I had my first experience with nuclear medicine this week.

Recently, as I was explaining my medical history and ongoing issues with chronic pain to my new doc here in California, he seemed to actually do some listening. Although he didn’t quite buy into a diagnosis of fibromyalgia to explain my problems, he seemed to concede that my symptoms could be accounted for thusly. He suggested we rule out other explanations as well, though, so he ordered some tests.

One of which is a nuclear-med procedure called a whole-body bone scan. I went to the hospital yesterday to have it performed.

The process started with an injection (into a vein in my arm) of a gamma-radiation-emitting radioactive substance (technetium-99m , a metastable nuclear isomer of technetium-99) suspended in methylene-diphosphonate (MDP), a substance which can be preferentially taken up by bone.

I was told to drink lots of water, then come back for the actual imaging procedure three hours later. I went back to work and tried to keep my mind on some simple tasks for awhile. Upon my return to the hospital, and after making sure I went to the restroom, the technician escorted me back to the nuclear-med scanner.

I emptied my pockets and took off my belt, sort of like preparing for airport security, and was told to lie down (face up) on the massage-table-like part of the machine. Buttons were pressed, there was a whirring sound, and soon I found myself inside the device with a portion of the machine about four inches above my nose. I closed my eyes and reminded myself to keep breathing.

Soon she said, “we’re taking pictures,” and I realized that the table was slowly moving. It wasn’t long before I was brave enough to open my eyes and discovered that my head was outside the chamber.

I lost track of time, but the first part of the scanning procedure probably lasted about 20 or 25 minutes. After a short rest-room break (I had taken the water-drinking assignment seriously!), we did the second part, which the technician called “close-ups.” It was during this part of the procedure, when my head was turned for a time, that I was able to see an image of the bones of my head and upper body, from my cranium down to my ribs.

Weird!

Apparently the way this works, for diagnostic purposes, is that any increased physiological function, such as a fracture in the bone, will typically lead to an increased concentration of the technetium-99m. This can result in the appearance of a hot-spot on the image. Some disease processes result in the exclusion of a tracer, resulting in the appearance of a cold-spot.

It should be noted that nuclear medicine differs from most other imaging types in that the tests primarily show the physiological function of the system being investigated as opposed to the anatomical. Additionally, this differs from an x-ray procedure because instead of delivering the radiation source externally, this time it is internal.

I’m told this is a pretty expensive procedure. Luckily, it’s covered by my insurance. And I’m hoping for a totally-negative result, because for many of the kinds of things this test picks up, well, nobody really wants to hear that kind of news.

The Mayo Clinic website has an easy-to-understand discussion of the procedure, in case you’re interested.

Soundtrack Suggestion

Toe bone connected foot bone
Foot bone connected leg bone
Leg bone connected knee bone
Don’t you hear the word of the Lord?

(“Dry Bones” – Negro Spiritual)