If I am not mistaken, exposure to radiation causes genetic mutation. Isn't that also the cause of multiple myeloma? Aren't these aberrant plasma cells mutations of normal cells?
They offered to take bone marrow stem cells from the workers at Fukushima to be saved for when they might develop blood cancers like leukemia and multiple myeloma.
I've been lit up 5 times so far this year for CT scans. My multiple myeloma specialist says this is too much and came to my rescue when they wanted to do another CT followed by a PET. My PCP actually apologized to me because my last CT and last chest Xray didn't show anything different so were not helpful.
As far as hard/soft goes, we begged for an MRI instead of a CT because this was a lung issue. We were told an MRI would not show what they were looking for.
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Re: Skeletal survey - what's the value?
This very interesting 2014 thread came to our attention as we were questioning my nephew's doctor's request for him to undergo a skeletal survey (including hands and feet) a couple of weeks after an MRI and PET-CT both suggest relapse and new areas of bone lesions.
While insurance is covering all the tests in his case, is this not simply overexposure? Can the xray pick up things the PET-CT and MRI missed?
We have been told that the x-ray is to determine if my nephew needs Zometa (which he had been on in the past until he achieved VGPR). My understanding of the recommendation on using bisphosphonates in myeloma treatment suggests that it should be restarted if there are any indications of a relapse. Is a skeletal xray really needed to determine a need for Zometa if a PET-CT suggests there is? What's the value of x-rays after PET-CT?
Thank you.
While insurance is covering all the tests in his case, is this not simply overexposure? Can the xray pick up things the PET-CT and MRI missed?
We have been told that the x-ray is to determine if my nephew needs Zometa (which he had been on in the past until he achieved VGPR). My understanding of the recommendation on using bisphosphonates in myeloma treatment suggests that it should be restarted if there are any indications of a relapse. Is a skeletal xray really needed to determine a need for Zometa if a PET-CT suggests there is? What's the value of x-rays after PET-CT?
Thank you.
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HopeNFaith - Name: Faith
- Who do you know with myeloma?: Nephew
- When were you/they diagnosed?: 2015
- Age at diagnosis: 51
Re: Skeletal survey - what's the value?
Hi Faith,
To my knowledge, when it comes to myeloma, a skeletal survey cannot pick up anything that an MRI or PET/CT can't. In general, whole-body MRIs and PET/CTs are superior to skeletal surveys when it comes to myeloma. See this article for a great explanation on the tradeoffs of the various imaging modalities:
https://myelomabeacon.org/forum/pet-scans-for-multiple-myeloma-t3687.html
If your nephew is being considered for Zometa, I would instead think that the doctor would order a DEXA scan to complement an earlier MRI or PET/CT. The DEXA scan can provide a set of figures related to your nephew's bone density (which xrays, PET/CT and MRIs simply cannot provide). Those density figures can then be used as a benchmark to see how his bone density changes over time and responds to the Zometa. DEXA scans only take about 15 minutes to do, are cheap and use very low dose radiation.
It just doesn't make sense to me to go back and get a skeletal survey if he already recently had both an MRI and a PET/CT.
To my knowledge, when it comes to myeloma, a skeletal survey cannot pick up anything that an MRI or PET/CT can't. In general, whole-body MRIs and PET/CTs are superior to skeletal surveys when it comes to myeloma. See this article for a great explanation on the tradeoffs of the various imaging modalities:
https://myelomabeacon.org/forum/pet-scans-for-multiple-myeloma-t3687.html
If your nephew is being considered for Zometa, I would instead think that the doctor would order a DEXA scan to complement an earlier MRI or PET/CT. The DEXA scan can provide a set of figures related to your nephew's bone density (which xrays, PET/CT and MRIs simply cannot provide). Those density figures can then be used as a benchmark to see how his bone density changes over time and responds to the Zometa. DEXA scans only take about 15 minutes to do, are cheap and use very low dose radiation.
It just doesn't make sense to me to go back and get a skeletal survey if he already recently had both an MRI and a PET/CT.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Skeletal survey - what's the value?
Thanks Multibilly. Your knowledge and perspectives are always so helpful!
I too don't see how one goes from a PET-CT and MRI to a skeletal X-ray to look for more detailed information. Maybe there's some value we are both missing. With respect to the bone density testing, the doctor has requested that too. This seems to be quite an overkill.
I too don't see how one goes from a PET-CT and MRI to a skeletal X-ray to look for more detailed information. Maybe there's some value we are both missing. With respect to the bone density testing, the doctor has requested that too. This seems to be quite an overkill.
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HopeNFaith - Name: Faith
- Who do you know with myeloma?: Nephew
- When were you/they diagnosed?: 2015
- Age at diagnosis: 51
Re: Skeletal survey - what's the value?
Full skeletal survey is relatively cheap, so, in my experience, doctors try to order that first.
Mine was done initially, after bone marrow biopsy multiple myeloma diagnosis, and showed one lesion on the skull that would justify treatment. However, that lesion was not later confirmed by CT scan of skull done by second opinion doctor.
Year later, after doctor change, it was ordered again, and in this case it was a prerequisite to get full body PET / MRI approved by insurance. At least, that was how it was explained to me when I asked the question "why", as PET/MRI was the plan.
I do think that it is a very rudimentary test, so MRI, PET/MRI, PET/CT and even just CT scan are more precise, yet full body x-ray is cheap and still is the standard order for multiple myeloma diagnosis,
Mine was done initially, after bone marrow biopsy multiple myeloma diagnosis, and showed one lesion on the skull that would justify treatment. However, that lesion was not later confirmed by CT scan of skull done by second opinion doctor.
Year later, after doctor change, it was ordered again, and in this case it was a prerequisite to get full body PET / MRI approved by insurance. At least, that was how it was explained to me when I asked the question "why", as PET/MRI was the plan.
I do think that it is a very rudimentary test, so MRI, PET/MRI, PET/CT and even just CT scan are more precise, yet full body x-ray is cheap and still is the standard order for multiple myeloma diagnosis,
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Dimamar - When were you/they diagnosed?: June, 2016
- Age at diagnosis: 54
Re: Skeletal survey - what's the value?
An interesting article published in the Beacon in 2014 reviews the different methods of scanning for smoldering and active myeloma patients:
"Researchers Review Current Diagnostic Imaging Techniques For Multiple Myeloma," The Myeloma Beacon, May 2, 2014
Skeletal X-ray surveys are still routinely used (I have had 8-9 of them, since they are done annually), but it seems that the other scans can be more thorough in what can be seen in the bones and in the bone marrow.
I don't know what amount of radioactive dye is used in PET scans though, and if it would be dangerous if the scan is done repeatedly.
"Researchers Review Current Diagnostic Imaging Techniques For Multiple Myeloma," The Myeloma Beacon, May 2, 2014
Skeletal X-ray surveys are still routinely used (I have had 8-9 of them, since they are done annually), but it seems that the other scans can be more thorough in what can be seen in the bones and in the bone marrow.
I don't know what amount of radioactive dye is used in PET scans though, and if it would be dangerous if the scan is done repeatedly.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
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