Bone Scan Image Quality Audit


Image quality of bone scans.


Suboptimal images can affect the accuracy of a report and lead to errors. The regular use of an image quality checklist (see Resources), can identify image quality problems (technical or processing) that can then be addressed to improve the accuracy of reporting.

The Cycle

The standard: 

All bone scan images should meet all the relevant criteria for the particular request.

1. Delayed only, 2 or 3 phase?

2. If 2/3 phase, correct areas covered?

3. If 2/3 phase, timing indicated?

4. If SPECT or SPECT-CT images taken, are sites appropriate?

5. For whole body scan, must show adequately:

• Chest

• Pelvis

• Shoulders

• Lower limbs at least to knees

• Skull

• C-spine

• T-spine

• L-spine

• SI joints




Assess local practice


Percentage of images which meet all the criteria set out in the checklist for assessing bone scan images (see Resources).

Data items to be collected: 

• Assess retrospectively a randomly selected sample of investigations

• Record the percentage of bone scans which meet the standard

• For each investigation, record whether or not it meets each of the criteria set out in the standard

Suggested number: 

30 examinations, randomly selected.

Suggestions for change if target not met: 

- Identify underlying problems

- Seek Medical Physicist’s advice if image quality issue

For example with:

   • Servicing of equipment  

  • Post-processing of images

- Consider the need for targeted CPD


• Checklist for image quality

• RIS-PACS for images and Electronic Requests

• Radiographer (4 hours)

  1. Van den Wyngaert T, Strobel K, Kampen WU. The EANM practice guidelines for bone scintigraphy. Eur J Nucl Med Mol Imaging (2016) 43:1723–1738 DOI 10.1007/s00259-016-3415-4.

  2. IAEA Human Health Series No. 16. Atlas of Bone Scintigraphy in the Developing Paediatric Skeleton: The Normal Skeleton, Variants and Pitfalls (2011). International Atomic Energy Agency, Vienna.

  3. Clark S. Specialty Supplement: Nuclear Medicine. Making Medical Audit Effective. London: Joint Centre for Education in Medicine, 1993.

  4. Collier BD et al. Bone. In: Early PJ, Sodee DB, eds. Principles and Practice of Nuclear Medicine. Second Edition. St Louis: Mosby, 1995:339–69.

Published Date: 
Monday 7 January 2008

Last Reviewed: 
Tuesday 7 January 2020