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Bone Scan - B2.1

Definition of Condition:  Bone scanning (scintigraphy) is a nuclear study performed to assist in diagnosing pathological conditions as well as complications of bone disease.

Issue Statement:  Bone scans are used for the early identification of bone lesions and identifying the age of fractures.  This is often helpful in the compensation setting.  Bone scans of fractures may show abnormalities as early as 24 hours after injury, but usually by 3 days.  The degree of uptake on the bone scan increases, reaching a maximum within several weeks.  This phase is followed by a decrease in uptake, eventually approaching normal levels. 

The time frame for a bone scan to return to normal following fractures varies.  It may be possible to identify the approximate age of a fracture by the degree of increased uptake.  Generally, recent fractures show intense increased uptake, whereas older fractures show progressive decrease in uptake as the fracture heals.

Radiography is relatively insensitive to osteomyelitis and pathology frequently may not become apparent until 10 to 14 days after the onset of the disease.  A bone scan may be positive as early as 24 hours after the onset of symptoms and may be positive and usually will remain positive until the lesion has healed completely.

Bone scanning is most utilized for its value in investigating metastic disease.  It allows for the early diagnosis of osteomyelitis and evaluation of the response to therapy. Vascular disease such as ischemic necrosis lends itself well to assessment by bone scan.  With traumatic insults to bone, scanning may be useful when radiography is less sensitive e.g. stress fractures.  Articular disease also can be well evaluated using this procedure. Bone scanning has not been used extensively in evaluation of metabolic diseases.

Bone scanning is used to diagnose or exclude a range of back problems.  In particular, it can help identify osteoporotic or traumatic vertebral collapse, Paget's disease, and other benign conditions such as spondylolysis and facet osteoarthritis.

WCB-Alberta position

Payment for a Bone Scan may be approved when recommended by the attending physician to assist in making the diagnosis or when requested by the unit medical advisor for appropriate reasons.

Indications

1. Confirmation of the presence of acute fractures and/or estimation of the approximate age of a fracture (particularly compression fractures of vertebrae and undisplaced fractures of long bones).
2. Assisting in the differential diagnosis of bone pain e.g. the extent of articular involvement of various forms of arthritis, osteomyelitis, primary bone cancer or metastatic bone cancer, benign bone lesions, ischemic necrosis of bone and myositis ossificans.

Clinical criteria for acceptance of responsibility

1. A recommendation by the attending physician that the scan is required to assist in the diagnosis.
2. A recommendation by the unit medical advisor that a scan is required.

WCB-Alberta requirements for arranging expedited examinations

When timing is important to determine the age of a fracture.

Criteria for denial of responsibility

Marginal or absent clinical findings.

Authorization

By the Unit Medical Advisor in conjunction with the case manager.

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