The Role of ¹⁸F-NaF Skeletal PET/CT in Oncology

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 24, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.50
Procedures: 0.50
Head, Spine, and Musculoskeletal: 0.50

Nuclear Medicine Technology: 3.00
Procedures: 3.00
Radionuclides and Radiopharmaceuticals: 0.50
Endocrine and Oncology Procedures: 0.50
Other Imaging Procedures: 2.00

Outline

1. Introduction
2. Sodium Fluoride ¹⁸F
3. Pharmacokinetics and Biologic Properties
4. Comparison of ¹⁸F-NaF and ^99mTc-MDP as Bone Agents
5. Clinical Indications
6. ¹⁸F-NaF PET/CT Protocol
7. Radiation Dosimetry
8. Image Interpretation
9. Extraosseous Uptake of ¹⁸F-NaF
10. Limitations
11. Comparison of ¹⁸F-NaF PET/CT and FDG PET/CT: Which Examination Should Be Performed
12. Conclusions

Objectives

Upon completion of this course, students will:

1. know the primary tumor types which are most likely to metastasize to bone
2. be familiar with the complications of bone metastases
3. know the particles actually used for imaging with ¹⁸F-NaF
4. identify the device which produces nearly all of the clinically used ¹⁸F-NaF
5. identify the basis of the mechanism of skeletal uptake of ¹⁸F-NaF
6. know how ¹⁸F-NaF uptake indicates osteoblastic activity
7. understand the comparative advantages of ¹⁸F-NaF over ^99mTc-MDP
8. understand why ¹⁸F-NaF patients can be imaged 1 hour or less post injection
9. know the advantages of bone imaging with ^99mTc-MDP over ¹⁸F-NaF
10. identify imaging modalities that improve ^99mTc-MDP bone imaging specificity
11. know a key similarity between ^99mTc-MDP and ¹⁸F-NaF bone imaging
12. understand why ¹⁸F-NaF depicts spinal lesions before ^99mTc-MDP imaging
13. identify the area of the body where the superior spatial resolution of ¹⁸F-NaF is particularly important
14. identify the current primary usage for ¹⁸F-NaF PET/CT
15. identify the initial imaging modality of choice for the evaluation of suspected child abuse
16. know the imaging modality of choice for evaluating the viability of the remaining femoral head after surgery
17. know the metabolic bone diseases that can be evaluated with ¹⁸F-NaF functional imaging
18. understand how ¹⁸F-NaF imaging can benefit in the characterization of the biology of atherosclerotic plaques
19. be familiar with the recommended dosages of ¹⁸F-NaF
20. know the factors that affect the time of imaging per bed position for ¹⁸F-NaF
21. understand the value of attenuation correction for ¹⁸F-NaF imaging
22. be familiar with the reasons for encouraging hydration for ¹⁸F-NaF imaging
23. understand the factors which effect radiation dosimetry in ¹⁸F-NaF PET/CT
24. identify the organ/structure which receives the highest radiation dose in ¹⁸F-NaF PET imaging
25. know the normal uptake pattern of ¹⁸F-NaF within the body
26. understand the mechanism by which metastatic lesions are visualized in ¹⁸F-NaF bone imaging
27. be familiar with what the discovery of bone metastases from breast cancer may indicate for a patient
28. know instances where ¹⁸F-NaF can better depict lesions than FDG PET/CT
29. be familiar with benign processes demonstrating increased ¹⁸F-NaF uptake
30. understand SUV limitations in ¹⁸F-NaF imaging interpretation
31. understand possible implications of ¹⁸F-NaF uptake in atherosclerotic plaque
32. know the possible interpretation of spinal lesions not associated with the endplate or joint surface that do not show a typical ¹⁸F-NaF uptake pattern
33. know the differences in ¹⁸F-NaF and FDG purpose and uptake pattern
34. know sites for which FDG PET imaging is advantageous
35. be familiar with the differences in ¹⁸F-NaF and FDG prospective evaluations