3 PHASE BONE SCAN :3 PHASE BONE SCAN JENNIFER LOMBANA PARKWAY REGIONAL


Why the test is performed :Why the test is performed Detecting areas of abnormal bone metabolism is valuable in determining whether there is associated tumor, fracture, infection (osteomyelitis), or an underlying metabolic disorder. Normal distribution areas appear uniform and gray throughout all the bones in your body. In abnormal results there should be no areas of asymmetric increased or decreased distribution of the radionuclide. "Hot spots" are areas where there is increased bone uptake (accumulation) of the radiotracer; these appear black. "Cold spots" are areas where there is less uptake of the radiotracer. These appear light or white.


Slide 3:Clinical History: 72 year old patient, with a history of Osteomyelitis. Reason: Osteomyelitis. Patient prep : None check pt chart for request by doctor, id the patient and check band Briefly explain the procedure to the patient, including: Administration of the radionuclide, Positioning, Procedure length, and ask to urinate before procedure begins, ask the questions required for the procedure. (cancer history, fractures, traumas, dental work, pain etc.)


ACQUISITION PARAMETERS :ACQUISITION PARAMETERS Gamma Camera: Set peak at Tc99m with a 15 % window Low Energy All Purpose Collimator (LEAP)


Technique: :Technique: 1ST Blood Flow - Following the intravenous administration of 25.5 mCi of Tc-99 MDP administered intravenously as a bolus injection, with the area of interest positioned directly under the gamma camera.. Immediately following the bolus IV injection of the radiopharmaceutical, start computer acquisition. Mark the ‘RIGHT’ side . The first phase flow (vascularity) included a series of sequential images taken every two seconds for 40 to 60 seconds. Since the area of intrest is an extremity, I obtained both rt and lt feet for comparison. Immediately the second phase (blood pool) was acquired as a static image for one to three minutes immediately after the 1st phase. Static images of both feet and ankle were obtained in the posterior projection.


Con’t :Con’t The third phase (delayed bone phase) was obtained three hours later. The delayed images of both ankles and feet in the posterior, anterior and both lateral projections were obtained. A fourth phase (24-hour delayed image) is occasionally useful to improve the specificity of the bone scan for osteomyelitis or when soft tissue elimination is unusually slow.


Findings: :Findings: On the flow images, there is significantly increased blood flow to the left ankle and the entire left foot. On the immediate static images, there is increased uptake in the soft tissues of the left ankle and foot. These findings suggest the presence of cellulitis. On the delayed images, there are no discrete foci of abnormally increased uptake in any of the regional bones to suggest the presence of acute osteomyelitis, but there is minimally increased uptake in the region of the ankle joint which is of uncertain etiology.


Impression: :Impression: The findings described above suggest the presence of cellulitis in the left ankle and foot. There is no definite evidence of acute osteomyelitis in the left ankle or foot, but there is a focus of faintly increased uptake in the left ankle joint, which is of uncertain etiology. This may be due to DJD(Degenerative Joint Disease) or septic joint among other possibilities. Correlation with plain films is advised. If osteomyelitis is highly suspected clinically, further evaluation with MRI is suggested. END