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Bone Imaging

PROCEDURE: BONE IMAGING
SECTION: SKELETAL 9.1
ORIGINAL DATE: 12-20-01
DATE REVISED: 4-4-17
REVIEWED: ANNUAL

Indications

  • Detection of bone metastases 
  • Diagnosis of osteomyelitis 
  • Evaluation of musculoskeletal trauma 
  • Evaluation of primary benign and malignant bone lesions
  • Diagnosis of Complex Regional Pain Syndrome
  • Evaluation of the response of Paget’s disease to treatment.
  • Evaluate/age/determine site of compression fractures prior to Kyphoplasty* Lincoln, etc. has requested BLOODPOOL and SPECT for this indication 
  • *** All children <10years old should have a Whole Body exam.

Indications – FLOW: Infection, stress fracture, avascular necrosis, primary bone tumor, CRPS or occult process; Blood pool only for kyphoplasty.

Contraindications

  • Patient should not have any Barium - 2 days before exam.
  • Patient’s with a history of recent intravenous/oral contrast administration should have their case reviewed with the Radiologist

Exam time length

  • Initially: 15 minutes for injection of the radiopharmaceutical; 25 minutes for perfusion and blood pool parts of three-phase study.
  • Delay 2‑3 hours later: 1 hour for image acquisition.

Patient Preparation

  • Have the patient drink 2 - 4 glasses (8oz.) of water between the injection and scan times. Pt may void as needed. 
  • Void before imaging 
  • Remove all heavy metal from imaging area of interest 
  • Remove all metal for SPECT/CT imaging

Radiopharmaceutical & Dose

  • Radiopharmaceutical: Tc‑99m‑methylene diphosphonate (MDP).
  • Dose: Adult:
    • 20 mCi 99m‑Tc MDP (Methylene diphosphonate) 
    • 25 mCi 99m‑Tc MDP for SPECT/extremities
    • 20 mCi 99m-Tc MDP for Pt > 100kg
  • Dose: Pediatric: 0.25 mCi/kg (Dosing Range 1-18.3 mCi) for Whole Body
  • Dose: Pediatric: 0.31 mCi/kg (Dosing Range 1.25-22.8 mCi) for SPECT/extremities

Administration Technique

  • Routine study: Standard intravenous injection. 
  • Three phase study: Oldendorf method.

Flow Bone Acquisition parameters

Time interval between tracer injection and imaging: immediate

Camera/Collimator: LEHR

Patient position

  • Supine
  • Upright as needed

Energy: 140 Kev

Matrix: 128 x 128

Start Position: NA

End Position: NA

Time per Stop/View: 10sec/view

Images taken

  • Flow of area of interest
  • Static blood pool images; 256 matrix; 240 sec.

Send to Fuji: All screen caps

Send to Dr. PET: none

Ltd Bone Acquisition Parameters

Time interval between tracer injection and imaging: 2-3 hrs

Camera/Collimator: LEHR

Patient position

  • Supine 
  • Upright as needed

Energy: 140 Kev

Matrix: 256 x 256

Scan Mode: Continuous

Start Position: NA for spot view– as needed for scan acquisition

End Position: NA for spot view– as needed for scan acquisition

Time per Stop/View

  • For Pt>100kg, Select "WB over 100Kg" acquisition protocol on both systems.
  • Optima 1 + 2: 300 sec exposure per pixel, 10 cm/min; 
  • Infinia 4: 240 sec exposure per pixel, 8 cm/min - 
  • For static images only, use acquisition time of 240 sec/image, with minimum of 240sec.

Images taken: As appropriate to study

Send to Fuji: All screen caps

Send to Dr. PET: none

Whole Body Bone Acquisition Parameters

Time interval between tracer injection and imaging: 2-3 Hours

Camera/Collimator: LEHR

Patient position: Supine

Energy: 140 KeV

Matrix: 1024*256 (wb) 256 (static’s)

Scan Mode: Continuous

Start Position: Just above top of Head

End Position: Just below bottom of Feet

Time per Stop/View

  • For Pt>100kg, Select "WB over 100Kg" acquisition protocol on both systems.
  • Optima 1 + 2: 240 sec exposure per pixel, 10 cm/min; 
  • Infinia 4: 240 sec exposure per pixel, 8 cm/min - 
  • For static images only, use acquisition time of 240 sec/image, with minimum of 240sec.

Images taken: WB head to toe, lateral skull statics (5 min; 256 matrix)

Send to Fuji: Screen cap

Send to Dr. Pet: none

Bone SPECT Acquisition Parameters

Time interval between tracer injection and imaging: 2-3 hrs

Camera/Collimator: GE Infinia Hi Res *see acquisition notes below

Patient position: Supine

Energy: 140kev

Matrix: 128 x 128

Number of projections: 60

Orbit CW or CCW: CW or CCW

Orbit type: Circular

Start Angle: 0 or as computer determines

End Angle: 360 from start

Time per view: 20 sec; Abdomen or chest

Uniformity and COR: Daily/weekly

Prefilter Type: Hanning– adjust if requested by radiologist

Filter cutoff/power: 0.9

Motion correction: Repeat if motion

Attenuation correction: CT

Name of program used: MI Evolutions for Bone

Send to Fuji: CT, MIP, Trans Emission; Trans Fused.

Send to Dr. PET: Entire study

Data Acquisition- Bone SPECT

When performing a SPECT acquisition where the pallet is NOT supported by the rollers in the gantry, the system applies a "table sag" correction to the data. In this scenario, we can use the body part "head or neck".
If the pallet is advanced far enough during the acquisition set-up where it is supported by the rollers, then use "other" for body part.
To change, as needed, per above:

  • Under SPECT/CT acquisition Tomo Key Parameters, click "More Parameters".
  • Click on "Tomo Admin Parameters",
  • Under "Image Orientation: Change ‘Body Part" needed by clicking on the drop down.

Data Processing – Flow

  1. Highlight patient name and make sure all data sets are there; 
  2. Select and highlight the data sets you need and select "load to new" or use "Bone Flow" program
  3. Arrange flow images on top half; 16 images 
  4. Arrange blood pool images under flow images 
  5. Label all images for RT, LT, view and time/frame (flow) 
  6. Select Linear color map 
  7. Adjust intensities 
  8. Screen capture as inverted image, exit page. 
  9. Send screen capture to Fuji

Data Processing – WB Bone (Insert note below for processing)

  1. Adjust intensities for each image.
  2. Screen capture as inverted image, exit page.
  3. Send screen capture, WB images and static’s to Fuji.

Data Processing – Ltd Bone (See note below for acquired images)

  1. Highlight patient name and make sure all data sets are there; 
  2. Select and highlight the data sets you need and select "load to new"
  3. Arrange images in order you desire using screen format
  4. Label all data for RT, LT, and view
  5. Select Linear color map
  6. Adjust intensities
  7. Screen capture as inverted image, exit page.
  8. Send screen capture to Fuji

Data Processing- LTD and WB

  • Run acquired pictures through the "Reduced Time LTD/WB Bone". 
  • Once the images come up, you can select File -> Save and Exit.
  • Select the patient dataset and select "HalfWBBone" which is located under the Favorite Applications (under the Gastric Emptying program) or you can find it under All Applications, under the User Application (on the top)
  • Type in the dose information 

Data Processing- Bone SPECT/CT

See General SOP- Xeleris SPECT/CT for processing.

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