Imaging with Bone-Seeking Radiopharmaceuticals

A review of the performance and the mechanisms of uptake of bone-seeking radiotracers for clinical and research applications.

Course ID: Q00395 Category:
Modalities: ,


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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after May 9, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Nuclear Medicine Technology: 2.50
Procedures: 2.50
Radionuclides and Radiopharmaceuticals: 1.25
Other Imaging Procedures: 1.25

Registered Radiologist Assistant: 1.25
Procedures: 1.25
Musculoskeletal and Endocrine Sections: 1.25


  1. Introduction
  2. Uptake Mechanisms of Bone-Seeking Radiopharmaceuticals
    1. Physiologic Mechanism of Radiopharmaceutical Uptake
    2. Radiotracer Delivery
    3. Radiotracer Localization to Bone
    4. Renal Excretion
    5. Environmental Factors
    6. Quantification Methods
    7. Dosimetry of 99mTc-MDP and 18F-NaF
  3. Clinical Applications
    1. Bone Viability
    2. Osteonecrosis and Avascular Necrosis
    3. Serial Bone Imaging at Multiple Time Points
      1. Pathophysiology of Bone Metastases
      2. Staging of Bone Metastases
      3. Therapeutic Response Evaluation
    4. Benign Metabolic Bone Disorders
    5. Bisphosphonate Treatment-Response Evaluation
  4. Conclusion


Upon completion of this course, students will:

  1. be familiar with the FDA approval of 18F-NaF for clinical use
  2. understand what imaging modality has renewed interest in using 18F-NaF
  3. identify the characteristics of 18F-NaF bone scans
  4. identify the first radiotracer used for skeletal imaging in the clinical setting
  5. be familiar with the physical half-life of 89Sr
  6. be familiar with the introduction of the 99mTc-labeled bone radiotracers
  7. understand the process of positron emission
  8. be familiar with the acronym of SPECT
  9. be familiar with the composition of hydroxyapatite
  10. identify the radiopharmaceuticals used for performing a bone scan
  11. be familiar with protein binding of 99mTc-MDP
  12. identify the primary mechanism of binding of 99mTc-diphosponates
  13. be familiar with the substitutions for bone histomorphometry
  14. identify the primary route of elimination of bone radiotracers
  15. be familiar with the acquisition time of a dynamic PET
  16. be familiar with the standard adult radiotracer dose for an 18F-NaF bone scan
  17. be familiar with the minimal patient preparation for a bone scan
  18. understand the route of administration of the radiotracer for a bone scan
  19. understand the primary purpose of performing CT during a PET/CT scan
  20. be familiar with the definition of SUV
  21. understand the factors that determine the SUV values
  22. be familiar with the role that 18F-NaF bone scans have in studying allografts
  23. be familiar with how disseminated tumor cells invade bone tissue
  24. be familiar with the reported low sensitivity of bone scans for myeloma
  25. identify the advantages of using 18F-FDG for staging of lung cancer skeletal metastases
  26. identify the advantages of using 18F-NaF bone scans vs. 99mTc-diphosphonates
  27. be able to define Paget disease
  28. realize that 18F-NaF bone scans are useful for bisphosphonate treatment assessment
  29. identify the most common cancer affecting men in the U.S.
  30. identify the imaging tests that may be negative or indeterminate in men with biochemical failure