Introduction: Fatigue fractures are secondary to excessive, unusual, repeated mechanical stress, occurring on healthy bone. Bone scintigraphy (BS) with 99mTc-HMDP is an excellent means of diagnosis. We report a case of stress fracture of the calcaneus with scintigraphic diagnosis, in a marathon runner. Patient and Methods: He is a 40-year-old athlete in overtraining with right calcaneal pain on running, intense at first, moderate in the middle and then persistent after exercise. The interrogation found no trauma to the right foot and the x-ray of the foot was without abnormality. The so 3 phases were performed following an injection of 564 MBq of 99mTc-HMDP, with a SPECT gamma camera. Results: Bone scintigraphy found in the early phase, hyper-perfusion and hyper-fixation of the right calcaneal region compared to its left counterpart and in the bone phase persistence of focal hyperfixation opposite the right calcaneus. This scintigraphic aspect of the right calcaneus in an overtrained marathon runner, in a painful context and in front of a normal X-ray, made us evoke a fracture of fatigue. A complementary CT scan performed two days after the BS was without abnormality. Conclusion: Fatigue fractures are micro-fractures generally not noticed on radiography and CT. BS due to its high sensitivity is an excellent or the best tool for the early diagnosis of stress fractures.

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The aim of this study was to evaluate the dose delivered to patients during scannographic examinations at the Kaolack Regional Hospital (one of the 14 regions of Senegal located in the center-west of the country, 192 km from Dakar) and to compare these irradiation doses at diagnostic reference levels found in the literature in order to optimize our scanning protocols. To achieve this goal, we carried out a prospective study involving 218 CT scans. These examinations focused on cerebral, thoracic, abdominopelvic and lumbar spine acquisitions made in adults and cerebral only in children. We compared the median values of dosimetric indicators (CTDIvol and DLP) per acquisition with NRDs in the literature. During the course of this study, we found a dosimetric ratio lower than that of the NRDs for thoracic, abdomino-pelvic and lumbar spine CT scans in adults and a significant dosimetric exceedance for brain scans in adults and in children. These results encourage us to extend these dosimetric evaluations to other hospital structures in order to establish rigorous monitoring of dosimetric indicators and to respect the principles of radiation protection and good practice.

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