The role of conventional radiography and scintigraphy in the third millennium

Imaging represents a cornerstone for diagnosing and monitoring rheumatic diseases. In the last few years, with the availability of highly effective therapies, demand for the technical performance of imaging has increased exponentially, leading to rapid development of new technologies such as magnetic resonance imaging (MRI) and ultrasound (US). In both clinical practice and clinical trials, there is a need for tools that are sensitive to change and to therapy response, which are able to depict inflammatory changes early, before irreversible joint damage has occurred. Despite these advances, conventional radiography (CR) and bone scintigraphy (BS), the two oldest imaging tests, continue to provide enormous diagnostic and prognostic help for the study of many musculoskeletal disorders. Furthermore, CR is an inexpensive, widely available and reproducible tool for evaluating and monitoring structural damage. This chapter focuses on the roles of CR and BS in rheumatological clinical practice, taking into account their performance in comparison with the newer imaging techniques.