WBC Bone Scans, the hospitals in my area are no longer providing this necessary evaluation. I am talking about five hospitals in North Georgia/South Carolina area. I called a friend who runs her own nuclear medicine department-contracted with the hospitals (not all five). She explained that the cost of the dye, roughly $ 1,250.00 is only reimbursed $ 250. by Medicare. Hospitals can not afford to lose money repeatedly on the procedure.
 
I do not know of any other method for evaluating bone to determine if it is inflamed or infected, excluding a bone biopsy.
 
Any one else out there having a problem with hospitals providing WBC Tagged Bone Scans?
 
Wm. Barry Turner, BSN, DPM, CWS, FAPWCA

William,

Wow.  Sorry to hear about that.  At least in my area, the hospitals are still performing nuclear studies, including WBC labeled exams. 

I guess the question becomes when do you get whacked from a lawsuit because you had to operate on a patient due to an MRI that was read as positive for osteomyelitis when in fact the pathology comes back negative?  And the surgery was unnecessary?

The only other imaging you could do, if you really suspect osteomyelitis, would be to have a triple phase done or have the patient perform a gallium bone scan.  But in the light of a pacemaker, then what do you do?  Triple phase isn't specific for OM.  That's why we do Ceretec....

I would have a talk with the radiology group and see what they can do to ask the hospital for a change in policy, it really seems to me that the standard of care in this particular issue is lacking based on the finanicial policy of the hospital rather than getting it right by the patient.

Eric

Quote: 

WBC Bone Scans, the hospitals in my area are no longer providing this necessary evaluation. I am talking about five hospitals in North Georgia/South Carolina area. I called a friend who runs her own nuclear medicine department-contracted with the hospitals (not all five). She explained that the cost of the dye, roughly $ 1,250.00 is only reimbursed $ 250. by Medicare. Hospitals can not afford to lose money repeatedly on the procedure. 
 
I do not know of any other method for evaluating bone to determine if it is inflamed or infected, excluding a bone biopsy. 
 
Any one else out there having a problem with hospitals providing WBC Tagged Bone Scans?
 
Wm. Barry Turner, BSN, DPM, CWS, FAPWCA

Interesting because MRI in the past generally have cost more than a bone scan, but with this newest reimbursement issue that thought may have to reconsidered.......socialized medicine anyone?

In regards to osteomyelitis.  MRI and a triphasic bone scan are both sensitive for bone destruction/turn over, however a MRI is more sensitive for a bone infection, especially in and around joints.  Of course, as with every thing there are some exceptions such as a WBC labeled bone scan is more specific test for osteomyelitis than a MRI, exspecially in a charcot patient.

Web MD had to offer this:

MRI vs. Bone Scan

1. According to WebMD, a "bone scan does not distinguish between normal and abnormal bone growth by itself." Therefore, bone scans are sometimes paired with additional techniques--such as MRI--to help determine a more definitive diagnosis. 
   
   MRIs are often able to provide greater detail and detect some diseases that bone scans cannot. The quality of MRI images and ability for early disease detection make MRIs a useful tool in diagnosing and creating treatment plans for patients.

But on the other side of the fence here is a negative patient testimonial about osteomyelitis and MRI:

I went into the hospital in late June of 2006 for a simple torn cartilaige
operation when i came out of it i was fine for about a week then my knee
started to fill up with fluids the pain was really unbearable i had the knee drained about seven times with the labs checking for infection everytime
i also at that time had a mri which showed nothing because they said the knee was to swollen at the time since June i went to the operating room
twice the most recent was before Christmas i guess at one point due to the many times i had my knee drained one lab came up with a staff infection
which one doc gave me oral anti biotics after ten days of no improvement
i spended two days in the hospital they cleaned out the knee with saline and
gave me a midline which failed two days after coming home and i went to
another hospital to have a picline put in had iv antibiotics at home for six weeks had another mri with dye and a bone scan with dye and i"m just
starting to take antibiotics again by mouth the findings are a bone infection
under the knee cap called the tibia ? i"m just starting to feel a little bit better but by know means I"m out of the woods yet i am still doing a little
more research to try to get to the bottom of this diease

from:  http://forums.wrongdiagnosis.com/showthread.php?t=189

Karr

 

Interesting....with the advent of healthcare reform coming down the pike...what are the options?
1. "Probe to bone test" is stated to be "80-85% specific." However, there is great disparity in practitioner proficiency with this technique unless you face lots of osteomyelitic infections in your practice;
2. Serial radiographs taken every 7 days to detect changes in the osseous interity of the bone can be useful;
3. Triple phase Technetium are rarely useful in my experience since they are highly "sensitive" but not "specific" in the determination and is used as supportive documentation;
4. MRI evaluation with intra-medullary edema/swelling should make one highly suspicious of infection. However, determination of an osteomyelitic process is dependent on the radiologist who may or may not be experienced with pedal osseous infections and is also used as supportive documentation;
5. Ceretec and Indium are highly "sensitive" and "specific," but often not available at smaller health centers/hospitals;
6. "Gold" standard may still be bone biopsy. The reason I consider this still the "gold" standard is that under fluoroscope with a Jamshidi you obtain not only sample for pathology but also a sample for bone culture (unlike the techniques stated above) to determine culture/sensitivity results for antibiosis treatment following any surgical treatments provided. The only thing to keep in mind is that such biopsy should be done through "clear" skin without any infectious involvement.

Food for thought on the biopsy.

If the patient is on antibiotics, the antibiotic needs to be stopped 10-14 days before the biopsy.

Karr 

Regarding hospitals not providing WBC Tagged Bone Scans; should medicine be profitable? If a hospital can not make money providing WBC Tagged Bone Scans, what initiative does the hospital have to provide the service? This is true in many aspects of medicine. If the private sector can not make a profit on nursing homes, how much longer will nursing homes be available.

I understand economics, I understand that our country and it's leaders feel that medical cost need to be brought under control and regulated. I just don't understand how anyone expects to get quality health care in a profitless system.

I know I went into medicine to heal people, but I am a physician.  I am not my office manager, who has to pay the bills. The bills to payroll, to the medical supply houses, to my landlord, the utility people. If we are going to lower reimbursement, shouldn't we also be making the people who work for me get paid less, maybe regulate medical supply cost, maybe even make the utility people reduce their charges to medical practices. Hmmm. Today WBC Tagged Bone Scans, what will health insurance feel they need to stop next?

Wm. Barry Turner, BSN, DPM, CWS, FAPWCA