Bone Survey

J. Taylor Whaley, MD
Last Modified: October 16, 2014

What is a bone survey?

  • A bone survey, also known as a skeletal survey, is a series of X-rays performed to evaluate the major bones of the body.
  • The most basic form of radiology test that assesses the health of bones is the X-Ray. A bone survey includes X-rays of the skull, the ribs, spine, pelvis, and long bones (humerus and femur, the largest bones in arm and leg, respectively).
  • A bone survey can be used to evaluate the involvement of bones with multiple myeloma. Without talking to the patient and knowing their medical history, the results of a bone survey can be very difficult to interpret. Previous bone injuries can be seen and do not necessarily look different than a myeloma lesion on the x-ray.

What is purpose of this test?

  • A bone survey should not be confused with a bone scan, which evaluates the functional metabolism of bones, or a bone density scan, which is used to detect osteoporosis.
  • Bone surveys have 2 major purposes:
    • A bone survey is good at detecting multiple myeloma bone lesions, which may not be detected by other radiology tests. Multiple myeloma causes bone destruction that creates "lytic lesions", which look like holes in bones on x-rays. A bone survey is done during initial work up and may be repeated to determine if the disease has responded to treatment or if recurrence of myeloma is suspected.
    • The second common use of skeletal survey occurs in the case of suspected child abuse. This is valuable as it can show fractures throughout the body.

How is this test performed?

  • The test involves lying still for only a few minutes so the X-rays can be captured in the proper orientation.
  • A radiologist, who is a doctor trained in interpretation of x-rays and other images, evaluates the X-rays and generates a report.
  • During the exam, the radiology technician must leave the room to avoid radiation exposure. They will be in an adjoining room, from where they can see and hear you. It should be noted that the amount of radiation received by the patient is small and generally insignificant.
  • If you are pregnant, however, you should notify your doctor prior to the procedure.

How do I prepare for a bone survey?

  • A bone survey requires no preparation.

How do I interpret the results of a bone survey report?

  • The report that the radiologist writes after a bone survey generally states the patient's name, date of birth, and indication (reason for the bone survey) at the top of the report. Radiology reports follow a standard outline, regardless where they are obtained. Radiologists report both normal and abnormal findings in a very systematic approach. For this reason, it is very important to discuss the results with your doctor.
    • The first paragraph typically includes the specific technical information involved in obtaining the scan (i.e. what areas of the body were included, from what angle, etc).
    • The middle paragraphs generally begin the description of findings, both normal and abnormal. Because reports are generated for other medical professionals, the terminology is often medically oriented and can be difficult to interpret.
    • Following the detailed interpretation above, an impression generally follows. This is a summary of the findings, often generated to answer the question posed by the ordering physician.
    • The radiologist may compare these findings to any previous bone surveys, if the images are accessible.
  • It is important to note that there are limitations to a bone survey. Some patients diagnosed with multiple myeloma via blood tests or bone marrow evaluation will not have any lesions visible on a bone survey; however, PET scans, MRI's, and CT scans are also useful in evaluating the bones. These scans are generally reserved to evaluate painful lesions that cannot be seen on a bone survey.
  • If spinal cord compression is suspected, X-rays are not sensitive enough to visualize the spinal cord, and a CT or MRI will need to be performed.

Myeloma Skull
Skull image from a skeletal survey in a patient with myeloma.
Note the "lytic lesions" that look like holes in the bone.