Imaging with Bone-Seeking Radiopharmaceuticals

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after May 9, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Nuclear Medicine Technology: 2.50
Procedures: 2.50
Radionuclides and Radiopharmaceuticals: 1.25
Other Imaging Procedures: 1.25

Registered Radiologist Assistant: 1.25
Procedures: 1.25
Musculoskeletal and Endocrine Sections: 1.25

Outline

1. Introduction
2. Uptake Mechanisms of Bone-Seeking Radiopharmaceuticals
   1. Physiologic Mechanism of Radiopharmaceutical Uptake
   2. Radiotracer Delivery
   3. Radiotracer Localization to Bone
   4. Renal Excretion
   5. Environmental Factors
   6. Quantification Methods
   7. Dosimetry of ^99mTc-MDP and ¹⁸F-NaF
3. Clinical Applications
   1. Bone Viability
   2. Osteonecrosis and Avascular Necrosis
   3. Serial Bone Imaging at Multiple Time Points
      1. Pathophysiology of Bone Metastases
      2. Staging of Bone Metastases
      3. Therapeutic Response Evaluation
   4. Benign Metabolic Bone Disorders
   5. Bisphosphonate Treatment-Response Evaluation
4. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the FDA approval of ¹⁸F-NaF for clinical use
2. understand what imaging modality has renewed interest in using ¹⁸F-NaF
3. identify the characteristics of ¹⁸F-NaF bone scans
4. identify the first radiotracer used for skeletal imaging in the clinical setting
5. be familiar with the physical half-life of ⁸⁹Sr
6. be familiar with the introduction of the ^99mTc-labeled bone radiotracers
7. understand the process of positron emission
8. be familiar with the acronym of SPECT
9. be familiar with the composition of hydroxyapatite
10. identify the radiopharmaceuticals used for performing a bone scan
11. be familiar with protein binding of ^99mTc-MDP
12. identify the primary mechanism of binding of ^99mTc-diphosponates
13. be familiar with the substitutions for bone histomorphometry
14. identify the primary route of elimination of bone radiotracers
15. be familiar with the acquisition time of a dynamic PET
16. be familiar with the standard adult radiotracer dose for an ¹⁸F-NaF bone scan
17. be familiar with the minimal patient preparation for a bone scan
18. understand the route of administration of the radiotracer for a bone scan
19. understand the primary purpose of performing CT during a PET/CT scan
20. be familiar with the definition of SUV
21. understand the factors that determine the SUV values
22. be familiar with the role that ¹⁸F-NaF bone scans have in studying allografts
23. be familiar with how disseminated tumor cells invade bone tissue
24. be familiar with the reported low sensitivity of bone scans for myeloma
25. identify the advantages of using ¹⁸F-FDG for staging of lung cancer skeletal metastases
26. identify the advantages of using ¹⁸F-NaF bone scans vs. ^99mTc-diphosphonates
27. be able to define Paget disease
28. realize that ¹⁸F-NaF bone scans are useful for bisphosphonate treatment assessment
29. identify the most common cancer affecting men in the U.S.
30. identify the imaging tests that may be negative or indeterminate in men with biochemical failure