1. Inaya medical science college Introduction To Nuclear Medicine Technology RAD364 L: Aya Ahmed Abd alrahium saeed MSC &BSC Nuclear medicine

3. The nuclear medicine bone scan is a versatile tool because of its high sensitivity for tumors, infection, and trauma, as well as its ability to image the entire skeleton at a reasonable cost. Introduction

4. Type of Skeletal Scintigraphy 1.three-phase imagin 2. Bone scan

5. Tc-99m hydroxymethylene diphosphonate (Tc-99m HMDP) Or (HDP) and Tc-99m methylene diphosphonate (Tc-99m MDP). Radiopharmaceuticals

6. Incomplete labeling may occur if air is introduced into the vial causing stannous ion hydrolysis (from Sn II into SnIV). Insufficient stannous ion results in free technetium pertechnetate (“free tech”), causing image degradation with increased background soft tissue activity and uptake in the thyroid, stomach, and salivary glands. Preparation of MDP

7. Adult Dose Range 20–30 mCi (740–1110 MBq), pediatrics by weight. Method of Administration Intravenous: Straight stick, butterfly or existing IV catheter with saline flush. Flow requires fast bolus injection.

8. After intravenous injection, Tc-99m MDP rapidly distributes into the extracellular fluid and is quickly taken up into bone. Note :Accumulation of Tc-99m MDP does relate to the amount of blood flow to a region, but uptake is primarily. controlled by the amount of osteogenic activity, being much. higher in areas of active bone formation or repair compared with mature bone. Uptake

9. Patient should be well hydrated. Patient voids immediately before study and frequently for next several hours. Patient should remove metal objects (jewelry, coins,keys) before imaging. patient preparation

10. The most frequent indication for three-phase imaging is to assess possible osteomyelitis. evaluation of the painful joint, trauma, and complex regional pain syndrome. the assessment of metastatic disease. Evaluation of response to chemotherapy, radiation therapy, antibiotic therapy, and other treatment. Indications

11. Differentiation between osteomyelitis (inflammation of bone and bone marrow) and cellulitis (inflammation of cellular or connective tissues). Detection and evaluation of metabolic bone diseases such as Paget's disease. Evaluation of abnormal laboratory results (e.g., elevated prostate specific antigen [PSA], elevated alkaline phosphatase in osteogenic sarcoma and metastatic prostate cancer, elevated Ca 2+ in breast, lung, and kidney cancer bone).

12. Patient who has recently ingested contrast medium (particularly barium) for a different study (x-ray) or has one scheduled between injection and imaging. CT and MRI agents do not seem to attenuate these studies. Patient who has recently (24–48 hours) had a technetium-based nuclear medicine scan performed. Contraindications

13. The patient should be well hydrated, and after injection the patient must be instructed to drink several cups of fluid to improve background clearance. If dynamic three-phase scanning is to be performed, abolus of Tc-99m MDP is injected intravenously with the area in question under the camera. The first phase consists of serial2- to 5-second dynamic images acquired for 60 seconds. Procedure

14. Delayed images constitute the third phase of a three phase bone scan. Alternatively, delayed images are done alone for routine studies. Then blood pool or soft tissue second-phase images are obtained of the region and secondary areas of interest,such as in patients with arthritis or multiple stress injuries. Procedure

15. obtained by whole-body scan or spot views. The whole-body scan allows rapid, seamless coverage as the camera moves over the patient at a predetermined rate. Spot views, on the other hand, can provide greater detail because of higher resolution and can better define pathological conditions by using different camera positions. Procedure

16. waiting 3 or 4 hours after injection is often necessary in the elderly and in those with poor renal function. Although a delay of 24hours may yield images of sufficient quality in younger patients. Images delayed further, at 24 hours, which is a fourth phase, may be needed to clear soft tissue activity in the most severe cases.

17. depending on age and history. Some bones, such the sacroiliac joints normally appear to have intense uptake. Other areas are more intense because of proximity to. The sternum often has residual ossification centers, and the normal sternomanubrial joint may have mild increased uptake. The skull is highly variable in appearance and may show increased uptake. Normal and Altered Distribution

18. Normal Tc-99m MDP whole-body bone scan

19. Normal radiotracer distribution in the immature skeleton

20. preparation Position gamma camera immediately over area of concern. Radiopharmaceutical administration Administer intravenous bolus of Tc-99m methylene diphosphonate using standard dosage. Flow phase Obtain dynamic 2- to 5-second images for 60 seconds after bolus injection. Blood pool and tissue phase Obtain immediate static images for time (5 minutes) or counts (300k). Skeletal phase Delayed 300k-1000k images at 2 to 4 hours. Three-Phase Skeletal Scintigraphy

21. Blood pool

22. Three-phase bone scan images

23. Characteristic appearance of osteoarthritis in the hands and wrists. Uptake is increased in multiple distal interphalangeal joints

24. Flare phenomena on bone scan (A to C). A, Metastatic lesions in a patient with breast cancer appear

25. Paget disease