Bone Marrow Scan

Indications:
-Evaluation of functional capacity of bone marrow (especially in cases of anemia).
-Evaluation of bone marrow space enlargement (E.g polycythemia)
-Assessment of bone marrow for metastasis.
-Evaluation of bone marrow abnormalities (e.g infarct, ischemia, asymmetric distribution).
-Evaluation of bone marrow sites for biopsy.
-Evaluation for liver disease, chronic anemia, leukemia or other blood disorders, thrombocytopenia (too few platelets), thrombocytosis, tumors, abscesses, cysts, and trauma.
-Evaluation of prosthetic joint for infection.
Contraindications:
-none
Radiopharmaceutical information:
  • Radionuclide: Tc-99m
  • Radiopharmaceutical:Tc-99m Sulfur Colloid,
  • Adult dosing: 12-15 mCi (444-555 MBq)
  • Pediatric dosing: 0.1-0.2mCi/kg
  • Method of administration: IV straight stick or catheter and flush
  • Method of Localization: Phagocytosis by reticular cells of liver, spleen, bone marrow, and lungs. Complete clearance by reticuloendothelial system by liver 80-90%, spleen 5-10%, and bone marrow 8%. Localization is flow dependent and requires functional integrity of RES cells in bone marrow sinusoids. The bone marrow study demonstrates the distribution of the functioning intravascular mononuclear phagocyte component of bone marrow.
  • Physical Half-life: 6 hours (blood clearence about 4 hours)

Patient Preparation:
  • Identify the patient. Verify doctor's order.
  • Explain the procedure.
  • Patient to void before imaging.
  • Adults fasting may have less effect then it does in children.
  • Children having a 2–4 hour fast may help reduce hepatobiliary excretion and bowel transit.


Equipment Used:
Type of Camera or Probe Gama camera
Collimator used: LEHR (16-18 hour delays with low count LEGP may be used)

Acquisition Setup:

Dynamic: View(s)
Matrix:
Time/Frame:
Number of Frames:

Statics: View(s)
Matrix: 256x256
Total Counts or Duration: 100k to 200k counts

Whole body: View(s)
Matrix:
Scan Speed: 10-12 cm per minute
Start/stop points:

SPECT:
180 or 90 degree configuration
Total Rotation: 180 or 360
Starting point:
Matrix
Time/Azmuiths
Number of Azmuiths:

Procedure:
Time : 60 minutes
Inject patient, wait at lease 15 minutes to 1 hour before imaging. This allows times for particles to concentrate in the reticuloendothelial system.
Position patient supine after emptying bladder.
Whole body:
Anterior head to toe.
Posterior at lease head to knees.
Statics of arms if necessary.
May want to shield liver/spleen

IF needed then obtain

Static: Obtain the following anterior/posterior images:
Lumbar and pelvis area
Head and thoracic spine
Left and right hips to include femur
Left shoulder to include humerus
Right shoulder to include humerus
Long bones if ectopic bone marrow production suspected.





Normal Uptake and common varients:
Tc-99m sulfur colloid localizes in the reticuloendothelial elements of the red marrow.
Abnormal Uptake and causes:
In patients with sickle cell anemia, the images obtained for bone marrow imaging shows marrow expansion into the extremeities.
Artifacts:
Insert an image with an artifact, and explain what the artifact is.

Questions asked in Patient History:
List the common questions asked when taking a patient history for this specific procedure.

References:
http://interactive.snm.org/docs/HMPAO_v3.pdf