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Comparison of the gamma camera bone scan and radiological survey in 190 patients with breast cancer has confirmed the superiority of the bone scan in the positive diagnosis of skeletal metastases. In 47 patients with known (X-ray positive) bony metastases the scan was positive in all but 2, and in 24 (50 per cent) the scan showed more lesions than the X-ray had indicated. In 60 patients with a clinical suspicion of bone metastases but negative X-rays, the scan was positive in 29 (48 per cent). Eighty-three patients with primary breast cancer were studied at the time of initial presentation. All had a normal radiographic skeletal survey but 24 (27 per cent) had scan evidence of occult metastases. It is concluded that a bone scan is indicated in all patients with breast cancer where skeletal metastases are suspected.Repeated bone scans may introduce new therapeutic possibilities, by providing an earlier objective index of progression of metastatic disease and also by providing a quantitative method of assessing the response to therapy.

None of the established bone-scanning compounds 85Sr, 87Srmnor 18F is entirely satisfactory and because of this the place of skeletal scanning is not clearly defined. 18F is the most effective of the available bone-scanning compounds but its 100 minute half-life makes distribution difficult and restricts its use in Britain to the Greater London Area.There has recently been considerable interest in certain compounds of phosphate which show great promise as bone scanning agents (Subramanian et al., 1972; Yano et al., 1973; Hosain, 1973; Citrin et al., 1974). The phosphate compounds polyphosphate, pyrophosphate and ethane hydroxy diphosphonate, are readily labelled with 99Tcmin the presence of the reducing agent stannous chloride. 99Tcmis one of the standard isotopes used in nuclear medicine. Its physical characteristics are ideal and it is produced from a simple generator on site. If Tc-labelled phosphates are shown to be effective and safe then bone scanning will be routinely available in hospitals with even the most limited isotope facilities.It is clearly important to know which of the currently available phosphate compounds, polyphosphate, pyrophosphate and ethane hydroxy diphosphonate (EHDP)*is the most effective agent. We have compared these three agents in 29 patients with known malignant disease of the skeleton to compare their relative efficiency in demonstrating bony metastases.We have also measured serial blood and whole-body levels in a number of normal subjects to establish which compound gives lowest blood activity and lowest whole-body radiation dose.

Thirty-eight patients with ankylosing spondylitis, with a wide range of disease severity and duration were studied for evidence of parenchymal lung disease. Significant restriction of ventilatory excursion and reduction of lung volume was confirmed. The transfer factor was normal. In no case was there radiological or functional evidence of pulmonary fibrosis, even in those with extensive long standing spinal disease.