3rd Level Nuclear Medicine BY Adam Hussein Mastour Nuclear Medicine BONE IMAGING Learning Outcome Bone Imaging Indication of bone imaging ID: 912967
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Slide1
Karary UniversityCollege of Radiologic Science3rd Level
Nuclear Medicine
BY
Adam Hussein Mastour
Slide2Nuclear Medicine
Slide3BONE IMAGING
Slide4Learning OutcomeBone ImagingIndication of bone imagingPatient preparationTechnique ( whole body scan} .Bone SPECT
Slide5Bone imaging NM imaging of bone has the advantage of giving dynamic information and abnormalities at any stage and shows bone metastases very clearly than X-ray . It is a non-specific investigation.
R.ph :
99m
Tc-MDP
,whose taken by bones is
dependent on factors like:
Blood supply , rate of bone turnover , quantity of minerals within bones , capillary permeability , local acid-base balance , fluids within bones and vitamins and hormones.
99m
Tc- labeled
diphosphonates
have been popularly MDP
used.
Diphosphonates
are absorbed on the surface of the bone such that both local
osteoblastic
activity and skeletal
vascularity
can be seen.
Non specific:
Bone scan picks up the ongoing
osteoblastic
response and not the primary pathology.
Metastases, infection, fracture and other bony lesions that incite an
osteoblastic
response can be easily detected.
Slide6Indications of bone imaging: Screening of high risk patients with tumors for skeletal metastases (breast, lung, prostate, kidney etc). Detection of
osteomyelitis
.
Detection of
avascular
necrosis.
Stress fracture and other occult skeletal trauma.
Metabolic bone disease.
Questionably abnormal skeletal radiographs.
Serial scan to see the treatment response. Localization of sites for biopsy.
Patient preparation:
IV injection - 740 MBq (20 mCi) of
99m
Tc
diphosphonate
.
Imaging (2-6 hrs) after 3 hrs of dose administration.
Instruct the patient to have plenty of fluid intake during the waiting period (clearance of background soft tissue activity for better target to background ratio).
Slide7Patient to void the bladder just before imaging (unbound MDP is excreted through kidneys). Explain the entire procedure to the patient.
Technique: whole body Scan:
Make sure the patient has voided before entering the imaging room.
Position the patient in supine position on the table (prone if supine is uncomfortable).
Place the collimator as close to the patient as possible to improve image quality.
Camera setting for
99m
Tc (140
keV) gamma rays with 20% window. Make sure that entire body is within scanning limits so that the whole body image is acquired in serial or continuous mode.
Static:
Whole body is imaged in one film , or in separate parts.
Abnormalities appear as:
1. No uptake
e.g
osteolytic
tumors ,
granulomata
, vascular bone lesions….
Slide82. Generalized reduced uptake , in severe cardiac failure , large doses of vitamin D, or steroids.3. Increased uptake: secondary tumors and normally in joints &other areas.4. local diminished uptake:
avascular
necrosis , some steroid treatment.
A
B
Bone Scan:
Normal.
Pathologic.
Slide9Three phase bone
scan:
Slide10Slide11Slide12Slide13Slide14Slide15Slide16SPECT ( A single photon emission computed tomography ) It is an imaging test that shows how blood flows to tissues and organs .It may be used to diagnose seizures, stroke, stress fractures, infections and tumors in the spine
.
Slide17Bone SPECTIndications:
In areas of complex anatomy (substantial superimposition of bony structures) bone SPECT is necessary.
Generally done in areas such as:
Lumbar spine.
Tempero
-
mandibular
joints (TMJ)/skull.
Hip /Sacro-iliac joints.
Knee.
Technique:
Patient preparation is identical as in routine bone imaging.
Patient position is very important during SPECT.
Keep arms out of field of view, pillow under the knees (Lumbar spine).
position hips symmetrically and secure knees/feet to prevent motion (Hips and Pelvis)
Slide18Acquisition protocol:
Matrix size :64x64, 128x128 (preferred)
Zoom :1
Orbit: circular/non circular
Time/frame:20-40 seconds
Angular step:4
-6
(90-60 stops)
SS/continuous
: stop
and shoot
Detector: LFOV
Collimator: LEHR (preferred)/LEGP
Rotation : 360
Rotation velocity:20 cm/min
140
keV
with 20% window
3. Secure neck in comfortable hyperextension, check lateral view to be sure that chin is in the field of view of camera, patient not to talk (TMJ).
4. Pad between the knees, strap to prevent motion and feet in natural position to prevent rotation (Knees).
Slide19Diabetic patient complaining of pain in the left ear, planar scan showing uptake in base of skull ( mastoid, TM joint ).
Slide20Bone SPECT reveals involvement of petrous
bone (Malignant
otitis
externa
).
Slide21Involvement
of
petrous
bone.
Slide22SPECT
reveals the involvement of whole concerned vertebrae extending
upto
intervertebral
space s/o end plates destruction, characteristic of
potts
spine.
Slide23Lumbar
SPECT reveals increased uptake in the left half of L4
body.
Slide24patient presented with pain Lt hip for 3 months and intermittent feverPlanar images showing increased radiotracer uptake in the region of head
Lt-femur.
SPECT shows
photopenic
area in the head of Lt femur with increased peripheral tracer
uptakeS
/O AVN
Slide25THANKYOU