During the current coronavirus COVID‐19 pandemic, remote interpretation of medical images, such as viewing studies from home, has become imperative for facilities to achieve their social‐distancing mandate and provide a safe workplace for image interpreters. To insure accurate interpretation of studies, it is self‐evident that monitors used for image interpretation, which we will refer to as primary diagnostic monitors (PDMs), must achieve adequate quality assurance standards and be compliant with relevant regulatory requirements.

In spite of this, almost all published regulations regarding PDMs do not provide clear instructions specific to the interpretation of nuclear medicine images and appear to aggregate all PDMs into the same set of specifications; according to our thinking this is not a reasonable alternative. The reports from the American Association of Physicists in Medicine (AAPM) Task Group 18 (TG18)1 and the ACR–AAPM–SIIM Technical Standard for Electronic Practice of Medical Imaging2 are all pertinent to performance of higher‐resolution modalities such as mammography and diagnostic CT but do not directly address needs specific to nuclear medicine. Most recently, the AAPM, in an online resource entitled “COVID‐19 Information for Medical Physicists,” shared a procedure note authored by the Clinical Imaging Physics Group at the Duke University School of Medicine which provides helpful guidance in setting up a temporary display device for diagnostic interpretation. Once again, this communication detailed high‐resolution monitor specifications and neither excluded nor addressed nuclear medicine needs.3 Tellingly, the NYC Department of Health and Mental Hygiene Office of Radiological Health, which licenses our facility, has recently revised guidelines regarding quality assurance programs for diagnostic facilities in New York City and, based on comments from users, explicitly excluded nuclear medicine imaging from the requirements for PDMs, Although not substituting replacement standards.4

The main source of specific guidance regarding nuclear medicine monitors that we have identified is authored by the AAPM Task Group 177 which states that “In the absence of any definitive study to determine the display characteristics needed for nuclear medicine monitors used for image interpretation, the task group recommends that nuclear medicine monitors should have a display white (maximum luminance) >120 cd/m², minimum luminance for black < 2 cd/m², and luminance nonuniformity of <20%.”5 In terms of quality assurance, the SNMMI and European Association of Nuclear Medicine (EANM) have authored a Practice Guideline for Tele‐Nuclear Medicine 2.0, which notes that full quality control of a monitor is not practical for remote sites, but states that “relatively simple test patterns should be readily displayable.”6

In our opinion, the need to codify and publicize specific standards and practical guidance regarding nuclear medicine remote reading stations and monitors on a national level is pressing. Even in the current situation, institutions may be loath to rely on home workstations and monitors that do not meet explicitly approved standards; the alternative of deploying monitors that are compliant with unnecessarily strict imaging standards would be wasteful if not impossible in situations of constrained resources and increased demand. As suggested in the SNMMI and EANM guidelines, it may be appropriate to allow some leniencies regarding off‐site monitors as a practical matter. Perhaps this would be an opportune time for the SNMMI to issue updated guidelines related to remote viewing of nuclear medicine images both in routine and exigent situations. It is our hope that the situation of expanded reading of nuclear medicine studies outside of the hospital engendered by the COVID‐19 pandemic may bring this need to the surface and galvanize some degree of change.

在当前的冠状病毒 COVID-19 大流行期间，医疗图像的远程判读（例如在家查看研究）已成为设施实现社交距离任务并为图像判读人员提供安全工作场所的必要条件。为了确保研究的准确解释，不言而喻的是，用于图像解释的显示器（我们将其称为主要诊断显示器（PDM））必须达到足够的质量保证标准并符合相关的监管要求。

尽管如此，几乎所有已发布的有关 PDM 的法规都没有针对核医学图像的解释提供明确的说明，并且似乎将所有 PDM 汇总到同一组规范中；根据我们的想法，这不是一个合理的选择。美国医学物理学家协会 (AAPM) 第 18 任务组 (TG18) 1和 ACR-AAPM-SIIM 医学影像电子实践技术标准2的报告均与更高分辨率模式的性能相关，例如乳腺 X 线摄影和诊断性 CT，但不能直接满足核医学的特定需求。最近，AAPM 在题为“医学物理学家的 COVID-19 信息”的在线资源中分享了由杜克大学医学院临床成像物理组撰写的程序说明，​​该说明为设置临时显示设备提供了有用的指导用于诊断解释。该通讯再次详细说明了高分辨率监测仪的规格，既没有排除也没有解决核医学需求。 3值得注意的是，为我们的设施颁发许可的纽约市卫生局和心理卫生放射健康办公室最近修订了纽约市诊断设施质量保证计划的指南，并根据用户的意见，明确将核医学成像排除在外。 PDM 的要求，尽管不能替代替代标准。 4

我们已确定的有关核医学监视器的具体指南的主要来源是由 AAPM 任务组 177 撰写，其中指出“由于缺乏任何明确的研究来确定用于图像解释的核医学监视器所需的显示特性，该任务小组建议核医学监视器的显示白色（最大亮度）>120 cd/m ² ，黑色最小亮度< 2 cd/m ² ，亮度不均匀性为<20%。” 5在质量保证方面，SNMMI 和欧洲核医学协会 (EANM) 撰写了《远程核医学 2.0 实践指南》，其中指出，监测仪的全面质量控制对于远程站点来说并不实用，但指出“相对简单的测试模式应该很容易显示。” 6

我们认为，迫切需要在国家层面制定和公布有关核医学远程读数站和监测仪的具体标准和实践指南。即使在当前情况下，机构也可能不愿意依赖不符合明确批准标准的家庭工作站和显示器；在资源有限和需求增加的情况下，部署符合不必要的严格成像标准的监视器的替代方案即使不是不可能，也是一种浪费。正如 SNMMI 和 EANM 指南中所建议的，在实际问题上，允许对场外监测器进行一些宽大处理可能是适当的。也许现在是 SNMMI 发布与常规和紧急情况下远程查看核医学图像相关的更新指南的最佳时机。我们希望，COVID-19 大流行引发的医院外核医学研究扩展阅读的情况可能会让这种需求浮出水面，并激发某种程度的改变。