The practice of adult whole-body nuclear medicine bone scanning in the UK: opportunities to optimise
Samantha J. Colosimo, Roger T. Staff, Kathryn Adamson, Maria Burniston, Kat Dixon, Sarah McQuaid, Julie Speakman, David Towey, John C. DicksonObjectives:
Recent advances in bone scintigraphy, including multi-head detector systems, improved reconstruction algorithms, and novel detector technologies, offer opportunities to enhance image quality, reduce acquisition times, and lower administered activities. However, it is unclear whether these changes have led to updates in clinical practice or optimisation of local diagnostic reference levels in the UK.
Methods:
The UK Heads of Nuclear Medicine Physics group commissioned a national survey to determine whether these developments have led to practical advancements.
Results:
Fifty-four responses were received: England (36), Scotland (11), Wales (5), and Northern Ireland (2). Of these, 50 sites perform planar bone scans, using predominantly Siemens or General Electric scanners (98%), with Siemens Symbia/Intevo and General Electric 600/800 systems each representing 43% of responses. Substantial variation in protocols was observed. Optimisation of planar imaging was reported by 24% of sites, with aims including reduced scan time, lower administered activity, improved image quality, or combinations thereof. The majority of sites (88%) use fixed administered activities for planar oncology scans, either 500 MBq (11%), 550 MBq (16%), or 600 MBq (73%), rather than weight-based activities.
Conclusions:
This study demonstrated that the majority of sites use the Administration of Radioactive Substances Advisory Committee national diagnostic reference levels (NDRLs) for administered activity. Sites that had optimised protocols were more likely to use weight-based administered activities. The majority of respondents (49/50) supported reviewing the current NDRLs, which predate many of the technological developments. This work demonstrates the considerable variation in UK bone scintigraphy practice and suggests further optimisation is achievable.