Bone Nuclear Medicine Scan
Definition, Purpose, Precautions, Description, Preparation, Aftercare, Normal results, Abnormal results
A bone scan is a diagnostic procedure used to evaluate abnormalities involving bones and joints. A radioactive substance is injected intravenously, and the image of its distribution in the skeletal system is analyzed to detect certain diseases or conditions.
Bone scans are most frequently ordered to check whether a cancer that originated elsewhere has spread to the bones. Cancers which begin in the breasts, kidneys, lungs, prostate, thyroid, or urinary bladder are most likely to spread, or metastasize, to the bones. If metastases are found, periodic bone scans may be ordered to see if therapy is effective against a cancer.
Some cancers arise in bone. These are called primary bone cancers. When an abnormality is found on an x ray of a bone, a bone scan may be helpful in deciding if it is a primary bone cancer, or a non-cancerous (benign) condition.
Infection in the bone (osteomyelitis) can be detected or confirmed by a bone scan, often days or weeks before an x ray would reveal it. Bone scans are useful in diagnosing early arthritic changes, and monitoring both the progression of the disease and the effectiveness of treatment. Unexplained pain may be evaluated with a bone scan, because it can demonstrate fractures which are difficult to detect on x ray. Bone scans can be used to see if artificial joints have loosened or become infected. Suspected child abuse may be evaluated with a bone scan, due to its ability to see an overall pattern of repeated trauma. Abnormalities caused by altered circulation to the bone may be diagnosed with a bone scan.
Women who are pregnant or breastfeeding should not have this test. A patient who is unable to remain still for an extended period of time may require sedation for a bone scan.
This test is performed in a radiology facility, either in a hospital department or an outpatient x-ray center. The patient usually sits or lies down while a radioactive substance is injected through a vein in the arm. For a bone scan, the radionuclide used is specifically chosen to accumulate in the bone. The patient then waits from three to four hours, for the substance to collect within the skeletal system. During this time, he or she will be instructed to drink several glasses of water. Patients are free to get up and move around as they desire during this waiting time, and should urinate frequently. Just before the scanning begins, the patient should empty his or her bladder again. This ensures that a lot of radioactive material is not concentrated in the urinary bladder, which could obscure part of the pelvic bones.
During the scan, the patient lies on his or her back on a table, but may be repositioned to the stomach or side during the study. It is important for the patient not to move, except when directed to by the technologist.
The radionuclide scanner, sometimes called a gamma camera, or scintillation camera, is positioned against the body part to be examined. Either the camera, the table, or both, may change position during the study. For a total body bone scan, the patient is scanned from head to foot, over a period of 30-60 minutes. Patients should experience no discomfort from this examination.
A special kind of bone scan, called a SPECT (Single Photon Emission Computed Tomography) scan may be added, to study a particular part of the body in more detail. Suspected diseases of the hips, lower back, or jaw are often evaluated using this study. It usually takes an additional 30-45 minutes. The camera circles completely around the area in question or multiple cameras are used to create a cross-sectional image. This helps pinpoint the location of the abnormality being evaluated.
Another variation is called a three-phase, or three-stage, bone scan. The procedure is the same, except the scanning takes place immediately after the radioactive substance is injected, approximately 20 minutes after the injection, then two to four hours later.
Some specialized blood studies should be drawn before this study is begun. Jewelry or metallic objects need to be removed. No other special physical preparation is required.
The patient should understand that there is no danger of radioactive exposure to themselves or others, as only small amounts of the radioisotope are used. The total dose of radiation absorbed is minimal, often less than the amount received from ordinary x rays. The radionuclide scanner does not emit any radiation at all, but detects and records it from the patient.
Fluids are encouraged after the scan to aid in the excretion of the radioisotope. It is almost completely eliminated from the body within 24 hours.
The normal appearance of the scan will vary according to the patient's age. In general, a uniform concentration of radionuclide uptake is present in all bones in a normal scan.
A high concentration of radionuclide occurs in areas of increased bone activity. These regions appear brighter and may be referred to as "hot spots". They may indicate healing fractures, tumors, infections, or other processes which trigger new bone formation. Lower concentrations of radionuclide may be called "cold spots". Poor blood flow to an area of bone, or bone destruction from tumor may produce a cold spot.
The bone scan is a very sensitive test and can detect subtle conditions more readily than other studies. However, it is not a very specific examination, and often cannot distinguish exactly what disease process is causing an abnormality. Results need to be correlated with the patient's medical history, and other radiologic and laboratory studies to make a definite diagnosis.
Christian, Paul E., and R. Edward Coleman. "Skeletal System." In Nuclear Medicine, Ed. Donald R. Bernier, et al. St. Louis: Mosby, 1997.
Sutter, Charles W., and David K. Shelton "Three-Phase Bone Scan in Osteomyelitis and Other Musculoskeletal Disorders." American Family Physician 54 (Oct. 1996): 1639-1648.
Ellen S. Weber, MSN
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