New Routine for Nuclear Medicine Technologists to Determine When to Add SPECT/CT to a Whole-Body Bone Scan

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FIGURE 1.
Training cases. Bone scan images are displayed on left. Clinical information from referral and symptoms from patient are on right. Desired decision “SPECT/CT required or not” is displayed only after technologist has made decision and has clicked button to show this information.
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FIGURE 2.
Test cases. Images are displayed in same way as for training cases except that desired decision regarding “SPECT/CT required or not” is not available.

TABLE 1

Criteria for Performing SPECT/CT After Whole-Body Bone Scan

Section	Description
A	Indications for not performing SPECT/CT after bone scan
	Patient cannot participate in SPECT/CT examination
	Widespread metastatic disease is present
	A previous whole-body bone scan is available and no new lesions are present
B	Indications for performing SPECT/CT after bone scan
	Focal lesions in spine or pelvis are present
	Patient reports newly developed pain from spine or pelvis
	Prostate cancer patients have prostate-specific antigen that is increasing or > 20 ng/mL even though no metastatic lesions are present (SPECT/CT of lumbar spine and pelvis)
	Large urinary bladder is covering sacrum and patient has reported symptoms from this area
C	Indications for not performing SPECT/CT
	Whole-body bone scan has normal results and no criteria from section B to perform SPECT/CT are fulfilled
D	If technologist is unsure whether SPECT/CT should be performed, technologist calls physician

These criteria apply to patients suspected of having metastatic disease. For other indications, nuclear medicine physician makes decision.