[Intl_DxMedPhys] [EXTERNAL] Re: New JAMA IM article on CT radiation dose and future cancers

Tue Apr 15 17:47:19 EDT 2025

Nima,

    Dr. Rebeccs Smith-Bindman is a power to be reckoned with.  She is a
very impressive person with a great deal of influence at UCSF as well as
within the HHS.  She is a prolific grantsman with over 134 peer-reviewed
papers.  Go to this UCSF site for more detail on her position and work:
https://urldefense.com/v3/__https://cancer.ucsf.edu/people/smith-bindman.rebecca__;!!KGKeukY!ytVHnFXwh22ca4utaKvv_GHtIPB8KERiTOykmfmORhbNvS3xFymqS1o5FJLVkAhHXqmee8XBF0k45K8i8z8OCQlMHEZlNwHCM1kh-s1VKYdXteI$ . She completed her
Radiology residency at UCSF in 1996 and followed up with a fellowship
in Epidemiology
and Biostatistics at UCSF in 1998.

    In Sep 2023 (7-9) she hosted a virtual conference "Everything you need
to know about CT:  Maximizing Quality and Safety".  I have attached the
meeting agenda.  That meeting was a clear outline of her long-term
objectives to "control / eliminate" CT dose -- the end objective of this
conference seemed to be zero CT dose -- e.g. eliminate CT from the practice
of medicine.  Many of the papers presented were without scientific merit
and were biased toward the work being done by ALARA, Inc.

     The horse may be out of the barn and it may be too late to modify
and/or stop the inertia and political clout she has in this area.  The ACR
and AAPM statements on the JAMA paper will most likely have little to no
impact on the momentum she has generated nor on her company ALARA, Inc or
on the CMS mandate.  It is unfortunate; but this may be a modern day Herman
Mueller (LNT came from his work) when it comes to the long-term impact of
her work.  Unfortunately, the negative impact her work is having on the use
of CT and the public's understanding of its relation to cancer induction
vs. the diagnostic benefit will be substantial.  Unless ACR, AAPM, HPS and
other scientific / medical based organizations can get the ear of HHS
leadership we may be stuck in a down-ward spiral.  To be a bit pessimistic,
I doubt that "good science" will win on this issue.

Jerry

Jerry Thomas, MS, FAAPM, DABR, CHP, DABSNM
Diagnostic Medical Physicist / Radiation Safety Officer
Ascension Via Christi Hospitals Wichita
Wichita, KS  67214

Phone:  316-268-5958  (office)
            240-447-1014  (cell)

On Tue, Apr 15, 2025 at 2:10 PM Nima Kasraie via Intl_dxmedphys_wd_osu_list
<intl_dxmedphys_wd_osu_list at lists.osu.edu> wrote:

> Silly suggestion: If this author is the same author that has been writing
> high-profile radio-phobic articles for +10 yrs now, would it not be a good
> idea maybe to sit down and perhaps open a channel of conversation with
> them? Otherwise from
>
> Silly suggestion: If this author is the same author that has been writing
> high-profile radio-phobic articles for +10 yrs now, would it not be a good
> idea maybe to sit down and perhaps open a channel of conversation with
> them?
>
>
>
> Otherwise from the laymen (non-expert) perspective, this will end up being
> a ‘our word vs. their word’ type of scenario, again. Truth and facts have
> (unfortunately) become subjective nowadays. So who does one choose to
> believe? A renowned Radiologist, or a physicist (that might have an alleged
> interest in trying to “sell” radiation)?
>
>
>
> All I’m saying is, this back and forth has been going on a for a while.
>
>
>
>
>
>
>
> Nima
>
>
>
>
>
>
>
> P.S: “Are you trying to sell Radiation to the public?” is EXACTLY what I
> was told by a PEDIATRIC RADIOLOGY manuscript reviewer a few years ago. (in
> response to a mere benefit-to-risk ratio verbiage I had in my draft).
>
>
>
>
>
>
>
>
>
>
>
> *Nima Kasraie, PhD, MSc, DABR, DABSNM *
>
> Lead Physicist, Children’s Medical Center Dallas
> <https://urldefense.com/v3/__https://www.childrens.com/__;!!KGKeukY!xzJ0kMP0axSIjBblGK0JrWaDtn1cXl9vAjSGQksnuV6J6YSoH2Ru6gGnC19yFEM3iO35rlA0RYHUwl71YYxrO67-unaOAf2XyhPySc4zUq2b9_gk9acN2w$>
>
> Associate Professor, Department of Radiology, UT Southwestern
> <https://urldefense.com/v3/__https://profiles.utsouthwestern.edu/profile/187443/nima-kasraie.html__;!!KGKeukY!xzJ0kMP0axSIjBblGK0JrWaDtn1cXl9vAjSGQksnuV6J6YSoH2Ru6gGnC19yFEM3iO35rlA0RYHUwl71YYxrO67-unaOAf2XyhPySc4zUq2b9_jq9hvz9A$>
>
> Phone: 214-648-7978
>
>
>
> *From:* Intl_dxmedphys_wd_osu_list <
> intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu> *On Behalf Of *Dr M.
> Mahesh via Intl_dxmedphys_wd_osu_list
> *Sent:* Tuesday, April 15, 2025 9:10 AM
> *To:* intl_dxmedphys_wd_osu_list at lists.osu.edu
> *Subject:* Re: [Intl_DxMedPhys] New JAMA IM article on CT radiation dose
> and future cancers
>
>
>
> Please see attached the AAPM Press release regarding the JAMA publication.
> This will be on the AAPM website under Press Release later today. Mahesh Be
> Curious! Please do not feel obligated to respond after normal working
> hours!
> ==========================================================================================
>
> Please see attached the AAPM Press release regarding the JAMA publication.
> This will be on the AAPM website under Press Release later today. Mahesh Be
> Curious! Please do not feel obligated to respond after normal working
> hours!
> ==========================================================================================
>
> Please see attached the AAPM Press release regarding the JAMA publication.
>
>
>
> This will be on the AAPM website under Press Release later today.
>
>
>
> Mahesh
>
>
>
> *Be Curious!*
>
> Please do not feel obligated to respond after normal working hours!
>
> [image: Screenshot 2025-04-15 at 10.09.46 AM.png]
>
>
> ==========================================================================================
>
> *M. Mahesh, MS, PhD, FAAPM, FACR, FACMP, FSCCT, FIOMP.*
>
> *(he/him/his)*
>
> *Professor -* The Russell H. Morgan Department of Radiology and
> Radiological Science
>
> Johns Hopkins University School of Medicine
>
> *Chair* – Radiation Control Committee, Johns Hopkins Health Systems
>
>
>
> *President, American Association of Physicists in Medicine (AAPM*)
>
>
>
> 601 N Caroline Street,
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>
>
> =========================================================================================
>
>
>
> *From: *Intl_dxmedphys_wd_osu_list <
> intl_dxmedphys_wd_osu_list-bounces+mmahesh=jhmi.edu at lists.osu.edu> on
> behalf of Robert Morrison via Intl_dxmedphys_wd_osu_list <
> intl_dxmedphys_wd_osu_list at lists.osu.edu>
> *Date: *Tuesday, April 15, 2025 at 9:25 AM
> *To: *Robert Walker <badgerpet at gmail.com>, Yang, Kai,PhD <
> KYANG11 at mgh.harvard.edu>
> *Cc: *intl_dxmedphys_wd_osu_list at lists.osu.edu <
> intl_dxmedphys_wd_osu_list at lists.osu.edu>
> *Subject: *Re: [Intl_DxMedPhys] New JAMA IM article on CT radiation dose
> and future cancers
>
>
> *      External Email - Use Caution      *
>
>
>
>
>
> The use of sensationalism and fear tactics is nothing new.  We see it
> continually used.  The whole Covid debacle is one case in point.  There is
> a power that we/people get from these types of things. I sent Mark's post
> on to a bunch of people yesterday so that they would be inoculated from
> this type of thing.  I guess we will see how this plays out.
>
>
>
> Rob Morrison
> ------------------------------
>
> *From:* Intl_dxmedphys_wd_osu_list on behalf of Yang, Kai, PhD via
> Intl_dxmedphys_wd_osu_list
> *Sent:* Tuesday, April 15, 2025 08:36
> *To:* Robert Walker
> *Cc:* intl_dxmedphys_wd_osu_list at lists.osu.edu
> *Subject:* Re: [Intl_DxMedPhys] New JAMA IM article on CT radiation dose
> and future cancers
>
>
>
> Unfortunately, I just heard this information as a breaking news from our
> local radio station in my car this morning. Cannot imagine how much more
> fear they are creating for every patients.
>
>
>
> *From:* Intl_dxmedphys_wd_osu_list <
> intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu> *On Behalf Of *Robert
> Walker via Intl_dxmedphys_wd_osu_list
> *Sent:* Monday, April 14, 2025 8:52 PM
> *Cc:* intl_dxmedphys_wd_osu_list at lists.osu.edu
> *Subject:* Re: [Intl_DxMedPhys] New JAMA IM article on CT radiation dose
> and future cancers
>
>
>
> *        External Email - Use Caution        *
>
> Thanks for going on the record Mark. In case you missed it, the lead
> author is also a cofounder of Alara Imaging, the steward of the CT
> radiation dose CMS measure. On Mon, Apr 14, 2025 at 8: 29 AM Mark
> Supanich via Intl_dxmedphys_wd_osu_list
>
> Thanks for going on the record Mark.
>
>
>
> In case you missed it, the lead author is also a cofounder of Alara
> Imaging, the steward of the CT radiation dose CMS measure.
>
>
>
>
>
> On Mon, Apr 14, 2025 at 8:29 AM Mark Supanich via
> Intl_dxmedphys_wd_osu_list <*intl_dxmedphys_wd_osu_list at lists.osu.edu
> <intl_dxmedphys_wd_osu_list at lists.osu.edu>*> wrote:
>
> There's a new article in JAMA internal medicine out predicting a large
> number of future cancers from CT scans. https: //jamanetwork. com/journals/jamainternalmedicine/fullarticle/2832778
> The work is entirely statistical in nature, there is no
>
> There's a new article in JAMA internal medicine out predicting a large
> number of future cancers from CT scans. *https://urldefense.com/v3/__https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2832778__;!!KGKeukY!ytVHnFXwh22ca4utaKvv_GHtIPB8KERiTOykmfmORhbNvS3xFymqS1o5FJLVkAhHXqmee8XBF0k45K8i8z8OCQlMHEZlNwHCM1kh-s1VMJNegNI$ 
> <https://urldefense.com/v3/__https:/secure-web.cisco.com/11c3R7RDCXdOZJAeh-qRdh8RQoy4MIyh-bGKSdYXybKeZeTkvWPCE5cxAVfLiLi0Q2PdKvJolVd8bPwhP3i3nBclYsE_nDLEajdXuRzgjQx9D3NDBU9qufW-DqJI_iU7MvY5L-6euVAPjcz5n6L59StkH6la9egu2M3QYHtegAOfn9_cv9Fr8_h7IalxNPkzALjSfai-BOTNJkjp6oMrcTo7QloFQ01N8iFgsvCHCpxxAhUDOriwE1RmRd4IyhFVjlxA4iKdyZPmqF6OlPh3kifG5QJuaT1X5ECZ8RxP2q4HlbJM6TLcotu4jbem_QNdhKncgqi37ETvCZwngIgqaQw/https*3A*2F*2Furldefense.com*2Fv3*2F__https*3A*2F*2Fjamanetwork.com*2Fjournals*2Fjamainternalmedicine*2Ffullarticle*2F2832778__*3B*21*21KGKeukY*213QiV5I4K5v5DkFeVCQcvqSvpeu1GCW4Xu2kfC-OIisjve02FMcil1jtQ4DKwavLox_91CTk9e1T7WF2R_hfH5GcmWjHVWZJE1htAOpCHDAyPO8c*24__;JSUlJSUlJSUlJSUlJSUlJSU!!KGKeukY!1Reaf_Fky05djN-QBH_RvPNHirWnP17iZGrZc8CdlACOX8map7-euQP6fldftfkSgFYl77xI8nXbDT7PoYly8kxaGJV7khHYGBxQmQCgqgfbcQ$>*
>
>  The work is entirely statistical in nature, there is no cohort study or
> causal link found, just multiplying the presumed very small individual risk
> of each CT scan times the tens of millions scans done each year. Please
> read the article and be prepared to discuss it with colleagues, patients,
> and physicians. A few key points to remember are:
> 1. When ordered for medically indicated reasons the benefits of CT far
> outweigh any future risk
> 2. CT catches cancer earlier, changes and informs diagnosis, and can help
> patients avoid unnecessary surgeries
> 3. Research into radiation risk from low levels of ionizing radiation is
> still a field of research and consensus on what the risk is has not been
> reached
> 4. Many CT scans are performed in the last years of patient's lives and
> those CT scans can't contribute to future cancers (as the latency period
> for most solid cancers is at least 4 years). The authors only excluded
> scans that would have been performed in the last year of life from this
> paper. A more realistic exclusion of 4 or 5 years would significantly
> reduce the number of theoretical cancer inductions they claim.
>
>
>
> If you want to point folks to a reasonably balanced write up - I suggest
> this one from Gizmodo (*https://urldefense.com/v3/__https://gizmodo.com/common-ct-scans-are-major-cancer-risk-study-claims-2000588963__;!!KGKeukY!ytVHnFXwh22ca4utaKvv_GHtIPB8KERiTOykmfmORhbNvS3xFymqS1o5FJLVkAhHXqmee8XBF0k45K8i8z8OCQlMHEZlNwHCM1kh-s1VJK3VASM$ 
> <https://urldefense.com/v3/__https:/secure-web.cisco.com/1wrV2WSfGaAaDNVWZIuE4w8B43lrQ3or0vqj-dCCs2cwV5kEL96Yrhp5c5pA9RycHBx7s2_48xiYuL7jSRebxiV_NKbCW4Z557Jvsuf_fNBx916U8vjc3iZtMt1uORMsjtbuYW6ke-jHUVQYLIOcpyy1FaM-cEbUd5xgkQlw8bPY39JUd7LfvIKmw06cchseq7DmlPAhxFuRzT6RudnkO8vUKhZPcyW5Km57eyA6pl8oVLJIN5RnJfvu2HfmJVqLNlO2maVvvndX0YQAPeU3X9mcI0ggaEpRyz8AosJ8ZNH5O7deNXt6iS1FObjj4Vmu0jqX47lxq4U_tESMMJ-lO3Q/https*3A*2F*2Furldefense.com*2Fv3*2F__https*3A*2F*2Fgizmodo.com*2Fcommon-ct-scans-are-major-cancer-risk-study-claims-2000588963__*3B*21*21KGKeukY*213QiV5I4K5v5DkFeVCQcvqSvpeu1GCW4Xu2kfC-OIisjve02FMcil1jtQ4DKwavLox_91CTk9e1T7WF2R_hfH5GcmWjHVWZJE1htAOpCHBbVsiPc*24__;JSUlJSUlJSUlJSUlJSU!!KGKeukY!1Reaf_Fky05djN-QBH_RvPNHirWnP17iZGrZc8CdlACOX8map7-euQP6fldftfkSgFYl77xI8nXbDT7PoYly8kxaGJV7khHYGBxQmQCuBbjgyg$>*).
> The author reached out for outside comment in advance of publication, and I
> am grateful that he did, as I was able to (with help from Cynthia
> McCollough and Rebecca Milman) provide some additional context and
> critiques.
>
>
>
>
>
>
>
> --
>
> *Mark P. Supanich, Ph.D., DABR, FAAPM* (he/him)
>
> Director – Diagnostic Medical Physics
>
> Rush University System for Health
>
> Associate Professor & Vice Chair for Physics and Informatics
>
> Rush Medical College Department of Diagnostic Radiology and Nuclear
> Medicine
>
> O: 312.563.4552
>
> *Book time with Mark Supanich
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>
> [image: RUSH]
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