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Bone Scan

A bone scan is an imaging test that looks inside bones to find damage caused by a number of 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 detect abnormal areas of bone. Because the tracer contains a small amount of radioactive substance, a bone scan is referred to as nuclear medicine.

Understandably, the words nuclear medicine can be a cause of concern for parents because exposure to a radioactive substance has potential health risks. Nuclear medicine specialists use the ALARA principle (As Low As Reasonably Achievable) to carefully select the amount of radiotracer that will provide an accurate test with the least amount of radiation exposure to the patient. The dosage is determined by the patient’s body weight, the reason for the study, and the body part being imaged. Nuclear medicine procedures have been performed for more than 50 years on adults and for more than 40 years on infants and children of all ages without any known adverse effects.

The test is performed by a certified nuclear medicine technologist and has 3 parts:

  1. Getting the tracer — First, the patient receives a small amount of tracer, usually through an IV. The IV is removed after the injection.
  2. Waiting period — The patient waits at 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, the patient returns to the nuclear medicine department to have the bone scan. The cameras rotate around the patient’s body to produce detailed images.

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

Because nuclear medicine procedures can image the functions of the body at the cellular level, they can identify disease in its earliest stages as well as a patient’s immediate response to therapy. A bone scan can often find abnormalities much earlier than a regular X-ray exam.

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, a positron emission tomography (PET) scan, magnetic resonance imaging (MRI), or a biopsy.

A nuclear medicine physician will interpret the scan results and will share them with the doctor who ordered the scan. The patient’s primary oncologist will share the results with the family.

What should families do before the bone scan?

Usually, patients do not need special preparations before a bone scan. They can eat and drink normally before the appointment.

  • Medications — Families should tell the medical team about all medications the patient takes. Medicines that contain barium or bismuth (such as Pepto-Bismol™) can affect the test results, and patients will need to avoid taking these medicines before the scan.
  • Allergies and medical conditions — Families should also inform the team about drug allergies or other medical conditions, including the possibility the patient could be pregnant.
  • Insurance — Parents should also check with their insurance provider in advance to find out how much of the cost of the test will be covered and how much you will need to pay.
  • Ask questions — Parents and patients should talk with the medical team about any concerns about the bone scan.
  • Parents should make sure the patient understands what is happening — By the day of the scan, parents should make sure the patient understand the reason for the bone scan and explain what will happen in simple terms. Parents may want to consult a child life specialist or nurse, or may want to reach out to the nuclear medicine department to help.

What happens the day of the bone scan?

  • Patients and parents should arrive a few minutes early for the appointment to allow time for check-in.
  • Parents may be asked to sign a consent form, which states that parents understand the benefits and risks of the bone scan and agree to have the test. Before the test, patients will 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 the patient and parent and explain what will happen. A child life specialist may be there as well.

What happens during the procedure?

First, a tracer will be injected into the patient’s body through an IV in the arm. The injection may sting a little bit, but the patient will not 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, and the patient can leave the area and resume normal activities. The technologist will give an exact time to return for the scan. The patient 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, the patient will:

  • Return for the scan a few minutes before the appointed 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 the patient’s body, taking pictures inside the bones. The camera does not make loud noises and will not touch the patient. The patient will not feel the pictures being taken.
  • The technologist may ask the patient to change positions to get pictures from different angles.
  • The scan takes 40 minutes to an hour. The patient must lie still because moving can cause the images to blur. If the patient moves, the procedure will have to be repeated.
  • A parent can stay with the patient during the procedure, and patients can usually read or watch a movie to help them remain still. Patients may also keep a comfort item with them as long as it doesn’t interfere with the scan.

What happens after the procedure?

Afterward, patients can return to normal activities. They should not feel any side effects. The medical team may ask patients 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.

Parents should contact the doctor immediately if they notice pain, redness, or swelling around the injection site on the patient’s arm because it could indicate an allergic reaction.

Even though the amount of radioactivity is very low, it is recommended that families take these precautions after the scan:

  • Pregnant women should not cuddle with the patient for at least 24 hours after the scan. Also, the patient should avoid direct contact with infants and toddlers until the next day.
  • Always wash hands after changing the patient’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.)
  • The patient may set off radiation alarms at airports, border crossings, and other places protected by Homeland Security for several days after the procedure. Parents should tell the nuclear medicine technologist if the patient might go through one of these areas during that time period. The technologist can provide written information about the bone scan to give to travel officials.

How do parents and patients find out the results of the bone scan?

The nuclear medicine physician will interpret the results of the scan and will provide a report to the doctor who ordered the bone scan. This doctor will then discuss the results with the family.

Questions to ask your doctor

Before having a bone scan, consider asking the following questions:

  • 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 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?


Reviewed: June 2018