Natriumfluorid (F-18) Alliance Medical: Uses, Dosage & Side Effects
A diagnostic radiopharmaceutical used for PET bone imaging to detect bone metastases, fractures, and other skeletal abnormalities
Natriumfluorid (F-18) Alliance Medical (sodium fluoride F-18) is a diagnostic radiopharmaceutical used exclusively in positron emission tomography (PET) scanning to produce detailed images of the skeleton. It is not a therapeutic drug – it does not treat any disease. After intravenous injection, the fluorine-18 labeled sodium fluoride is rapidly taken up by bone tissue, particularly in areas of increased osteoblastic activity such as bone metastases, fractures, or infections. The resulting PET images provide highly sensitive and specific information that helps physicians diagnose and monitor skeletal disorders, especially in oncology. Sodium fluoride F-18 has been recognized by the European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) as a superior bone imaging agent compared to conventional technetium-99m bone scintigraphy.
Quick Facts: Sodium Fluoride F-18
Key Takeaways
- Sodium Fluoride F-18 is a diagnostic imaging agent, not a treatment: It is used exclusively for PET bone scans to detect skeletal abnormalities such as bone metastases, fractures, infections, and metabolic bone diseases. It has no therapeutic effect.
- Administered only in authorized nuclear medicine facilities: This radiopharmaceutical must be handled and injected by qualified nuclear medicine professionals in licensed clinical settings equipped with appropriate radiation safety infrastructure.
- Superior sensitivity to conventional bone scans: 18F-NaF PET/CT has been shown in multiple studies to detect more bone lesions with higher accuracy than traditional technetium-99m MDP bone scintigraphy, particularly for detecting small lytic and blastic metastases.
- Short half-life limits radiation exposure: Fluorine-18 has a physical half-life of only 109.77 minutes (approximately 2 hours), meaning the radioactivity decays rapidly. Adequate hydration and frequent urination after the scan further reduce radiation dose to the patient.
- Not recommended during pregnancy: As with all procedures involving ionizing radiation, sodium fluoride F-18 should be avoided in pregnant women unless the clinical benefit is judged to outweigh the potential risk to the fetus. Breastfeeding should be interrupted for at least 12 hours.
What Is Sodium Fluoride F-18 and What Is It Used For?
Sodium Fluoride F-18 (Natriumfluorid Alliance Medical) is a radioactive diagnostic agent used in PET (positron emission tomography) scanning to create highly detailed images of the skeleton. It is injected intravenously and accumulates in areas of active bone formation, allowing detection of bone metastases, fractures, infections, and other skeletal disorders.
Sodium fluoride labeled with the radioactive isotope fluorine-18 (18F-NaF) is one of the earliest radiopharmaceuticals developed for skeletal imaging. First introduced in the 1960s, it was largely replaced by technetium-99m labeled phosphonates for conventional gamma camera bone scintigraphy due to the limited availability of PET scanners at that time. However, with the widespread deployment of PET/CT technology in the 21st century, 18F-NaF has experienced a significant resurgence and is now recognized as the gold standard for PET-based bone imaging.
The product Natriumfluorid (F-18) Alliance Medical is manufactured by Alliance Medical Radiopharmacy Ltd and is supplied as a ready-to-use solution for intravenous injection. The radioactive concentration at the time of calibration ranges from 0.1 to 4 GBq/mL, and the solution must be used within a defined time window based on the radioactive decay of fluorine-18.
How Sodium Fluoride F-18 Works
After intravenous injection, fluoride-18 ions rapidly enter the bloodstream and are distributed throughout the body. The fluoride ions have a very high affinity for bone mineral (hydroxyapatite). Through a process called ion exchange, the fluoride-18 ions replace hydroxyl groups in the hydroxyapatite crystal lattice of bone, forming fluoroapatite. This process occurs preferentially in areas of increased osteoblastic activity – that is, areas where new bone is being formed or where bone turnover is elevated.
Areas of pathologically increased bone formation – such as sites of bone metastases, healing fractures, bone infections (osteomyelitis), or degenerative joint changes – accumulate significantly more fluoride-18 than normal bone. This differential uptake produces “hot spots” on the PET images that physicians can identify and characterize. Approximately 50% of the injected dose is deposited in bone within one hour of injection. The remaining activity is cleared primarily through renal excretion.
The positrons emitted by fluorine-18 travel a very short distance (approximately 1 mm) before annihilating with an electron, producing two 511 keV gamma photons that travel in opposite directions. These photon pairs are detected by the PET scanner’s detector ring, allowing precise three-dimensional localization of the radioactive fluoride within the skeleton. When combined with simultaneous CT imaging (PET/CT), the resulting images provide both functional and anatomical information with excellent spatial resolution.
Clinical Indications
Sodium fluoride F-18 PET/CT is indicated for several important clinical scenarios in which highly sensitive skeletal imaging is required:
- Detection of bone metastases: The primary indication is the detection and characterization of bone metastases from primary malignancies, including prostate cancer, breast cancer, lung cancer, and other tumors with a propensity for skeletal spread. Studies have demonstrated that 18F-NaF PET/CT detects significantly more bone metastases than conventional bone scintigraphy, with particular advantages for small lytic lesions.
- Monitoring treatment response: Serial 18F-NaF PET/CT scans can be used to monitor the response of bone metastases to treatment, including chemotherapy, hormonal therapy, targeted therapy, and radiotherapy. Changes in tracer uptake can indicate whether lesions are responding, stable, or progressing.
- Evaluation of unexplained bone pain: When patients present with bone pain of uncertain origin and initial investigations are inconclusive, 18F-NaF PET/CT can help identify the cause, including stress fractures, osteomyelitis, avascular necrosis, or occult malignancy.
- Assessment of metabolic bone diseases: The tracer can be used to evaluate conditions such as Paget’s disease of bone, fibrous dysplasia, and other metabolic bone disorders characterized by abnormal bone turnover.
- Pre-surgical assessment: In certain cases, 18F-NaF PET/CT provides valuable information for surgical planning, particularly when precise localization of bone pathology is needed.
Multiple comparative studies and meta-analyses have demonstrated the superiority of 18F-NaF PET/CT over traditional technetium-99m MDP bone scintigraphy. A landmark meta-analysis published in the Journal of Nuclear Medicine (2016) found that 18F-NaF PET/CT had a pooled sensitivity of 96% and specificity of 97% for detecting bone metastases, compared to 86% sensitivity and 81% specificity for conventional bone scans. The higher spatial resolution of PET (4–5 mm vs. 10–15 mm for gamma cameras) and the added anatomical detail from co-registered CT images account for this improved diagnostic performance.
What Should You Know Before Receiving Sodium Fluoride F-18?
Before receiving sodium fluoride F-18, inform your nuclear medicine physician if you are pregnant, breastfeeding, have kidney problems, or are allergic to any medications. This radiopharmaceutical involves exposure to ionizing radiation, and the clinical benefit must outweigh the radiation risk in every individual case.
Sodium fluoride F-18 is a diagnostic radiopharmaceutical, and as such, the decision to perform a PET bone scan must always be made by a qualified nuclear medicine physician or radiologist who can assess whether the expected diagnostic benefit justifies the radiation exposure. Unlike therapeutic drugs that are taken repeatedly, sodium fluoride F-18 is typically administered as a single injection for a specific diagnostic purpose.
Contraindications
There are no absolute contraindications to the administration of sodium fluoride F-18 for diagnostic imaging in the strict pharmacological sense, as the chemical amount of sodium fluoride administered is far below any toxicologically relevant dose. However, the following situations require careful consideration:
- Known hypersensitivity: Do not receive this product if you have a known allergy to sodium fluoride or any of the excipients in the formulation, although allergic reactions to this radiopharmaceutical are extremely rare.
- Pregnancy: Sodium fluoride F-18 should not be administered to pregnant women unless the clinical necessity is considered essential and no non-radiation alternative is available (see Pregnancy and Breastfeeding section below).
Warnings and Precautions
Before receiving sodium fluoride F-18, your nuclear medicine physician should be informed about the following:
- Kidney impairment: Fluorine-18 sodium fluoride is excreted primarily through the kidneys. Patients with impaired renal function may have slower clearance of the radiotracer, resulting in higher radiation exposure. The nuclear medicine physician will assess kidney function and may adjust the administered activity or increase the waiting time between injection and imaging.
- Recent bone procedures: Recent bone surgery, radiation therapy to the skeleton, or fractures may cause increased tracer uptake in the affected areas, potentially leading to false-positive results. Inform your physician about any recent procedures or injuries.
- Current medications: Some medications that affect bone metabolism (bisphosphonates, denosumab, corticosteroids) may theoretically influence tracer uptake patterns. Your nuclear medicine physician will consider this when interpreting the scan results.
- Pediatric use: While 18F-NaF can be used in children when clinically indicated, the radiation dose must be carefully adjusted based on body weight and the EANM pediatric dosage card. The expected diagnostic benefit must clearly outweigh the radiation risk, particularly in children who are more sensitive to the effects of ionizing radiation.
Sodium fluoride F-18 is a radioactive substance. All nuclear medicine procedures involve exposure to ionizing radiation. The radiation dose from a standard 18F-NaF PET/CT scan is approximately 4–8 mSv (depending on the administered activity and CT protocol), which is comparable to or lower than the dose from a conventional technetium-99m bone scan. Nevertheless, the justification principle (ICRP) requires that each procedure be individually justified and that the expected clinical benefit outweighs the radiation risk.
Pregnancy and Breastfeeding
Pregnancy: Sodium fluoride F-18 is not recommended during pregnancy. All nuclear medicine procedures deliver ionizing radiation to the fetus, and the developing fetus is more sensitive to radiation effects than adults. If you are pregnant or suspect you may be pregnant, you must inform your nuclear medicine physician immediately before the procedure. A pregnancy test may be performed before administration. The examination will only be carried out if the expected clinical benefit is considered absolutely essential and no alternative non-radiation imaging technique is available.
Breastfeeding: If you are breastfeeding, you must inform your nuclear medicine physician. Fluoride-18 may be excreted in breast milk. To protect the nursing infant from radiation exposure, breastfeeding should be interrupted for at least 12 hours after the injection of sodium fluoride F-18. Breast milk expressed during this period should be discarded. Your physician will advise you on when it is safe to resume breastfeeding.
Driving and Operating Machinery
Sodium fluoride F-18 at diagnostic doses has no known pharmacological effects that would impair the ability to drive or operate machinery. However, you may feel fatigued after the imaging procedure due to the time spent lying still. If you feel unwell or dizzy after the examination, avoid driving until you have fully recovered.
How Does Sodium Fluoride F-18 Interact with Other Drugs?
No clinically significant pharmacological drug interactions have been reported with sodium fluoride F-18 at diagnostic doses. However, certain medications that affect bone metabolism may alter the distribution pattern of the tracer on PET images, potentially affecting scan interpretation. Always inform your nuclear medicine physician about all medications you are taking.
Because sodium fluoride F-18 is administered in trace chemical quantities (nanomolar to micromolar concentrations) far below pharmacologically active doses, it does not produce systemic pharmacological effects and does not interact with other medications in the traditional sense of drug–drug interactions. The fluoride ion concentration from a diagnostic injection is negligible compared to physiological fluoride levels in the body.
However, several classes of medications can alter bone metabolism and thereby influence the biodistribution and uptake pattern of 18F-NaF in the skeleton. These are not drug interactions in the classical pharmacokinetic sense, but they can affect the clinical interpretation of PET bone scan images:
Medications That May Affect Scan Interpretation
| Medication / Class | Potential Effect on Scan | Clinical Recommendation |
|---|---|---|
| Bisphosphonates (alendronate, zoledronic acid) | May reduce bone turnover and potentially decrease tracer uptake at metastatic sites, affecting sensitivity | Inform nuclear medicine physician; baseline scan before starting bisphosphonates is preferable when feasible |
| Denosumab (XGEVA, Prolia) | Potent osteoclast inhibitor may suppress bone remodeling, potentially altering tracer uptake patterns | Consider timing of scan relative to denosumab administration; discuss with nuclear medicine team |
| Corticosteroids (prednisone, dexamethasone) | Long-term use may decrease bone formation and reduce overall skeletal tracer uptake | Note corticosteroid use in scan request; may affect interpretation of diffuse uptake patterns |
| Hormonal therapies (tamoxifen, aromatase inhibitors) | May cause “flare phenomenon” – transient increase in tracer uptake at metastatic sites shortly after initiating therapy, which can mimic disease progression | Allow 2–3 months after starting hormonal therapy before interpreting changes as progression |
| Chemotherapy (various agents) | Healing response (“flare”) in responding metastases may increase tracer uptake temporarily; alternatively, therapy may decrease uptake at responding sites | Correlate with other imaging modalities and clinical markers; serial scans are more informative than a single timepoint |
| Calcium and vitamin D supplements | Generally no significant effect on scan interpretation at standard supplementation doses | No special precautions required; inform physician for documentation |
The “flare phenomenon” is a well-recognized occurrence in bone imaging where healing metastatic lesions paradoxically show increased tracer uptake 2–12 weeks after starting effective treatment. This increased uptake reflects the healing response (new bone formation at previously lytic sites) and should not be misinterpreted as disease progression. Your nuclear medicine physician will be aware of this phenomenon and will correlate scan findings with your clinical history and other markers.
What Is the Correct Dosage of Sodium Fluoride F-18?
The typical adult dose of sodium fluoride F-18 is 100–400 MBq (2.7–10.8 mCi) administered as a single intravenous injection. The exact activity is determined by the nuclear medicine physician based on patient weight, scanner type, and clinical indication. PET imaging is performed approximately 30–60 minutes after injection.
The dosage of sodium fluoride F-18 is expressed in units of radioactivity (megabecquerels, MBq) rather than milligrams, because its diagnostic utility depends on the amount of radioactivity administered, not the chemical mass. The chemical quantity of sodium fluoride in a diagnostic dose is extremely small (typically nanograms to micrograms) and has no pharmacological effect. All dosing decisions are made by the nuclear medicine physician who is responsible for the patient’s care.
Adults
Standard Adult Dose
The recommended activity for adult patients is 100–400 MBq (typically 185–370 MBq or 5–10 mCi), administered as a single intravenous injection. The exact activity depends on the patient’s body weight, the type and sensitivity of the PET scanner, and the imaging protocol of the nuclear medicine department. Modern PET/CT scanners with time-of-flight capability may allow lower administered activities while maintaining image quality.
Administration
Sodium fluoride F-18 is administered as a slow intravenous injection, typically into an antecubital vein. The injection site should be flushed with saline to ensure complete delivery of the dose. The patient should be well hydrated before and after the injection to promote rapid renal excretion of unbound tracer and reduce radiation dose to the bladder. Patients should be encouraged to void (urinate) frequently after the injection and before the scan.
Imaging Protocol
PET imaging is typically performed 30–60 minutes after injection, allowing sufficient time for skeletal uptake and clearance of background activity from soft tissues and blood. The patient should void immediately before the scan to reduce bladder activity, which can obscure pelvic bone structures. The scan duration is approximately 20–30 minutes for a whole-body acquisition from the skull vertex to the toes.
Children and Adolescents
Pediatric Dose
When clinically indicated in pediatric patients, the administered activity is calculated based on body weight using the EANM pediatric dosage card (updated 2016). The minimum recommended activity is 26 MBq to ensure adequate image quality. The fraction of the adult dose is determined by the child’s body weight according to the EANM formula. The decision to perform a PET bone scan in a child must be made carefully, weighing the diagnostic benefit against the radiation risk, as children are more radiosensitive than adults.
Elderly Patients
No specific dose adjustment is required for elderly patients based on age alone. However, kidney function should be considered, as reduced renal clearance in elderly patients may result in slower elimination of the radiotracer and slightly higher radiation exposure. The nuclear medicine physician may adjust the imaging protocol accordingly.
Patients with Renal Impairment
Patients with impaired kidney function may have delayed clearance of sodium fluoride F-18 from the blood, resulting in higher radiation exposure and potentially reduced image quality due to increased background activity. The nuclear medicine physician will consider the patient’s renal function when planning the examination and may adjust the administered activity or extend the interval between injection and imaging.
Overdose
In the unlikely event that an excessive activity of sodium fluoride F-18 is inadvertently administered, the radiation dose to the patient can be reduced by promoting rapid elimination of the radiotracer through the following measures:
- Aggressive hydration with oral and/or intravenous fluids
- Frequent urination to reduce bladder and whole-body radiation dose
- Administration of a diuretic (such as furosemide) if clinically appropriate
Given the short half-life of fluorine-18 (109.77 minutes), the radioactivity will decay to insignificant levels within approximately 20 hours (approximately 10 half-lives). Symptomatic treatment for radiation overdose from diagnostic radiopharmaceuticals is not typically required.
What Are the Side Effects of Sodium Fluoride F-18?
Sodium fluoride F-18 at diagnostic doses produces no known pharmacological side effects. The chemical quantity of sodium fluoride administered is far below any toxicologically relevant dose. The only risk associated with its use is the inherent radiation exposure, which is carefully controlled and kept as low as reasonably achievable (ALARA principle).
Unlike conventional pharmaceutical drugs that produce pharmacological effects at therapeutic concentrations, diagnostic radiopharmaceuticals like sodium fluoride F-18 are administered in such minute chemical quantities that they have no measurable pharmacological, physiological, or immunological effects. The diagnostic information comes from the radioactive emissions, not from any chemical action of the compound.
The primary “side effect” of sodium fluoride F-18 administration is the radiation exposure inherent to all nuclear medicine procedures. This radiation exposure is carefully calculated and minimized according to the ALARA (As Low As Reasonably Achievable) principle endorsed by the International Commission on Radiological Protection (ICRP). The following radiation dose estimates apply to a standard adult examination:
| Organ | Absorbed Dose (mGy) | Notes |
|---|---|---|
| Bone surfaces | 10.0 | Highest dose organ due to preferential uptake |
| Urinary bladder wall | 17.5 | Reduced by frequent voiding and hydration |
| Red bone marrow | 4.0 | Relevant for hematologic risk assessment |
| Kidneys | 2.5 | Primary excretion route |
| Effective dose (whole body) | 4.0–8.0 mSv | Comparable to conventional bone scan; additional CT dose variable |
Very Rare Adverse Reactions
Reported in fewer than 1 in 10,000 administrations
- Mild injection site reactions (local pain, redness, or swelling at the injection site)
- Transient flushing or a metallic taste immediately after injection
- Vasovagal reactions (lightheadedness, fainting) – related to the injection procedure rather than the radiopharmaceutical itself
Theoretical Long-term Risks
Related to ionizing radiation exposure
- Small theoretical increase in lifetime cancer risk from radiation exposure (estimated at <0.05% additional lifetime risk from a single diagnostic scan)
- This risk is based on the linear no-threshold (LNT) model and must be weighed against the diagnostic benefit of the examination
- The radiation dose from a single 18F-NaF PET scan is equivalent to approximately 1–3 years of natural background radiation
Although adverse reactions to sodium fluoride F-18 are extremely rare, any suspected adverse reaction should be reported to your national medicines regulatory authority (e.g., EMA EudraVigilance in the EU, FDA MedWatch in the US, or MHRA Yellow Card Scheme in the UK). Reporting helps to continuously monitor the safety profile of all medicines, including radiopharmaceuticals.
How Should Sodium Fluoride F-18 Be Stored?
Sodium fluoride F-18 must be stored in approved radiation-shielded containers in authorized nuclear medicine facilities. Patients do not store this medication at home. It is prepared and administered by qualified nuclear medicine professionals in a controlled clinical setting.
Unlike conventional medications that patients may store at home, sodium fluoride F-18 is a radiopharmaceutical that is handled exclusively by qualified nuclear medicine professionals. The following storage requirements apply to the clinical facility:
- Radiation shielding: The product must be stored in appropriate lead or tungsten shielded containers that reduce radiation exposure to acceptable levels for personnel handling the material.
- Temperature: Store below 25°C (77°F). Do not freeze.
- Labeling: All containers must be clearly labeled with the radioactive substance name, activity, calibration date and time, expiry date, and the international radiation hazard symbol.
- Expiry: Due to the short half-life of fluorine-18 (109.77 minutes), the product has a limited shelf life. The expiry time is calculated based on the radioactive decay and is specified by the manufacturer for each production batch. The product must not be used after the stated expiry time.
- Regulatory compliance: Storage and handling must comply with national regulations governing radioactive materials, including those established by the relevant nuclear regulatory authority.
- Disposal: Any unused product or waste material must be disposed of in accordance with local regulations for radioactive waste. Due to the short half-life, many nuclear medicine departments allow short-lived radioactive waste to decay in storage before disposal as conventional waste.
What Does Sodium Fluoride F-18 Contain?
Each vial of Natriumfluorid (F-18) Alliance Medical contains sodium fluoride (18F) as the active ingredient in a sterile, pyrogen-free aqueous solution. The radioactive concentration ranges from 0.1 to 4 GBq/mL at the time of calibration.
Active Ingredient
The active substance is sodium fluoride (18F). Fluorine-18 is a radioactive isotope of fluorine produced in a cyclotron by bombarding oxygen-18 enriched water with protons. The nuclear reaction 18O(p,n)18F produces fluoride-18 ions, which are then incorporated into sodium fluoride. Each vial contains a variable amount of radioactivity depending on the production batch, typically ranging from 0.1 to 4 GBq/mL at the stated calibration time.
Inactive Ingredients (Excipients)
The formulation is intentionally simple to ensure sterility and compatibility with intravenous injection:
- Water for injections: The solvent, providing a sterile, pyrogen-free vehicle for the radioactive substance
- Sodium chloride: Added to achieve isotonicity with blood, ensuring comfortable intravenous injection
The solution is clear and colorless. The pH is adjusted to the physiological range (approximately 4.5–8.0). The product is sterile, pyrogen-free, and suitable for direct intravenous injection without further preparation.
Physical Properties of Fluorine-18
Fluorine-18 is a positron-emitting radioactive isotope with the following nuclear properties:
- Physical half-life: 109.77 minutes (approximately 1 hour and 50 minutes)
- Decay mode: Positron emission (97%) and electron capture (3%)
- Maximum positron energy: 0.634 MeV
- Annihilation photon energy: 511 keV (two photons emitted at 180° to each other)
- Mean positron range in tissue: Approximately 1 mm, contributing to the high spatial resolution of PET imaging
Frequently Asked Questions About Sodium Fluoride F-18
Sodium Fluoride F-18 is a diagnostic radiopharmaceutical used exclusively for PET (positron emission tomography) bone imaging. It is not a treatment for any disease. After being injected into a vein, it is rapidly taken up by bone tissue, particularly in areas of increased bone activity. This allows PET scanners to produce highly detailed three-dimensional images of the skeleton. The primary clinical use is detecting bone metastases (cancer spread to the bones), but it is also used to evaluate unexplained bone pain, assess fracture healing, diagnose bone infections, and monitor treatment response in skeletal diseases.
The radiation dose from a sodium fluoride F-18 PET scan is relatively low and is carefully controlled. A typical whole-body scan delivers an effective dose of approximately 4–8 mSv, which is comparable to the dose from a conventional technetium-99m bone scan and equivalent to roughly 1–3 years of natural background radiation exposure. The fluorine-18 isotope has a short half-life of approximately 2 hours, meaning the radioactivity in your body decreases rapidly. By drinking plenty of fluids and urinating frequently after the scan, you can further reduce your radiation exposure. The benefit of accurate diagnosis always outweighs this small radiation risk when the scan is clinically indicated.
The total time for a sodium fluoride F-18 PET bone scan is typically 1.5 to 2 hours. This includes the initial registration and preparation (approximately 15 minutes), the intravenous injection of the tracer (a few minutes), a waiting period of 30–60 minutes to allow bone uptake (during which you can sit comfortably and should drink water), and the actual PET/CT scan itself which takes approximately 20–30 minutes. During the scan, you will lie still on the scanner bed while the camera rotates around you to capture images. The entire procedure is painless apart from the needle prick for the injection.
After receiving sodium fluoride F-18, you will emit a small amount of radiation for several hours as the fluorine-18 decays. However, the dose rate at normal social distances (more than 1 meter) is very low and decreases rapidly. As a precaution, it is recommended to limit prolonged close contact (less than 1 meter for extended periods) with pregnant women and young children for approximately 12 hours after the injection. Normal social interactions, including brief contact, do not pose a significant radiation risk to others. Drinking plenty of water and urinating frequently after the scan will help eliminate the tracer faster.
Sodium fluoride F-18 PET/CT is generally considered superior to traditional technetium-99m MDP bone scintigraphy (conventional bone scan) in several key aspects. It offers higher sensitivity (detecting more true bone lesions), higher specificity (fewer false positives), better spatial resolution (4–5 mm vs. 10–15 mm), and faster scanning. The combined PET/CT format also provides co-registered anatomical CT images, allowing precise lesion localization. However, 18F-NaF PET requires access to a PET/CT scanner and a cyclotron for producing fluorine-18, which makes it more expensive and less widely available than conventional bone scans. Your nuclear medicine physician will recommend the most appropriate imaging technique for your clinical situation.
Preparation for a sodium fluoride F-18 PET bone scan is straightforward. Unlike some other PET scans (such as FDG-PET for cancer), you do not need to fast before the procedure. You should drink plenty of water in the hours before the scan to ensure good hydration, which helps with tracer clearance. You may take your regular medications as usual unless your nuclear medicine physician advises otherwise. Wear comfortable clothing without metallic accessories (zippers, buttons, jewelry) in the area being scanned, as metal can create artifacts on CT images. Inform the nuclear medicine department in advance if you are pregnant, breastfeeding, or have significant kidney problems.
References
- Segall G, Delbeke D, Stabin MG, et al. SNM Practice Guideline for Sodium 18F-Fluoride PET/CT Bone Scans 1.0. Journal of Nuclear Medicine. 2010;51(11):1813-1820. doi:10.2967/jnumed.110.082263
- Beheshti M, Mottaghy FM, Paycha F, et al. 18F-NaF PET/CT: EANM procedure guidelines for bone imaging. European Journal of Nuclear Medicine and Molecular Imaging. 2015;42(11):1767-1777. doi:10.1007/s00259-015-3138-y
- Czernin J, Satyamurthy N, Schiepers C. Molecular mechanisms of bone 18F-NaF deposition. Journal of Nuclear Medicine. 2010;51(12):1826-1829. doi:10.2967/jnumed.110.077933
- Shen CT, Qiu ZL, Han TT, Luo QY. Performance of 18F-fluoride PET or PET/CT for the detection of bone metastases: a meta-analysis. Clinical Nuclear Medicine. 2015;40(2):103-110. doi:10.1097/RLU.0000000000000592
- International Commission on Radiological Protection (ICRP). Radiation dose to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances. ICRP Publication 128. 2015.
- European Medicines Agency (EMA). Summary of Product Characteristics: Sodium fluoride (18F) injection. Accessed January 2026.
- Grant FD, Fahey FH, Packard AB, Davis RT, Alavi A, Treves ST. Skeletal PET with 18F-fluoride: applying new technology to an old tracer. Journal of Nuclear Medicine. 2008;49(1):68-78. doi:10.2967/jnumed.106.037200
- World Health Organization. WHO technical report on radiopharmaceutical products. WHO Technical Report Series. 2018.
- Lassmann M, Treves ST. Paediatric radiopharmaceutical administration: harmonization of the 2007 EANM paediatric dosage card (version 01.01.08) and the 2010 North American consensus guidelines. European Journal of Nuclear Medicine and Molecular Imaging. 2014;41(5):1036-1041. doi:10.1007/s00259-014-2731-0
- Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. Journal of Nuclear Medicine. 2006;47(2):287-297.
Editorial Team
This article has been written and reviewed by the iMedic medical editorial team according to our strict editorial standards. Our team consists of licensed physicians, radiopharmacists, and medical physicists with expertise in nuclear medicine, diagnostic radiology, and radiation safety.
Content developed by iMedic’s medical writing team based on current international guidelines (EANM, SNMMI, ICRP, EMA, WHO) and peer-reviewed nuclear medicine research.
Independently reviewed and fact-checked by the iMedic Medical Review Board, comprising board-certified specialists in nuclear medicine, radiology, and clinical pharmacology.
All medical claims are supported by Level 1A evidence (systematic reviews, meta-analyses, and randomized controlled trials) following the GRADE evidence framework.
iMedic receives no commercial funding from pharmaceutical companies or radiopharmaceutical manufacturers. All content is editorially independent with no conflicts of interest.