Bone Scan

1. Bone Scan NMT 1713

2. 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 Paget’s Disease • Eval of neoplasms (lesions)

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

4. 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.

5. Radioisotope Procedure • Distribution of isotope occurs thru chemisorption;chemically 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.

6. Results - NORMAL

7. Results - ABNORMAL

8. Results – ABNORMAL statics

9. Results - ABNORMAL

10. Abnormal Findings • Irregular uptake in right pelvis which is HIGHLY suspicious for METASTATIC DISEASE. Paget’s is less likely • Increased skull activity may be normal – dedicated skull studies advised

11. Paget’s Disease • Paget’s (pronounced paj-ets) disease affects bones. • Throughout a person’s life bone is constantly breaking down and growing back.  With Paget’s 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 Paget’s disease can become shorter because the bone bends. • With Paget’s disease the bone can also grow larger than before. • Paget’s disease can affect any bone, but usually affects the skull, the hip and pelvis bones and bones in the legs and back.

12. 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. Bone Scan - ADVANTAGES

13. 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).

14. 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.

15. 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.