Limited Bone Scan

Indications:
  1. Metastases
  2. Detecting a benign or malignant tumor
  3. Trauma detection
  4. Joint Prosthesis

Contraindications:
  1. Pregnant women
  2. Patient had another Nuclear Medicine procedure within the last three days.

Radiopharmaceutical information:
  • Radionuclide:Tc-99
  • Radiopharmaceutical: Tc-99 MDP/HDP
  • Adult dosing: 20-25 mCi
  • Pediatric dosing: Adult dose x [(age+1)/(age+7)] with a minimum dose of 2mCi
  • Method of administration: IV into opposite side of pathology, and away from the heart
  • Method of Localization: Chemiabsorption
  • Physical Half-life: 6 hours
Patient Preparation:
  1. Try to come into the test well hydrated, remove all metal
  2. Depending on where the limited is being taken, may need to empty bladder immediately before the scan
  3. There are no dietary restrictions
  4. Avoid urine contamination of clothing.

Equipment Used:
Type of Camera or Probe: Gamma Camera
Collimator used: LEHR

Acquisition Setup:



Statics: View(s)
Matrix: 256 x 256
Total Counts or Duration: 300k to 1 million counts depending on the area or 5 to 10 minutes time

Whole body: View(s)
Matrix: 512 x 1024
Scan Speed: 10 cm/sec
Start/stop points: Start: just above the head. End: just below the feel

SPECT:
180 or 90 degree configuration
Total Rotation: 180 degree intervals over 180 degrees, or 360 degrees
Starting point:
Matrix: 128x128
Time/Azmuiths: Time 15- 20 minutes per scan= 15/30 seconds per stop
Number of Azmuiths: 60 stops=30 per head if using a 2 headed camera

Procedure:
Describe the procedure from verifying the requisition to completing the scan. Include any patient instructions pre- or post- injection/scan, delays between injection and imaging, and any side effects.
  1. Patient are scheduled for two appointments.
  2. An injection of a radio tracer will be administered into the patients vein. This will take about 15 to 20 minutes.
  3. Two to four hours later, patient must return for the actual scan which will take about 45 minutes to 1 hour.
  4. Stay hydrated and drink a lot of liquids prior to the scan.
  5. Void bladder before the actual scan.

Normal Uptake and common varients:

external image bones_scan_normal.jpg
http://phimaimedicine.blogspot.com/2010/07/668-bone-scan-28-bone-scan.html

Normal increased uptake of bladder and kidneys. Areas of increased uptake at joints due to normal activity.

Abnormal Uptake and causes:
Insert an image of an abnormal scan. Describe the abnormal uptake, and the cause of the abnormal uptake.
aj28-eftekhari-fig001.jpg
http://www2.alasbimnjournal.cl/alasbimn/CDA/imprime/0,1208,PRT%253D14160,00.html

In this bone scan, it shows that there are some abnormal activity in the right parasternal area. There's some uptake on the left knee and a linear uptake near the clavicle and spine region.

Artifacts:
Insert an image with an artifact, and explain what the artifact is.

F1_medium.gif
http://tech.snmjournals.org/content/31/3/149.full

Due to an injection of Tc-99m - MDP into the radial artery of the right hand, it causes a soft tissue uptake towards the side of the had and wrist.

Questions asked in Patient History:
  1. Are you pregnant?
  2. Are you breastfeeding?
  3. Have you had any other scans recently?
  4. Do you have any history of cancer?
  5. Have you had chemotherapy or radiation therapy?
  6. Do you have an history of fractures?
  7. Do you have any history of surgery?
  8. Do you sustain any trauma?
  9. Do you have pain? If so, where? How long?
  10. Have you had any recent dental work?
  11. Have you had any recent abnormal blood tests or lab work?

References: