The COVID-19 pandemic: impact on NHS England PET-CT services and lessons learnt

Abstract

Purpose The purpose of the study was to examine the impact of the first wave of COVID-19 on National Health Service (NHS) 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET-CT) scanning activity across England. Methods Monthly FDG PET-CT scanning activity was collected from 41/48 NHS England provider sites. Data from 31/41 sites were stratified by nononcology/oncology, cancer type, with lung cancer and lymphoma split into specific indications, turn-around times and delays due to radiotracer. Results In April and May 2020, a 32 and 31% decrease in activity was observed, a larger decrease for noncancer compared with cancer FDG PET-CT. In June 2020, activity started to recover with 6% fewer scans recorded compared with June 2019. Of the six most common indications, lung and oesophageal cancer had the largest decrease in activity and slowest recovery. Lymphoma and melanoma showed the smallest decrease and fastest recovery. Lung cancer scans for initial diagnosis/staging saw the largest fall and slowest recovery compared with scans for known lung cancer. There was no percentage increase in overall turn-around time compared with the same months in 2019, and no increase in turn-around time of more than 7 working days due to FDG supply during April and May 2020 compared with the 3 previous months. Conclusions There is no correlation between FDG PET-CT activity (fall and recovery) in England and the ability to provide the service by NHS England. It most likely reflects a combination of changes in health-seeking behaviour, NHS health policy and a decrease in the use of investigations that carry a high risk of COVID-19 transmission.

Impact of COVID-19 pandemic on 2-[18F]FDG PET/CT imaging work-flow in a single medical institution: comparison among the three Italian waves

“…A similar multi-center study was performed by Wong et al. [ 13 ] in England during the first COVID-19 wave comparing the impact of pandemic on oncological and non-oncological 2-[ 18 F]FDG PET/CT workload. They found that the total number of 2-[ 18 F]FDG PET/CT scans fell significantly during the first COVID-19 wave, with the reduction being greater for non-oncological PET/CT studies.…”

“…Therefore, our experience and these other investigations confirm that 2-[ 18 F]FDG PET-CT imaging for cancer patients was not significantly affected by the restrictive medical measures of COVID-19 pandemic. However, even though 2-[ 18 F]FDG PET/CT imaging workflow for cancer patients was less impaired by the pandemic [ 11 , 13 ], an overall reduction in nuclear medicine procedures has been reported in worldwide and national surveys [ 18 , 19 , 20 ]. Of note, the decrease and/or the postponement of diagnostic examinations due to the pandemic might impact on the disease's clinical course, potentially affecting the quality of life and patient survival [ 21 ].…”

Oncology and cardiology positron emission tomography/computed tomography faced with COVID-19: A review of available literature data

“…According to a survey on the impact of the first wave of COVID-19 (estimated to have started in March 2020 and ended at the end of May 2020) on NHS England PET/CT services, there was a reduction in the number of FDG PET/CT examinations of 32% in April 2020 and 31% in May 2020 compared with those performed in the same months in 2019, and recovered to a reduction of 6% in June 2020. The first wave of COVID-19 had a much greater influence on non-oncological FDG PET/CT (reduction of 55% in April 2020 and 33% in May 2020) than on oncological PET/CT (reduction of 23% in April 2020 and 26% in May 2020) (17), similar to the trends reported in other studies (12,18). This finding was the result of recommendations by professional organizations and published guidance that PET/CT services for people with cancer should remain uninterrupted as far as possible (1).…”

The Impact of COVID-19 on Nuclear Medicine in Europe

“…In NHS England PET-CT services, the turnaround time for [ 18 F]FDG PET-CT scans did not increase (indeed, the percentage of scans with a turnaround time of more than seven working days during April and May 2020 was lower than that in the same months in 2019). Overall, these PET/CT services maintained their ability to meet demand ( 25 ).…”

“…PET/CT examinations for diagnosis and staging of lung cancer showed a fall of 29% in April, 47% in May, and 26% in June 2020 relative to 2019. For lymphoma, which showed the less relevant dip, the decrease was 9% in April, 28% in May, and 14% in June 2020 ( 25 ). These results are in line with those that emerged from the BNMS survey, which 138 members completed.…”