SNM issues guidelines for sodium 18F-Fluoride PET/CT bone scans

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SNM has issued practice guidelines to assist healthcare professionals in performing, interpreting and reporting the results of PET/CT bone scans performed with 18F-fluoride in the November issue of the Journal of Nuclear Medicine.

Variable institutional factors and individual patient considerations make it impossible to create procedures applicable to all situations or to all patients, according to Dominique Delbeke, MD, PhD, president of SNM and director of nuclear medicine and the PET Center at Vanderbilt University Medical Center in Nashville, Tenn., and guideline co-author.

PET/CT 18F bone scans may be used to identify skeletal metastases, including localization and determination of the extent of disease. According to the guidelines, insufficient information exists to recommend the following indications in all patients, but these indications may be appropriate in certain individuals:
•    Back pain and otherwise unexplained bone pain;
•    Child abuse;
•    Abnormal radiographic or laboratory findings;
•    Osteomyelitis;
•    Trauma;
•    Inflammatory and degenerative arthritis;
•    Avascular necrosis;
•    Osteonecrosis of the mandible;
•    Condylar hyperplasia;
•    Metabolic bone disease;
•    Paget disease;
•    Bone graft viability;
•    Complications of prosthetic joints;
•    Reflex sympathetic dystrophy; and
•    Distribution of osteoblastic activity before administration of therapeutic radiopharmaceuticals for bone pain.

18F-fluoride is injected intravenously by direct venipuncture or intravenous catheter. The activity for adults is 185 to 370 MBq (5 to 10 mCi). A higher activity (370 MBq [10 mCi]) may be used in obese patients. Pediatric activity should be weight-based (2.22 MBq/kg [0.06 mCi/kg]), using a range of 18.5 t0 185 MBq (0.5 to 5 mCi), according to the guidelines.

With PET/CT, the radiation dose to the patient is the combination of the radiation dose from the PET radiopharmaceutical and the radiation dose from the CT portion of the study. The effective dose for a typical adult whole-body CT scan performed for attenuation correction and registration of emission images is 3.2 mSv (0.32 rem), using the following parameters: voltage of 120 keV, current of 30 mA, rotation of 0.5 seconds and pitch of 1, stated the guidelines.

Accurate interpretation requires correlation with clinical history, symptoms, prior imaging studies and other diagnostic tests, noted the guidelines.