The Role of 18F-NaF Skeletal PET/CT in Oncology

A review of the indications, imaging appearances, and utility of 18F-NaF PET/CT in the evaluation of skeletal disease.

Course ID: Q00420 Category:
Modalities: , , ,


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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 24, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.50
Procedures: 0.50
Head, Spine, and Musculoskeletal: 0.50

Nuclear Medicine Technology: 3.00
Procedures: 3.00
Radionuclides and Radiopharmaceuticals: 0.50
Endocrine and Oncology Procedures: 0.50
Other Imaging Procedures: 2.00


  1. Introduction
  2. Sodium Fluoride 18F
  3. Pharmacokinetics and Biologic Properties
  4. Comparison of 18F-NaF and 99mTc-MDP as Bone Agents
  5. Clinical Indications
  6. 18F-NaF PET/CT Protocol
  7. Radiation Dosimetry
  8. Image Interpretation
  9. Extraosseous Uptake of 18F-NaF
  10. Limitations
  11. Comparison of 18F-NaF PET/CT and FDG PET/CT: Which Examination Should Be Performed
  12. Conclusions


Upon completion of this course, students will:

  1. be familiar with the FDA approval of 131Iodine
  2. identify which cancer is commonly treated with radioiodine
  3. identify what cells comprise the thyroid gland
  4. be familiar with the role of radioiodine in medullary thyroid cancer
  5. identify the undifferentiated thyroid cancer cells
  6. identify the differentiated thyroid cancer subtypes
  7. identify the categories of radioiodine use for thyroid cancer
  8. be familiar with the thyroid cancer risks after remnant ablation
  9. be familiar with criteria for patient selection for adjuvant therapy
  10. understand the meaning of radioactive iodine therapy
  11. be familiar with the level of toxicity for thyroid cancer treatment
  12. identify the organizational guidelines for thyroid cancer therapy
  13. be familiar with ATA guidelines for thyroid cancer patients not requiring radioiodine therapy
  14. be familiar with the tumor size criterion for whom radioiodine therapy is definitely recommended
  15. identify the criteria for radioactive iodine therapy
  16. be familiar with the radioactive properties of 131Iodine
  17. be familiar with the factors taken into account when selecting a radioiodine dose for therapeutic intent
  18. identify who is credited with the whole-body and blood dosimetry for radioiodine therapy
  19. identify the radioisotope of iodine that is positron emitting
  20. be familiar with the advantage of using 124Iodine for quantification of individual thyroid lesions
  21. be able to define iodine-refractory disease
  22. identify the drug approved in 2013 for use in iodine-refractory disease
  23. be familiar with the PET/CT radiopharmaceutical used to help stratify iodine refractory disease
  24. identify the role of selemetinib in iodine-refractory disease
  25. be familiar with the signaling pathways exploited in thyroid cancer
  26. understand the role that sorafenib plays in the treatment of iodine-refractory disease
  27. identify tumor cells signaling pathways that sorafenib effects
  28. be familiar with the disadvantages of current targeted therapeutics
  29. identify 131Iodine as a theranostic agent
  30. understand the potential 124Iodine PET/CT may have on response to radioiodine therapy