CME Sessions at EANM’05

EANM’05 – CME Session VI

October 17, 2005, 11:30 – 13:00
Nuclear orthopedics today: old and new procedures and indications

Moderator: L. Mansi (Naples)
Co-Moderator: L. Kabasakal (Istanbul)

L. Mansi (Naples):
Pathophysiological premises and procedures
T. Varetto (Turin):
The role in benign diseases
L. Kabasakal (Istanbul):
The role in malignancy

Educational objectives:

Upon completion of this course the attendee will be able to:

  1. Define the diagnostic scenario in orthopedics, also discussing advantages and limitations of the most important alternative imaging procedures (X-ray, CT, MRI) involved.
  2. Learn pathophysiological premises and standardize the most important technical aspects of how bone scan, including the 3 phase study and SPECT, should be performed.
  3. Analyse the possible role of SPECT-CT in improving diagnostic accuracy of bone scan.
  4. Discuss the role of bone scan in benign bone diseases, in comparison with alternative procedures, providing guidelines for the clinical use.
  5. Review the role of bone scan in the contemporary diagnostic work-up of patients with malignancies, learning strength and limitations in diagnosis of bone metastases.
  6. Discuss the impact of SPECT and 3 phase bone scan, of Tumor Markers and of other radiotracers, including PET tracers, in improving the diagnostic accuracy in malignancy.
  7. Discuss the role of bone scan in the radiometabolic treatment planning and dosimetry.


The session is designed for Physicians and Technicians interested in Nuclear Orthopedics and it is mainly based on the evaluation of the present clinical role of bone scintigraphy in benign and malignant diseases. To find indications, the diagnostic scenario, including information achievable with X-ray, CT and MRI, will be described. Then, pathophysiological premises and techniques related to bone scintigraphy, including SPECT and the 3 phase scan, the description of capabilities added by SPECT–CT and by other radiocompounds, including those requiring PET, will be presented. To analyze the clinical value, the panel made the choice in giving more evidence to the most relevant capabilities available in the routine practice. Therefore, in analyzing benign diseases, the role of bone scan, in comparison with alternative procedures as MRI, will be mainly discussed in pathological conditions as musculoskeletal trauma, rheumatic diseases, back and hip pain, stress and insufficiency fractures, occult fractures, child abuse, pointing out the primary role in emergency. The present role of bone scan in staging, treatment planning and follow-up of patients with cancer, with main reference to the diagnosis of bone metastases, will be then reviewed. The possible improvement of specificity and accuracy using techniques as SPECT and dynamic imaging and/or adding data deriving from Serum tumor markers levels and from other radiopharmaceuticals as octreotide, MIBG, I-131 and positron emitters, as F-18 fluoride and F-18 Fluoro-deoxyglucose (FDG), will be also discussed. Lastly, the capability of bone scan to act as premise to a radiometabolic treatment planning of cancer related bone pain and as a reliable procedure for an accurate dosimetry, will be analysed.

Key Words:

  1. Nuclear Orthopedics
  2. bone scan
  3. bone metastases
  4. benign bone diseases
  5. SPECT
  6. PET
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