Bone Scans: Seeing Your Skeleton

Patient Expert

As I lay on the table and watched the big square pass slowly over my body, I shuddered at the thought of the radiation it must be emitting. It was my first bone scan, scheduled to find out if my recently diagnosed inflammatory breast cancer  had spread.

"What kind of radiation is that putting into me?" I asked the technician.

She looked at me with a funny expression on her face and hesitated before finally answering, "You are sending the radiation onto it."

Of course I felt foolish. Two hours before I had climbed up on that table, I had received nuclear medicine and then waited for it to find its way to my bones.

That was 14 years ago, and these days I'm an old hand at bone scans.

Why might your doctor order a bone scan? You might have one as a part of the battery of tests when you are diagnosed  with breast cancer to make sure that is has not already spread to your bones.  This would mainly be done if you are already at Stage III or IV at the time of diagnosis. Because the bones are a favorite place for breast cancer to go, checking the bones at the time of diagnosis can be an important part of staging.

In the years after your treatment, a bone scan might be ordered if you have unexplained bone pain. Bone scans are better than X-rays at seeing problems with the bones, and compared to some other tests, they have the advantage of letting the doctor see your whole skeleton. Because bone scans involve a radioactive tracer, they are not usually a routine part of follow-up care, so most of the time they are ordered because of a specific problem. My doctors have ordered bone scans when I have had abnormal blood tests related to the bones and when I have had bone pain.

If your doctor orders a scan for you, don't be alarmed; it's all part of the diagnostic process, and there is a good chance that everything will check out fine. Be sure to tell the doctor is you might be pregnant or if you are nursing. Bone scans are not usually done on pregnant women, and those who are breastfeeding should feed the baby with previously pumped breastmilk or formula for two or three days after the test until all the tracer is out of their system.

Here is how my recent bone scan visit went.

After check-in, a nuclear medicine tech injected me with the radioactive tracer. Then I was free to do whatever I wanted for the next three hours. Sometimes the scan is done after two hours, and I have read that in some cases the doctor might want more than one picture to see how your bones are absorbing the tracer over time. Your waiting time could be anywhere from two to four hours.

I was advised to drink plenty of water to get the tracer to my bones and afterwards to flush it from my system. Since I always drink lots of water ahead of these kinds of tests to plump up my veins to make the injection easier, I made sure I was near a bathroom for the duration of my time at the hospital.

When the time was up, I went back and lay on a narrow metal table and rested while the bone scanner camera checked me out. The machine had two flat detectors about two square feet, one above me and one below me. The tech positioned the device, and then I took a little nap while it moved slowly from my head to my toes for about 30 minutes. One hard part of a bone scan can be lying still, so get as comfortable as possible before the scanning starts.   Ask for a blanket or pillow for under your knees if you need it. Depending on what your doctor wants to see and the machinery used, this part of the test could take up to an hour. When that was over, the tech turned the detectors so that they were at my sides and took some extra pictures of my ribs.

The most interesting part of the scan is seeing the picture. When I ask, the tech will usually let me see the images. The first time it was alarming. The damaged parts of the bones showed in stark contrast to the rest of the skeleton. My right knee was clearly a problem. Fortunately, knees are more likely to be arthritis than breast cancer bone metastases, and over the years I have been able to see the progress of my arthritis on bone scans even before I've felt any pain or stiffness.

Don't be alarmed at spots on the scan that stand out. Bone scans pick up old fractures, arthritis, or any bone damage, not just cancer. The tech will probably answer questions like, "Is this view from the top?" or "Is that my bladder?", but they are not allowed to interpret the test.

My most recent test was to see if a questionable spot on my shoulder blade had grown the way cancer would. So I was very nervous as I waited for the results of this test. For most people, the most difficult part of a bone scan is the wait. Be sure to double check that they have the correct name of the doctor who will receive the results. If you are working with more than one doctor, it is a good idea to have the reports sent to them all. I like to have tests sent to both my oncologist and my primary care doctor.

Also before you leave, ask when your doctor will probably get the report. These days most records are sent digitally, so your doctor should have them within two days, but if there are holidays or back-ups, it may take longer. If you have not heard by the promised date, call your doctor's office and politely inquire as to whether the doctor has received the report yet. Sometimes it takes your phone call to move your case to a higher place on the doctor's To Do list. A long wait may mean that everything is OK. When a report comes in with terrible news, it becomes a higher priority for immediate action from the doctor's point of view. However, you are the one waiting at home and worrying, so a gentle reminder from you is appropriate.

A bone scan cannot diagnose cancer. If the location and shape of a spot on the bone scan look worrisome, the doctor will need some other tests for a final diagnosis. A biopsy or a PET scan might be the next step depending on the circumstances.

My test was on a Tuesday, and my oncology appointment was for Friday, so this time I just waited for my appointment to learn the results of my bone scan and another test the doctor had ordered. I took my husband with me because I knew that I would need some support if the news was bad. Fortunately, the spot has not grown. My doctor says he is not worried, so I am not going to worry. My husband and I went out to lunch to celebrate. If you need a bone scan, I hope you get similar good news.