Skip to main content

Main menu

  • Home
  • Content
    • Current
      • JNMT Supplement
    • Ahead of print
    • Past Issues
    • Continuing Education
    • JNMT Podcast
    • SNMMI Annual Meeting Abstracts
  • Subscriptions
    • Subscribers
    • Rates
    • Journal Claims
    • Institutional and Non-member
  • Authors
    • Submit to JNMT
    • Information for Authors
    • Assignment of Copyright
    • AQARA Requirements
  • Info
    • Reviewers
    • Permissions
    • Advertisers
    • Corporate & Special Sales
  • About
    • About Us
    • Editorial Board
    • Contact Information
  • More
    • Alerts
    • Feedback
    • Help
    • SNMMI Journals
  • SNMMI
    • JNMT
    • JNM
    • SNMMI Journals
    • SNMMI

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
Journal of Nuclear Medicine Technology
  • SNMMI
    • JNMT
    • JNM
    • SNMMI Journals
    • SNMMI
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Journal of Nuclear Medicine Technology

Advanced Search

  • Home
  • Content
    • Current
    • Ahead of print
    • Past Issues
    • Continuing Education
    • JNMT Podcast
    • SNMMI Annual Meeting Abstracts
  • Subscriptions
    • Subscribers
    • Rates
    • Journal Claims
    • Institutional and Non-member
  • Authors
    • Submit to JNMT
    • Information for Authors
    • Assignment of Copyright
    • AQARA Requirements
  • Info
    • Reviewers
    • Permissions
    • Advertisers
    • Corporate & Special Sales
  • About
    • About Us
    • Editorial Board
    • Contact Information
  • More
    • Alerts
    • Feedback
    • Help
    • SNMMI Journals
  • Watch or Listen to JNMT Podcast
  • Visit SNMMI on Facebook
  • Join SNMMI on LinkedIn
  • Follow SNMMI on Twitter
  • Subscribe to JNMT RSS feeds
Review ArticlePractical Protocol Tip

18F-NaF PET/CT

Krystle W. Glasgow
Journal of Nuclear Medicine Technology June 2021, 49 (2) 105-106; DOI: https://doi.org/10.2967/jnmt.121.262379
Krystle W. Glasgow
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Rationale

18F-NaF PET/CT is indicated for diagnostic imaging of bone to define altered osteogenic areas of activity. It provides high-resolution, high-contrast images of the skeletal tissue and has higher sensitivity, specificity, and accuracy than conventional nuclear bone scintigraphy. The low-dose CT component provides accurate anatomic localization of structures within the body and enables differentiation of benign versus malignant boney lesions (1 ⇓–3).

Clinical Indications (4)

  • • Diagnosis of occult fracture, stress reaction or stress fracture, avascular necrosis, arthritis, bone infarcts, bone graft viability, Paget disease, reflex sympathetic dystrophy, and unexplained bone pain.

  • • Evaluation of distribution of osteoblastic activity before radionuclide therapy for bone pain.

Contraindications (3,4)

  • • Pregnancy or breastfeeding. Pregnancy should be excluded following institutional policy. If the patient is breastfeeding, she should be told to pump and discard breast milk for at least 4 h after tracer administration and to limit contact with the infant for 4 h after tracer administration.

  • • Barium contrast 24–48 h before the 18F-NaF procedure.

Patient Preparation/Education (2,3)

Prearrival

  • • Tell the patient that food and prescribed medications can be taken before the procedure.

  • • Tell the patient to ensure adequate hydration before arrival (i.e., by drinking two or more 237-mL [8-oz] glasses of water 1 h before injection).

Arrival in PET/CT Department

  • • Obtain a focused history of past and current diseases, interventional or surgical procedures, and medications.

  • • Measure and record the patient’s height and weight.

  • • Describe the procedure to the patient, including the time to completion, the required position for imaging (supine), and the need to drink plenty of fluids during the wait time (two 237-mL [8-oz] glasses of water) and after the procedure (as much as tolerated by the patient). Please note that theses glasses of water are in addition to the glasses of water consumed by the patient prior to arrival for the procedure.

  • • Evaluate the patient’s ability to lie still for up to 30 min.

PET/CT Acquisition Parameters (2,3)

The manufacturer’s recommendations for PET and low-dose CT acquisition parameters are shown in Tables 1 and 2.

View this table:
  • View inline
  • View popup
TABLE 1

Standard Parameters for PET Acquisition

View this table:
  • View inline
  • View popup
TABLE 2

Standard Parameters for Low-Dose CT Acquisition

Protocol/Acquisition Instructions (1⇓–3)

  • • Administer the 18F-NaF intravenously (Table 3, followed by a saline flush.

  • • Allow a tracer uptake period of 30–45 min (90–120 min when scanning the whole body). There are no physical or eating restrictions during the uptake period. Instruct the patient to drink water and to void frequently.

  • • Instruct the patient to void immediately before imaging and between image sets, as necessary.

  • • Position the patient supine on the imaging table with the arms above the head for axial skeleton imaging or at the patient’s side for whole-body imaging.

  • • Assess the patient’s comfort level. If needed, add wedges under the patient’s knees to alleviate pressure on the back.

  • • Perform a topogram (scout) CT scan to set the CT and PET region from skull base to mid thigh and to be used for anatomic localization and attenuation correction.

  • • Begin the PET acquisition immediately after the CT scan.

  • • Assess the raw images for motion before the patient departs.

  • • Instruct the departing patient to continue drinking fluids and voiding frequently for the rest of the day.

View this table:
  • View inline
  • View popup
TABLE 3

18F-NaF Administration Recommendations

Image Processing ( 2,3 )

  • • Keep in mind that the appropriate reconstruction parameters depend on the acquisition mode. Iterative reconstruction is most often used for clinical applications.

  • • Refer to the manufacturer’s guidelines for reconstruction protocols for emission data that correct for detector efficiency (normalization), system dead time, random coincidences, scatter attenuation, and sampling nonuniformity.

  • • Create non–attenuation-corrected and attenuation-corrected images.

  • • Appropriately scale the data and display them in transaxial, coronal, and sagittal planes and as a rotating maximum-intensity-projection image.

REFERENCES

  1. 1.↵
    1. Ahuja K,
    2. Sotoudeh H,
    3. Galgano SJ
    et al. 18F-sodium fluoride PET: history, technical feasibility, mechanism of action, normal biodistribution, and diagnostic performance in bone metastasis detection compared with other imaging modalities. J Nucl Med Technol. 2020;48:9–16.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Farrell MB
    , ed. Quick-Reference Protocol Manual for Nuclear Medicine Technologists. Society of Nuclear Medicine and Molecular Imaging; 2014:282–284.
  3. 3.↵
    1. Segall G,
    2. Delbeke D,
    3. Stabin MG
    et al. SNM practice guideline for sodium 18F-fluoride PET/CT bone scans 1.0. J Nucl Med. 2010;51:1813–1820.
    OpenUrlFREE Full Text
  4. 4.↵
    Sodium fluoride F 18 injection. Package insert. Jubilant Radiopharma; 2020.
PreviousNext
Back to top

In this issue

Journal of Nuclear Medicine Technology: 49 (2)
Journal of Nuclear Medicine Technology
Vol. 49, Issue 2
June 1, 2021
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Journal of Nuclear Medicine Technology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
18F-NaF PET/CT
(Your Name) has sent you a message from Journal of Nuclear Medicine Technology
(Your Name) thought you would like to see the Journal of Nuclear Medicine Technology web site.
Citation Tools
18F-NaF PET/CT
Krystle W. Glasgow
Journal of Nuclear Medicine Technology Jun 2021, 49 (2) 105-106; DOI: 10.2967/jnmt.121.262379

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
18F-NaF PET/CT
Krystle W. Glasgow
Journal of Nuclear Medicine Technology Jun 2021, 49 (2) 105-106; DOI: 10.2967/jnmt.121.262379
Twitter logo Facebook logo LinkedIn logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Bookmark this article

Jump to section

  • Article
    • Rationale
    • Clinical Indications (4)
    • Contraindications (3,4)
    • Patient Preparation/Education (2,3)
    • PET/CT Acquisition Parameters (2,3)
    • Protocol/Acquisition Instructions (1⇓–3)
    • Image Processing ( 2,3 )
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Virtually Celebrating the Advances of Nuclear Medicine and Molecular Imaging: 2021
  • Google Scholar

More in this TOC Section

  • Fatty Meal Hepatobiliary Scintigraphy for Gallbladder Ejection Fraction Determination
  • Gastric Emptying Study: Liquids
  • Ventricular Shunt Patency
Show more Practical Protocol Tip

Similar Articles

SNMMI

© 2025 SNMMI

Powered by HighWire