Bone Scan

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Bone Scan

• NMT 1713

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Indications

• Detection of primary and staging metastatic
  disease. (types known to mets to bone are
  breast,lung,prostate,and kidney)
• Eval of bone pain / fractures.
• Arthritic disease
• Detection of Pagets Disease
• Eval of neoplasms (lesions)

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Contraindications

• Pt. recently had contrast media for a different
  study.
• Pt. Recently (24-48 hrs) had a TC99m-based
  nuclear scan

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Procedure

• ID patient
• Inject pt. with 20-30mCi of TC99m-HDP
  (hydroxymethylene diphosphonate)
• Pt. asked to return for imaging in 2-3 hours.
• Pt. asked to drink lots of fluid (hydrate well)
  and urinate often before imaging
• Pt. returns and imaging takes 20-30 minutes.

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Radioisotope Procedure

• Distribution of isotope occurs thru
  chemisorptionchemically bonds on surface of
  hydroxyapatite crystals.
• These hydrolyze and bind normally to bone as tin
  oxide and/or TcO2, and present as prominent focal
  areas during the process of osteoblastic activity
  of bone repair.

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Results - NORMAL
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Results - ABNORMAL
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Results ABNORMAL statics
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Results - ABNORMAL
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Abnormal Findings

• Irregular uptake in right pelvis which is HIGHLY
  suspicious for METASTATIC DISEASE. Pagets is
  less likely
• Increased skull activity may be normal
  dedicated skull studies advised

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Pagets Disease

• Pagets (pronounced paj-ets) disease affects
  bones.
• Throughout a persons life bone is constantly
  breaking down and growing back.  With Pagets
  disease the normal process of bone growth is
  changed. The bone breaks down more quickly, and
  when it grows again it is softer than normal
  bone.
• Soft bones can bend or break more easily.  The
  area affected by Pagets disease can become
  shorter because the bone bends.
• With Pagets disease the bone can also grow
  larger than before.
• Pagets disease can affect any bone, but usually
  affects the skull, the hip and pelvis bones and
  bones in the legs and back.

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Bone Scan - ADVANTAGES

• Bone scanning with nuclear medicine can be an
  important step in diagnosing and assessing
  treatment of various types of Cancer.
• It can reveal if the cancer has spread
  (metastasized) beyond its primary site and
  developed secondary cancer growths in the bones.

• On an x-ray one might see that the bone is not
  broken, but on a bone scan, physicians can see
  metabolic changes caused by fine fractures, small
  tumors, or degenerative diseases such as
  arthritis.

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Bone Scan - SUMMARY

• Nuclear medicine is used mainly to allow
  visualization of organs and regions within organs
  that can not be seen on conventional x-ray
  images.
• Space occupying lesions (injury or abnormality),
  especially tumors, may stand out on nuclear
  medicine images.
• Generally, these lesions are seen as areas of
  reduced radioactivity (called a "coldspot")
  however, in some instances, like bone scanning,
  areas of increased activity (called a "hotspot")
  represent disease or injury (pathology).

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Bone Scan possible follow up

• Depending on what is seen by the Dr. he may
  recommend a Gallium or Indium Scan to see the
  lesion / tumor.
• Depending on abnormal findings, you may be sent
  for followup MRI , PET scans
• Depending on the stage of pain you may be sent
  for palliation therapy with other radioisotopes.

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Bone Scan and Nuclear Medicine

• Remember that the reason your patient is having
  this procedure done may not be obvious.
• Do your research via the patient chart and ALWAYS
  work with utmost professionalism and DIGNITY
  towards your patient.