RIT-506

SPECIAL RADIOLOGICAL TECHNIQUES

SAMRA ZAHOOR
LECTURER|CASHT
19TH JUNE,2020.
 Definition

• A bone scan is a test that detects areas of

increased or decreased bone activity by
injecting a certain radiopharmaceutical i.e.
Tc-99m MDP.

• This may indicate bone injury or disease.

Radiopharmaceutical uptake depends on
osteoblast and osteoclast activity.

• Increased uptake- more osteoblastic

activity present
•Decreased uptake- more osteoclast activity
 indicaTions
 Neoplastic disease: Primary bone tumors & Bone metastasis
– Staging for malignancies that have high incidence of bone
metastasis eg. cancers of prostate, breast, lung,
neuroblastoma.
– Unexplained bone pain in a patient with known
malignancy (neg X-ray)
– Unexplained bone pain in a patient with no history of
malignancy.
 Trauma: Fracture/ Stress injuries (eg, stress fracture,
shin splints).
 Infection:(osteomyelitis)
 Avascular necrosis
 Arthritis:Degenerative changes
 Metabolic & Endocrine disorders: (eg, Paget’s Disease,
Hyperparathyroidism)
 Bone marrow diseases: Sickle cell disease
 Contraindications

• Pt. recently had contrast media

for a different study.
• Pt. Recently (24-48 hrs) had a
TC99m-based nuclear scan
• Pregnancy
• Renal failure
 aDvantageS vS DiSaDvantageS

Advantages Disadvantages

 Whole-body evaluation in one  Needs radiopharmaceuticals

test/ same rad exposure. & gamma camera not widely
available.
 Low radiation exposure. 
Low specificity.

 Sensitive evaluation

Cost is high.
anatomy
 RadiophaRmaceuticals

 Bone-seeking agents are analogs of calcium,

phosphates.

The most widely used

Radiopharmaceuticals is
Tc-99m labeled
diphosphonates
Tc-99m MDP

Tc-99m Methylene diphosphonate

(Tc-99m MDP)
 tc-99m mdp

• Used within 4 hrs after preparation.

• High target ratio within 2-3 hrs. with
• Rapid renal clearance
• Renal Impairment: increased soft tissue
activity, poor image quality, delayed excretion,
higher radiation exposure due to retained
high activity
 technique
• Preparation: None
• Empty bladder prior to
scanning.
• Change the cloth and remove
things likely cause artifact.
• Injection of Tc-99m 740
MBq is given, good
hydration afterwards &
frequent voiding.
• Wait for about 2-3 hrs to
start imaging, avoid
contamination
• Effective dose obtained is
6.3 mSv.
Normal Bone Scan

• Tracer uptake greatest in axial

skeleton

• Sites of persistently
increased symmetric uptake:
• Acromial and coracoid
processes of the scapulae.
• Medial ends of the clavicles.
• The junction of the body and
manubrium of the sternum
(angle of Louis), and the
sacral alae. 
• Spine
 pooR image quality

• Renal impairment
• Decreased cardiac output
• Dehydration
• Extravasation of the radiopharamceutical
• Aging.
• Underdosage of the radiopharmacetical.
• Obesity.
imaging acquisition
 Routine Bone scan imaging

• Whole-body planar
imaging in anterior and
posterior projection.
• Additional static images if
required eg. Oblique or
additional spot views.
• This is the bony phase of bone scan.
• Inject radiopharmaceutical and image in 2-
4 hours.
• When we say bone scan, we usually mean
whole body bone scan.
 3-phase bone scan imaging
Vascular phase

• Phase 1; Vascular phase: 60 s

dynamic immediately post
injection

• Phase 2; Soft-tissue (blood-

pool) phase: 5 min post
injection.

• Phase 3; Delayed (bone) Soft-tissue delayed 2-3hr

phase: 2-3 hr post injection.
 First phase

• 30-60 dynamic images are usually obtained

over 1 minute immediately after injection.
• This is radionuclide angiography and gives an
idea about the local vasculature. During the
first minute after injection, injected dose is
still intravascular.
 second phase

• Static image is obtained in 5 minutes after

dose injection.
• Within 5 minutes post injection,
radiopharmaceutical moves from
intravascular space to extravascular space
(soft tissue). It gives idea about soft
tissue edema.
blood pool
 Hyperemia

• If there is focal increased activity in

the first and second phases,
hyperemia or acute inflammatory
process is present.
 THird pHase

• It is the bony phase image obtained in

2-4 hours post injection.
• It is the same as whole body bone
scan.
 Metastatic Bone Disease

Prostate Cancer
• The presence of multiple, randomly
distributed areas of increased uptake of
varying size, shape, and intensity is highly
suggestive of bone metastases.
 Stress Fractures

• Radiograph can be negative

• Most common sites are the femoral neck and
tibia.
• Typical pattern is oval area of increased
uptake with long axis parallel to axis of bone
 clinical applicaTions

• Malignancy
1- Primary bone cancer
2- Secondary metastatic bone disease
• Osteomyelitis
• Stress fractures