18F Sodium Fluoride (NaF) PET for Bone Scanning

The higher quality image, increased clinical accuracy, greater convenience to the patient and referring physician, and more efficient use of nuclear medicine resources all indicate the need to consider the use of 18F Sodium Fluoride (NaF) PET for imaging benign and malignant diseases of the skeleton.

The National Oncologic PET Registry (NOPR) has opened the Coverage with Evidence Development (CED) program to accept Medicare patients for CMS coverage of qualified NaF PET bone scan procedures.

PET Imaging with 18F NaF: Benefits for Bone Imaging

  • Highly sensitive test for osseous metastasis
  • Rapid whole body tomographic 3-D imaging
  • Rapid blood pool clearance allows significant reduction of injection-to-scan time
  • Similar dosimetry to 99mTc MDP bone scan
  • Bone uptake of 18F NaF is considerably higher than for 99mTc MDP
  • Shorter radiation exposure period
  • High bone to background ratios
  • Minimal patient preparation, including no restrictions on food intake and medication
  • Shorter study times resulting in improved patient convenience
  • Rapid clearance and low protein binding
  • No cost to patients registered in NOPR

Differences Between FDG-PET and 18F NaF PET


  • Glucose based
  • Visualizes soft tissue, i.e. visceral tumors and metastases
  • Good for lytic and trabecular osseous metastases

18F NaF PET:

  • Fluorine based
  • Visualizes osseous tumors and bony metastases better than 99mTc MDP bone scan
  • Reduced radiation exposure compared to FDG
  • Higher resolution compared to 99mTc MDP bone scan

For more information please contact Rene Siegel, Clinical Imaging Research and NOPR Administrator at 310-423-3398 or siegelr@cshs.org.

To schedule a patient for 18F NaF PET please call 310-423-3899.

Case Study

A patient with a history of breast cancer presented with increasing back pain two weeks after a fall. The patient was referred for a whole body planar bone scan. The patient received appropriate systemic chemotherapy after accurate identification of the presence and the extent of bone disease with NaF18 PET bone imaging.

Far left: 30 mCi 99mTc MDP Bone Scan; Center: 10 mCi F FDG, FDG PET; Far right: 10 mCi 18F NaF,18F NaF PET