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 CT modality focus page provides information, videos, podcasts, and the latest news about industry product developments, trial results, screening guidelines, and protocol guidance that touch on the use of CT across the healthcare continuum, from various cancer screenings, such as lung and colon, to cardiothoracic imaging, to appendicitis, and more.

While recently published research raised concerns about projections of future radiation-induced cancers from computed tomography (CT) scans, Joseph Cavallo, M.D., maintained in a new 

 that advances in technology may continue to facilitate lower radiation dosing with CT.

“Whether it's the photon-counting CT machines or AI post-processing algorithms, there are multiple avenues to lower dosing … It's not going to be a one size fits all, or a silver bullet. It's going to be a combination of different technologies on the machine side, on the software side, that help us continually make these examinations safer and improve the risk benefit profile moving forward,” noted Dr. Cavallo, an assistant professor of radiology and biomedical imaging at Yale School of Medicine in New Haven, Ct.

Highlighting significant reductions with cardiac CT radiation dosing in recent years, Mahadevappa Mahesh, MS, Ph.D., also challenged perceptions about overuse of CT scans in the emergency room setting.

“Generally, emergency room physicians get the bad rap (with the perception that) they're ordering too many studies. … If we look (at this) closely, emergency room physicians, radiology, everybody (is) working with such a time-compressed timeline, and they're trying to save the patient. … As a medical physicist, I am all for radiation dose reduction, but at the same time, I am also a proponent of never tying anybody's hand because of radiation, even in the cath lab. If you have to do the procedure, do it,” asserted Dr. Mahesh. the president of the American Association of Physicists in Medicine (AAPM), and a professor of radiology and radiological sciences at the Johns Hopkins School of Medicine.

(Editor’s note: For related content, see “

The Reading Room Podcast: Current Insights on Recent Research About Radiation-Induced Cancers with CT Scans, Part 1

What New Research Reveals About Computed Tomography and Radiation-Induced Cancer Risk

Nine Takeaways from New Research on CT Scans and Radiation-Induced Cancers

For more insights from Dr. Cavallo and Dr. Mahesh, listen below or 

In a second part of a new podcast episode on recently published research on projected radiation-induced cancers from computed tomography (CT) scans, Mahadevappa Mahesh, MS, Ph.D., and Joseph Cavallo, M.D., offer current perspectives on cardiac CT dosing, AI advances and the importance of teamwork in ensuring appropriate dosing for CT. 

The Reading Room Podcast: Current Insights on Recent Research About Radiation-Induced Cancers with CT Scans, Part 2

In a recently published study, researchers estimated that out of an estimated 93 million computed tomography (CT) exams performed in 2023, there may be 103,000 future cases of radiation-induced cancers. Based on current CT use and radiation dosing levels, the study authors suggested that radiation-induced cancers from CT exposure may account for 5 percent of all cancer cases.

, Joseph Cavallo, M.D., emphasized appropriate perspective with the aforementioned risk modeling study and taking all the risks into account to optimize patient care.

“I would have liked to see a little more discussion about underlying risk in general. They speak to the risk of CT, but we're really not comparing the risk of a CT versus the risk of doing nothing … Hopefully, in all the cases where we're doing CT or other radiation-based imaging, we should be comparing the risk of CT versus the risk of the underlying disease and the risk of complications from the underlying disease, and ultimately, the risk of missing the diagnosis of some of those diseases,” posited Dr. Cavallo, an assistant professor of radiology and biomedical imaging at Yale School of Medicine in New Haven, Ct.

 suggested that multiphase scanning, occurring in 28.5 percent of CT exams, is commonly overutilized, Mahadevappa Mahesh, MS, Ph.D., emphasized that patient history and disease presentation are key considerations.

“Which patients (had the multiphase scanning)? Was it necessary? Because it's very subjective to say overused. … Did any of them have cancer-related studies? Do they have other underlying diseases? (In these cases), you only (get) answers with a triphasic study. That's important to say. I'm not refuting the numbers, but the justification of these numbers is very important,” added Dr. Mahesh, the president of the American Association of Physicists in Medicine (AAPM), and a professor of radiology and radiological sciences at the Johns Hopkins School of Medicine.

AI Denoising Bolsters Ultra-Low-Dose CT Detection of Pneumonia Findings in Immunocompromised Adults

For more insights from Dr. Cavallo and Dr. Mahesh, listen below or 

In a new podcast, Mahadevappa Mahesh, MS, Ph.D., and Joseph Cavallo, M.D., share their perspectives on recently published research looking at projections for future radiation-induced cancers from computed tomography (CT) scans.

When it comes to brain imaging, functional MRI – commonly called fMRI – is considered the gold standard. However, it can be costly, time consuming, and come with several restrictions that can prohibit use with certain patients. 

In recent years, investigators have been searching for a different brain imaging method that can side-step these problems and potentially provide better quality scans at the same time. Researchers from the University of Southern California Keck School of Medicine and California Institute of Technology recently succeeded. They’ve developed functional photoacoustic computed tomography (fPACT) – a technique that works by emitting a laser beam of light into the area being imaged. 

Drs. Charles Liu and Jonathan Russin join me to discuss the differences and benefits with fPACT.

Drs. Charles Liu and Jonathan Russin discuss the benefits and potential of fPACT, the alternative to functional MRI.

The Reading Room: Potential fMRI Alternative -- fPACT

COVID-19 halted all cancer screening services at the beginning of the pandemic, and slowly those scans have become more and more available -- but, not necessarily for everyone.

In many instances, racial and minority patients continue to face the same healthcare disparities that made it difficult for them to access the services at the outset. Now, the fear and trepidation associated with the pandemic are layered on top. 

Despite these difficulties, there are things healthcare institutions and providers can do to help. In this episode of 

 spoke with Shalmon Kalnicki, M.D., chair of radiation and oncology at Montefiore and Albert Einstein College of Medicine about the challenges these patients continue to face with cancer screenings. Not only did he share with us how COVID-19 has impacted this existing problem, but he also outlined the steps institutions can take to improve this situation.


In this podcast episode, Dr. Shalom Kalnicki, from Montefiore and Albert Einstein College of Medicine, discusses the disparities minority patients face with cancer screenings and what can be done to increase access during the pandemic.

The Reading Room: Racial and Ethnic Minorities, Cancer Screenings, and COVID-19

Current lung cancer screening guidelines could be overlooking African American smokers who are at risk for developing lung cancer.

According to a study published in the Sept. 15 

Journal of the American College of Radiology

 the current guideline based on the 30-pack-year threshold sets the bar too high, as most African American smokers self-report a less than 30 pack-year history. This determination sounds an alarm bell because African Americans have a high incidence of and worse outcomes from lung cancer.

“There is growing concern that there are healthcare disparities in lung cancer screening guidelines and programs,” said lead study author Anupam Basu, M.D., a diagnostic radiologist in Cook County Health. “Evidence suggests that the National Lung Screening Trial (NLST) and Preventive Services Take Force inclusion threshold of a 30-pack-year smoking history excludes a portion of African American patients at risk for lung cancer.”

Even though African Americans are more significantly impacted by lung cancer, the team said, they still only account for 4 percent of the NLST. Based on existing evidence this group does have a smoking duration history similar to their white counterparts – but, they actually smoke fewer packs a day. Consequently, they have a shorter pack history – the benchmark providers use to determine who should undergo lung cancer screening.

The team, therefore, suggested lung cancer screenings would be much more accurate and impactful if they adopted a 20-pack-year threshold.

To subscribe to The Reading Room podcast, click 

To identify a threshold that could better identify more African American smokers who could benefit from lung cancer screening, the team retrospectively reviewed low-dose CT scans from patients in their public hospital between September 2017 to December 2019. 

All total, they reviewed data from 784 patients, 57.5 percent of whom were men with an average age of 62. The majority were African American (66.2 percent), followed by white (20.4 percent), Hispanic (8.3 percent), Asian (4.8 percent), and Native American (0.3 percent).

Of the group, three-quarters – 75.5 percent – were active smokers, and just more than half – 51.5 percent revealed a pack history of fewer than 30 years. Total years smoked did not vary much by race, the team said. But, the African American experience was somewhat different, and it painted a grim picture.

“African Americans smoked fewer packs per day and had fewer pack-years compared with other races,” the team said. “African Americans were more likely to be active smokers but also more likely to report [less than] 30 pack-years compared with other races.”

Low-dose CT findings determined that lung cancer incidence did not vary by race, but African American had an incidence of 2.5 percent while whites experience 1.9 percent. Fortunately, the majority of cancers identified (75 percent) were Stage 1, and all patients had the cancerous tissues successfully removed with surgery.

Looking at lung cancer diagnosis specifically in the context of smoking brought more bad news. African Americans were the only race diagnosed with lung cancer when their self-reported pack-year history was less than 30. For smokers in this group with more than 30-pack-year histories, the incidence rate was 2.2 percent. For those with less than 30 years, it was 2.7 percent.

“We are concerned that the 30-pack-year threshold in the African American population may exclude a portion of patients who are still at risk for lung cancer,” the team said. “We propose prospective study of African Americans with [less than] 30-pack-year histories to determine the potential benefits and harms of [lung cancer screening] in this unique underserved population.”

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter

In this podcast, Dr. Anupam Basu from Cook County Health in Chicago discusses the 30-pack-year threshold for lung cancer screening that overlooks at-risk African American smokers.

The Reading Room: Lung Cancer Screening Misses At-Risk African American Smokers

Lung injuries caused by vaping leave signature marks on CT scans, a follow-up study has revealed, arming radiologists with the details needed to potentially make more accurate diagnoses and help patients avoid unnecessary biopsies.

 a team led by Michael Gotway, M.D., a radiologist at the Mayo Clinic in Arizona, laid out their findings that show these lung injuries – called EVALI (electronic cigarette or vaping product use-associated lung injury) – produce patterns on chest CT scans that correlate with previously observed pathological findings.

The first reports of EVALI surfaced last year from the Centers for Disease Control & Prevention. Within the first six months after this report, almost 3,000 EVALI-related hospitalization were recorded, as well as 68 confirmed deaths. Almost all patients present with complaints of shortness-of-breath, chest pain, and constitutional symptoms that can resemble viral illness. The non-specific nature of these symptoms can make an accurate diagnosis difficult.

 Chest Imaging Reveals Traits of Vaping-Related Lung Injuries in Teens

Based on their findings, he said, 96 percent of patients exhibited multi-focal or diffuse ground-glass opacities and consolidation that involves most or all lobes bilaterally and could involve mild interlobular septal thickening and subpleural sparing. As the illness evolves, imaging findings can suggest mild architectural distortion, intralobular lines, lobular distortion, and traction bronchiectasis.

These findings can be particularly helpful, he said, when providers are imaging younger patients with chest pain and shortness-of-breath. In those cases, a diagnosis of EVALI should be strongly considered.

Even though patients may be reticent to admit they are vaping, he said, if a radiologist recognizes one of these patterns on CT, he or she can advise the clinician, potentially leading to a nicotine metabolite test and further questions about exposure. Employing that approach could help patients avoid the invasiveness, time, expense, and risk associated with unnecessary biopsies.

“These radiological findings will be especially beneficial to physicians to help them determine potentially less invasive treatment options,” Gotway said. “We could potentially make that diagnosis non-invasively through cooperation with our clinical colleagues. By alerting them to a scan pattern that is suggestive of the possibility of EVALI, we may actually save patients from having to meet a surgeon.”

Michael Gotway, M.D., cardiopulmonary radiologist with the Mayo Clinic, discusses the signature signs of EVALI on CT scans in this podcast.

The Reading Room: Signature Signs of EVALI on CT

[[{"type":"media","view_mode":"media_crop","fid":"8165","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_9348676445430","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"213","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 5px; float: left;","title":" ","typeof":"foaf:Image"}}]] Bridging the two complementary modalities of PET and MR has advantages over PET/CT, as a lower dose and more differentiating modality. That's according to Osman Ratib, MD, PhD, FAHA, professor and chief of nuclear medicine in the Department of Radiology and chairman of the Department of Imaging and Medical Informatics at the University Hospital of Geneva. His orgnanization was an early adopter of PET/MR with Philips’ Ingenuity TF, which received FDA clearance in November 2011.

The system includes two devices separated by about 10 feet with a rotating table so the patient can be scanned in the same position in each machine. Data are merged via software. In this podcast, Ratib discusses the advantages of this hybrid modality, what the transition was like for hospital staff, and the future of PET/MR.

Osman Ratib, MD, PhD, FAHA, professor and chief of nuclear medicine in the Department of Radiology  at the University Hospital of Geneva, discusses the advantages and future of the hybrid PET/MR modality.

Podcast: Advantages of Hybrid PET/MR

spoke with Dr. Johnsey Leef III, a radiologist with Charleston Area Medical Center in Charleston, WV, about how the industry is responding to the call for lower dose imaging and what his department is doing to address the issue.

Diagnostic Imaging spoke with Dr. Johnsey Leef III, a radiologist with Charleston Area Medical Center in Charleston, WV, about how the industry is responding to the call for lower dose imaging and what his department is doing to address the issue.

Podcast: A Conversation about Lowering Radiation Dose

The Planmed XFI full-body weightbearing cone-beam CT scanner reportedly enables upright and supine patient positioning.

Versatile Full-Body Cone-Beam CT Scanner Gets FDA Clearance

Providing adjunctive AI detection for multiple conditions on CT through a single workflow, the multi-triage platform would be available through Aidoc’s aiOS platform.

FDA Issues Breakthrough Device Designation for AI-Powered Multi-Triage System for Computed Tomography

While pooled data from 38 studies showed markedly higher sensitivity rates for the use of adjunctive AI for ischemic stroke detection on non-contrast CT exams, researchers noted a high degree of bias and lack of external validation in many of the studies.

Meta-Analysis Reveals Mixed Results on Adjunctive AI for Non-Contrast CT Detection of Ischemic Stroke 

New research suggests the combination of multiparametric dual-energy CT and deep learning image reconstruction for liver metastases detection enables a 45 percent reduction in radiation dosing.

Can AI-Powered Image Reconstruction Facilitate Lower Radiation Dosing with Dual-Energy CT Detection of Liver Metastases?

Facilitating increased efficiency in radiation therapy planning, the new Rembra RT and Areta RT computed tomography platforms reportedly offer 4D CT capabilities and image reconstruction speeds up to 106 images per second.

Philips to Introduce New CT and MRI Systems at ASTRO Conference

’s Weekly Scan, which offers an opportunity to catch up on the most well-viewed radiology content of the past week.

New research, published earlier this week in 

MRI-based pancreatic risk stratification model (M-PRiSM)

 offers enhanced prognostic insight into postoperative survival for patients being treated for pancreatic ductal adenocarcinoma (PDAC).

In a prospective study, recently published in the 

, researchers found that deep learning image reconstruction (DLIR) may facilitate up to a 

45 percent reduction in radiation dosing with dual-energy computed tomography (DECT)

Speaking of radiation dosing, in a recent interview with 

, Dr. Rebecca Smith-Bindman discussed a new study, published in the 

impact of cumulative radiation exposure from medical imaging upon hematologic cancer risk in children

In a new 67-study meta-analysis published in 

PSMA PET offered significantly higher accuracy in detecting biochemical recurrence (BCR), lymph node metastasis and bone metastasis

 in comparison to multiparametric MRI (mpMRI) and computed tomography (CT).

combination of digital breast tomosynthesis (DBT) and molecular breast imaging (MBI)

 offered more than double the detection of invasive breast cancer with DBT in the first year of screening, according to a prospective study of nearly 3,000 women with dense breasts.

Diagnostic Imaging's Weekly Scan is your chance to catch up on the latest radiology content, from new research and device news to the latest interviews and conference reports. 

Diagnostic Imaging's Weekly Scan: September 21 — September 27

Catch up on the top radiology content of the past week.

 suggested that cumulative exposure to radiation from medical imaging may account for up to 10.1 percent of hematologic cancers in children.

For the multicenter retrospective study, researchers reviewed data from over 3.7 million children with a mean-follow-up of 10.1 years and found 

a significant impact of cumulative radiation dose upon hematologic cancer risk

“If a child has a dose of one to five mGy, the (relative) risk is about 1.4. If a child has a dose that's 15 to 20 mGy, the relative risk is 1.8 and if a child has a (dose) of 50 to 100 mGy, the relative risk is 3.6 so the risk goes up the more the exposure (to imaging radiation),” explained lead study author Rebecca Smith-Bindman, M.D., during a recent interview with 

After many years of declining CT use in pediatric populations, Dr. Smith-Bindman said CT scans have increased “pretty substantially” over the last few years with no new indications for CT scanning. While acknowledging that cancer risks are low in children overall, Dr. Smith-Bindman noted that low-value imaging continues to be a concern and emphasized that there is significant work to be done with respect to standardizing radiation dosing for children.

“While medical imaging remains an invaluable tool in pediatric care, our findings highlight the need to carefully balance its diagnostic benefits with potential long-term risks, particularly for radiation-based studies,” maintained Dr. Smith-Bindman, the director of the Radiology Outcomes Research Laboratory and a professor of epidemiology and biostatistics at the University of California, San Francisco (UCSF) School of Medicine.

New Research Estimates Radiation Exposure from Imaging Causes 10 Percent of Hematologic Cancers in Children

New Research Examines Radiation Risks with CT Exposure Prior to Pregnancy

Photon-Counting CT Study Examines Impact of Scan Mode on Radiation Dosing for CCTA in Patients with Non-Acute Chest Pain

For more insights from Dr. Smith-Bindman, watch the video below.

In a recent interview, Rebecca Smith-Bindman, M.D., discussed new research examining cumulative radiation exposure from imaging, its potential impact on the development of hematologic cancers in children, and keys to judicious imaging and radiation dosing.

CT Radiation Exposure and Hematologic Cancers in Children: An Interview with Rebecca Smith-Bindman, MD

Welcome to Diagnostic Imaging’s Weekly Scan, which offers an opportunity to catch up on the most well-viewed radiology content of the past week.

In light of emerging research suggesting an 

increased incidence of breast cancer among women under the age of 40

, Drs. Jean Seely, MD, Zeeshan Shah, MD and Amy Patel, MD, discussed what they’re seeing in practice and emphasized increased vigilance to facilitate early detection.

In a new retrospective study published earlier this week in the 

the impact of radiation exposure from medical imaging

 in a cohort of over 3.7 million children. They estimated that radiation exposure from imaging may be associated with 10.1 percent of hematologic cancers in this patient population.

, Drs. Noa Antonissen and Colin Jacobs discussed new research suggesting that a CT-based deep learning model may facilitate 

a nearly 40 percent reduction in false positives with indeterminate lung nodules

Multiple nuclear medicine societies, including the Society of Nuclear Medicine and Molecular Imaging, unveiled 

guidelines this week for PET myocardial perfusion imaging (MPI)

. Check out our takeaways from the new recommendations on appropriate protocols and keys for interpretation of PET MPI.

In a new breast ultrasound study focusing on BI-RADS category 4 and 5 mass presentations, researchers noted that the 

 had an 81 to 85 percent specificity for malignancy.

Diagnostic Imaging's Weekly Scan is your chance to catch up on the latest radiology content, from new research and device news to the latest conference reports.

Diagnostic Imaging's Weekly Scan: September 14 — September 20

It has been estimated that up to 50 percent of those who have acute dissection in the ascending aorta may die before they get to the hospital. However, for those who survive hospitalization for acute aortic dissection, Alan Braverman, M.D., noted that 90 percent are “alive and well” one year later.

, Dr. Braverman emphasized that the knowledge of common risk factors in concert with imaging findings may facilitate earlier diagnosis of aortic dissection.

In addition to a family history of aortic diseases and genetic conditions, such as Marfan syndrome and Loeys-Dietz syndrome, hypertension is another common risk factor for the development of aortic dissection, according to Dr. Braverman, the head of general cardiology with the John T. Milliken Department of Medicine at the University of Washington School of Medicine.

“About 75 percent of people with an aortic dissection have underlying hypertension and, importantly, they don't have to have severe, uncontrolled hypertension. Just the presence of hypertension, even when controlled, can be a risk factor because it can affect the architecture of the aorta,” pointed out Dr. Braverman.

While noting the limitations of point-of-care ultrasound (POCUS) and chest X-ray, Dr. Braverman said they can serve as useful screening tools for triggering subsequent imaging.

“Sometimes the shadow of the aorta in the mediastinum around the heart will be enlarged because the aorta has stretched because of the dissection, or there'll be other evidence on a chest X-ray that heighten your suspicion,” noted Dr. Braverman.

However, Dr. Braverman said computed tomography (CT) provides a highly sensitive gold standard.

“A contrast CT scan, especially when it's gated so it doesn't have a lot of motion artifacts, has at least 95 to 98 percent ability to detect an aortic dissection, so that is the most commonly performed test,” added Dr. Braverman.

Pertinent Insights into the Imaging of Patients with Marfan Syndrome

Image IQ Quiz: Middle-Aged Female with Chest Pain, Back Pain and Shortness of Breath

AI-Powered Algorithm May Enhance CT Assessment of Aortic Dissection

For more insights from Dr. Braverman, watch the video below.

In a recent interview, Alan Braverman, M.D., discussed challenges with the detection of aortic dissection, reviewed pertinent risk factors and offered insights on imaging that may facilitate earlier diagnosis of the life-threatening condition. 

CT

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