Bone Survey

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Bone survey

Definition

A bone survey is an x ray to check the health and status of a person's bones. It is an important tool for diagnosing the presence of multiple myeloma lesions in bone.

Purpose

The bone survey is the standard method for determining if there is bone involvement in multiple myeloma.Multiple myeloma lesions may not show up in other bone studies. However, if the lesions are present, they are likely to appear on a bone survey, making this an important diagnostic tool.

In patients who have been treated for multiple myeloma, bone surveys should be repeated to see if the disease has responded to treatment, or if it has progressed further. While the repeated bone survey may show that bone healing has occurred, this is not usually the case. Only 30% of patients whose multiple myeloma is responding to treatment show an improvement on their bone surveys. Multiple myeloma patients whose disease is progressing, or who have new areas of bone pain , can benefit from repeat bone surveys because this procedure can locate sites of potential fractures that may then be prevented by radiation or surgery.

Precautions

The dose of radiation in diagnostic x rays is very small, and this procedure is considered relatively safe. However, x rays are generally not advised for pregnant women. These women should inform their physician or the x-ray technician of their pregnancy (or suspected pregnancy) prior to the procedure.

Description

A bone survey in people with multiple myeloma includes x rays of the skull, spine, pelvis, and long bones of the legs and arms because the disease may spread to these particular areas. The procedure may be done in the radiology department of a hospital (for inpatients or out-patients) or in an imaging facility.

Patients may be given a hospital gown and asked to remove clothing that could interfere with the image, such as buttons or snaps. A lead shield for protection from radiation may be placed over the parts of the body that are not undergoing an x ray.

An x ray creates a two dimensional (flat) image shown on film. Since the human body is three-dimensional, at least two different angles of the same area will be x-rayed. The radiology technician helps the patient achieve the proper position. Most imaging centers have special tables that help position the patient.

When the patient is properly positioned, the technician will leave the room to activate the x-ray machine. It is important that the patient remain completely still while the x ray is being taken. The x ray does not cause any pain or other sensation, and gives off no smell, sound, or taste, although it is penetrating the body. The patient may hear a sound, but this is the equipment and not the x ray itself.

The x ray creates shadows on film, and the film is viewed by a physician (radiologist) who specializes in imaging studies . The film will have contrasts that appear as varying shades of gray.

Preparation

Because the procedure in non-invasive, no specific preparation is necessary.

Aftercare

Bone surveys do not require any aftercare.

Risks

While radiation in high doses may present a cancer risk, the dosage for diagnostic purposes is very low. New technology has increased the safety of radiologic procedures. As in any procedure, the risk must be weighed against the benefit. In patients with multiple myeloma, the bone survey is needed to determine bone involvement, which could then dictate treatment. Pregnant women generally do not receive x rays, and should discuss this with their physician.

Normal results

Bone structure that is free of disease, fracture, or other problem areas is a normal result.

Abnormal results

Areas where multiple myeloma is present show up as destructive bone lesions. Parts of the bone may appear moth-eaten, and fractures may be present.

Resources

BOOKS

Bos, Gary D., and H. Robert Brashear. "Tumors." In General Orthopaedics. Wilson, F., amd Lin, P., eds. New York: McGraw-Hill, 1997, pp. 316-18.

Helms, Clyde A. "Malignant Bone and Soft-Tissue Tumors" InFundamentals of Diagnostic Radiology, 2nd ed. Brant, W., and Helms, C., eds. Philadelphia: Williams & Wilkins, 1999, pp. 991-3.

Hosley, Julie B., et al. Lippincott's Textbook for Medical Assistants. Philadelphia, PA: Lippincott-Raven Publishers, 1997.

Kyle, Robert A., and Joan Blade. "Multiple Myeloma and Related Disorders." In Clinical Oncology. Abeloff, M., et al, eds. Philadelphia: Churchill Livingstone, 2000, pp. 2601-3.

Vescio, Robert A., and James R. Berenson. "Myeloma, Macroglobulinemia, and Amyloidosis." In Cancer Treatment, 5th ed. Haskell, C., ed. Philadelphia: W. B. Saunders, 2001, pp. 1503-4.

Wolbarst, Anthony Brinton. Looking Within: How X-Ray, CT, MRI, Ultrasound, and Other Medical Images Are Created and How They Help Physicians Save Lives. Berkeley, CA: University of California Press, 1999.

Rhonda Cloos, R.N.

KEY TERMS

Radiologic procedure

—A medical procedure, such as an x ray, that uses radiation or other sources to create images useful in diagnosis.

Radiologist

—A medical doctor who specializes in interpreting radiologic (imaging) studies. Imaging studies include x ray, computed tomography (CT), and magnetic resonance imaging (MRI).