RadteraThree-Phase Bone Scan (Tc-99m MDP)
NM+ ContrastMSK
Indications
- Osteomyelitis vs cellulitis
- Complex regional pain syndrome (CRPS/RSD)
- Painful joint prosthesis (loosening vs infection)
- Occult fracture
- Evaluation of focal bone/soft-tissue pain
Patient prep
- No fasting required
- Hydrate after injection and void before delayed imaging
- Position region of interest under/over the camera before injection for flow phase
Contrast
AgentTc-99m MDP/HDP
RouteIV (bolus)
Dose20-25 mCi (740-925 MBq)
TimingFlow immediately at injection; blood pool 5-10 min; delayed 2-4 h; optional 4th phase 24 h
Technique
- LEHR collimator, 140 keV, region centered over symptomatic area for dynamic flow
- Phase 1 (flow): 1-3 sec/frame for 60 sec at injection
- Phase 2 (blood pool): static images within 5-10 min
- Phase 3 (delayed): static/SPECT at 2-4 h
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Flow (angiographic) phase | Dynamic | 1-3 sec/frame x 60 sec, bolus injection over ROI |
| 2 | Blood pool (tissue) phase | Static | Within 5-10 min, soft-tissue hyperemia |
| 3 | Delayed bone phase | Static/SPECT | 2-4 h, osteoblastic activity |
| 4 | Fourth phase (optional) | Static | 24 h delayed for osteomyelitis specificity |
Key points
- Osteomyelitis: focal increased uptake on all three phases; cellulitis: increased flow/blood pool without focal delayed bone uptake
- Bolus injection quality is critical for the flow phase
- Position the symptomatic area under the detector before injecting
Source: Researched — verify against your institution
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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.