August 2006: Radiology's Secret, and Letting in the Light

There's an old yarn that has been afloat for years about the famous (or infamous, which is part of the point) radio "shock jock" Howard Stern.

The radio station that he worked for at the time conducted a survey of elements of his show, which yielded the following responses:

"Absolute tabloid trash."

"Should be taken off the air."

"He needs to get his facts straight or get out."

You catch the drift by this point.

Part 2 of the survey then asked the listener/survey respondents above how often they listened to the show.

The response: "Five hours a day."

When Dr. Richard Semelka and I set out early in 2006 to frame a discussion of the potential dangers of imaging radiation (specifically CT radiation) to patients (an earlier article on this topic that Dr. Semelka developed for Medscape was the fifth most read item of content on the site in all of 2005), and the lack of patient, referring physician, and even radiologist knowledge regarding the recent scientific findings of the BEIR VII report and other publications on this topic, we had no inkling of the firestorm that would ensue. We have literally received thousands of emails from caregivers and patients related to this topic; the commentaries both agree with Dr. Semelka's interpretation of the BEIR VII report and the other scientific literature and vehemently contest his conclusions.

Samples of the con and the pro and the quest for answers:

"Semelka has lost his mind."

"Your articles read like ads for parasitic lawyers."

"This is tabloid sensationalism!"

"Either get it right, or get out!"

"If I take Dr. Semelka at face value, does this mean we should do away with CT scanning entirely?"

"I have only been sued for not ordering a CT scan, never for ordering one...1 or 2 more suits like this protecting [patients'/plaintiffs'] rights and I will be out of practice."

"What is...clear is that there is an alarming lack of awareness on the part of both referring clinicians and radiologists regarding the CT radiation issue."

"After...years, the ordering physician or nurse is gone, the radiologist is gone, and the only one left is the patient, who received x-ray radiation as a child and now harbors a malignancy..."

"As a member of this great specialty, I am especially concerned about the deep state of denial (or ignorance) that practicing radiologists manifest about the radiation burden CT is imposing on the public."

"The era in which Wilhelm C. Roentgen, father of the field of diagnostic radiology, lived with its identifiable tradition of silence, did not lend itself to the disclosure of information. We must act toward grafting the principle of informed consent to the practice of radiology."

"A quick, but giant thanks for your influential words and efforts regarding cancer risks associated with radiation exposure."

"However, if the cancer rate is 1.2%-1.5% for a 5-year-old child receiving under 100 mSv of radiation (according to Dr. Nickoloff of Columbia University), millions of kids will get cancer from CT scans."

In meeting the CT radiation issue head on, our intention was not to become the Howard Stern of the imaging community (someone even sent me a note last week referring to Dr. Semelka as the "Geraldo Rivera of Radiology"). However, Medscape Radiology site membership numbers, retention, and CME credits are up, and the debate regarding this issue has reached a crescendo of passion and conjecture, which points out that even those who disagree are engaged by the colloquy.

We are on to something.

Patients, referring physicians, and radiologists need to hear more and talk more about this issue in the interest of an enlightened discussion that leads to the path of improved patient care and, ultimately, "care" for the rights of patients, their safety, and their children's safety.

I'm just the caretaker of this forum, the gardener, if you will, of this fertile Medscape real estate. This is your site, to be presented and administered under the editorial auspices of the esteemed complement of key opinion leaders who comprise our advisory board. Where we go from here regarding the critical and enduring dialogue of how best to administer a mainstay technology such as CT scanning in the face of a growing body of scientific data indicating that CT may carry significant radiation risks, especially in children, is up to you, our dedicated and expanding Medscape audience of caregivers and consumers. Please peruse the articles below on this topic that have been showcased on Medscape – if they have not already captured your interest or your ire -- and get back to me with comments, Letters to the Editor, or a clinical article of your own at bchevrier@medscape.net

Bob Chevrier
Medscape Radiology

Imaging X-rays Cause Cancer: A Call to Action for Caregivers and Patients CME/CE
Author: Richard C. Semelka, MD
https://www.medscape.com/viewprogram/5063

Expert Interview - CT Scanning and Cancer: Why You and Your Family Are at Risk, Part 1: An Expert Interview With Richard C. Semelka, MD (Full-Text Article) "Although patients have always had a right to know what was in store for them, it was in the interest of referring physicians and imagers to convey that an x-ray-based study was just another test...."
from Medscape Radiology, April 2006
https://www.medscape.com/viewarticle/529944

Expert Interview - CT Scanning and Cancer: Why You and Your Family Are at Risk, Part 2: An Expert Interview With Richard C. Semelka, MD (Full-Text Article) "If the pattern of overordering CT scans does not change, there will be legal suits from patients who can trace their cancers back to CT that will dwarf the tobacco lawsuits and settlements."
from Medscape Radiology, April 2006
https://www.medscape.com/viewarticle/530719

Articles - Radiation Risk From CT Scans: A Call for Patient-Focused Imaging (Full-Text Article)
Author: Richard C. Semelka, MD
"It is ironic that considerable energy has been directed toward patient-protection practices with little measurable benefit, whereas the health risks of radiation from CT proceed unchecked."
from Medscape Radiology, January 2005
https://www.medscape.com/viewarticle/496297

From the Editor - April 2006: CT Scans and Cancer: How One Radiologist Is Safeguarding His Patients (Full-Text Article)
"It is clear that there is an alarming lack of awareness on the part of both referring clinicians and radiologists in regard to the CT radiation issue."
from Medscape Radiology, April 2006
https://www.medscape.com/viewarticle/528936

From the Editor - March 2006: CT and Cancer: A Mother's Story (Full-Text Article)
"In 1998, my son Danny died of complications of acute myeloid leukemia (AML) after a brief but valiant battle with the disease. Of course we were devastated. But this is not about our grief."
from Medscape Radiology, March 2006
https://www.medscape.com/viewarticle/524239

Semelka's Spin: Pathways to Imaging Excellence - What Is An Appropriate Response to the Dangers of CT Radiation?(Full-Text Article)
Says one doctor, "I have only been sued for not ordering a CT scan, never for ordering one...1 or 2 more suits like this protecting [patients'/plaintiffs'] rights and I will be out of practice."
https://www.medscape.com/viewarticle/522212

From the Editor - June 2006: Mothers Against Silence About CT Radiation Risks (MASACRR) (Full-Text Article)
"We learned after the fact that he actually underwent 4 CT studies, only when we saw his medical records. The hospital apologized...how we can tell the public more of the truth about CT radiation...."
from Medscape Radiology, June 2006
https://www.medscape.com/viewarticle/536132

Semelka's Spin: Pathways to Imaging Excellence --
Roentgen's Real Legacy, In the Age of Informed Consent (Full-Text Article)
"With the recognition of the potential deleterious effects of radiation mediated by CT, physicians are now learning that, despite its availability, technology should not always be used."
from Medscape Radiology, July 2006
https://www.medscape.com/viewarticle/536109

Semelka's Spin: Pathways to Imaging Excellence - When Will Radiologists Do the Right Thing About CT Radiation? (Full-Text Article)
"In my conversations with residents and staff...I am able to summon only grudging acceptance of the realities of the adverse biological effects of what has become a nearly reflex use of CT...."
from Medscape Radiology, July 2006
https://www.medscape.com/viewarticle/540733

Medscape Radiology. 2006;7(2) © 2006  Medscape

Cite this: August 2006: Radiology's Secret, and Letting in the Light - Medscape - Aug 07, 2006.