This article was written to answer many of the most frequently asked questions on the subject of bone scans. If you have chronic back pain, a bone scan may be one of the scarier tests that you may undergo, but it is actually a fairly safe and relatively painless procedure.

First off, what is a bone scan?

Simply put it's a study done to show problem spots on the spine. A radioactive chemical, sometimes called a "tracer", is injected into the bloodstream. The chemical quickly attaches itself to sections of the bones that are actively making new bone. Images are taken of the skeleton, several hours after the shot.

How is a bone scan done?

An intravenous line (IV) goes in your arm or hand. The chemical tracer is injected into the bloodstream through the IV.

There is a waiting time of two to three hours, while the chemical attaches itself to any areas of bone that are undergoing quick changes. Generally, you are free to leave and come back after this time.

After that, you will be asked to lie or sit underneath a large "camera" that takes pictures of your skeleton. Because the chemical tracer is radioactive, it sends out radiation that can be captured by a unique camera. The camera is analogous to a “Geiger counter" in that it uses film to capture the radioactivity. The process takes 30-90 minutes.

Why a bone scan?

When it is uncertain precisely where the problem is in the skeleton, a bone scan is very helpful. It offers the ability to isolate any problem areas by taking a picture of the whole skeleton. Concentrations of the chemical look like dark spots on the film. In an adult, this usually indicates there is a problem. The increased bone-making activity is an answer to the trouble. For example, bone cells will very rapidly start to make new bone to try to mend it, if there is a crack of the bone.

Once these areas are located on the bone scan, the physician may order other tests for exact information about your condition.

A bone scan can show problems such as fractures of the spine, infection, and bone tumors. It can also be used to resolve bone density and the bone-thinning condition of osteoporosis.

How risky is a bone scan?

The chemical is radioactive, but it disappears from the body very rapidly-within hours. Something injected into the bloodstream can always provoke an allergic response. Generally, an allergic reaction to the chemical is uncommon.

What are the limitations of a bone scan?

The bone scan does not show details of the bones or soft tissue. It simply shows how greatly the bone around an exact area is reacting to the problem.

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The best method of preventing mesothelioma is to avoid or limit exposure to asbestos. People who might experience asbestos exposure at work include miners, insulation manufacturers, construction workers, ship builders, and factory workers.

A person with symptoms of mesothelioma will most likely seek help from a primary physician initially. During the diagnostic phase, various technicians will perform the imaging studies. A specially trained physician—a thoracic surgeon or, rarely, a pulmonologist— performs other diagnostic tests like pleural biopsy and thoracoscopy. A pathologist will view the tissue samples and make the tissue diagnosis. Following diagnosis, the patient will be offered some form of treatment, which may entail surgery, radiation therapy, chemotherapy, or a combination of these. The patient may receive care from a thoracic surgeon, an anesthesiologist, medical and radiation oncologists, and specially trained nurses who administer chemotherapy.
Treatment of MM using conventional therapies has not proved successful and patients have a median survival time of 6 - 12 months after presentation. The clinical behaviour of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favours local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of occupational exposure to asbestos may increase clinical suspicion for mesothelioma. A doctor should be seen if a person experiences shortness of breath, chest pain, or pain or swelling in the abdomen. If these symptoms are present, the doctor may order an x ray of the abdomen or chest. The doctor will do a complete physical examination and take a thorough medical history. Then, one or more of the following methods may be used to ascertain whether mesothelioma is present: A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure). Diagnosing mesothelioma is often difficult, even with tissue biopsies. Microscopically, mesothelioma is often difficult to distinguish from several other forms of cancer. For this reason, certain laboratory tests are performed to help correctly diagnose mesothelioma. Some of these tests involve using antibodies to distinguish lung cancer from mesothelioma. Sometimes the tissue samples must be viewed under an electron microscope in order to get the correct diagnosis.

Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity).
Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face. These symptoms may be caused by mesothelioma or by other, less serious conditions.