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Changing of the Guard (The Sodium Fluoride Bone Scan)

Changing of the Guard (The Sodium Fluoride Bone Scan). By Karen Wiki Sponsored by Cyclotek. What is 18 F-Sodium Fluoride (NaF). Half Life = 109mins Energy = 511 keV Highly sensitive bone seeking tracer Uptake mechanism resembles 99m Tc MDP Excellent pharmacokinetic characteristics.

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Changing of the Guard (The Sodium Fluoride Bone Scan)

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  1. Changing of the Guard(The Sodium Fluoride Bone Scan) By Karen Wiki Sponsored by Cyclotek

  2. What is18F-Sodium Fluoride (NaF) • Half Life = 109mins • Energy = 511 keV • Highly sensitive bone seeking tracer • Uptake mechanism resembles 99mTc MDP • Excellent pharmacokinetic characteristics

  3. History • Recognised in the late 60’s Early 70’s 18Fas an excellent tracer for skeletal imaging • Limitations = short half life, high energy level, poor scanner design and availability

  4. 99mTc Bone Scan

  5. PET/CT • 18F NaF

  6. 99mTc BS 18F NaF

  7. GE Discovery VCT 64 slice GE Infinia Hawkeye SPECT/CT 64 SLICE

  8. Combined Total Bone Scan Referrals

  9. Oncology Referrers

  10. Ca Breast

  11. Case Study 1

  12. Case Study 2 • 99mTc BS

  13. 18FNaF

  14. 18FNaF

  15. Advantages of NaF PET/CT • Superior pharmacokinetics • Sensitive for lytic lesions • Better resolution and sensitivity • Routine tomographic data • Routine use of CT improves specificity • Shorter total examination time • One stop shop

  16. References • The SNM Practice Guideline For Sodium 18F-Fluoride PET/CT Bone Scans 1.1 • Grant FD, Fahey FH, Packard AB, Davis RT, Alvai A, and Treves ST. Skeletal PET with 18-Fluoride: Applying New Technology to an Old Tracer. JNM 2008;49:68-78. • Apostolova I, Brenner W. Measuring Bone Metabolism with Fluoride PET: Methodological Considerations. PET Clin 2010;5:247-257. • Abikhzer G, Kennedy J. 18F NaF PET/CT and conventional Bone Scanning in Routine Clinical Practice; Compartive Analysis of Tracers, Clinical Acquisition Protocols, and Performance Indices. PET Clin 2012;:315-328. • Czernin J, Satyamurthy N, Schiepers C. Molecular Mechanisms of Bone 18F-NaF Deposition. JNM 2010;51:1826-1829 • Klaus Strodel, Reza Vali. 18F NaF PET/CT Versus Conventional Bone Scanning in the Assessment of Benign Bone Disease. PET Clin 2012 • Mosci C, Lagaru A. 18F NaF PET/CT in the Assessment of Malignant Bone Disease. PET Clin 2012 • Southern Cross Health Insurance Eligibility criteria PET/CT

  17. Breast Cancer • Initial Staging in high risk Breast Cancer(Clinical Stage lllA or higher) or • Initial Staging in Clinical l-llB Breast Cancer with symptoms of bone pain or elevated alkaline phosphatase levels suggesting the presence of bone metastases • Restaging of all stage disease with symptoms of bone pain or elevated alkaline phosphatase levels strongly suggestive of the presence of bone metastases Southern Cross Health Insurance

  18. PET 2012Clin 7 () 315-328

  19. By Dr Alex Mitchell QHP

  20. Limitations of 99mTc Bone Scan • Inferior spatial resolution and sensitivity of gamma cameras • Longer uptake time • Longer scan times • SPECT/CT isn’t routinely used

  21. Advantages of 99mTc Bone Scan • Wide availability • Generator produced/daily elution • Longer physical half-life • Flow, blood pool and delayed • Lower radiation dose(0.0057mSv/MBq)

  22. Limitations of NaF PET/CT • Cyclotron produced • Availability • Higher radiation exposure • Lack of flow and blood pool capabilities

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