Bone Scan

What is a bone scan?

A bone scan is an imaging test. It looks inside bones to find damage caused by several conditions, including cancer. It can also help monitor how well cancer treatment is working.

A bone scan uses a very small amount of a radioactive substance called a tracer (also called a radiotracer or radiopharmaceutical) to help find abnormal areas of bone. 

The tracer contains a small amount of radioactive substance. So, a bone scan is referred to as nuclear medicine.

Who performs a bone scan?

The test is performed by a certified nuclear medicine technologist.

What is involved in a bone scan?

1. Getting the tracer — First, your child will receive a small amount of tracer. It is usually through an IV. The IV may be removed after the injection.
2. Waiting period — Your child will wait least 2 hours to allow the tracer to travel through the bloodstream and reach its target. During this time, the patient can resume normal activities.
3. Having the scan — After the tracer is absorbed, your child will return to the nuclear medicine department to have the bone scan. The cameras go over the front side and back side of the patient. It may rotate around your child’s body to produce detailed images.

The gamma cameras, with the help of a computer, will create images. Areas that appear lighter or darker could indicate an abnormality.

What parts of the body does a bone scan show?

Usually, the entire body is scanned during this procedure. If results show bone damage that may be caused by cancer, more tests may be needed. These tests may include:

• Computed tomography (CT) scan 
• Positron emission tomography (PET) scan 
• Magnetic resonance imaging (MRI)
• Biopsy

What questions should I ask my child’s doctor about bone scans?

These are some common questions you might want to ask:

• Who will perform the bone scan?
• Is the radiologist or nuclear medicine physician board-certified?
• Is the facility accredited by the American College of Radiology or other accrediting agency to perform bone scans?
• What will happen during the bone scan?
• How long will the procedure take?
• What are the risks and benefits of having a bone scan?
• How accurately can a bone scan find cancer?
• 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 evidence of cancer?

What do I need to do before my child’s bone scan?

Your child most likely won’t need to do anything differently before a bone scan. But be sure you follow any instructions from the imaging center.

• Medications — You should tell the care team about all the medicines your child takes. Medicines that contain barium or bismuth (such as Pepto-Bismol™) can affect the test results. Your child will need to avoid taking these medicines before the scan.
• Allergies and medical conditions — You should let your child’s care team know about any drug allergies or other medical conditions. The care team also needs to know if the patient could be pregnant.
• Insurance — You’ll want to check with your insurance provider to find out how much of the cost your plan will cover and what you may need to pay. 
• Ask questions — You should talk with your care team about any concerns about the bone scan.
• Make sure your child understands what is happening — Talk with your child about the reason they need the bone scan and what will happen. Explain it in simple, age-appropriate terms.  You may want to consult a child life specialist or nurse. Or you may want to reach out to the nuclear medicine department to help.

What happens the day of the bone scan?

• Be sure you arrive a few minutes early for the appointment to allow time for check-in.
• You may be asked to sign a consent form. It usually states that you understand the benefits and risks of the bone scan and agree to have the test. 
• Your child will need to remove jewelry and any other metal objects. In some cases, they may be asked to change into a hospital gown. 
• When it’s time for the first part of the procedure, a nurse or nuclear medicine technologist will greet you and explain what will happen. A child life specialist may be there as well.

What happens during a bone scan?

• First, a tracer will be injected through an IV your child’s arm. The injection may sting a little bit. Your child won’t feel the tracer move through the body. It takes a few hours for the bones to absorb the tracer.
• There will be a 2–4-hour delay between the injection and the scan. You and your child can leave the area and resume normal activities. The technologist let you know when to return for the scan.
• Your child may be asked to drink water during the waiting period to encourage urination. By urinating frequently, the body will remove radioactive material that has not collected in the bones.

After the waiting period, your child will:

• Return for the scan a few minutes before the scheduled time.
• Be asked to urinate one more time before the scan begins.
• Then lie on a table and may be secured with soft safety belts.

During the procedure:

• The gamma camera will move slowly around your child, taking pictures inside the bones. The camera does not make loud noises and will not touch your child. Your child won’t feel the pictures being taken.
• The technologist may ask your child to change positions to get pictures from different angles.
• The scan takes 40 minutes to an hour. Your child must lie still because moving can cause the images to blur. If the patient moves, the procedure will have to be repeated.
• You may be able to stay with your child during the test. Your child may be able to read or watch a movie to help them remain still. Your child may also keep a comfort item with them if it doesn’t interfere with the scan.

What happens after the bone scan?

Your child will be able to return to normal activities after the scan. They should not feel any side effects. 

The care team may your child to drink several glasses of water during the next 24-48 hours to flush out any remaining tracer. Usually, it is gone after 2 days.

Even though the amount of radioactivity is very low, experts recommend you and your family take these precautions after the scan:

• If you are pregnant, you should not cuddle with your child for at least 24 hours after the scan. Your child should avoid direct contact with infants and toddlers until the next day.
• Always wash hands after changing your child’s diapers or handling body fluids.
• Hold soiled diapers in a separate trash can for 2 days before placing them in the regular trash. (Note: Some landfills have radiation detectors that may alarm if they detect radioactivity coming from the trash. If trash pickup is 2 or more days away, it should be OK to put the diapers in the regular trash.)
• If you’re traveling, your child may set off radiation alarms at airports, border crossings, and other places protected by Homeland Security for several days after the procedure. Let the care team know if your child might go through one of these areas during that time. The technologist can provide written information about the bone scan to give to travel officials.

How do you get the results of a bone scan?

A nuclear medicine physician will interpret the scan results and will share them with the doctor who ordered the scan. Your child’s primary oncologist will share the results with you.