Bone scintigraphy is usually obtained as a whole-body scan producing 2 images: an anterior view and a posterior view. Sometimes abnormal findings in the spine are difficult to distinguish on whole-body bone scans. SPECT/CT may be performed to localize and interpret a lesion correctly and to help differentiate between benign and metastatic lesions. The assessment of whether SPECT/CT is needed is usually made by a physician. The aim of this study was to evaluate our new routine for nuclear medicine technologists to determine when to add SPECT/CT to whole-body bone scintigraphy. Methods: A 3-part educational course was developed for the nuclear medicine technologists. The first part was to learn criteria for when SPECT/CT should be added to a whole-body bone scan. The second part was to review a selection of training whole-body bone scans illustrating the criteria. The third part was to pass a test of whether whole-body bone scans should be supplemented by SPECT/CT. Results: The nuclear medicine technologists and the physicians agreed that SPECT/CT was required in 63 cases and not required in 27 cases. The resulting percentage agreement was 90%, and the k value was 0.77. There was disagreement in 10 cases. In 6 of these cases only the nuclear medicine technologists wanted to add SPECT/CT, and in 4 of these cases only the physicians wanted to add SPECT/CT. Conclusion: After participating in the training course developed in this project, the nuclear medicine technologists were able to decide whether a SPECT/CT study is needed. An implication of this result is that the effectiveness of the nuclear medicine department should be improved after our new routine is implemented. The successful outcome of this project may stimulate departments to take on similar quality-improvement projects in the future. Bone scintigraphy, one of the most frequently performed nuclear medicine procedures in most nuclear medicine departments, has been shown to be sensitive in identifying skeletal metastatic lesions (1-3). The main indication for bone scintigraphy is to detect bone metastases as early as possible and to evaluate problems with malignant bone involvement such as pathologic fractures or degenerative changes (4,5). The most common localization site of malignant tumors is the skeleton, followed by the lungs and the liver (6). Love et al. demonstrated that about 75% of patients with skeletal pain show abnormal uptake on bone scintigraphy and that 25%-45% of asymptomatic patients with malignancy have bone metastasis findings (7).Bone scintigraphy is usually obtained as a whole-body scan producing 2 images: an anterior view and a posterior view. Abnormal lesions in the bone scans appear as areas of either increased or decreased intensity. These findings are, however, nonspecific and may have causes other than tumors, such as fractures and degenerative disease. Sometimes, abnormal findings in the spine are difficult to distinguish on whole-body bone scans. SPECT/CT may be performed to localize and interpret a lesion correctly and to he...