[Intl_DxMedPhys] [EXTERNAL] Re: Heads up on NEJM paper on radiation exposure in peds and hematologic cancer risk

[Jerry Thomas]

Mark and Baojun,

      Great points.  Both need to be in a letter to the editor.
Unfortunately, the reviewers of this paper failed to do their job.  -- They
were either, biased in favor of the paper's conclusions, busy and did not
read the paper critically, or were reviewing work that they were not
qualified to review.  Regardless this paper will be quoted, so it is now
imperative that a letter to the editor be written.  I would enjoy reading
the response to the letter. --- especially the support for hormesis that
Mark pointed out.


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 Fri, Sep 19, 2025 at 3:18 PM Mark Supanich via
Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu> wrote:

> An interesting note on this is that they also could have claimed that low
> levels of ionizing radiation have a positive impact on hematologic cancer
> rates. They cancer incidence rate (cases per 10,000 in their cohort) was
> lower for groups receiving
> An interesting note on this is that they also could have claimed that low
> levels of ionizing radiation have a positive impact on hematologic cancer
> rates. They cancer incidence rate (cases per 10,000 in their cohort) was
> lower for groups receiving between 5-15 mGy dose to the bone marrow than
> the group with no medical imaging. Their own calculated ERR was even <1 for
> the 5-10 mGy group.
>
> I wonder why the headlines aren't: "exposure to low levels of ionizing
> radiation protects children from blood cancer"?
> [image: Beaming face with smiling eyes]
>
>
> ------------------------------
> *From:* Intl_dxmedphys_wd_osu_list <
> intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu> on behalf of Li, Baojun
> via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu>
> *Sent:* Friday, September 19, 2025 1:01 PM
> *To:* intl_dxmedphys_wd_osu_list at lists.osu.edu <
> intl_dxmedphys_wd_osu_list at lists.osu.edu>
> *Subject:* Re: [Intl_DxMedPhys] Heads up on NEJM paper on radiation
> exposure in peds and hematologic cancer risk
>
> Rush Email Security
>
> This email originated from outside of RUSH. Do not click links or
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> If we replace “accumulative dose to bone marrow” with “total number of
> blood draws or hospital visits,” the relationship would likely still hold.
> By the authors’ reasoning, one could then conclude that blood draws or
> hospital visits cause cancer?!
>
> If we replace “accumulative dose to bone marrow” with “total number of
> blood draws or hospital visits,” the relationship would likely still
> hold. By the authors’ reasoning, one could then conclude that blood draws
> or hospital visits cause cancer?!
>
>
>
> In reality, children who undergo multiple CT examinations typically do so
> because of more severe or complex medical conditions. These patients are
> inherently predisposed to more hospital encounters and already have a
> higher baseline risk of hematologic malignancies, independent of imaging.
> The causal inference presented by the authors is deeply flawed and
> misleading.
>
>
>
> Thanks,
>
> Baojun
>
>
>
>
>
> *From:* Intl_dxmedphys_wd_osu_list
> <intl_dxmedphys_wd_osu_list-bounces+baojunli=bu.edu at lists.osu.edu> *On
> Behalf Of *Mark Supanich via Intl_dxmedphys_wd_osu_list
> *Sent:* Wednesday, September 17, 2025 6:35 PM
> *To:* intl_dxmedphys_wd_osu_list at lists.osu.edu
> *Subject:* [Intl_DxMedPhys] Heads up on NEJM paper on radiation exposure
> in peds and hematologic cancer risk
>
>
>
> Hi all, Just a heads up that NEJM published a paper from Smith-Bindman et
> al this afternoon. https: //www. nejm. org/doi/full/10.
> 1056/NEJMoa2502098?query=featured_home It’s an observational study of 3. 5+
> million peds looking at cumulative
>
> Hi all,
>
>
>
>
>
> Just a heads up that NEJM published a paper from Smith-Bindman et al this
> afternoon.
> https://urldefense.com/v3/__https://www.nejm.org/doi/full/10.1056/NEJMoa2502098?query=featured_home__;!!KGKeukY!xCjvV8hv3xtlfKupNIfTMI3-mpBm97HcHIHD61x4u27aEhFBzH_hdZIvpzsIloEnt9PRYcl0X9vOMmSsWljFNrPZU9pdpIIjt6TOk7BFaq92zNc$ 
> <https://urldefense.com/v3/__https:/www.nejm.org/doi/full/10.1056/NEJMoa2502098?query=featured_home__;!!KGKeukY!1m_oRWHMFCepm1fT1RIhzq46cPRXjfbhAvYKAO_5iNUOWD5mqN0G-iBdtAZYZy1h5_JOVRouzbgwoLM5N75lJAFaFMiQA3UTRzxHR2RjJ7wH4P8$>
>
>
>
> It’s an observational study of 3.5+ million peds looking at cumulative
> exposure to ionizing radiation, particularly focused on bone marrow dose,
> and increased risk of hematologic cancer incidence. Their results claim an
> increased incidence of cancer in patients with exposure to imaging, and
> demonstrate a cummulative dose effect. They claim their results are not
> likely due to reverse causation as they have reasons for exams and symptoms
> of these cancers were not common reasons for exams. They also note their
> results are inline with the EPI-CT study. Of note, it appears that they
> looked at imaging from 1996-2017 – so much of the imaging likely occurred
> on imaging equipment without many of the modern dose reduction features.
>
>
>
> This is sure to get media play and parents will certainly have questions
> as the media coverage develops. Continuing to focus on the judicious use of
> imaging, the benefits of diagnostic imaging to answer clinical questions,
> and the fact that modern imaging equipment adapts to patient size and uses
> optimized radiation will be key talking points.
>
>
>
> From the paper: “By the end of follow-up, 7.5% (280,548 of 3,724,623) of
> all the children and 9.2% (272 of 2961) of those in whom a hematologic
> cancer developed had received a cumulative dose of at least 1 mGy.”
>
>
>
>
>
> There is a lot to look at in this paper and the supplemental materials, so
> more information/analysis is sure to come.
>
> --
>
> *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
>
> [image: RUSH]
>
>
>


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