A bone scan is a diagnostic test that detects abnormal bone activity using a radiopharmaceutical, primarily tc-99m mdp/hdp, to identify bone diseases, pain sources, and treatment responses. It is particularly useful for spotting tumors, trauma, and infections, providing early detection and differentiation between benign and malignant conditions. The procedure requires patient hydration, and a systematic approach to imaging, including various phases to assess blood flow and soft tissue abnormalities.

1. BONE SCAN

2. BONE SCAN
A bone scan is a diagnostic test that detects areas of increased or decreased bone activity
by injecting a certain radiopharmaceutical i.e tc-99m MDP/HDP. This test can be used by
doctors to detect suspected bone diseases, determine the reason underlying unexplained
bone pain, and track a patients response to treatment.

3. Indications
Bone tumors benign tumors osteoid osteoma & chondroblastoma- malignant tumors
osteosarcoma and metastasis.
o Early detection (6 - 18 months earlier than X-ray) and staging.
o Differentiation between benign and malignant neoplasms.
Bone trauma:
o Detection of bone trauma not obvious on X-ray.
o Assessment of blood flow to the adjacent areas.
Bone infections: osteomyelitis.
Paget’s disease.
Survey of whole skeleton

4. Radiopharmaceutical:
99m
Tc-methylene di-phosphonate (MDP): mostly commonly used
o Dose: 25 To 30 mci dose in bone scan for adults
o (Pedia age + 1) / (age + 7) x(adult dose)
o Half life: 6 hours.
o Adjust dose for pediatric patients
o Route: IV
EQUIPMENT
collimator
Low energy high resolution, low energy all purpose (collimator)
Gamma camera

5. • Patient preparation:
• The patient should be well hydrated: the patient is asked to drink 1.5-2 liters of water.
• The patient is asked to void immediately before imaging.
• Frequent voiding before the procedure to reduce radiation dose to the bladder wall
• Remove metallic object (coin, jewelry, keys etc) prior to imaging (can cause artifact due to
attenuation)

6. • Procedure
 For whole body, patient is supine with arms at side

7. • 3 PHASE BONE
• A 3 phase bone can assist in the diagnosis of complex regional pain. The various phases of a 3- phase scan
can demonstrate positive findings at certain time points in the exam while being negative at other time
points.
• Indications
• Flow phase and blood pool phase
• Soft tissue abnormalities
• cellulitis

8. 3 phase bone scan can be used to differentiate pathologies such as osteomyelitis and
cellulitis
1.Flow phase
• Demonstrate and characterizes relative perfusion to a particular area
2. Blood pool phase
• . the blood pool image is obtained immediately after flow phase
• . inflammation causes capillary dilation and increased blood flow
3 . Delayed phase
• . the bone is obtained 2- 4 hours later
• . urinary excretion has decreased the amount of the radionuclide in soft tissue.