Bone Scan

Test Overview

A bone scan is a test that can find damage to the bones, find cancer that has spread to the bones, and watch problems such as infection and trauma to the bones. A bone scan can often find a problem days to months earlier than a regular X-ray test.

During a bone scan, a radioactive substance called a tracer is injected into a vein in your arm. The tracer travels through your bloodstream and into your bones. Then a special camera takes pictures of the tracer in your bones.

Areas that absorb little or no amount of tracer appear as dark or "cold" spots. This could show a lack of blood supply to the bone or certain types of cancer.

Areas of fast bone growth or repair absorb more tracer and show up as bright or "hot" spots in the pictures. Hot spots may point to problems such as arthritis, a tumor, a fracture, or an infection.

Why It Is Done

A bone scan is done to:

• Find bone cancer or determine whether cancer from another area, such as the breast, lung, kidney, thyroid gland, or prostate gland, has spread (metastasized) to the bone.
• Help diagnose the cause or location of unexplained bone pain, such as ongoing low back pain. A bone scan may be done first to help determine the location of an abnormal bone in complex bone structures such as the foot or spine. Follow-up evaluation then may be done with a computed tomography (CT) scan or magnetic resonance imaging (MRI).
• Help diagnose broken bones, such as a hip fracture or a stress fracture, not clearly seen on X-ray.
• Find damage to the bones caused by infection or other conditions, such as Paget's disease.

How To Prepare

If you are breastfeeding, you may want to pump enough breast milk before the test to get through 1 to 2 days of feeding. The radioactive tracer used in this test can get into your breast milk and is not good for the baby.

You probably will have to wait 1 to 3 hours after the tracer is injected before your bone scan is done. So you may want to bring something to read or a project to pass the time. For some types of bone scans, pictures are taken during the tracer injection, right afterward, and then 3 to 5 hours after the injection.

How It Is Done

You will need to remove any jewelry that might get in the way of the scan. You may need to take off all or most of your clothes. You will be given a cloth or paper covering to use during the test.

Your arm will be cleaned where the tracer will be injected. A small amount of the tracer is injected.

It takes about 2 to 5 hours for the tracer to bind to your bone so that pictures can be taken with a special camera. During this time, you may be asked to drink 4 to 6 glasses of water so your body can wash out the tracer that does not collect in your bones. Just before the scan begins, you will probably be asked to empty your bladder to prevent any radioactive urine from blocking the view of your pelvic bones during the scan.

You will lie on a table, with a large scanning camera above you. It may move slowly above, below, and around your body, scanning for radiation released by the tracer and producing pictures. The camera does not produce any radiation.

You may be asked to move into different positions. You need to lie very still during each scan to avoid blurring the pictures.

How long the test takes

A bone scan takes about 1 hour.

How It Feels

You may feel nothing at all from the needle when the tracer is injected, or you may feel a brief sting or pinch. The bone scan is usually painless. You may find it hard to remain still during the scan. Ask for a pillow or blanket to make yourself as comfortable as possible before the scan begins.

The test may be uncomfortable if you are having joint or bone pain. Try to relax by breathing slowly and deeply.

Risks

Allergic reactions to the tracer are very rare.

Anytime you're exposed to radiation, there's a small chance of damage to cells or tissue. That's the case even with the low-level radioactive tracer used for this test. But the chance of damage is very low compared with the benefits of the test.

Steps you can take

Most of the tracer will leave your body through your urine or stool within a day. So be sure to flush the toilet right after you use it, and wash your hands well with soap and water. The amount of radiation in the tracer is very small. This means it isn't a risk for people to be around you after the test.

The radioactive tracer used in this test can get into your breast milk. Do not breastfeed your baby for 1 or 2 days after this test. During this time, you can give your baby breast milk you stored before the test, or you can give formula. Discard the breast milk you pump in the 1 or 2 days after the test.

You may have some soreness or swelling where the needle went in. These symptoms can usually be relieved by applying moist, warm compresses to your arm.

Results

The results of a bone scan are usually available within 2 days.

Bone scan

Normal:	The radioactive tracer is evenly spread among the bones. No areas of too much or too little tracer are seen.
Abnormal:	The tracer collects in certain areas of the bone, showing one or more "hot" spots. Hot spots may be caused by a fracture that is healing, bone cancer, a bone infection (osteomyelitis), arthritis, or a disease of abnormal bone metabolism (such as Paget's disease).
	Certain areas of the bone lack the presence of tracer, showing one or more "cold" spots. Cold spots may be caused by a certain type of cancer (such as multiple myeloma) or lack of blood supply to the bone (bone infarction).