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Bone Scan – Indications, Procedures, Results

Scintigraphy – bone

A bone scan is an imaging test used to diagnose bone diseases and find out how severe they are.

A bone scan is an imaging test used to help diagnose problems with your bones. It safely uses a very small amount of a radioactive drug called a radiopharmaceutical. It has also been referred to as a “dye,” but it doesn’t stain the tissue. Specifically, a bone scan is done to reveal problems with bone metabolism.

The Different Kinds of Bone Scan

If your doctor recommends a bone scan, what does it mean? A bone scan is a detailed, noninvasive imaging test that allows doctors to observe the inside of your bones in order to diagnose illnesses and track their progression.

There are two main types of bone exams. A three-phase bone scan is a nuclear imaging test that shows how the bones process an injected agent. A DEXA bone scan is a type of X-ray that tests bone strength and density to diagnose osteoporosis.

No preparation is necessary for either of these scans. Let’s look at these two types of scans in further detail:

Three-Phase Bone Scan (Nuclear Imaging)

A three-phase bone scan allows doctors to observe changes in the way your bones process an injected tracer over a period of time. The tracer is made of radioactive material that is harmless to your body. The tracer emits less radiation than a CT scan.

The doctor uses a special camera to take images of your bones right after the injection, and again several hours later. This shows details in your bone structure that can reveal a number of medical conditions.

Phase 1 – Injection

The radioactive tracer is injected into a vein, where the tracer will be absorbed into your bones.

Phase 2 – Initial Imaging

The technician will (painlessly) capture images immediately after the injection is given. The images will record the locations and the amounts of the tracer substance in your body.

Phase 3 – Detailed Scan

After a predetermined time (usually several hours), you will go back and undergo a detailed scan. This can take approximately an hour.

What a Three-Phase Bone Scan Shows

The three-phase bone scan reveals how and where the tracer moves through the bones. A radiologist will read the results of your bone scan and send them to your doctor.

This scan can show a tiny fracture that doesn’t appear on X-rays. It can also reveal whether there is an infection, a tumor, or cancer in the bone.

Any concentration of the tracer material, or the absence of it, will show where there may be a problem. Additional tests may be required.

DEXA Bone Density Scan (X-ray)

A DEXA scan is used to measure the strength of your bones. DEXA is a detailed type of X-ray that uses two frequencies to measure the density of bone mass.

How the Test is Performed

A bone scan involves injecting a very small amount of radioactive material (radiotracer) into a vein. The substance travels through your blood to the bones and organs. As it wears off, it gives off a little bit of radiation. This radiation is detected by a camera that slowly scans your body. The camera takes pictures of how much radiotracer collects in the bones.

If a bone scan is done to see if you have a bone infection, images may be taken shortly after the radioactive material is injected and again 3 to 4 hours later, when it has collected in the bones. This process is called a 3-phase bone scan.

To evaluate metastatic bone disease, images are taken only after the 3- to 4-hour delay.

The scanning part of the test will last about 1 hour. The scanner’s camera may move above and around you. You may need to change positions.

You will probably be asked to drink extra water after you receive the radiotracer to keep the material from collecting in your bladder.

How to Prepare for the Test

You must remove the jewelry and other metal objects. You may be asked to wear a hospital gown.

Tell your doctor if you are or may be pregnant.

DO NOT take any medicine with bismuth in it, such as Pepto-Bismol, for 4 days before the test.

Follow any other instructions you are given.

How the Test will Feel

There is a small amount of pain when the needle is inserted. During the scan, there is no pain. You must remain still during the scan. You will be instructed when to change positions by the technologist.

You may experience some discomfort due to lying still for a long period.

Why the Test is Performed

A bone scan is used to:

  • Diagnose a bone tumor or cancer
  • Determine if cancer that began elsewhere in your body has spread to the bones. Common cancers that spread to the bones include breast, lung, prostate, thyroid, and kidney.
  • Diagnose a fracture, when it cannot be seen on a regular x-ray (most commonly hip fractures, stress fractures in the feet or legs, or spine fractures)
  • Diagnose a bone infection (osteomyelitis)
  • Diagnose or determine the cause of bone pain, when no other cause has been identified
  • Evaluate metabolic disorders, such as osteomalacia, primary hyperparathyroidism, osteoporosis, complex regional pain syndrome, and Paget disease

Normal Results

Test results are considered normal if the radiotracer is present evenly throughout all the bones.

What Abnormal Results Mean

An abnormal scan will show “hot spots” and/or “cold spots” as compared to surrounding bone. Hot spots are areas where there is an increased collection of radioactive material. Cold spots are areas that have taken up less of the radioactive material.

Bone scan findings must be compared with other imaging studies, in addition to clinical information. Your provider will discuss any abnormal findings with you.

Risks

If you are pregnant or nursing, the test may be postponed to prevent exposing the baby to radiation. If you must have the test while breastfeeding, you should pump and throw away the breast milk for the next 2 days.

The amount of radiation injected into your vein is very small. All radiation is gone from the body within 2 to 3 days. The radiotracer that is used exposes you to a very small amount of radiation. The risk is probably no greater than with routine or conventional x-rays.

Risks related to the bone radiotracer are rare, but may include:

  • Anaphylaxis (severe allergic response)
  • Rash
  • Swelling

There is a slight risk of infection or bleeding when the needle is inserted into a vein.

FAQ

Why would a doctor order a bone scan?

  • Bone scans are used primarily to detect the spread of metastatic cancer. Because cancer cells multiply rapidly, they will appear as a hot spot on a bone scan. This is due to the increased bone metabolism and bone repair in the area of the cancer cells.

What is a bone scan looking for?

  • A bone scan can provide early detection of primary cancer and cancer that has spread to the bones from other parts of the body. A bone scan can detect osteomyelitis, an infection of the bone or bone marrow. A bone scan helps monitor the effects of treatment on bone abnormalities.

How accurate is a bone scan for detecting cancer?

  • Results: The sensitivity, specificity, and accuracy for detecting skeletal metastatic disease of FDG PET/CT were 97%, 98%, and 98%, respectively, and of the bone scan were 83%, 98%, and 93%, respectively. The lesions that the bone scan most commonly missed were located in the pelvis, spine, and sacrum.

What is a bone scan and how long does it take?

  • The scan takes 30 minutes to an hour. It is painless and you can go home after the scan. The body gets rid of the tracer through your urine over the next day. A bone scan shows up changes or abnormalities in the bones.

What diseases can a bone scan detect?

A bone scan can help detect the following conditions:

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