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The International Atomic Energy Agency (IAEA) conducted a survey to determine the impact of the COVID-19 pandemic on nuclear medicine services worldwide at two specific time-points: June and October 2020. In this paper, we describe the impact of COVID-19 on nuclear medicine departments in Africa (19 countries, 41 centers) and Latin America (15 countries, 83 centers) obtained from the survey. Respectively in Africa and Latin America, the volume of nuclear medicine procedures decreased by 69% and 79% in June 2020 and 44% and 67% in October 2020. Among the nuclear medicine procedures, oncological PET studies showed less of a decline in utilization compared to conventional nuclear medicine studies. A gradual trend towards a return to the pre-COVID-19 status of the supply chains of radioisotopes, generators, and other essential materials was evident. Overall, in 2020, the pandemic-related challenges resulted in significant decrease in nuclear medicine diagnostic and therapeutic procedures in Africa and Latin America. The impact was more pronounced in Latin America than in Africa. The current COVID-19 pandemic poses many challenges for the practice of nuclear medicine. If adequately prepared, departments can continue to deliver their essential services, while mitigating the risk for patients and staff. This requires adapting the SOPs, as quickly as possible, to meet the new requirements.

The current pandemic has resulted in unprecedented demands on health care systems overloaded with COVID-19–afflicted patients, with the challenges of an insufficient number of beds and insufficient equipment and personal protective equipment for staff. In an effort to spare resources and to minimize exposure of patients and personnel, a shift to limit access only to patients needing essential services was undertaken. This invariably led to decreased access to many routine hospital services. Furthermore, patients themselves were not accessing hospital services because house confinement, social distancing, limitation of gatherings, and general business lockdowns to flatten the curve came into effect. Under these unique circumstances, the move to telemedicine resources became a natural solution to pressing health care needs constrained by the disruptive crisis. Current telemedicine use Telemedicine, or the electronic transmission of medical information via digital communications, has become an essential tool. It has led to a significant increase in the utilization of remote telemedicine and telehealth interventions, with many physicians in some regions using these technologies to manage patients remotely. Expanded use of telemedicine in medical care and teleradiology occurred in tandem with the increased need for social distancing. Telemedicine tools are more commonly used for remote treatment, particularly in the United States, where 63% of health care practitioners have used it. Among physicians currently using telemedicine for consultation, nearly half (48%) are using it for the first time. When the outbreak ends, one-fifth of physicians using telemedicine tools expect to use them significantly more than before the pandemic.1 The COVID-19 pandemic has shone a spotlight on the innovative degree to which eHealth can empower health systems to avoid cross-infection of COVID-19 patients and ensure continuity of essential health services.

From the outset of the COVID-19 pandemic we, the nuclear medicine (NM) community, expediently mobilized to enable continuity of essential services to the best of our abilities. For example, we effectuated adapted guidelines for NM standard operating procedures (SOPs) and enacted heightened infection protection measures for staff, patients, and the public, alike. Challenges in radionuclide supply chains were identified and often met. NM procedural volumes declined globally and underwent restoration of varying degrees, contingent upon local contexts. Serial surveys have gauged and chronicled such geographical variance of the impact of COVID-19 on NM service delivery and, though it may be too early to fully understand the long-term consequences of reduced NM services, overall we can certainly expect that this era adversely affected the management of many patients afflicted with non-communicable diseases. Today we are unquestionably better prepared to face unforeseen outbreaks, but a degree of uncertainty lingers. Which lessons learned will endure in the form of permanent NM pandemic preparedness procedures and protocols? In this spirit, the present manuscript presents a revision of prior recommendations issued mid-pandemic to NM centres, some of which may become mainstays in NM service delivery and implementation. Discussed herein are (i.) comparative worldwide survey results of the measurable impact of COVID-19 on the practice of nuclear medicine (ii.) the definitions of a pandemic and its phases (iii.) relevant, recently developed or updated guidelines specific to nuclear medicine (iv.) incidental findings of COVID-19 on hybrid nuclear medicine studies performed primarily for oncologic indications and (v.) how pertinent pedagogical methods for medical education, research, and development have been re-invented in a suddenly more virtual world. NM professionals shall indefinitely adopt many of the measures implemented during this pandemic, to enable continuity of essential services while preventing the spread of the virus. Which ones? Practices must remain ready for possible new peaks or variants of the roiling COVID-19 contagion and for the emergence of potential new pathogens that may incite future outbreaks or pandemics. Communications technologies are here to stay and will continue to be used in a broad spectrum of applications, from telemedicine to education, but how best? NM departments must align synergistically with these trends, considering what adaptations to a more virtual professional environment should not only last but be further innovated. The paper aims to provide recent history, analysis, and a springboard for continued constructive dialogue. To best navigate the future, NM must continue to learn from this crisis and must continue to bring new questions, evidence, ideas, and warranted systematic updates to the figurative table.

Summary Background Accurate survival estimates are important for cancer control planning. Although observed survival estimates are unavailable for many countries, where they are available, wide variations are reported. Understanding the impact of specific treatment and imaging modalities can help decision makers to effectively allocate resources to improve cancer survival in their local context. Methods We developed a microsimulation model of stage-specific cancer survival in 200 countries and territories for 11 cancers (oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, breast, cervix uteri, and prostate) comprising 60% of global diagnosed cancer cases. The model accounts for country-specific availability of treatment (chemotherapy, surgery, radiotherapy, and targeted therapy) and imaging modalities (ultrasound, x-ray, CT, MRI, PET, single-photon emission CT), as well as quality of care. We calibrated the model to reported survival estimates from CONCORD-3 (which reports global trends in cancer survival in 2000–14). We estimated 5-year net survival for diagnosed cancers in each country or territory and estimated potential survival gains from increasing the availability of individual treatment and imaging modalities, and more comprehensive packages of scale-up of these interventions. We report the mean and 95% uncertainty intervals (UIs) for all outcomes, calculated as the 2·5 and 97·5 percentiles of the simulation results. Findings The estimated global 5-year net survival for all 11 cancers combined is 42·6% (95% uncertainty interval 40·3–44·3), with survival in high-income countries being an average of 12 times (range 4–17) higher than that in low-income countries. Expanding availability of surgery or radiotherapy or improving quality of care would yield the largest survival gains in low-income (2·5–3·4 percentage point increase in survival) and lower-middle-income countries (2·4–6·1 percentage point increase), whereas upper-middle-income and high-income countries are more likely to benefit from improved availability of targeted therapy (0·7 percentage point increase for upper-middle income and 0·4 percentage point increase for high income). Investing in medical imaging will also be necessary to achieve substantial survival gains, with traditional modalities estimated to provide the largest gains in low-income settings, while MRI and PET would yield the largest gains in higher-income countries. Simultaneous expansion of treatment, imaging, and quality of care could improve 5-year net survival by more than ten times in low-income countries (3·8% [95% UI 0·5–9·2] to 45·2% [40·2–52·1]) and could more than double 5-year net survival in lower-middle-income countries (20·1% [7·2–31·7] to 47·1% [42·8–50·8]). Interpretation Scaling up both treatment and imaging availability could yield synergistic survival gains for patients with cancer. Expanding traditional modalities in lower-income settings might be a feasible pathway to improve survival before scaling up more modern technologies. Funding Harvard T H Chan School of Public Health.

Radiology in low- and middle-income (developing) countries continues to make progress. Research and international outreach projects presented at the 2015 annual RAD-AID conference emphasize important global themes, including (1) recent slowing of emerging market growth that threatens to constrain the advance of radiology, (2) increasing global noncommunicable diseases (such as cancer and cardiovascular disease) needing radiology for detection and management, (3) strategic prioritization for pediatric radiology in global public health initiatives, (4) continuous expansion of global health curricula at radiology residencies and the RAD-AID Chapter Network's participating institutions, and (5) technologic innovation for recently accelerated implementation of PACS in low-resource countries.