Lymph nodes and bone are the most common sites of metastatic spread. Body scans are necessary to determine the extent of the cancer. CT scans and bone scans are used to detect lymph node and bone metastases respectively. Positron emission tomography (PET) scans provide additional information because they can detect metastases as small as 5-6 mm.

Standard bone scans use a radiotracer called Technetium-99, which is unfortunately not as accurate as PET technology. A PET scan called NaF-18 (radioactive sodium fluoride) provides superior specificity and sensitivity when compared with Technetium-99. NaF-18 PET imaging used in combination with C-11 Acetate, Axumin, or Gallium-68 PSMA PET imaging offers the most comprehensive method currently available for detecting cancer metastases.


Fabio Almeida, MD graduated top of his class and with honors from The Chicago Medical School. He completed a residency and fellowship in nuclear medicine at the University of San Francisco, and is certified by the American Board of Nuclear Medicine and the Certification Board of Nuclear Cardiology. He was in academic practice at the University of California, San Francisco, and private practice until 2005. Dr. Almeida is one of the pioneers in the development and implementation of cross modality fusion for cancer imaging (SPECT, PET, CT and MRI) and PET/CT. He also worked for the Centers for Disease Control after 9/11 for several years as a physician and informatics specialist consultant.