37 The EANM practice guideline for Bone Scintigraphy Bone scanmay be indicated for metabolic assessment prior to initiation of therapy 1. Evaluation of the activity of arthropathies and to confirm active synovitis prior to radiation synovectomy or before infiltration with corticosteroids of facet joints 2. Evaluation of osteoblast activity in case of Paget’s disease before initiating treatment with bisphosphonates 3. Assessment of benign or malignant vertebral compression fracture prior to vertebroplasty or kyphoplasty Bone scan may be indicated for treatment monitoring Quantitative bone SPECT/CT is a novel technique with potentially useful applications in treatment response monitoring in bone [43]. However, the exact role in routine clinical practice has yet to be determined. Bone scan may not be the preferred investigation in the following conditions 1. Bone lesions with known inconsistent scintigraphic findings, such as plasmacytoma, multiple myeloma, chordoma, or Ewing’s sarcoma. 2. Benign bone lesions and incidentalomas when properly characterized by radiological imaging, including bone island, uncomplicated hemangioma, osteitis condensans ilii, nonossifying fibromas, asymptomatic enchondroma of the long bones, ganglion cyst, or asymptomatic Paget’s disease. 3. Symptomatic degenerative joint disease well characterized on radiological imaging, properly diagnosed based on the pain syndrome and a well performed clinical examination. Even though bone scintigraphy may in general not be the preferred imaging modality in the conditions listed above, this recommendation should be assessed within the specific clinical context of the patient. Procedure specification of the examination Qualifications and responsibilities of personnel All physicians and personnel implicated in performing and reporting bone scintigraphy should be sufficiently qualified and experienced according to applicable law and individual responsibilities should be documented in standard operating procedures. Request The written or electronic request form should provide sufficient information to demonstrate the medical necessity of the examination. This should include current signs and symptoms, relevant history (skeletal surgery, trauma, or recent radiation or 2