Occipital exostosis resulting from excessive screen time

3047 Objectives: We are in a new age where kids have a vast array of electronics at their fingertips including smartphones, tablets, video games and the internet. Video games are increasing in usage and can be considered a major contributor to the "gaming disorder", which is acknowledged by the International Classification of Disease 11 (ICD 11) as gaming behavior that weakens one’s control over gaming and intensifies priority to gaming over other activities. We are now seeing the effects of this increased screen time. While it can provide endless hours of entertainment and education, harmful effects can also be seen. Children use these devices with their head tilted down and poor posture resulting in increased stress on the skull from attached structures and develop an exostosis at the external occipital protuberance (EOP). This is more commonly known as a bone spur, or excess bone formation on the surface of another bone. It will be painless until growth progresses leading to friction. There is no treatment for this benign growth. If discomfort remains or increases, then the bone may be shaved down to prevent chronic pain. The purpose of this study is to understand the mechanism of exostosis at the EOP and potential impact on bone scan. Methods: A literature review was conducted for the mechanism of exostosis at the EOP. In addition, pediatric patients who underwent a whole-body bone scan and between 10-19 years old were included in the study for a total of 43 unique patients. Bone scans were reviewed by a board certified Nuclear Medicine physician to assess for a focus of uptake midline in the occipital skull. Additional imaging was also reviewed for confirmation or to show progression. The most prominent case was then chosen for further investigation. The parents of the patient were contacted and gave input on the child9s lifestyle, posture, and electronic usage. Results: The EOP is a midline bony prominence in the occipital bone that ligamentum nuchae and trapezius muscle attach to its tip. The ligamentum nuchae Extends from the EOP on the skull and median nuchal line, to the spinous process of C7 (Figure 1) . Its function is to limit flexion and to provide an attachment for Trapezius and Splenius capitis. The use of electronics leading to an extended period of neck hyperflexion resulting in a gradual chronic irritation which leads to exostosis at the EOP which would result in a focus of increased MDP uptake in bone scanning that may mimic skull metastases. The parents of the pediatric case with the most prominent uptake at the EOP were contacted and confirmed slouching while staring at electronic devices which occurs for several hours a day for 3 years (Figure 2). Conclusions: The rapidly advancing technology means today’s parents are dealing with the first generation dealing with increased screen time. As new research is coming out showing the harmful effects of increased screen time, we are struggling to impose healthy limits. Our case study shows that chromic use of electronics may result into exostosis and higher MDP uptake at the EOP. We continue to analyze data regarding the frequency of encountering this uptake in our pediatric population. When present, such uptake may be a source of false positive interpretation. It is particularly important clinicians are aware of this entity when reading bone scans to distinguish it from metastasis.