Bone Scan

What is a bone scan?

A bone scan is the most fundamental method used to check for any abnormalities or damage in the bone. It is an imaging test that uses special gamma cameras and a computer to analyze the interiors of a bone in minute detail. The process uses radioactive materials called radiotracers which are introduced into the bloodstream through an injection. This material is detected by the camera and helps in the formation of the images of the bones. The process is also termed as skeletal scintigraphy.

The process allows the detection of detailed molecular activity within the bone and pinpoints any problems related to bone metabolism or cancer. While it is done for the entire skeletal structure in most cases, it can also be conducted for specific areas or joints. The method can detect a problem in a bone in its early stage and are much more effective than normal x-ray studies.

It is often used to determine the response of a patient to particular treatments, especially in the case of cancer. The main advantages of the process are in the fact that it is quick, relatively inexpensive, easily available, and intricately sensitive for the correct detection of a wide range of bone-related conditions.

Why do I need to undergo a bone scan?

The bone scan is used to diagnose any ailment that a physician may suspect in the skeletal structure. It is also used to investigate any pain or discomfort in the bone that might result from an injury. In general, the scan is advised under the following conditions.

– Various cases of arthritis.

– Bone cancer or other forms of cancer that have spread to the bone.

– Problems related to bone tissue like avascular necrosis.

– Abnormal growth in the bone tissue-like fibrous dysplasia.

-To diagnose bone damage or trauma, a breakage or issues like plantar fasciitis that cannot be detected by an x-ray.

– Any infection related to the bone and conditions like osteomyelitis.

– To assess unexplained bone pain.

– Paget’s disease in the bone.

– As a follow-up for cancer treatment to judge the effectiveness of the same.

– Conditions such as Reflex Sympathetic Dystrophy.

How is the bone scan performed?

The basic method that is used in a bone scan is nuclear imaging. The test can be divided into two parts. In the first part, tiny amounts of radioactive tracers are injected into a vein and it is absorbed in varying amounts at different sites in the bones. The tracer tends to get collected more in the areas where the bone structure is breaking down or abnormal for some reason.

In the second half of the test, the camera scans the body slowly and picks up these “hot spots”. The test generally takes place in the nuclear medicine or x-ray department of the hospital or the clinic. The actual test may take around 40-60 minutes but you will need to stay in the hospital for a few hours. Sedation is not necessary in this process unless in the case of children.

The process generally involves the following steps.

– You will need to wear clothes that are free from metal zippers, belts or buttons. Spectacles, watches and all jewellery needs to be removed. Many hospitals will ask you to change into a cloth or paper gown to wear.

– You may be asked to sign a consent form that seeks your permission for the test. Go through the details and clarify any doubts that you may have.

– The tracer will be injected through a vein in your arm by an intravenous line or through an injection.

-The tracer will then be allowed to permeate the bone tissue for two to three hours. You can walk around or relax during this period. Since the tracer element emits minimum radioactivity, there is little chance of physical harm from it.

-During the waiting period you will be asked to drink several glasses of water which will help in flushing out any excess tracer element that does not accumulate in the bones, from your system.

– Once the waiting period is over, you will be asked to empty your bladder as a full bladder can distort the shape of the pelvic bones and be uncomfortable during the test.

– You will be asked to lie still on a table as the camera scan the bones by detecting the radioactive rays emitted by the tracer. This process can take up to an hour. You may be asked to change your position to make it easier for the camera to scan specific bones.

– After the scan is complete, the intravenous line will be removed.

– You can go home right after the scan. You will be asked to consume plenty of water through the rest of the day to help in the removal of the tracer element from the body. In general the material is completely removed from the system within two days.

What is the price for a bone scan in India? 

The price for a bone scan varies between Rs 8000 to 12500 in India, depending on the location and the quality of the facilities.

When will I get the test results?

The results of the test are generally delivered within 1 to 2 days.

What is the normal range for a bone scan?

A radiologist studies the images in scanned images and detects the areas which appear as darker “hot spots” and lighter “cold spots” depending on the accumulation of the tracer. The “hot spots” can be signs of any abnormal bone formation or metabolism while the “cold spots” though less severe, can indicate the lack of blood flow inside a bone. When the scan is normal, the tracer will be spread evenly within the bones without any variations.

What do the results mean?

The detection of “hot spots” indicate certain bone abnormalities that will be investigated by the doctor depending on your medical condition and symptoms. They may indicate a bone disorder, such as cancer or arthritis or any type of infection in the bone. In some cases, additional tests like CT, MRI, blood tests or a biopsy can be ordered to help diagnose the abnormalities in the bone more effectively. At times, a single-photon emission computed tomography (SPECT) test can be advised as a follow-up if the doctor wants to take a deeper look into the bones.

Do I need to fast for the bone marrow aspiration?

No fasting or any special preparations are required for a bone scan.

What else do I need to know before I appear for a bone scan?

The process of bone scan is painless except for the small discomfort that the injection delivers. The process does not involve any side-effects in general. You can perform your normal activities as usual after the test is over. At the same time, it is best that you avoid close contact with pregnant women and young children for two days after the test. The following are some of the risk factors and precautions involved with the procedure that you need to be aware of.

– Allergic reactions to radiotracers is very rare and is not serious. In case you have had such experience earlier, share it with the doctor.

– There is always the chance of some minimum damage to the cells and tissues from radiation. Discuss it with your doctor if you are uncomfortable with it.

– Some soreness or swelling is possible in the injection site, which should get healed in a few days.

– In case you have undergone a test recently that involved a radioactive substance, discuss with your doctor.

– The urine excreted after the injection will contain traces of the radioactive element for some period, so wash your hands after visiting the toilet. In case of children, small amounts of radioactive material may get collected in the child’s nappy. It is best to wash the cloth nappies thoroughly and tie the disposable nappies securely in a plastic bag before disposing.

Can pregnant women undergo a bone scan?

Inform the doctor if you are pregnant or breastfeeding a baby since the radiation can have some negative impact on the baby. In general, bone scans are not carried out on pregnant women.

Is bone scan possible for new-born babies?

A bone scan is possible for babies and children and the doctor can analyze the situation and advise you as required. The baby can be given an anesthetic during the test that will help him to lie still for some time.