Who Interprets My Scans
It is also important to understand that every medical imaging performed is read by a physician, and a dictated written report is issued. This interpreting physician will be either a radiologist or a nuclear medicine physician.
So although the scan may be ordered by a urologist, medical oncologist or radiation oncologist, the physician who interprets the imaging is someone different. He or she is an M.D. trained in a different area of medicine , and does not see patients in a clinic. Their job is to read, decipher and translate imaging into a dictated written report, which they provide to your ordering clinical physician.
The difference between radiology and nuclear medicine is basically whether or not a radiopharmaceutical is used. These injections are designed to adhere to certain types of tissues , and reveal a spot or uptake in that area.
For example, the bone scan is nuclear medicine, and cancer in the bone is revealed as a hot spot, or excess uptake of the radiopharmaceutical. PET scans are also nuclear medicine, and there are many different types of radiopharmaceuticals used which dictate the type of PET scan. F18 and FDG18 are currently utilized for bone imaging in the U.S. for prostate cancer.
A CT scan, on the other hand, may also involve an injection, but it is not a radiopharmaceutical, so CT is radiology, not nuclear medicine. MRI is radiology, even if an injection is used . Ultrasounds and X-rays are radiology.
Preparing For Your Bone Scan
You can eat and drink normally before your scan. Take your medicines as normal unless your doctor tells you otherwise.
You have to arrive about 4 hours before your scan. You will get a clinic appointment letter that tells you exactly when you need to arrive.
A radiographer explains what happens and asks you to sign a consent form. You can ask them any questions that you have.
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Improving Pet Scans Are Good News For Doctors And Patients Alike
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
A recent blog post discussed a newly approved imaging agent with an unwieldy name: gallium-68 PMA-11. Delivered in small amounts by injection, this minimally radioactive tracer sticks to prostate cancer cells, which subsequently glow and reveal themselves on a positron emission tomography scan. Offered to men with rising PSA levels after initial prostate cancer treatment , this sort of imaging can allow doctors to find and treat new tumors that they might otherwise miss. With currently available imaging technology, such tumors could potentially escape detection until they were larger and more dangerous.
But while gallium-68 PMA-11 is the latest PET tracer to win FDA approval, not everyone can get it. In the United States, its currently available only to patients treated at the University of California, Los Angeles, or the University of California, San Francisco, where the tracer is manufactured. However, two other PET tracers approved for prostate cancer imaging in the US are becoming more accessible.
In January 2021, a team at Stanford University published findings showing that one those tracers, called fluciclovine F18 , identified significantly more metastatic cancers than other conventional types of imaging. Axumin was approved in 2016, and these are among the first data to show how well the tracer performs in real-world settings.
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Table : Effective Doses Of Radiation2425
Return to Summary Table
Criterion 9: Relative availability of personnel with expertise and experience required for the test
Reliability of the interpretation of bone scans by different readers is routinely assessed using the kappa score a measure of agreement beyond that expected by chance alone.49 A kappa score of less than 0.20 means poor agreement, 0.21 to 0.40 fair agreement, 0.41 to 0.60 moderate agreement, 0.61 to 0.80 good agreement, and 0.81 to 1.00 very good agreement.50
Interobserver agreement of bone scans was compared in a retrospective study published in 2008 of 59 breast and prostate cancer patients.29 Thirty-seven physicians with daily experience in reading bone scans were involved in the study. Clinical examination of all patients by the same experienced physician was used as the gold standard. Pairwise comparisons between two different examiners were calculated for 666 pairs. The mean kappa coefficient between the observers was 0.48, which is classified as a “moderate” level of agreement. The mean kappa coefficient for inexperienced observers compared with the gold standard was 0.40, and the moderately experienced and experienced observers had a mean kappa coefficient of 0.51.
Qualified medical physicists should be available for the installation, testing, and ongoing quality control of nuclear medicine equipment.51
Appendix : Acr Appropriateness Criteria40
The American College of Radiology uses a modified Delphi process to reach its appropriateness criteria. ACR authors first review relevant information and create a summary. This summary is reviewed by clinicians and other medical professionals. The process allows for the incorporation of expert consensus when published evidence is lacking. A panel of experts rates the information to determine appropriateness of the imaging intervention.
Appropriateness is rated between 1 and 9 and is grouped into three categories: “usually not appropriate” or as not indicated in a certain clinical setting and unlikely to have a favourable risk-benefit ratio for patients “maybe appropriate” or as potentially indicated in certain clinical settings and having potential to have an equivocal risk-benefit for patients and “usually appropriate” or as indicated in certain clinical settings and having a favourable risk-benefit ratio for patients. All ratings are based on peer-reviewed literature and the opinions of the expert panel. The expert panel must reach consensus after three rounds of scoring before the ACR appropriateness scores are finalized.
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What Else Should I Know About A Nuclear Scan
- The radiation exposure from a nuclear scan comes from the radionuclides used the scanner itself does not put out radiation. The radioactive material in your body will naturally decay and lose its radioactivity over time. It may also leave your body through your urine or stool within a few hours or a few days. Talk to your health care team about whether you need to take precautions about having sex, or being close to children or pregnant women after these tests.
- You will be asked to drink a lot of water to flush out the radioactive material.
- To reduce the risk of being exposed to radioactive material in your urine after a scan, you should put the lid down and flush the toilet right after you use it.
- Nuclear scans are rarely recommended for pregnant women, so let your doctor know if you are or might be pregnant.
- If you are breastfeeding, be sure to tell the doctor ahead of time. You may need to pump breast milk and discard it until the radionuclide is gone from your system.
Nm Bone Whole Body Scan For Breast Cancer Worry
My name is Rachael & I am 47,
Recently diagnosed with breast cancer. After finding a lump in my breast I was referred to the breadt clinic. On examination the dr found another as well as a lymph node she wanted checked. I had multiple biopsies of my breast & then a weeks wait.
on return to the clinic the dr confirmed that cancer had been found in all areas biopsied including the node. She suggests surgery followed by chemo followed by radiotherapy… The dr was fairly positive saying words such as treatable & curable… I met my assigned cancer nurse & had bloods taken. I already had an mri scan booked for next Friday & the dr said that she may order a ct scan as well. A lot to get my head round. Just when I’d started to accept all that’s going on a letter arrived this morning for a NM bone whole body scan appointment for this Thursday! I am now terrified that maybe my blood test is showing something?? I have worked a physical job for years & regulary have aches and pains from it & my back has niggled on & off since slipping a disc 20 odd years ago. Now however I am freaked out that maybe these pains are something more & paranoid my cancer has spread.
thank you x
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Use In Men Already Diagnosed With Prostate Cancer
The PSA test can also be useful if you have already been diagnosed with prostate cancer.
- In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
- The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
- PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .
What Preparation Do I Need
Usually very little. Your hospital should provide you with information regarding any special arrangements. This test should not be carried out in pregnant women. You should advise your doctor if you are pregnant or, if you think you may be pregnant. You should also inform your hospital if you are breastfeeding, as special precautions may be necessary. You may also be asked to empty your bladder of urine before the scanning begins. You will be asked to drink plenty of water between the injection and the scan.
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Table : Sensitivity And Specificity Of Diagnostic Methods To Detect Bone Metastasis In Lung Cancer8
CI = confidence interval 18FDG =18F fluorodeoxyglucose MRI = magnetic resonance imaging PET = positron emission tomography.
Observational studiesTwo observational studies, one in patients with NSCLC and one in patients with small cell lung cancer , were identified that evaluated the diagnostic performance of bone scan relative to 18FDG-PET13 or 18FDG-PET/CT14 for preoperative staging. These studies are summarized in Tables 13 and 14 in Appendix 4. Bone scan was performed with 99mTc-labelled oxydronate in one study,14 while the radiopharmaceutical used in the other study was not specified.13 Both studies used prospective cohort designs. One was conducted in Italy13 and one was conducted in Denmark.14 It was unclear if patients in the two studies were symptomatic or asymptomatic.
Outcomes were not reported according to cancer stage. In patients with NSCLC, the sensitivity of bone scan was 67% compared with 96% with 18FDG-PET, while the specificity of bone scan was 94% compared with 99% with 18FDG-PET. For patients with SCLC, the sensitivity of bone scan was 75% but was not reported for 18FDG-PET/CT.14 In 17% of patients, 18FDG-PET/CT suggested a different stage than conventional staging.14 Conclusions and limitations of the individual studies can be found in Appendix 4, Table 14.
Studies Involving Multiple Cancer Types
A Different Way To Detect Metastases
Most men diagnosed with prostate cancer have localized disease, meaning the cancer appears to be confined to the prostate gland. However, certain factors have been linked to a higher risk of the cancer eventually spreading .
Currently, in the United States and many other countries, most men diagnosed with high-risk localized prostate cancer undergo additional testing to see if there is evidence of metastatic cancer. For many years, that has been done with a conventional CT scan and a bone scan , the latter because prostate cancer often spreads to the bones.
But both imaging technologies have limitations. Neither is particularly good at finding individual prostate cancer cells, and thus can miss very small tumors. And bone scans can detect bone damage or abnormalities that were caused by something other than cancer , resulting in false-positive findings that can lead to unnecessary additional testing.
So, researchers have been developing and testing other imaging agents that can find prostate cancer cells specifically in the body, Dr. Shankar explained.
As their name implies, PET-CT scans combine a CT scan with a PET scan, another type of nuclear imaging test that requires patients to receive intravenous injections of a radioactive tracer that can be detected on the scan.
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Questions To Ask Your Health Care Team
Consider asking these questions before having a bone scan:
Who will do the bone scan?
Is the radiologist or nuclear medicine physician board-certified?
Is the facility accredited by the American College of Radiology to do bone scans?
What will happen during the bone scan?
How long will the scan take? How long will I need to be at the hospital/center?
What are the risks and benefits of having a bone scan?
What will the results of this bone scan tell you?
When and how will I learn the results?
Who will explain the results to me?
What other tests will I need if the bone scan finds signs of cancer?
Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11, 18F-DCFPyl , and Ga 68 gozetotide , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body. PSMA PET scans can also be used to help determine if the cancer can be treated with a radiopharmaceutical that targets PSMA.
Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers.
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Is A Bone Scan An Appropriate Study For A 65
Bone scans generally are not sensitive for lytic bone lesions, and patients who show multiple myeloma or lytic abnormalities on computed tomography or x-ray should not be referred for a bone scan. These patients should undergo a bone survey with multiple plain film x-rays. Patients with certain cancers that can have mixed lytic and blastic bone metastases may still benefit from a bone scan. Also, a patient with multiple myeloma with lytic disease in weight-bearing bones that might be susceptible to pathologic fracture may benefit because the fracture would show up as a focus of increased uptake. If a nuclear medicine scan is needed to differentiate bone metastases better, fluorodeoxyglucose positron emission tomography scan may be the most appropriate choice.
Harvey A. Ziessman MD, … James H. Thrall MD, in, 2006
Getting Ready For A Bone Scan
When you schedule your bone scan, the hospital or imaging center staff will tell you how to prepare. Usually, you do not need much special preparation before a bone scan, but it’s important to confirm this with the place giving you the test. If anything is unclear in the instructions, talk with your health care team. Here are some things that you can expect: What to eat. You can typically eat and drink normally before your appointment. Your usual medications. Tell your health care team about all medications you take, including over the counter drugs and supplements. Medicines that contain barium or bismuth can affect the test results. Your doctor may ask you not to take them before your scan. Personal medical history. Tell the staff if you have any drug allergies or medical conditions. Women should tell their health care team if they are breastfeeding or may be pregnant.What to wear. Before the test, you will need to remove metal objects, such as jewelry. You may also need to change into a hospital gown.
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When You Need Themand When You Dont
It is normal to want to do everything you can to treat prostate cancer. But its not always a good idea to get all the tests that are available. You may not need them. And the risks from the tests may be greater than the benefits.
The information below explains why cancer experts usually do not recommend certain imaging tests if you are diagnosed with early-stage prostate cancer. You can use this information to talk about your options with your doctor and choose whats best for you.
How is prostate cancer usually found?
Prostate cancer is cancer in the male prostate gland. It usually grows slowly and does not have symptoms until it has spread. Most men are diagnosed in the early stages when their doctor does a rectal exam or a PSA blood test. PSA is a protein made in the prostate. High levels of PSA may indicate cancer in the prostate.
If one of these tests shows that you might have prostate cancer, you will be given more tests. These tests help your doctor find out if you actually have cancer and what stage your cancer is.
What are the stages of prostate cancer?
Prostate cancer is divided into stages one to four . Cancer stages tell how far the cancer has spread.
Stages I and II are considered early-stage prostate cancer. The cancer has not spread outside the prostate. However, stage II cancer may be more likely to spread over time than stage I cancer. In stages III and IV, the cancer has already spread to other parts of the body.
Imaging tests have risks.