49 The EANM practice guideline for Bone Scintigraphy 7. Indications for SPECT/CT imaging The indications for SPECT/CT imaging in daily clinical practice are broad and include (non-exhaustive list): 1. Oncology: in case of abnormal planar scintigraphy to improve lesion localization 2. Suspected traumatic injuries of the axial or appendicular skeleton 3. Assessment of lesions in the tarsal or carpal small bones, in particular after trauma 4. Suspicion of axial or peripheral osteoid osteoma 5. Assessment of the spine and sacro-iliac joints in case of rheumatic disorders 6. Diagnosis of osteonecrosis and bone infarction 7. Diagnosis of infectious lesions, such as osteomyelitis and spondylodiscitis (complemented with infection imaging) 8. Diagnosis of tendinitis 9. Evaluation of painful prosthesis 10. Evaluation of residual pain after orthopedic surgery on the axial or peripheral skeleton 11. Assessment of malignant or pseudo-malignant lesions 12. Exploration of extra-skeletal pathology or uptake Interpretation 1. Normal distribution of radiolabeled bisphosphonates Bone scintigraphy is a very sensitive method for localization of skeletal diseases, but the specificity may be low. The interpretation of skeletal or joint abnormalities should be performed taking into account all available information, especially patient history, recent findings, physical examination and other test or examination results. Correct image interpretation requires detailed knowledge of the normal distribution of radiolabelled bisphosphonates. Particular attention should be paid to the symmetry and homogeneity of tracer uptake. Image quality should be assessed before starting to report scan findings (figure 1). 2