NUCLEAR MEDICINE IMAGING AND SPORTS INJURIES

Exercise is important for good health, although it’s also important that you take care while participating in sports or other physical activities to avoid injury. According to Statistics Canada, approximately 35% of injuries occur during some type of sport or exercise.

Often these injuries can be prevented with proper stretching and cooldowns, wearing the right equipment, using the correct techniques for the activity, and developing a fitness plan that includes cardiovascular exercise, strength training, and flexibility.

When injuries do happen, they need to be accurately diagnosed to ensure you get the appropriate treatment. This can help prevent further or more serious injury and get you back to the activities you enjoy more quickly.

The most common types of injuries are strains or sprains at 51%, followed by fractures and broken bones at 17%. These injuries can affect any part of the body, but injuries to complex areas like the spine, foot, ankle, wrist, and hand can be complicated to diagnose.

For example, each foot contains 26 bones, 33 joints, and more than a hundred muscles, ligaments, and tendons. Foot fractures are fairly common and may be caused by falls, twisting, or direct impact of your foot against a hard object. They can cause pain which is made worse by trying to walk or put weight on the foot. Treatment can depend on which bone is fractured and the type of fracture.

HOW IS A SPORT INJURY DIAGNOSED?

Your health care practitioner will examine the area of concern to look for external signs of injury, such as swelling or deformities, but for a specific diagnosis it is usually necessary to take a look inside. A standard X-ray can confirm a bone fracture or arthritis damage, but a more detailed look might require a bone scan.

For complex cases, a type of nuclear medicine imaging called a bone scan with SPECT/CT  (single photon emission computed tomography/computed tomography) can be used to diagnose inflammation, stress fractures, or sources of unexplained pain. This type of exam can provide detailed pictures of the area of concern and localized information about each specific bone or even specific regions of particular bones. This makes it particularly useful in examining areas with many small bones and joints like the foot and ankle.

A bone scan with SPECT/CT can look at both the structure and function of the area of concern, offering high diagnostic accuracy. For example, a stress fracture can be visualized within a few days upon the onset of symptoms. If surgery is indicated, exact localization of the injury is necessary for optimal results.

WHAT IS A BONE SCAN?

Bone scans, also known as bone scintigraphy, use a small amount of radioactive material (called a radiopharmaceutical) injected into a vein that travels through your bloodstream into your bones. A gamma camera detects the radiation emitted from your body, which is put together by a computer that creates images of the bones.

Areas that take up little or no amount of the radiopharmaceutical appear as “cold” spots and could show a lack of blood supply to the bone. Areas which take up more radiopharmaceutical show up as “hot” spots, indicating increased blood flow or bone turnover, and could point to problems like a fracture, arthritis, a tumour, or an infection.

Depending on the area of concern, a bone scan can image the entire body or pay particular attention to certain parts. A SPECT/CT scan can also potentially guide targeted pain management procedures to treat the pain.

A SPECT/CT exam is a type of bone scan with additional imaging at the end of the exam. It’s “SPECT” imaging combined with “CT” imaging to help localize the area of abnormal activity that may be present on the planar bone scan image. For the “SPECT” part, the nuclear medicine gamma camera rotates 360 degrees around the body and forms pictures. The system can reconstruct this into an image. For the “CT” portion, a low-dose CT image is taken, similar to other CT imaging. These CT images are fused electronically with the SPECT images to get the SPECT/CT image.

WHAT HAPPENS DURING A BONE SCAN?

A bone scan involves two separate appointments booked on the same day. The first appointment will take approximately 15 minutes. During this time, the radiopharmaceutical is injected into an arm vein and travels throughout the body. You will be asked to lie on your back on the imaging bed while a gamma camera is placed over your body. The first set of images documents increased or decreased flow to the areas of concern. Afterwards, you will be able to go about your normal daily activities until the second appointment (2-4 hours after the first).

During the second appointment, imaging will be performed without any additional injections, to document uptake in the bones. It will take approximately 30-45 minutes. You will be asked to hold as still as possible, while breathing normally – movement can blur the images and make them more difficult to interpret. The SPECT/CT imaging is performed towards the end of this second appointment.

Watch the video: What happens during a bone scan?

HOW DO I GET A BONE SCAN?

This exam is covered under your Alberta Health Care insurance plan and must be requested by a health care practitioner. To determine whether it’s appropriate for you, your doctor will often review your medical and family history, risk factors, how long symptoms have been present, and how they affect daily activities. If this exam is indicated as a best next course of action, your doctor will provide you with a requisition and the appointment can be booked.

These exams are performed at our Castleridge, Mahogany Village, Market Mall, Mayfair Place, and Sunpark locations.

It’s important to note that this exam involves a small dose of ionizing radiation from the radiopharmaceutical injected into your vein, and also from the CT scan. CT imaging is a form of X-ray and the exposure to radiation from this scan is slightly higher than that of standard X-rays, but the associated risk is still small. Overall, the radiation exposure from a bone scan with SPECT/CT is about the equivalent of exposure to the earth’s natural background radiation over two years. In most cases, the benefits of an accurate diagnosis outweigh the small increased risk from radiation exposure.

REFERENCES

John Hopkins Medicine (2024) “Preventing Sports Injuries.” hopkinsmedicine.org. Accessed May 2024.

Journal of Arthroscopy and Joint Surgery (2024) “Imaging in Sports Medicine”  journals.lww.com. Accessed May 2024.

Radiological Society of North America (2024) “Imaging of Muscle Injuries in Sports Medicine: Sports Imaging Series” pubs.rsna.org. Accessed May 2024.

Radiopaedia (2024) “Stress Fracture” radiopaedia.org Accessed May 2024.

Statistics Canada (2015) “Injury in Canada: Insights from the Canadian Community Health Survey”  www150.statcan.gc.ca/. Accessed May 2024.