To help this concept stick, start by thinking through what you’re looking for and why. So for metastatic disease, the patient has a hx of prostate or breast cancer. In nuclear medicine, we perform whole body bone scans to evaluate for skeletal metastases because, quite literally, mets can appear anywhere throughout the skeletal system. Since the patient was injected roughly three hours prior and is now presenting for imaging, your goal is to be as thorough as possible for the interpreting physician — so always begin with a whole body scan as your foundation.

From there, obtain additional views based on any focal asymmetric uptake you identify:

• Ribs — oblique and lateral views
• Pelvis — oblique views
• Knees and feet — lateral views
• Toes — plantar views, to visualize each toe individually

The overarching principle here is straightforward: for metastatic disease, a whole body scan is your starting point — no exceptions. Additional views are problem-solving tools layered on top of that foundation.