check in the hospital's electronic administrative system whether the patient is still in the ward indicated. RESULTS: A total of 436 cancelled or delayed examinations were reported in 2004. In 249 cases the examination was cancelled, and since the recorded total number of cancellations was 1,435, we estimate the total number of cancelled or delayed exams to be approximately 2,500 (1,435 x 436/249). The estimated total waste of time is 66 weeks (1(1/2) years' work). The estimated price of the cancelled or delayed examinations is 2.4 million Danish kroner. When we relate the savings if the problem is solved to the cost of prevention, we find that it would be clearly profitable to address fluoroscopy and CT scanning. Conversely, addressing bone X-rays would generate a loss. CONCLUSION: We conclude that there is a very large waste of resources caused by cancelled or delayed imaging examinations.

Acquiring new technology and surviving environmental pressures.

CONTEXT: The U.S. health care system faces increased pressures to expand coverage to the elderly, the uninsured and the poor, while maintaining costs and quality of care. Because of the federal budget deficit and continued fiscal uncertainties, resource allocation will become even more scrutinized. OBJECTIVE: How does a health care system allocate limited funds and still provide quality care using innovative technology? METHOD: This article reviews the literature on the acquisition of new technologies from a theoretical perspective, using positron emission tomography (PET) as an example. A unified model, including concepts from the resource dependency theory (RDT) supplemented with organizational survival concepts from the ecological theory, was used to analyze resource acquisition for technological innovation and organizational survival. An attempt was made to evaluate a hospital's profit maximization, recognition as a center of clinical excellence and role as a technological leader of the community with respect to acquisition of PET equipment. CONCLUSION: Organizations acquire new technology for a variety of reasons that can be explained by RDT and ecological theory concepts. In terms of the profit maximization motive, hospitals purchase PET equipment to enhance revenue generation. From the clinical excellence perspective, organizations seek the best available technology to meet the needs of their patients. Finally, hospitals adopt new technology to enhance their image as a technological leader.

Workflow in nuclear medicine.

This paper discusses a workflow management system for nuclear medicine. It augments the more conventional PACS with automatic transfer of studies along the chain of activities making up an examination in nuclear medicine. A prototype system has been designed, built, and installed in a department of nuclear medicine, active in a network of hospitals.

The economics of creating a positron emission tomography center.

Positron emission tomography (PET) scanning has been a powerful research tool since its inception. Changes in the marketplace that have allowed PET to move into the clinical environment include the commercial availability of appropriate radiopharmaceuticals, reimbursement of procedures by insurance companies, and increasing awareness of physicians of the benefits of PET. Facilities that are interested in clinical PET need to develop a process to purchase equipment with an appropriate business plan. This is necessary to assure financial viability and to convince hospital administrators of the viability. The creation of a successful PET program requires an understanding of all aspects relating to a center. The process begins with reviewing the mission statement of the facility. The next step is to prepare the feasibility study, which includes reviewing the existing marketplace and determining the volume, level of referring physicians' interest, and availability of radiopharmaceuticals. Finally, an appropriate pro forma needs to be constructed to facilitate the final decision concerning the potential financial viability of such an endeavor.

Counting the cost of patients who do not attend nuclear medicine departments.

The mean rate of non-attendance at this hospital is 16%, with the Nuclear Medicine Department averaging 4%. Although only a small percentage, increasing demand for nuclear medicine studies has led to a need for greater efficiency to reduce financial losses. From April 1995 to March 1996, 104 patients did not attend over a range of 16 studies. We examined the types of study, patients and costs. The costs of wasted staff time, camera time and radiopharmaceutical ranged from pound sterling 24 (99Tc(m) thyroid) to pound sterling 470 (75Se cholesterol adrenal). This results in a loss equivalent to pound sterling 7258 over the year. There was no significant difference in non-attendance rates between different types of procedure, source and type of referral, or in the three age groups: children, working and retired population. Finally, we looked at cultural origins, segregating the groups into Asian and European origins based on surname. A significantly higher proportion of patients of Asian origin did not attend. This study has shown that it may be of benefit to target specific groups and tests. For example, at City Hospital, perhaps we should concentrate on our Asian community to ensure they understand fully what the study involves. It would also be worthwhile targeting the more expensive nuclear medicine studies.

Nuclear cardiology in hospital-based practice.

Managed care has drastically changed the environment in which we practice hospital-based nuclear cardiology. As of 1995, traditional fee for service comprises only 8% of all reimbursement in the United States. Nuclear cardiology is now a cost center, not a revenue center, for the hospital. In Minnesota, many physicians and hospitals work together toward common goals in various "integrated health service networks." There are several ways in which nuclear cardiology can help a health care network reduce costs. Results of myocardial perfusion, for example, can be used to help reduce unnecessary coronary angiography and revascularization procedures. On the other hand, nuclear cardiology is generally not cost-effective in patients with a low likelihood of benefitting from the test and should usually be avoided in such patients.

Positron emission tomography: a financial and operational analysis.

Positron emission tomography (PET) is an emerging clinical imaging technique that is facing the challenges of expansion in a period of imminent health care contraction and reform. Although PET began showing utility in clinical medicine in the mid-1980s [1], its proliferation into mainstream medical practice has not matched that of other new imaging technologies such as MR imaging. Many factors have contributed to this, including the changing health care economy, the high cost of PET, the length of time it takes to develop a PET facility, and its inherent complexity. In part because of the proliferation of the use of other technologies and the general explosion of costs, insurance carriers are now holding diagnostic techniques, including PET, to stricter standards of efficacy. New techniques must show improvement in long-term outcome of patients, a difficult task for diagnostic tools. In addition to these issues, PET is an expensive technology that requires highly trained multidisciplinary personnel. Questions have also been raised about the most appropriate mechanism for regulation of PET isotope preparation, leading to speculation about future regulatory requirements. The current pioneers of PET must meet these challenges in order for it to become a routine imaging technique. Because of its clinical value, PET will probably survive despite the challenges. For many reasons, though, not every hospital should necessarily develop PET services. Conversely, many hospitals without this technology should consider acquiring PET. The purpose of this article is to identify the financial, operational, and clinical challenges facing PET centers today, describe potential organizational configurations that may enable PET to survive in an antitechnology environment, and delineate which institutions should consider this new technology.

Effect on patient management of a weekend 'on-call' nuclear medicine service.

The Nuclear Medicine Department at Kent and Canterbury Hospital operates a limited weekend on-call service staffed on a rota basis by a technician, a nurse and a doctor. Following a review of the service over a 2-year period, a prospective study was carried out to analyse the workload of the on-call service from August 1991 to July 1992. The aim was to assess the impact of the service on patient management and examine the cost implications. Sixty-two scans were performed during the year (38 Saturday, 22 Sunday, 2 Bank Holiday) of which 52 were ventilation/perfusion (V/Q) lung scans. The study examined the reports on the scans and the subsequent course of treatment and changes in patient management. For V/Q lung scans, anticoagulation therapy was changed in 13 cases as a result of the scan report. Of the lung scans showing low probability of pulmonary emboli, four patients were discharged on the day of the scan and a further eight within 48 h. The total cost of the on-call service (staff and consumables) was 6020 pounds, i.e. less than 100 pounds per patient and less than 2% of the departmental budget. The low cost and high number of changes in patient management indicate a reasonable cost-benefit ratio.