Current state of bone scintigraphy protocols and practice in Japan

Document Type : Short communication


1 Department of Radiology, Toyohashi Municipal Hospital, Toyohashi, Japan

2 Department of Radiological Sciences, School of Health Sciences, International University of Health and Welfare, Tochigi, Japan

3 Department of Physics, Kanazawa Medical University, Kanazawa, Japan

4 Department of Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences,Kanazawa University, Kanazawa, Japan

5 Department of Radiology, Kurashiki Central Hospital

6 Department of Radiological Sciences, Ibaraki prefectural University of Health Sciences, Ibaraki, Japan

7 Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Japan


Objective(s): Nuclear medicine technologists in Japan often perform additional single-photon emission computed tomography (SPECT) with or without computed tomography (CT) after whole-body imaging for bone scintigraphy. In this study, we wanted to identify the bone scanning protocols used in Japan, together with the current clinical practices.
Methods: The study was conducted between October and December 2017. We created a web survey that was hosted by the Japanese Society of Radiological Technology. The questionnaire included 12 items regarding the demographics of the responders, their scan protocols, and the imaging added to, or omitted from, routine protocols.
Results: In total, 228 eligible responses were collected from participants with a mean of 11.6±8.4 years’ experience in nuclear medicine examination. All responders reported using routine scan protocols that included whole-body imaging. However, only 2%, 4%, 20%, and 14% of the responders also acquired single-field SPECT, single-field SPECT/CT, multi-field SPECT, and multi-field SPECT/CT, respectively. 
Conclusion: Our survey results indicate that nuclear medicine practice in Japan is beginning to shift from planar whole-body imaging with additional spot planar images to additional SPECT or SPECT/CT. Further study is required to examine the optimal protocols for bone scintigraphy.


  1. The Present State of Nuclear Medicine Practice in Japan—A Report of the 8th Nationwide Survey in 2017. Radioisotopes. 2018; 67:339–87.
  2. Sadik M, Suurkula M, Hoglund P, Jarund A, Edenbrandt L. Quality of planar whole-body bone scan interpretations a nationwide survey. Eur J Nucl Med Mol Imaging. 2008; 35:1464–72.
  3. Sadik M, Suurkula M, Hoglund P, Jarund A, Edenbrandt L. Improved classifications of planar whole-body bone scans using a computer-assisted diagnosis system: a multicenter, multiple-reader, multiple-case study. J Nucl Med. 2009; 50:368–75.
  4.    Wesolowski CA, Yahil A, Puetter RC, Babyn PS, Gilday DL, Khan MZ. Improved lesion detection from spatially adaptive, minimally complex, Pixon reconstruction of planar scintigraphic images. Comput Med Imaging Graph. 2005; 29:65–81.
  5. Einat ES, Ur M, Eyal M, Gennady L, Hedva L, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med. 2006; 47:287–97
  6. Abikhzer GKG, Kagna O, Israel O, Frenkel A, Keidar Z. Whole-body bone SPECT in breast cancer patients: the future bone scan protocol? Nucl Med Commun. 2016; 37:247–53.
  7. Schirrmeister HGG, Glatting G, Hetzel J, Nussle K, Arslandemir C, Buck AK, et al. Prospective evaluation of the clinical value of planar bone scans, SPECT, and (18)F-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med. 2001; 42:1800–804
  8. Palmedo H, Marx C, Ebert A, Kreft B, Ko Y, Turler A, et al. Whole-body SPECT/CT for bone scintigraphy: diagnostic value and effect on patient management in oncological patients. Eur J Nucl Med Mol Imaging. 2014; 41:59–67.
  9. Rager O, Nkoulou R, Exquis N, Garibotto V, Tabouret-Viaud C, Zaidi H, et al. Whole-body SPECT/CT versus planar bone scan with targeted SPECT/CT for metastatic workup. Biomed Res Int. 2017; 2017:7039406.
  10. Lofgren J, Mortensen J, Rasmussen SH, Madsen C, Loft A, Hansen AE, et al. A prospective study comparing (99m) Tc-hydroxyethylene-diphosphonate planar bone scintigraphy and whole-body SPECT/CT with (18) F-fluoride PET/CT and (18) F-fluoride PET/MRI for diagnosing bone metastases. J Nucl Med. 2017; 58:1778–785.
  11. Utsunomiya D, Shiraishi S, Imuta M, Tomiguchi S, Kawanaka K, Morishita S, et al. Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology. 2006; 238:264–71.
  12. Sedonja I, Budihna NV. The benefit of SPECT when added to planar scintigraphy in patients with bone metastases in the spine. Clin Nucl Med. 1999; 24:407–13.
  13. Han LJ, Au-Yong TK, Tong WC, Chu KS, Szeto LT, Wong CP. Comparison of bone single-photon emission tomography and planar imaging in the detection of vertebral metastases in patients with back pain. Eur J Nucl Med. 1998; 25:635–38.
  14. Kosuda S, Kaji T, Yokoyama H, Yokokawa T, Katayama M, Iriye T, et al. Does bone SPECT actually have lower sensitivity for detecting vertebral metastasis than MRI? J Nucl Med 1996; 37:975–78.
  15. Reinartz P, Schaffeldt J, Sabri O, Zimny M, Nowak B, Ostwald E, et al. Benign versus malignant osseous lesions in the lumbar vertebrae: differentiation by means of bone SPET. Eur J Nucl Med. 2000; 27:721–26.
  16. Shafi A, Thorsson O, Edenbrandt L. New routine for nuclear medicine technologists to determine when to add SPECT/CT to a whole-body bone scan. J Nucl Med Technol. 2014; 42:28–32.
  17. Horikoshi H, Kikuchi A, Onoguchi M, Sjostrand K, Edenbrandt L. Computer-aided diagnosis system for bone scintigrams from Japanese patients: importance of training database. Ann Nucl Med. 2012; 26:622–26.
  18. Sadik M, Hamadeh I, Nordblom P, Suurkula M, Hoglund P, Ohlsson M, et al. Computer-assisted interpretation of planar whole-body bone scans. J Nucl Med. 2008; 49:1958–65.
  19. Takahashi Y, Yoshimura M, Suzuki K, Hashimoto T, Hirose H, Uchida K, et al. Assessment of bone scans in advanced prostate carcinoma using fully automated and semi-automated bone scan index methods. Ann Nucl Med. 2012; 26:586–93.
  20. Iball GR, Bebbington NA, Burniston M, Edyvean S, Fraser L, Julyan P, et al. A national survey of computed tomography doses in hybrid PET-CT and SPECT-CT examinations in the UK. Nucl Med Commun. 2017; 38:459–70.
  21. Iqbal B, Currie GM, Wheat JM, Raza H, Kiat H. The incremental value of SPECT/CT in characterizing solitary spine lesions. J Nucl Med Technol. 2011; 39:201–7.
  22. De Maeseneer M, Lenchik L, Everaert H, Marcelis S, Bossuyt A, Osteaux M, et al. Evaluation of lower back pain with bone scintigraphy and SPECT. Radiographics. 1999; 19:901–12.
  23. Delpassand ES Jr G, Bhadkamkar V, Podoloff DA. Value of SPECT imaging of the thoracolumbar spine in cancer patients. Clin Nucl Med. 1995; 20:1047–51.
  24. Horger M, Eschmann SM, Pfannenberg C, Vonthein R, Besenfelder H, Claussen CD, et al. Evaluation of combined transmission and emission tomography for classification of skeletal lesions. AJR 2004; 183:655–61.
  25. Ichikawa H, Kato T, Shimada H, Watanabe Y, Miwa K, Matsutomo N, et al. Detectability of thoracic bonc scintigraphy evaluated using a novel custom-designed phantom. Jpn J Nucl Med Technol. 2017; 37:229–38.
  26. Zacho HD, Manresa JAB, Aleksyniene R, Ejlersen JA, Fledelius J, Bertelsen H, et al. Three-minute SPECT/CT is sufficient for the assessment of bone metastasis as add-on to planar bone scintigraphy: prospective head-to-head comparison to 11-min SPECT/CT. EJNMMI Res. 2017;7:1.
  27. 27. Van den Wyngaert T, Strobel K, KampenWU, Kuwert T, van der Bruggen W, Mohan HK, et al. The EANM practice guidelines for bone scintigraphy. Eur J Nucl Med Mol Imaging. 2016; 43:1723–38