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CA19-9 for many of us is a pretty good indicator to follow. For some of us, it does not go up/down with our cancer, and then we must rely upon scans alone. CA19-9 in combination with scans is very useful.
CT is really best for your brother. It is fast, comfortable, relatively less expensive than other imaging used and shows excellent pictures. The tiny risk to your brother from the xrays is FAR outweighed by the utility and benefit from the test. As long as your brother has normal, working kidneys, the risk of the dye is almost nothing. He should hydrate (drink) well before and after the scans, for extra protection.
PET scans have more radiation than a typical CT scans and would still use a dye. MRIs are sometimes used in unusual situations or if you are severely allergic to CT contrast dye, but they are much more expensive, less comfortable to perform and would still involve using a dye.
With everything in life, you weigh the benefits and risks. But you have to realize.... your brother has Stage 4 cancer. This is as rough as it gets. The last thing you need to be worrying about is the tiny tiny additional risk to him from getting CT scans.
Thank you for trying to help your brother. Good luck to you.
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