Pandora, what does two plus two equal?

————————————–

“A bone scan or bone scintigraphy is a nuclear medicine imaging technique used to help diagnose and assess different bone diseases. These include cancer of the bone or metastasis, location of bone inflammation and fractures (that may not be visible in traditional X-ray images), and bone infection (osteomyelitis).

————————————-

The most common radiopharmaceutical for bone scintigraphy is 99mTc with methylene diphosphonate (MDP). Other bone radiopharmaceuticals include 99mTc with HDP, HMDP and DPD. MDP adsorbs onto the crystalline hydroxyapatite mineral of bone. Mineralisation occurs at osteoblasts, representing sites of bone growth, where MDP (and other diphosphates) “bind to the hydroxyapatite crystals in proportion to local blood flow and osteoblastic activity and are therefore markers of bone turnover and bone perfusion”.”

From Wikipedia

——————————————

I have not long returned from the Nuclear Medicine suite at Yves Le Foll hospital Saint Brieuc. The pretext from my bone scan was to look at where there might be inflammation in my right femoral head / neck and hip prior to an operation. The first orthopaedic surgeon, who prescribed the scan, suggested that it might be done with an Iodine radio-tracer. That is not for bones. He became a little flustered when questioned and pressed on the subject. The second orthopaedic surgeon questioned why he might even order such a test. It seemed incongruous to him.

Nobody in France has yet mentioned the C word! Looking in Pandora’s box can have unexpected results. They could be doing a “Basil Fawlty”.

At the end of my scan today the operatives in the control room were all looking intently at my images, pointing and talking animatedly. Before the scan they did not help me onto the scanner table, after it they were very helpful with the dismount. The images changed behaviour. I was not privy to my gamma ray “only fans” content which had them talking. The secretary suggested that I will get the results in a letter at some unspecified time in the future. The results will go to the first orthopaedic surgeon and my GP.

The following outcomes are possible:

1)  The results simply show osteo-arthritic frictional inflammation in the bony tissues. What I call the pepper mill effect. In which case I will get the results through the post and I can take a good scooby at them myself.

2) There is a long delay during which a conflab occurs. I do not get the results in a timely fashion, some other follow up plan is hatched. Something needing to be followed up has been found.

3) I get a telephone call to tell me bad news. I am being followed for elevated prostate specific antigen and have had colon cancer. There are anomalies in my blood work.

4) The results arrive in a tardy fashion with bad news therein, before anyone contacts me.

This is what the Canadian Cancer Society says:

————————————-

Société canadienne du cancer

La scintigraphie osseuse aide les médecins à diagnostiquer et à évaluer différentes maladies et affections osseuses. On peut y avoir recours pour:

  • trouver un cancer des os ou déterminer si un cancer présent dans une autre région s’est propagé aux os;
  • aider à diagnostiquer la cause ou à déterminer l’emplacement d’une douleur osseuse inexpliquée;
  • aider à diagnostiquer des fractures osseuses qui ne sont pas évidentes à la radiographie;
  • voir jusqu’où le cancer s’est propagé;
  • trouver des lésions osseuses causées par une infection ou d’autres affections osseuses;
  • savoir si le traitement du cancer est efficace ou pour faire un suivi.

————————————————-

Obviously, they are going to have a cancer bias. My gut feeling is that people are not being 100% straightforward with me. My gut feelings are often with substance. The French can beat around the bush so to speak.

Waffle, moi?

Whatever the outcome, knowing what the data says does not change the actual physical plane reality. It does / might affect how things move on from here…

It is out of my hands; I can do nothing…

We shall see…

Travelling With a 511 keV Gamma Emitter Tomorrow

We are a four cancer household of two. I have had stage 3 colon cancer and a couple of basal cell carcinomas. The wife has recently had a lumpectomy for breast cancer, stage 1, followed by 15 sessions of radiotherapy. Tomorrow, she has a Positron Emission Tomography {PET} scan to check on the state of play with her multiple myeloma, it will be an 18F – FDG PET scan. The [18F] fluorodeoxyglucose shows sites of hypermetabolism associated with regular cancer or myeloma. It decays by positron emission, an up quark changes to a down quark.

The annihilation of the emitted positron causes two ~511 keV gamma “rays” emitted at exactly 180 degrees to each other to conserve momentum. The half-life of 18F is around 110 minutes. The drive back from the centre of nuclear medicine is half an hour, we have a smallish Peugeot 207 and it takes place at less than one half life after injection.

According to what I have read in the scarce literature, this car journey gives me an exposure of ~0.4% of the annual average exposure to radiation.

Perhaps there is a need for more research on what happens when a patient leaves the nuclear medicine centre? There are health and safety assessments for the healthcare practitioners, what about the carers? This is the third journey like this for me. There will be more.

We have an appointment with the radio-oncology specialist and the haematologist week beginning 2nd December.  We will know a little more about what our immediate future holds by the end of that week….