I added 49thParallel's to mine to show a full example. In this one, if it's from any fusker site, deny it any return hotlink.gif. Otherwise, just drop the request.
RewriteEngine On
RewriteCond {HTTP_REFERER} .*.fusker* [NC]
RewriteRule .*\.(gif|jpg|jpeg|bmp)$
http://www.yourdomain.com/images/hotlink.gif [R,NC]
RewriteCond {HTTP_REFERER} !^$
RewriteCond {HTTP_REFERER} !^
http://(www\.)?18pluspics.com(/)?.*$ [NC]
RewriteCond {HTTP_REFERER} !^
http://216.130.168.161(/)?.*$ [NC]
RewriteRule .*\.(gif|jpg|jpeg|bmp)$ - [F,NC]
The Options part in his post is dependent on the server config. It will NOT hurt anything to have it there. You just may not need it.