A working group of several clinical societies developed appropriate use criteria for the use of bone scintigraphy in the diagnosis and management of prostate and breast cancer. The guidelines were published in the Journal of Nuclear Medicine.

Highly sensitive and readily available imaging can lead to inappropriate use with associated unnecessary exposure to ionizing radiation and increased health-care costs. Bone scintigraphy is a high volume procedure with more than 400,000 studies performed for Medicare patients in 2014. Further, bone scintigraphy is commonly used in the setting of breast and prostate cancer diagnosis and treatment.  

The appropriate use criteria were developed in collaboration with the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the European Association of Nuclear Medicine (EANM), and the American Society of Clinical Oncology (ASCO). The group developed a list of clinical scenarios and contraindications for the use of bone scintigraphy in the diagnosis and management of breast and prostate cancer. Likewise, the Pacific Northwest Evidence-Based Practice Center of Oregon Health and Science University conducted a systematic review of the literature to help inform the workgroup.

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Key recommendations for the use of bone scintigraphy in patients with prostate cancer include initial staging in patients with intermediate-risk and high-risk prostate cancer. The recommendations also indicate that bone scintigraphy is usually appropriate in patients with bone-related symptoms at any stage, patients with a pathologic fracture, and patients undergoing radionuclide bone treatment.  

Key recommendations for use of bone scintigraphy in patients with breast cancer include initial staging in patients with positive nodes, bone related symptoms at any stage, and those undergoing radionuclide bone treatment.

“It is felt that by combining multispecialty expert opinion with the existing literature, the most accurate assessment possible can be made for the clinical utility of bone scintigraphy,” the authors wrote.

“The lack of published evidence for the use of bone scintigraphy in specific clinical scenarios has not yet had a dramatic effect on relative reimbursement for this important test; however, as new regulations take effect requiring referring physicians to consult clinical decision support tools before ordering bone scintigraphy, access to this important technology may become severely limited unless [appropriate use criteria] are written for inclusion of this test as an option in clinical decision support tools,” the authors stated.


1. Donohoe KJ, Cohen EJ, Giammarile F, et al. Appropriate use criteria for bone scintigraphy in prostate and breast cancer: summary and excerpts. J Nucl Med. 2017;58(4):14N-17N.