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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.

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

Based on survey findings and subsequent voting from radiologists at nine facilities, the Society of Abdominal Radiology has issued new consensus recommendations on the use of adult abdominal photon-counting CT.

Nine Takeaways from New Consensus on Abdominal Photon-Counting CT Protocols in Adults

Researchers found comparable 10-year overall survival rates for people who had computed tomography (CT) surveillance (94.7 percent) and those who had surgery for ground-glass nodules (97.6 percent), according to a new prospective study involving over 680 participants.

CT Study Shows No Significant Difference in Long-Term Outcomes Between Surveillance and Surgery for Ground-Glass Nodules

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

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?

’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

New research suggests that a computed tomography (CT)-based deep learning model may offer comparable detection of lung cancer while offering a significant reduction of false positive findings in contrast to the Pan-Canadian Early Detection of Lung Cancer (PanCan) risk stratification model.

For the retrospective study, recently published in 

, researchers assessed the deep learning model in a cohort of 4,146 participants with a median smoking history of 38 pack years. The cohort included 7,614 benign nodules and 180 malignant nodules, according to the study authors.

The researchers found that the deep learning model offered an equivalent AUC for predicting cancer at one year (98 percent) and a slightly higher AUC at two years (96 percent vs. 94 percent) in comparison to the PanCan model. For cases involving indeterminate nodules on CT, the study authors noted the deep learning model correctly identified 68.1 percent of benign lesions as low risk at one year in comparison to 47.4 percent with the PanCan model.

“We saw that we could reduce the false positive rate relative to (the) PanCan (model) by 39.4 percent, which is substantial, without missing any of the cancers that required urgent care … cancers that were diagnosed within one year during the initial screening trials,” noted lead study author Noa Antonissen, M.D., who is affiliated with the Department of Medical Imaging at Radboud University Medical Center in Nijmegen, the Netherlands.

“… Having an AI tool that can do an accurate risk stratification at the level of an expert radiologist can really help to manage these screenings better, so that we can reduce the number of false positive screens in the end to the minimum that we need to still detect the cancers that we find in the screening program,” added study co-author Colin Jacobs, Ph.D., an associate professor of artificial intelligence in thoracic oncology at the Radboud University Medical Center in Nijmegen, the Netherlands. “I think that is the ultimate goal that we have with this research: that we can support screening programs with AI tools that improve the effectiveness and the efficiency of our screening programs.”

Can Deep Learning Enhance Low-Dose Chest CT Assessment of Lung Cancer Risk?

Can CT-Based Deep Learning Bolster Prognostic Assessments of Ground-Glass Nodules?

Olympus Launches CT-Based AI Software for Emphysema Screening

For more insights from Drs. Antonissen and Jacobs, watch the video below.

In a recent interview with Diagnostic Imaging, Noa Antonissen, M.D., and Colin Jacobs, Ph.D., discussed new research findings demonstrating robust risk stratification with a CT-based deep learning model for lung nodules as well as a 39.4 percent reduction in false positives in comparison to traditional classification. 

CT-Based Deep Learning Model May Reduce False Positives with Indeterminate Lung Nodules by Nearly 40 Percent

Exposure to a single computed tomography (CT) scan up to four weeks prior to conception was associated with an eight percent higher risk of spontaneous pregnancy loss and a six percent higher risk of congenital anomaly, according to new research published in the 

For the retrospective study, researchers examined the impact of CT-associated radiation with data from 5,142,339 pregnancies and 3,451,968 live births that occurred between 1992 and 2023. The mean maternal age of the cohort was 29, according to the study authors.

Based on adjusted hazard ratios (aHRs), the study authors noted an eight percent higher risk for spontaneous pregnancy loss (including miscarriage, ectopic pregnancy or stillbirth) for one CT scan obtained four weeks prior to pregnancy, a 14 percent higher risk with two CT scans and a 19 percent higher risk for three or more CT scans.

“We found that not only was there a relationship between the use of CT scan and spontaneous pregnancy loss, it was a dose-dependent relationship,” noted lead study author Camille Simard, MD, MSc in a recent interview with 

. “We saw that in individuals who had no CT versus one two or three or more CTs, the risk of spontaneous pregnancy loss, or rather, pregnancy loss, increased.”

Exposure to CT scans within four weeks prior to conception was also associated with increased risks of congenital anomalies, according to Dr. Simard, an assistant professor of medicine in the Department of Medicine within the Division of General Internal Medicine at McGill University in Montreal. Utilizing aHRs, Dr. Simard and her colleagues noted a six percent higher risk with one CT scan, an 11 percent higher risk for two CT scans and 15 percent higher risk for three or more CT scans.

Dr. Simard noted that these results were drawn from a retrospective database study with possible residual bias and that the overall effect of CT radiation was small in proportion to the study cohort.

“We have to be cautious with our interpretation. (These are) very interesting findings that hopefully will generate more questioning and more research around this area,” added Dr. Simard. “ … In no way is this study discouraging the use of CT when indicated to rule out important pathologies but I think it generates a hypothesis that maybe other modalities could be explored in this patient population.”

New Study Examines Impact of Mammography in Detecting Pregnancy-Associated Breast Cancer

FDA Clears AI-Enhanced Portfolio of Ultrasound Systems for Women with High-Risk Pregnancies

Predicting Nipple-Areolar Complex Involvement in Early-Stage Breast Cancer: Can Cone-Beam CT Have an Impact?

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

In a recent interview, Camille Simard, M.D., MSc, discussed findings from a new study assessing elevated risks of spontaneous pregnancy loss and congenital anomalies associated with CT exposure in the month prior to conception.

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