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

  • Comments (17)
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  • Dr. Markinson - you raise a good point. My Dad had eye surgery. He had to pay for the lens. He did, and he happens to have excellent insurance.
    I think as the clamps get squeezed this is what will happen. It already occurs at surgery centers.
  • How come no one asks or comments on the price of the imaging agent being $1250.00? I think hospitals are getting ripped off. Implant manufacturers come up with $750.00 screws, $1000.00 dollar plates, $10,000.00 total joints, etc, and then when pressure is put on them, guess what, there suddenly is a lot of room to maneuver the price lower. Also, why aren't patients given the option to cover these costs, instead of just saying the materials are unavailable. If a doctor wants to use an implant in a hospital or oupatient surgical facility, why can't the patient be told that the screw desired by their surgeon costs $750.00 and is not covered by their insurance, and be offered the opportunity to pay for it themselves?

  • Good Morning, 

    To answer the question to what did I do, in reference to the patient that urged me to revisit my earlier complaint regarding WBC Bone scans, I did an x-ray and I am having her come back in a week. 

    I feel "fairly" comfortable that her infection has subsided. I had her on the appropriate antibiotics. When she first presented she had a wound medial to the number two toe, PIPJ. The wound traveled intra-articular and down the lateral side of the joint. Using a flexible IV 18 ga needle, I would irrigate that area every 2-3 days with betadine, follow with a normal saline rinse. I did a deep C&S, and started her on IV Vancomycin and Flagyl. She stayed on the Vanco for about 20 days. After she had been on the IV antibiotics for roughly two weeks, I did another deep culture, the sensitivity had changed to allow me to prescribe Augmentin. Which she is still taking. I have her coming back today to repeat her x-rays, as her wound closed last week. The toe was still red when I last saw her. I explained that the redness may just take awhile to fully resolve or that she may still have an underlining bone infection. I have healed wounds over active bone infections before, but that is not typically the case. Usually the tissue will not heal over until the bone infection is either dormant or killed off. Plus, I was able to put her in my HBO chambers for a few dives to enhance the antimicrobial penetration. 


    I would have felt much more comfortable having her under go a WBC Bone scan. At this time, she will still show up positvie with a three phase bone scan,  an MRI and Sed rate.Do you really want to go through cellulitis to do a bone biopsy?

    Guys, I am a small town podiatrist. I did a one year PPR. I can not believe I am the only one seeing this curtailment of available diagnostic testing as a serious encroachment on health care and the American people's right to the best health care available!


    Regarding amputations. I don't. I will  debride "bad" bone, until I get to "good" bone, then I will  pack the area with a collagen product that I have impregnanted with a few drops on an amioglycoside eye gtts solution (or whatever the cultures indicate). Leave the wound open. I will repeat this 2-3 times per week. Once the bacterial invasion destruction is under control, I may change over to a product that is less destructive to healing tissue, or even a tissue substitute product. Sometimes between the time of the active infection and the skin substitutes, I will try to repair the health  of the wound using a honey product or the DeRoyal product, Multidex gel. Both of those products have a fairly wide range of antimicrobial effectiveness.  

  • Percutaneously or not, it is a procedure. It seems Dr. Turner prefers non-invasive.
  • Biopsy can be done percutaneously with a local anesthetic. Ask for a JamShidi [brand name] disposable trochar.

    http://www.carefusion.com/medical-products/interventional-procedures/biopsy/jamshidi/

     

    Dave Gottlieb, DPM personal opinons only

  • Barry - a biopsy is dangerous by definition of it being an invasive procedure agreed.
    Your point of a valid test not being available due to cost/reimbursable is also valid.
    That aside, what are you planning on your patient?
  • David and Jeffery, I appreciate your comments. I may be getting up there in years, but I do not remember or know of any test more specific to identify an active bone infection, as well as non-invasive, than a WBC tagged bone scan. David, i agree with your view of bones scans, but I am talking about a WBC tagged bones scans. This particular test was very specific for identifying osteomylitis as well as if the infection was still a concern. The tagged WBC would accumulate anywhere an infection was present. The timing of WBC bone scan would allow you to seperate it from soft tissue and infection.  A  3 phase bone sdan and a sed rate are only vaguely specific. A bone biobsy is an option, but it would not be my first recommendation. Much more dangerous to the patient. 

    On another note, I am not for militant or violent revolution. I am just angry that the government is purposely destroying health care via multiple channels. Another example is UCR. Is that a term to endear and support trust between the patient and their health care provider? What is the use of UCR on an EOB, escept to cast suspicion on the intergity of the health care provider?

     

  • Dave - while I like you use sed rates to monitor Osteo, we both know that isn't specific either.
    Although one may not want to do it for whatever the reason: its a procedure, its invasive etc, the bone biopsy or culture remains the standard.
  • Frankly, the old bone scans are considered too sensitive and non-specific. They provide no real additional knowledge. They take time. They were good when that was all we had but there's better now. MRI for instance. I haven't orderd a bone scan in years and have little need for it.

    Concerned about osteomyelitis and/or response to treatement? Get a series of Sed rate panels.

    Using one antiquated test as the basis for militant political action will not attract many.

    Dave Gottleib, DPM personal opinions only.

  • Dr. Turner - these scans have't been available by me for years either. Having said that, we have all dealt with osteo etc before these scans were around. The politics is another story.

    If you have noticed more bone erosion and the toe continues to be red and swollen then it sounds plausible to me osteo is still there. You make no mention of the medical history other than the lady is old.
    Medical problems? Is she ambulatory? Diabetic?
    You might do her more good if she is medically stable by amputating that toe then having her worry about it, having to keep her on antibiotics and having her follow up etc.....
    Again, hard to comment without knowing any history.

    With regards to politics in this country the WBC labeled scan is the least of the issues.
    I'm still trying to figure out how the medical community allowed themselves to go from well respected doctors, to "yes ma'am worker bees".
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