Thank you.
That is an excellent question. There are major challenges. At present, we are being asked to do the impossible with a bare minimum. Among the major challenges, there is the fact that the shortage varies from one day to the next. It is extremely difficult to schedule exams, even within a 24-hour window. Since I don't know how much radioactive products my department will receive the next day, it's difficult to tell a patient the night before to get ready for a given exam. It's really a logistics problem. Sometimes patients are asked to come to the hospital, but then there isn't any radioactive product to use for their exams. That is really the number one problem.
Second, there is the issue of priority. When you only have 15% or 20% of a component needed for exams, it's clear that the most urgent cases get priority. However, it is difficult to determine which cases are the most urgent. In some cases, it may be a matter of life or death. We have to rely on common sense. It is essential to always determine whether the patient's exam can be postponed a few days or whether it is really essential, for example if the patient is about to undergo surgery or chemotherapy in the next few hours. It's a logistics issue. In order to compensate for this, we need to be able to operate on evenings and weekends, to ensure that the department is open when the product is available.
Third it is a matter of looking at the choices that can be provided to patients. The myocardial perfusion can be done to check blood vessels. Coronary angiographies or angiograms allow us to see blood vessels. The main advantage of nuclear medicine is that these exams are not invasive. Injecting radioactive products is the most invasive part of our exams. However, the proposed alternatives are sometimes more invasive. It may be necessary to put a patient on a gurney and use special injection products. Ultimately, the alternative may carry a higher risk of mortality than the nuclear medicine exam. Furthermore, diagnostic sensitivity can be decreased when using alternatives.
We provide other choices while ensuring that they will enable good diagnostic results and that they will not be harmful, while trying to do the utmost for our nuclear medicine patients. This is a daily challenge.