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Mar 29, 2021

Watch and Read: The Specialist Interview – Dr Karsten Ridder, Breast Radiologist, on Photon Counting in the Clinic

- By Jacqueline Wheeler

Dr Karsten Ridder is a leading radiologist and breast cancer specialist at MVZ Professor Dr Uhlenbrock and Partner, Dortmund, Germany.  

In April 2020, Dr Ridder introduced a new type of breast CT scanner into his practice that is based on a Direct Conversion photon counting X-ray detector – the AB-CT nu:view.    

Women attending Dr Ridder’s clinics were soon sharing their positive experiences with friends. For the first time ever, they felt comfortable and relaxed during a breast scan. But more crucially, the images that the photon counting detector captured were incredibly detailed.  

News of this innovative breast CT technology has spread, word of mouth, far beyond Dortmund and Dr Ridder now sees women from all over Europe. 

Here, Dr Ridder tells York Haemisch, Director of Sales for Medical and Research markets, why Direct Conversion technology is transforming his work. 

York Haemisch: Tell us about your work at the Uhlenbrock Centre. 

Dr Karsten Ridder: We have practices in twelve locations in the Dortmund area and offer a wide range of imaging services, including radiotherapy, and nuclear medicine. We also keep pace with the latest technologies. We were the first to look at tomosynthesis and 3D scanners. The advantage to the patients is that they can undergo a scan in a more relaxed environment than a large hospital.   

YH: What drove your decision to acquire the AB-CT nu:view system? 

KR: We already had a range of excellent diagnostic machines and modalities in our clinics, including mammography and all its further developments, such as tomosynthesis and contrast enhanced mammography, MRI, stereotactic and ultrasound. However, what was missing was a method which could help us evaluate masses, or microcalcifications, or offer contrast enhancement in the morphology of the breast without compromising the patient, and without compressing the breasts. So, we brought the AB-CT nu:view into the clinic and about 30% of my patients have now told us that they prefer to use this system because examination times are short and the image quality is excellent. 

YH: Breast screening is very challenging for some women. Why does this system make such a difference? 

KR: In the Netherlands and Germany, I would say at least 20% of women, maybe more, avoid having an examination because of breast compression. Also, there are patients who won’t go into an MRI because they have claustrophobia, or they’ve had a pacemaker fitted. Then there are patients with silicone implants, and if these implants are older, you have to be very careful about compressing them. That’s about 200,000 women in this area. These are the patients for whom the nu:view system offers distinct advantages. 

YH: You have already mentioned that examination time matters to your patients. Can you tell us more about their experience? 

KR: The whole process, for both breasts, takes only five minutes. For example, one scan takes about 12 seconds. It’s very fast, robust and rapid and the image quality is extremely good. These are the factors that will make it a big success in the future 

YH: What has been the reaction of your fellow radiologists to the system? 

KR: Initially, some of my colleagues called me and asked me why I had bought this machine because I already had all the latest equipment.  

My answer is that this system is the first modality to have a very high spatial resolution, about 0.15 millimeters in 3D spatial resolution, as well as offering contrast enhancement. This makes microcalcifications visible that are completely lost in MRI. That’s very impressive.  

But what is most impressive is the response of the patients. 

YH: So, although many of the women who come to your clinic won’t know about photon counting X-ray imaging, they have noticed the difference? 

KR: Yes, our patients tell their friends about their experiences, and now people are driving 400 or 700 kilometers to get this examination done. I even had a patient who came from Majorca last week. Our referrals are increasing because we are the first clinic in the world to install this system for clinical use rather than a study.  

At least 10 or 15 patients whom I saw 12 years ago contacted me and said they had become aware of the new system and wanted to have an examination using the technology. They were even willing to pay for it themselves because their insurers probably wouldn’t pay for it, but they felt it was worth it. 99% of the patients we have examined say it’s absolutely astonishing how quick and comfortable it is.  

YH: Photon counting X-ray imaging is a low dose procedure. Are your patients relieved about this? 

KR: They can’t believe it when I tell them it’s the same or even less dosage than normal mammography. There are some patients who are very concerned about the dosage and I can reassure them that, OK this is kind of technical miracle, but it works. I’ll show them the images that I can get and when they see an X-ray of their own breasts in 3D, with a very high resolution, they’re really amazed at the image quality.  

YH: Finally, as a pioneer of this system in the clinic, what is your view on its reliability? 

KR: It’s complex technology but I can give very positive feedback. This machine was only out of action once in the last 10 months. However, this is because we had a serious problem with the installation, not with the machine itself. And it proves its reliability every day. You can examine at least 20 patients a day. It’s very robust. 

YH: Thank you so much for sharing your experiences with us Dr Ridder. We very much look forward to hearing more of your insights and feedback in the future.