How and when should CT scans be used? What do they show?

[Music] how and when should CT scans be used and what did they show there for CT I am already promoting CT I am not paid by an ECG vendor whatsoever this is just my personal opinion and the experience I have developed over the years CT as I mentioned the the x-ray machine going around your body looking from every angle so you have kind of 3d information about your skeleton advantage it is definitely superior and we have done an analysis worldwide we collected patients it was not too many but we had like we started with 200 and something patients all over the world where a CT and an x-ray was done at the same time point and we compared it and we found that in 25% of x-ray negative patients CT was positive so those patients would have been missed if a CT would not have been done so that is very relevant I think 25% more with the CT so we have really a number to prove that CT is better than x-ray we have so-called low-dose protocols and just last week I received an email from our radiology department that they have the software now it's just a change of software you can use every CT scanner at least a bit more modern ones and you can use a so-called low-dose protocol with the lower radiation dose because it II it takes a bit longer to take the images not the whole examination but you have a bit more radiation exposure but you get this much more information and as I mentioned low dose protocols have a lower dose and a regular CT you would do in another cancer patient for myeloma we are made mainly interested in the bones for this and for the phones because they are very dense as you know you don't need a very high dose and that's something that's very relevant so that we can use those low dose protocols as I mentioned several times now 3d information because we look from every angle which is very important especially for the spine because the spine is the part of our skeleton that keeps us upright and as you know if they had a fracture in your spine that is really bad and we get information from every angle so we know where the fracture was not only that the vertebral body is lower but where it is slower and how it behaved and where where our potential or stability lesions that might cause further frictions it's rather convenient because it's a safe light life led on your back go into the machine go out again it's not the long tube as the MRI it's kind of just this ring and you go in and you go out it takes about three year three minutes so that's much more convenient than a conventional x-ray as well it was included in the new definition I had a lot of discussions with colleagues when I was rather early convinced that x-ray that city is better than x-ray but colleagues said yeah but then we will see so much more I said what's that's your argument you don't want to see that much more and in the end most colleagues are really convinced now that see more knowing more about the patient especially about the bones it's really relevant it's what I was surprised that people really asked that question and it came more than once so it is a prognostic significance we know more bone disease on the long run can have an adverse prognostic effect it's not that strong as fish and the other stuff but we found that there can be some information on prognosis it doesn't change treatment same as with to a certain degree with fish it has a bit higher radiation dose as I mentioned it takes a bit more radiation to give that get this VD information so it's about two times the skeletal survey but as you know most of you in the past hopefully not that much today anymore had x-ray every year because the sensitivity is so low you have to do it every year because if you want to see a change that is 30 to 50 percent already you have to do it more often and my experience we had the privilege in Germany that we could use CT for I think we started in 2006 so we had it for over 10 years we found out we don't need a yearly imaging because if the CT is negative or if we see there's stability and there's no progression in the serological markers then there is no high rate of a very very low risk indeed to develop only sees so because of the higher sensitivity we can it can do it less often and then we kind of actually save radiation those it is a bit lower sensitive for the plasma cell infiltration because as I mentioned that is especially for the bone the CT part is very good for the bone marrow the other techniques I will talk about now are more sensitive so we still don't know which one is the best and which is the best combination but we know that for the bone the CT is the best this is how a so-called low dose CT looks like we can really we get this 3d information this is myeloma patient you can see here we kind kind of fly it through the body we get also additional information we see how the lungs are if the heart is bigger or smaller if there's something going on it's not perfect because we use this lower radiation dose that gives us a bit lower sensitivity but you can see here we can very nicely see the bones we see how strong the bones are and depending on the height of the patient we can go pretty far down to get this whole information on the whole skeleton this is the dimension study we compared CT positive skeletal survey negative and we found 25% more sensitivity in the CT part we look where other of stability collisions because that's something that's not it to some degree it is relevant because austenitic lesion even though it's frightening to have an oscillating lesion in the skull it doesn't really matter for you because it does not hurt you it does not grow into the brain which some people are concerned and i understand this concern but it's not really happening so about 10% of patients had escalations the most of the patients have deletions in the spine and the pelvis where it's very relevant because it's causing instability in the worst case so this is very relevant the theory behind that is that because in the spine and in the Peris we as adults have most of our blood forming bone marrow and this is a very very nice environment not only for blood forming cells but also for our myeloma cells so they get all the nutrition they need to get it's highly perfused we have a lot of blood vessels there and so the the nutrition comes there the oxygen comes there so the brass my cells love it and that's that's one theory why most of the oscillate equations are actually in the spine and the pelvis and this is something as you can see here with my very limited more than limited artists artists skills that the spine and the pelvis are the most important ones and if your doctor says okay I'm sorry kind of do a whole body imaging I can do a spine in the pelvis this is already very good because it covers most of the oscillating lesions also the most clinically relevant ones so the CT is our new in the new guidelines for multiple myeloma imaging we decided to recommend CT so called whole body low-dose CT instead of a skeletal survey and it should be used definitely at first diagnosis of a symptomatic patient because it has a very high sensitivity to show the oscillating lesions the holes in the bones and we we recommend also to repeat it after the treatment for example after stem cell transplant to have a baseline when the disease comes back if there is a progression also in the bones so those are the major time points in the early stages there was a lot of discussion at the moment we recommend to do it as a screening in smoldering myeloma patients at least once to see if there's anything happening the bone which then will cost the patient to be a symptomatic patient and should be treated in MDS patients it's difficult because there's kind of the high risk Emma's patient that is very close to smoldering myeloma they we also recommend it in low-risk and Gus it's not really necessary because the lowest and best patients have only a very low risk to progresses then the term would suggest and there we don't want to expose the patients to the radiation if it's not necessary [Music]