[Intl_DxMedPhys] [EXTERNAL] Re: Heads up on NEJM paper on radiation exposure in peds and hematologic cancer risk
Philip Doyle
phil_doyle at yahoo.com
Wed Sep 24 14:08:48 EDT 2025
Furthermore, the authors reference a paper still in draft for the methodology (Stewart C et al)!Still it's an attempt significantly better than the similar study by Pearce (2012) in the Lancet which simply stated 'we estimated bone marrow doses per CT scan in mGy'.I find it interesting that 3 of the highest dose study types included are of the head/temporal bone/neck area contributing 66% of the collective dose the cohort recieved, yet there is only 4% of the total bodies active bone marrow located in the skull (of a typical 10 year old, the mean age investigated). Perhaps dose to a different organ, blood or tissue shows further insight.....What a great paper for a journal club discussion.Phil.
Hi everyone, as I am reading through the appendix 1 for that paper, it turned out that they didn't even have most of the real dose data, but other than "guessing it out"? Below is the exact text, would love to hear what others think.
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-------- Original message --------From: "Yang, Kai, PhD via Intl_dxmedphys_wd_osu_list" <intl_dxmedphys_wd_osu_list at lists.osu.edu> Date: 24/09/2025 14:55 (GMT+00:00) To: Mark Supanich <Mark_Supanich at rush.edu>, Jerry Thomas <jerry.thomas at ascension.org> Cc: intl_dxmedphys_wd_osu_list at lists.osu.edu Subject: Re: [Intl_DxMedPhys] [EXTERNAL] Re: Heads up on NEJM paper on radiation exposure in peds and hematologic cancer risk
Hi everyone, as I am reading through the appendix 1 for that paper, it turned out that they didn't even have most of the real dose data, but other than "guessing it out"? Below is the exact text, would love to hear what others think.
From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu> on behalf of Jerry Thomas via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu>
Sent: Monday, September 22, 2025 12:11 PM
To: Mark Supanich <Mark_Supanich at rush.edu>
Cc: intl_dxmedphys_wd_osu_list at lists.osu.edu <intl_dxmedphys_wd_osu_list at lists.osu.edu>
Subject: Re: [Intl_DxMedPhys] [EXTERNAL] Re: Heads up on NEJM paper on radiation exposure in peds and hematologic cancer risk
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
External Email - Use Caution
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"?
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
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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!xpDAYwmdXmlTUqXQm1Xw2-dw5argkGPFXOsUvJtMnHbE2xhxuC62fD0-cNqsdREcUd4ygXmZpPFnRweF4Sxh9EJBwMEwhUKPlRhjY4c9HA$
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
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