Thesis

39 The EANM practice guideline for Bone Scintigraphy Protocol/image acquisition). Unless contraindicated, patients should be well hydrated and instructed to drink one or more liter of water between the time of injection and the time of imaging. All patients should be asked to void the bladder frequently during the interval between injection and delayed imaging as well as immediately prior to the scan. The patients should drink a large amount of fluids during the 24 hours after radiopharmaceutical administration. In patients on renal replacement therapy, hemodialysis performed from 15 minutes to 5 hours after injection of the radiopharmaceutical can successfully decrease blood pool and soft tissue activity to nearly normal levels [44, 45]. However, careful planning of the examination and consultation with the treating nephrologist is recommended. Precautions 1. Pregnancy and lactation For women of childbearing age, it is necessary to verify the absence of pregnancy. In a patient who is known or suspected to be pregnant, a clinical decision is necessary to consider the benefits against the possible harm of carrying out any procedure. If medically warranted, radiation exposure should be delayed until after both pregnancy and breastfeeding. Evaluation by other techniques such as ultrasound or MRI is preferred. While the interruption of breastfeeding is not essential according to the ICRP, this assumes that no free pertechnetate exists in the radiopharmaceutical [46]. Therefore, an interruption of at least 4h during which one meal is discarded is advised to be on the safe side. 2. Possible drug interactions The main drugs that may interfere with the quality of the scintigraphic images are: 1. Aluminum: reduced skeletal tracer uptake, diffuse hepatic tracer uptake, increased renal tracer uptake 2. Androgen deprivation therapy for prostate cancer (bicalutamide, estrogens): increased mammary tracer uptake in case of gynecomastia 3. Bone modifying agents (including bisphosphonates and denosumab) or agents interfering with osteoblast function (e.g. cabozantinib): reduced skeletal tracer uptake[47] 4. Corticosteroids: reduced skeletal tracer uptake, reduced tracer uptake at fracture sites 2

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