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

Matt Wait Matt.Wait at kp.org
Fri Apr 18 13:30:01 EDT 2025 

I reached out to NPR with a “correction request” to their article, which I felt was unusually one-sided. https://urldefense.com/v3/__https://www.npr.org/sections/shots-health-news/2025/04/16/g-s1-60488/ct-scan-cancer-risk-ionizing-radiation__;!!KGKeukY!1j0sb0A9_7ndU1RwMWjkvu2iMmZiSadet27yZqPsJNkyLpKFF3fJ_BvZms5-XoIPnhFA5MHBOl5bRjWHok8a5BKApBYZPHazXWGNeSs$ 

I suggest others try the same process with other media outlets you see. Clearly our press release is not breaking through. Interestingly, though they quote the ACR press release, their takeaway was:

“Dr. Dana Smetherman, chief executive officer of the American College of Radiologists, praised the study for bringing awareness to the question of radiation risk. Some people are unaware, for example, that ultrasounds and MRIs do not emit radiation and that CT scans do, she said. "As radiologists, we always want patients to be informed and feel comfortable asking the questions, 'tell me more about this test, what's involved, what's it going to show you?' " said Smetherman, who was not involved with the research. Echoing a statement<https://urldefense.com/v3/__https://www.acr.org/News-and-Publications/Media-Center/2025/jama-ct-scan-radiation-study__;!!KGKeukY!1j0sb0A9_7ndU1RwMWjkvu2iMmZiSadet27yZqPsJNkyLpKFF3fJ_BvZms5-XoIPnhFA5MHBOl5bRjWHok8a5BKApBYZPHazlJZhWqg$ > from the American College of Radiology after the study's release, she stressed that the study's projection of cancer diagnoses from CT scans was based on statistical modeling, not actual patient outcomes. There are no published studies directly linking CT scans to cancer, the statement says. "Americans should not forgo necessary, life-saving medical imaging and continue to discuss the benefits and risks of these exams with their healthcare providers," it continues.”


Matt Wait, MS, DABR, DABSNM, MRSE
Senior Diagnostic Physicist
Assistant Radiation Safety Officer
Assistant Residency Director
Kaiser Permanente
Southern Permanente Medical Group
Medical Imaging Technology and Informatics
4867 Sunset Blvd
Los Angeles, CA 90027
x5347 (office)
(818) 232-2427 (mobile phone)

From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+matt.wait=kp.org at lists.osu.edu> On Behalf Of Bill Erwin via Intl_dxmedphys_wd_osu_list
Sent: Friday, April 18, 2025 10:19 AM
To: Jerry Thomas <jerry.thomas at ascension.org>
Cc: intl_dxmedphys_wd_osu_list at lists.osu.edu
Subject: Re: [Intl_DxMedPhys] [EXTERNAL] Re: New JAMA IM article on CT radiation dose and future cancers


Caution: This email came from outside Kaiser Permanente. Do not open attachments or click on links if you do not recognize the sender.

________________________________
This has made it to national television news. (I heard the "parroting" of the study and results on XM this morning, by a television network to which I happened to be listening. I will wager that all the other major networks have or
This has made it to national television news.  (I heard the "parroting" of the study and results on XM this morning, by a television network to which I happened to be listening.  I will wager that all the other major networks have or will also "parrot".)

On Tue, Apr 15, 2025 at 4:49 PM Jerry Thomas via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>> wrote:
This message was sent securely using Zix® 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
This message was sent securely using Zix®<https://urldefense.com/v3/__http:/www.zixcorp.com/get-started/__;!!KGKeukY!ytVHnFXwh22ca4utaKvv_GHtIPB8KERiTOykmfmORhbNvS3xFymqS1o5FJLVkAhHXqmee8XBF0k45K8i8z8OCQlMHEZlNwHCM1kh-s1VAdDPDtU$>

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!1j0sb0A9_7ndU1RwMWjkvu2iMmZiSadet27yZqPsJNkyLpKFF3fJ_BvZms5-XoIPnhFA5MHBOl5bRjWHok8a5BKApBYZPHazULsM9QE$ <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<mailto: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<mailto: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<mailto: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!

[Screenshot 2025-04-15 at 10.09.46 AM.png][cid:image002.png at 01DBB04C.D605D0B0]

==========================================================================================

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,

Baltimore, MD 21287-0856

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From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+mmahesh=jhmi.edu at lists.osu.edu<mailto: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<mailto: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<mailto:badgerpet at gmail.com>>, Yang, Kai,PhD <KYANG11 at mgh.harvard.edu<mailto:KYANG11 at mgh.harvard.edu>>
Cc: intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu> <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto: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<mailto: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<mailto: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<mailto: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<mailto: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!1j0sb0A9_7ndU1RwMWjkvu2iMmZiSadet27yZqPsJNkyLpKFF3fJ_BvZms5-XoIPnhFA5MHBOl5bRjWHok8a5BKApBYZPHazwV_de_k$ <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!1j0sb0A9_7ndU1RwMWjkvu2iMmZiSadet27yZqPsJNkyLpKFF3fJ_BvZms5-XoIPnhFA5MHBOl5bRjWHok8a5BKApBYZPHazSrdyzbY$ <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

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