X-Rays Made Easy

What is It?

    Bone scans, also known as radionuclide scan, scintigram, and nuclear medicine gram, are used to diagnose the location and severity of bone-related diseases. The nuclear imaging test is generally painless and low risk with no expected side effects or complications. It can indicate and reveal a variety of diseases, including but not limited to, arthritis, avascular necrosis, fibrous dysplasia, fractures, bone infections, bone cancer, and Paget’s disease.

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Who's Involved?

    The test is performed by a certified nuclear medicine technologist who is supervised by a radiologist, a doctor who specializes in the use of imaging tests for diagnosis, or a nuclear medicine physician, another professional who is trained to use tracers.

As a result, facilitates that offer bone scans include a hospital’s radiology or nuclear medicine departments and an outpatient imaging center.

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Process

    The process begins when a radiotracer or radionuclide is injected into a vein in a limb where it flows to bones and organs. A common radioactive compound used is technetium (99mTc) medronic acid. After some time, the radioactive material wears off and emits gamma rays, which are detected by a camera. The amount of time to wait for images can vary. For instance, in the diagnosis of metastatic bone disease, in which cancer spreads to the bone from another organ, images are taken after three to four hours.

    However, in the case of the three phase scan, images are taken three times over a three to four hour interval. In the first phase, the image is taken only seconds after the injection. The second time occurs after five minutes and finally, three hours later, the final image is taken. The use of three images can track the change over time. This method is typically used to check for bone infections, which may not be visible under regular x-rays.

    Despite the painless and harmless factors of the bone scan, scanning itself can take up to one hour. The camera moves around to take pictures of the entire skeleton while the patient lies down on an X-ray couch and stays motionless. The body goes through the scanner, sometimes inducing feelings of discomfort in claustrophobic patients.

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Before and After Session

    Other than the avoidance of bismuth and barium, which can interfere with results, patients do need any other preparations. Nonetheless, listening to the physician’s directions is always imperative. Because the radioactive material is flushed out of their systems through the renal system, patients are advised to drink more water after the procedure and empty their bladder to rid themselves of the radionuclide before the scan.

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Results

    Even without extensive study, the results can inform the patient of certain facts, right off the bat. In normal and healthy patients, the spread of radiation is even through the entire skeleton. However, abnormal results are distinguished by the presence of hot and cold spots in the images. The hot spots appear as dark areas where radiation accumulations and can show healing fractures. On the other hand, the lighter cold spots can mark bone infarction, or ischemic death of bone cells due to lack of blood supply.  However, both types of spots can indicate the presence of cancer or tumors. The specialist will analyze the images and provide a clearer explanation and diagnosis. News are expected to come a couple of weeks after the test, after the specialist has examined the results. Despite the efficiency of this test, some tumors are not visible in the scan and thus, cannot be diagnosed. In this situation, further tests are required, such as a computed tomography (CT) scan, a PET scan, an MRI, or a biopsy.