[Intl_DxMedPhys] Article in today's ACR Daily Email newsletter

[Rebecca Milman]

A few things to ponder, for those who are prone to such things:

1) I don't find the actual article as problematic as the accompanying
editorial. This view is admittedly biased because the commentary has an
anti-physicist view. The editorial also uses some rather inflammatory
language and misrepresents the study's findings.

2) The editorial mentions a recurring theme in radiology - overutilization
of imaging. While many valiant attempts have been made in curtailing this
practice, it persists. I think most of us agree that overutilization is an
issue, but this is separate from the current discussion. I will also argue
that overutilization is a physician issue, not a medical physicist issue.
My QMP scope ends abruptly when there is a question about whether an
imaging exam is clinically justified. We can't let the problem of
overutilization dominate the discussion about these tangential - but
separate - topics. Otherwise we run the risk of denying appropriate
healthcare to the patients for whom imaging *is* clinically justified.
(This is also why "justification" and "optimization" are separate radiation
safety tenets.)

3) We have to be careful with our messaging. There are certainly study
limitations - lack of any dosimetry, lack of tracking other behaviors that
increase fetal risk (e.g., concurrent medication use), lack of information
about clinical indications for CT scans performed. But our "talking points"
should include more than this. Otherwise we risk coming off as being
callous to concerns about radiation risk, which we aren't. We care about
patient safety. We care about providing patients with accurate risk
information. We just may not feel this is the burning platform the
editorial author seems to think it is.

4) The final - and most important - consideration is the impact on patient
health. The editorial emphasizes the importance of informing young women of
potential risks and benefits. So how will this change how I discuss risk
with patients? It won't. Not because I don't care (because I really do!)
but because in my professional opinion, the current study doesn't
present any new information that would add to that conversation. I will
still continue to tell patients that there may be a small risk, and that
they should discuss the potential small risk with the exam's benefits with
their physician.

Rebecca.


On Thu, Sep 11, 2025 at 1:36 PM Bob Kobistek via Intl_dxmedphys_wd_osu_list
<intl_dxmedphys_wd_osu_list at lists.osu.edu> wrote:

> You read my mind on the meeting the threshold for publication.
> Unfortunately, however, once USA Today or similar catch a glimpse of the
> title of the paper, you’ll be reading how CT scans kill unborn babies.
> Robert J. Kobistek, MS, FACR,
>
> You read my mind on the meeting the threshold for publication.
> Unfortunately, however, once USA Today or similar catch a glimpse of the
> title of the paper, you’ll be reading how CT scans kill unborn babies.
>
>
>
>
>
> Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)
>
> Medical Physicist
>
> RJK Medical Physics, Inc.
>
> 440-463-7879
>
>
>
> *From:* Matt Wait <Matt.Wait at kp.org>
> *Sent:* Thursday, September 11, 2025 2:36 PM
> *To:* Bob Kobistek <bob at rjkmedphys.com>; International Diagnostic Medical
> Physics List <intl_dxmedphys_wd_osu_list at lists.osu.edu>
> *Subject:* RE: Article in today's ACR Daily Email newsletter
>
>
>
> Well observed, Bob. This limitation is pretty glaring: “Incomplete
> ascertainment of CT exposure and underlying indication may have contributed
> to residual confounding.” To be entirely honest, I’m not sure how this
> meets the threshold for publication. Annals of Internal Medicine has an
> impact factor of 15.3.
>
>
>
> *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 *Bob Kobistek via Intl_dxmedphys_wd_osu_list
> *Sent:* Thursday, September 11, 2025 8:58 AM
> *To:* International Diagnostic Medical Physics List <
> intl_dxmedphys_wd_osu_list at lists.osu.edu>
> *Subject:* [Intl_DxMedPhys] Article in today's ACR Daily Email newsletter
>
>
>
> Check this out: Exposure to Computed Tomography Before Pregnancy and Risk
> for Pregnancy Loss and Congenital Anomalies: A Population-Based Cohort
> Study: Annals of Internal Medicine: Vol 0, No 0 Be prepared for the
> mainstream press to get hold
>
> *Caution: *This email came from outside Kaiser Permanente. Do not open
> attachments or click on links if you do not recognize the sender.
> ------------------------------
>
> Check this out:  Exposure to Computed Tomography Before Pregnancy and
> Risk for Pregnancy Loss and Congenital Anomalies: A Population-Based Cohort
> Study: Annals of Internal Medicine: Vol 0, No 0
> <https://urldefense.com/v3/__https:/www.acpjournals.org/doi/10.7326/ANNALS-24-03479__;!!KGKeukY!2RFiwk-DhCEzP1hEYpNHsMYSNb-6qlx646jkJZ7UBqULioIM9Ol_odI2MlR7Mc0MTMfHfEHYejqKxkMqHbZzoLKNlDRBQo5Mj54Qeg$>
>
>
>
> Be prepared for the mainstream press to get hold of this and
> sensationalize it.
>
>
>
> My observations:
>
>
>
> Is the increase in spontaneous abortion due to the CT scans or the reasons
> the patients got the CT scans to begin with? The authors acknowledge that
> the majority of the cohort had diabetes, hypertension, obesity or were
> smokers. (Smokers and pregnant???)
>
>
>
> The results also make the statement, “The risk observed with head CT was
> not consistently lower than with CT of the abdomen, pelvis, or lower
> spine.”  How is that possible unless the increased rate of spontaneous
> abortion was due to some factor other than X-ray exposure?
>
>
>
>
>
>
>
> Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)
>
> Medical Physicist
>
> RJK Medical Physics, Inc.
>
> 440-463-7879
>
>
>
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> v.173.295  Thank you.
>
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