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NMED 251 - Clinical Procedures > Intro To Bone Scanning > Flashcards

Intro To Bone Scanning Flashcards

1
Q

How many bones are in the human skeleton?

A

206

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2
Q

What makes up the axial skeleton?

A

Skull, sternum, ribs, and spine

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3
Q

What makes up the appendicular skeleton?

A

Upper and lower extremities, pectoral girdles (scapula and clavicle), pelvic girdle

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4
Q

Where does majority of the RP distribute in the skeleton?

A

The axial skeleton

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5
Q

What 4 types of cells do we find in bone tissue?

A
  1. Osteoprogenitor
  2. Osteoblasts
  3. Osteoclasts
  4. Osteocytes
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6
Q

What is the ecm made of?

A
  • water
  • organic components such as collagen fibers
  • inorganic components such as: minerals, ACP, HA
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7
Q

What minerals are found in the ecm?

A

Ca, P, OH, F, K, Mg

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8
Q

What’s another word for compact bones?

A

Cortical

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9
Q

What is spongy bones also known as?

A

Cancellous or trabecular

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10
Q

~_____% of the skeleton is spongy.
~_____% is compact.

A

20% spongy
80% compact

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11
Q

what type of bone has the higher turnover rate? by how much in comparison to the other type?

A

spongy bones have a higher over rate
by ~8x

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12
Q

what type of bone is the appendicular skeleton primarily composed of?

A

compact aka cortical

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13
Q

what type of bone is the vertebral column primarily composed of?

A

spongy aka trabecular aka cancellous = body of the vertebra
compact at endplates and posterior elements

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14
Q

what qualities make an ideal bone RP?

A
  • rapid localization in bone
  • fast background clearance
  • inexpensive
  • stable
  • good imaging characteristics
  • favorable dosimetry
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15
Q

what are the two RP that we use for bone imaging?

A

99mTc-MDP and 99mTc-HDP

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16
Q

what makes HDP have greater bone uptake?

A

it’s extra hydroxyl group (OH)

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17
Q

what is dosimetry?

A

absorbed doses received by critical organs for a procedure involving radionuclides

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18
Q

what is the critical organ for MDP?

A

the bladder wall

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19
Q

how can we reduce the dose to the patient/critical organ in bone scans?

A

increase fluid intake and void frequently

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20
Q

MDP and HDP is excreted in breastmilk. that is why we tell patients to discard their breastmilk. t/f

A

false.
MDP and HDP is NOT excreted in breastmilk but free pertechnetate is.

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21
Q

what are some potential side effects patients can experience from 99mTc-MDP?

A
  • allergic reactions
  • itching, rashes, hypotension, chills, nausea, fever, vomitting
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22
Q

what is uptake of the RP dependent on?

A

osteogenic activity
- more uptake = more activity = more repair + bone formation
- less uptake = less activity = less repair + bone formation

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23
Q

how does the RP attach to the bones?

A

through chemisorption; attachment to hydroxyapatite (inorganic component of bone matrix)

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24
Q

what makes up a normal biodistribution of a bone scan?

A
  • bones
  • kidneys
  • bladder
  • soft tissue
    **symmetrical
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25
Q

is there an increase or decrease of activity in the nasopharynx?

A

increase

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26
Q

describe what you see anteriorly as normal biodistribution.

A

prominent uptake in sternum, sternoclavicular joint, acromioclavicular joint, shoulders, iliac crest, hips

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27
Q

describe what you see posteriorly as normal biodistribution.

A

prominent uptake in spine, scapular tips, sacroiliac joints

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28
Q

what is different in a child scan in comparison to an adults?

A

greater uptake at growth plates (epiphyses)

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29
Q

where do we see the increased of activity in kids’ scans?

A

knees, ankles, shoulders and wrists

30
Q

What 6 things needs to be included in a patient explanation for a bone scan?

A
  1. purpose of test
  2. mention it’s an injection of small amounts of radioactive material
  3. mention it has minimal risk and how they shouldn’t experience side effects
  4. patient instructions - they should increase their fluid intake, but no change in what they do daily other than that, scan requirements (claustrophobic?) and return time)
  5. imaging time
  6. ask if they have questions and if it’s okay to proceed.
31
Q

if a patient has a hx of ca, what is required?

A

a whole body scan is needed regardless of what scan they came in for

32
Q

why do you need to ask if patients are on any medications?

A

because if they are taking corticol steroids, it’ll decrease generalized uptake in the skeleton

33
Q

if a patient has recently had some prosthetics put in, what do you think will show up on the scan?

A

prosthetic itself will be cold, but there should be increase uptake around the prosthetic

34
Q

what should you be asking the patient?

A
  • previous bone scan?
  • bone pain? symptoms?
  • recent falls/injuries?
  • any #, trauma, infections? arthritis? edema?
  • bone sx?
  • other tests? (X-rays? contrast used? nm?)
  • medications?
  • bone/kidney disease?
  • hx ca?
  • pregnancy – LMP? bf?
35
Q

what are indications?

A

reasons why we would do a NM scan

36
Q

what are contraindications?

A

factors that could interfere with a NM scan
- resulting in a cancellation or delay)

37
Q

what are indications of a bone scan?

A
  • hx of ca – metastatic bone disease
  • degenerative bone disease
  • Paget’s disease
  • bone infections/trauma
  • primary bone tumours
  • bone necrosis
  • inflammatory bone disorders
38
Q

what are metastatic bone diseases?

A

when cancer spreads from its primary site to bone tissues

39
Q

what are the 3 main cancers that are more commonly spread to the bone?

A
  1. prostate
  2. breast
  3. lung
40
Q

what is Paget’s disease?

A

increase bone formation which leads to abnormal bone growth + bowing of the bones

41
Q

what is bone necrosis?

A

death of bone tissue mainly due to the lack of blood flow to that region

42
Q

osteoporosis vs. osteoarthritis

A

osteoporosis = inflammatory bone disorder
osteoarthritis = degenerative bone disease

43
Q

what are the 3 common contraindications?

A
  1. recent barium study, but dependent on region of interest (ROI)
  2. recent nm study
  3. pregnancy
44
Q

how long does it typically take barium to clear if it was ingested?

A

2-3 days

45
Q

how long does it typically take barium to clear if it was through the rectum?

A

1-2 days

46
Q

what is needed if a patient recently had a nm scan?

A

you need to have waited 10 T1/2 of the RN used in the previous study

47
Q

99mTc-MDP aka ____nate
99mTc-HDP aka ____ nate

A

MDP = medronate
HDP = oxidronate

48
Q

how is the RP used for bone scans excreted?

A

by the kidneys

49
Q

what is the dose of 99mTc-MDP/HDP for bone scans?

A

740-1110 MBq

50
Q

what is the route of administration of the RP for bone scans?

A

intravenously

51
Q

radioactive tracer uptake is _____ (dis/proportional) to blood flow and osteogenic activity.

A

proportional

52
Q

Peak bone uptake is at 1h following injection, so why wait 2-4h for delayed bone images?

A

to excrete the rest of the rp that wasn’t taken up
it’ll increase target to non-target ratio

53
Q

50% of the injected dose is localized to the bone. What about the rest?

A

will be excreted through urine

54
Q

the selection of imaging techniques is dependent on indication, patient hx, and previous diagnostic tests. t/f

A

true

55
Q

what are the 2 bone imaging techniques?

A
  1. immediate imaging
  2. delayed imaging
56
Q

when immediate imaging is indicated, what type of scan is done?

A

3-phase bone scan

57
Q

what are the 3 phases to the 3-phase bone scan?

A
  1. blood flow
  2. blood pools
  3. delayed
58
Q

what are the 3 types of delayed imaging?

A
  1. whole body
  2. delayed statics
  3. SPECT imaging
59
Q

what are the types of immediate imaging?

A
  • blood flow: done immediately after rp injection
  • blood pool: images acquired within 10 minutes of rp injection
60
Q

what type of imaging is done for blood flows?

A

dynamic imaging

61
Q

what type of imaging is done for blood pools?

A

static imaging

62
Q

what patient demographic would you wait 4 hours post injection to do imaging for? why?

A

diabetics, kidney disease patients and those with compromised cardiac function.

they would require more time because of their impaired kidney + circulation

63
Q

what do blood flows do?

A

they give vascular information about the region of interest

64
Q

what do blood pools do?

A

they assess blood accumulation so giving you soft tissue information

65
Q

what do delayed images do?

A

assesses osteogenic activity; give bone information

66
Q

a bone scan has high sensitivity and is specific for detecting bone pathologies. t/f

A

false.
it only has high sensitivity but not specific

67
Q

how are view names determined?

A

by the position of the camera (ANT/POST, LAT/MED, LPO/RAO)

68
Q

in terms of image display, if patient’s feet is pointing up, what is their orientation? where would you find on the “right side” of the patient?

A

head first
their right will be our left

69
Q

in terms of image display, if patient’s feet is pointing down, what is their orientation? where would you find on the “right side” of the patient?

A

feet first
their right will be our right

70
Q

how do we describe normal bone uptake for a flow image?

A

L/R symmetry in terms of timing of tracer arrival + intensity of radioactivity

71
Q

how do we describe normal bone uptake for a blood pool image?

A

L/R symmetry and is the intensity homogeneous

NMED 251 - Clinical Procedures (11 decks)

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