Deployment of a Dedicated "Covid-19" CT in Nuclear Medicine : Strategic Issues in the Context of an Epidemic Emergency

Aim/Introduction: With rapid spread of the new SARS-CoV-2 Coronavirus (Covid-19) and high prevalence of pulmonary involvements leading to respiratory failure, clinical needs for thorax CTs have dramatically increased in our hospital The Nuclear Medicine department is equipped with a hybrid SPECT/CT camera ideally located at an extremity of the department, close to the Emergency Room (ER) Materials and Methods: In this context, and owing to the close collaborations between all imaging departments already set up, we decided to deploy a 'Covid-19' CT in Nuclear Medicine, dedicated to ER out-patient workflow, another 'Covid-19' CT in the Neuroradiology department being deployed for in-patient workflow, the remaining CTs in the Radiology department being reserved for non-Covid patients This deployment required to take into account several strategic issues First, creating 3 distinct pathways would help reducing internal spread of the infection Regulation of these pathways was ensured by a senior radiologist with a dedicated phone number Then, we thought preferable for ER patients to be scanned as close as possible from the ER department, without using the elevator to reach the Neuroradiology CT Nuclear Medicine technologists were rapidly formed to the disinfection procedures and were paired with Radiology technologists Results: This organization was set up in only 24 hours thanks to the collaboration between technologists, physicians, physicist, radiation protection specialist, biomedical engineer and staff : a contrast media injector was connected to the SPECT/CT, all necessary CT protocols were programmed and validated on a phantom to ensure dose level conformity and DACS integration, and written declaration of this activity was performed to the Nuclear Security Agency (ASN) as the CT from the SPECT/CT does not have an authorization for diagnostic examinations, but a temporary derogation could be obtained if technical performances and medical organization were clearly stated During 10 weekdays (08:00-18:00) of deployment at the pandemic peak, 111 CT scans were performed on the SPECT/CT, including 50% thorax CT angiographies and 50% thorax CT without contrast A typical Covid-19 lung pattern was found in 63% of patients and pulmonary embolism was diagnosed in 11% of patients who underwent thorax CT angiography Conclusion: In the context of an epidemic emergency, multidisciplinary cooperation between imaging professionals allowed us to arm a dedicated 'Covid-19' CT in Nuclear Medicine within 24 hours and to optimize patient pathways This reactive organization is a pledge for increased collaborations especially when healthcare pathways are essential for population safety