How It Works And What To Expect
Most scans donât take more than an hour or so, though you may have to wait a few hours as health care workers prep you for the test.
These scans are usually done at a nuclear medicine or radiology department at a hospital. A little bit of radioactive material will go into your body. Doctors call this material a radioactive âtracer,â radionuclide, or radiopharmaceutical.
Hospital staff may inject this tracer or give it to you to swallow in a pill or inhale as a gas.
It can take from a few seconds to several days for the tracer to collect in the part of the body that will get scanned.
Before the scan, youâll remove all jewelry and metal that could interfere with the images. Medical staff may ask you to wear a hospital gown, though in some cases you can wear your own clothes.
Youâll lie on a table or sit on a chair for the scan. Technicians use a special camera, or âscanner,â on the appropriate parts of your body to detect gamma rays from the tracer. Technicians might ask you to change positions to get different angles as the scanner works.
The scanner sends the information to computer software that creates pictures, sometimes in three dimensions and with color added for clarity.
A specialized doctor called a radiologist will review the pictures and talk to your doctor about what they show.
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.
What Makes Yale Medicines Work In Nuclear Medicine Unique
We are in the process of bringing a unique prostate cancer imaging agent to Yale Medicine, Dr. Saperstein says. Positron Emission Tomography scans with C11 choline will enable us to more accurately characterize the extent of prostate cancer than ever possible. There are currently no other hospitals in the region that are using this technology.
Beyond Yale Medicines commitment to using the most cutting edge, accurate scanning equipment, Dr. Saperstein emphasizes the level of care patients receive from Yale Medicines radiologists, technologists and staff.
Ive worked in many hospitals, and what Ive really noticed is how everyone on the staff, throughout the department, goes above and beyond to make sure that patients receive compassionate care. Theres a real dedication to patient well-being and comfort,” he says.
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Nuclear Bone Scan Procedure
The first step in the procedure is the injection of the tracer material. A technician will do this through a vein in your arm or hand. You might feel a sting from the IV.
Then, you wait for the tracer to travel through your body and bind to your bones. That can take 2 to 4 hours.
Your doctor might order a scan before your body absorbs the tracer for comparison, especially if you could have a bone infection. If youâre having two scans, the first will happen right after the injection.
While your body is absorbing the nuclear material, youâll need to drink 4 to 6 glasses of water to flush extra tracer from your body. Youâll use the restroom before the test so any concentration in your urine doesnât cause a misleading picture.
For the scan itself, youâll lie on a table while a camera takes pictures. Youâll have to remain very still for certain portions of the scan, and you may have to change positions several times. The scanning may take up to an hour. Itâs not painful, but lying on the table may become uncomfortable.
Your doctor may also order a type of test called single-photon emission-computed tomography . The camera rotates around your body to make more detailed images.
What Exactly Is A Whole
A SPECT-CT scan combines the high sensitivity of a bone scan with the increased specificity of a CT scan. The SPECT-CT study improves the localisation of bone uptake and helps characterise the cause of the bone uptake more clearly. This helps improve the diagnostic accuracy of the bone scan.
Whole-body SPECT/CT is the optimal modality of choice for metastatic workup, including detection of extra-axial lesions.
Rager et al. BioMed Research International. Volume 2017
The two sets of three-dimensional images are produced in one sitting and the scans are fused together so that we can correlate the findings on the bone scan with the CT.
A whole-body SPECT-CT consists of multiple SPECT-CT scans stitched together to create a continuous image from the head to the toes. In practice it is sufficient to cover from the head to the thigh region. In any case, it is performed in one sitting in a hybrid SPECT-CT scanner.
Modern SPECT-CT scanners with resolution recovery software can perform a whole-body SPECT-CT in a little over 30 minutes, and those with solid state detectors, can be even faster. For instance in a paper by Zacho HD et al. the authors compared the performance of a standard SPECT acquisition of 11 mins with an ultra fast SPECT acquisition of under 3 minutes. They found no significant difference in observer agreement between the two scans.
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Preparing For A Nuclear Bone Scan
You can eat and drink as you usually would before your scan. You donât have to do anything special to prepare. But certain things can interfere with the tracer, so tell your doctor if you have:
Youâll need to remove jewelry and other metal objects before the scan. You may have to change into a hospital gown.
Ethics Approval And Consent To Participate
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Tc-PSMA-I& S-SPECT/CT imaging was performed on a compassionate use basis according to German Medicinal Products Act and the responsible regulatory bodies .
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How Does A Bone Scan Work
A bone scan is a nuclear medicine test. This means that the procedure uses a very small amount of a radioactive substance, called a tracer. The tracer is injected into a vein. The tracer is absorbed in different amounts and those areas are highlighted on the scan. When cells and tissues are changing, they absorb more of the tracer. This may indicate the presence of cancer.
If the result shows change or damage to your bones, you may need more tests. These tests may include other types of bone scans. A computed tomography scan and a positron-emission tomography scan can be done following a bone scan. Further testing may also include a magnetic resonance imaging , or a biopsy.
Grading Of Carcinomas According To Gleason Scores
In accordance with grading of Gleason score , PCa would be classified into: Grade 1 when carcinomas displayed expansive growth with clear definitions and they were arranged closely with round shapes Grade 2 when acinar carcinomas were divided by matrix and they were loosely ranked Grade 3 when carcinomas grew invasively and occurred much in prostate peripheral zone Grade 4 when acinar carcinomas were irregularly fused into shapes of tiny nipples and sieves Grade 5 when carcinomas were poorly differentiated with boundaries of circular shapes and they grew in the form of single cells or comedocarcinoma together with necrosis. To solve inconsistent histological differentiation within tissues, scores of the main and secondary organizational structures were added. Finally, carcinomas with total points of 24 were regarded as well differentiated carcinomas, while those assessed as 57 scores and 810 scores were, respectively, deemed as moderately and poorly differentiated carcinomas.
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Summary Of The Main Findings
The most thoroughly validated tests in clinical trials and in clinical practice are the good old tests such as bone scan and contrast-enhanced thorax, abdomen, and pelvis CT.
Nevertheless, most of the evidence based for bone scan and CT are old and retrospective. There is actually a much larger amount of prospective data for modern PET/CT. Prospective data also shows clear superiority of PSMA-PET or fluciclovine-PET to choline-PET. Data from a new study suggests that PSMA-PET imaging is superior to fluciclovine-PET for detecting biochemical recurrence in men with prostate cancer . However, whether one of these radiotracers improves patient survival over the other is unknown and further research is needed to determine which has the greater effect.
The new tracers do not have the same accessibility and need further validation in clinical trials to evaluate their benefits and clarify their usage in routine clinical practice. It is important that we consider the imaging requirements of the PCWG as this defines the imaging definitions for subjects in those clinical trials. EORTC algorithms also need to be considered for the imaging strategies. Experts in nuclear medicine and radiology should be represented in medical decision-making teams for PCa.
When Can I Expect The Results Of My Bone Scan
The time that it takes your doctor to receive a written report on the test or procedure you have had will vary, depending on:
- the urgency with which the result is needed
- the complexity of the examination
- whether more information is needed from your doctor before the examination can be interpreted by the nuclear medicine specialist
- whether you have had previous X-rays or other medical imaging procedures that need to be compared with this new test or procedure
- how the report is conveyed from the practice or hospital to your doctor .
Please feel free to ask the private practice, clinic or hospital where you are having your test or procedure when your doctor is likely to have the written report.
It is important that you discuss the results with the doctor who referred you, either in person or on the telephone, so that they can explain what the results mean for you.
*The author has no conflict of interest with this topic.
Page last modified on 26/7/2017.
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.
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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Nuclear Medicine Scans For Cancer
Nuclear medicine scans can help doctors find tumors and see how much the cancer has spread in the body . They may also be used to decide if treatment is working. These tests are painless and usually done as an outpatient procedure. The specific type of nuclear scan youll have depends on which organ the doctor wants to look into. Some of the nuclear medicine scans most commonly used for cancer are:
- Bone scans
- PET scans
- Thyroid scans
- Gallium scans
Diagnostic Performance Of Whole
Among the papers published studying the performance of bone scan in prostate cancer, none evaluated the performances of systematic whole-body bone SPECT/CT in BR of PC. These previously published studies rather evaluated the performances of planar bone scintigraphy an out-of-date procedure , or the performances of non-systematic SPECT/CT indicated on the basis of planar scintigraphic findings .
Our study confirms the good diagnostic performances of WB bone SPECT/CT in prostate BR with sensitivity, specificity, positive and negative predictive values of 86.7% , 98.8% , 96.3% , and 95.5% when equivocal WB bone SPECT/CT were considered as negative, in comparison to the BVC and regardless of the PSA level.
Picchio et al. classified equivocal results from scintigraphy as either positive or negative, inducing a quite large range for sensitivity and specificity . However, an optimal strategy taking into account both the medical and medico-economical perspectives obviously requires the classification of equivocal studies as negative since all equivocal cases require an additional test to establish a reliable diagnosis.
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The Future Of Psma Pet
This is a solid study and reflects the real-world experience with PSMA PET-CT in other countries, Dr. Pomper said. Because there are several PSMA-targeted tracers, a next step will be to have them approved for use in the United States outside of clinical trials, he added.
He predicted that, eventually, the different PSMA tracers will be tested head to head.
The Australian trial adds to a growing body of research on improving the detection of metastatic tumors in men with prostate cancer. One imaging agent, fluciclovine F18 which targets prostate cancer cells in a different way than PSMA-targeted tracersis already approved in the United States for use in men with previously treated prostate cancer that appears to be progressing .
PSMA PET-CT is also being studied in this group of men, Dr. Shankar said. One small clinical trial that directly compared PSMA PET-CT with fluciclovine F18 PET-CT showed that the PSMA-targeted scan found more metastatic tumors, regardless of their location. NCI is funding a similar but larger clinical trial.
Dr. Pomper noted that PSMA also is found at relatively high levels in the vasculature of a number of other cancersincluding kidney, thyroid, and breastso hes hopeful that PSMA PET-CT might be useful beyond prostate cancer.
Urologists and radiation oncologists in many places are already ordering this scan as the standard of care, he said.
Study Design And Patients
We conducted a single-center retrospective study at the Grenoble Alpes University Hospital. From January 2011 to November 2017, a total of 386 consecutive patients were addressed in the nuclear medicine department to perform a FCH PET/CT in the setting of biochemical recurrence of PC. We included patients with biochemical recurrence of a histologically proven PC who benefited from whole-body BS coupled to a double field of view SPECT/CT and a FCH PET/CT within 3months, and for whom data on initial tumor and follow-up were available . Such data were available since both tests were systematically performed for patients referred to our center for BR of PC. Data concerning the initial tumor , the initial treatment of PC, the kinetics of PSA and the follow up were collected for all patients using our institution database. Data from patients followed in other institutions were collected through their corresponding prescribing physicians and medical biology laboratories by phone or email. The PSA doubling time was calculated using the most recent PSA values and the least squares fitting-exponential methodology . The study was approved by the local ethics committee.
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Detection Rate In Bcr
The overall detection rate was 20% and 55% at PSA levels lower than 1 and 4 ng/ml, respectively. At PSA levels greater than or equal 4 ng/ml, the detection rate was 83%, reaching 100% at PSA levels â¥ 10 ng/ml . Recent studies with another dedicated PSMA-targeted SPECT agent reported higher detection rates in patients with recurrent of PCa . In those studies, a detection rate of 90% and 91.4% was observed at PSA levels â¥ 2 ng/ml. Another group also reported higher detection rates for SPECT in recurrent PCa . Here, a detection rate of 80% and 100% at PSA levels â¥ 1 and 4 ng/ml, respectively, was achieved. Figure provides an overview on PSMA-SPECT detection rates in comparison to PSMA-PET.
Detection rates of different PSMA ligands in recurrent PCa. The figure was adapted from PSMA imaging detection rates from Su H-C. et al. , Eiber M. et al. , Schmidkonz C. et al. , and the present study
Upon careful comparison with the study of Schmidkonz et al. , it becomes obvious that the difference between Tc-MIP-1404 and Tc-PSMA-I& S is more pronounced at very low PSA levels. Schmidkonz et al. report a detection rate of 58% at an average PSA level of 0.47 ng/ml, while in this study a detection rate of 20% was observed at the same PSA level . A lower difference is present at higher PSA levels. At an average PSA level of 1.9 ng/ml, Schmidkonz et al. reported a detection rate of 62%, whereas we found a detection rate of 55% at an average PSA level of 2.1 ng/ml.