33 The EANM practice guideline for Bone Scintigraphy The corresponding guidelines from the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the Dutch Society of Nuclear Medicine (NVNG), and the French Society of Nuclear Medicine and Molecular Imaging (SFMN), as well as the existing EANM bone scintigraphy procedures guideline for tumor imaging have been consulted while preparing this consensus document [3-6]. For specific applications of bone scintigraphy in selected indications or populations, the reader is also referred to the EANM guidelines for paediatric bone scanning, and the EANM and SNMMI practice guidelines for sodium 18F-Fluoride PET/CT bone scans [7-9]. Other excellent reference works are recommended as well [10]. The goal of this guideline is to offer an educational tool designed to assist the nuclear medicine practitioner in appropriately recommending, performing, interpreting, and reporting the results of bone scintigraphy. Definitions 1. Planar whole body images in anterior and posterior projections of the axial and appendicular skeleton. If necessary, additional localized or spot views can be obtained. 2. Focal planar images limited to a specific portion of the skeleton. 3. Single photon emission tomography (SPECT, also known as SPET) allows the visualization of the three-dimensional distribution of the radiopharmaceutical in the skeleton. 4. SPECT/CT images consist of a SPECT acquisition combined with a Computed Tomography (CT) using an integrated CT scanner. 5. Multi-phase bone scan produces planar images of the vascular inflow, the soft tissue phase, and delayed phase images of the radiopharmaceutical over a given area of the skeleton. The vascular inflow images are acquired during intravenous injection. The study of the soft tissue distribution of the radiopharmaceutical in the region of interest is performed within the first 5 - 10 minutes after injection. Finally, delayed whole body, focal views, and/or tomographic images are usually acquired between two and four hours after injection of the radiopharmaceutical. In some cases, it may be useful to acquire late-phase images, up to until 24 hours after tracer administration [11]. 6. Quantification is the process of calculating the osseous radioactivity concentration expressed as standardized uptake values (SUV). 2