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HCB News: Can you give us an example of a situation where a pediatric patient was harmed by efforts to reduce the amount of radiation they were exposed to?
JS: The answer to that is not known with any precision. Let’s say the image quality was nondiagnostic. The radiologist will read it and the consequence may be a misdiagnosis, the likelihood and harm of which are difficult to quantify.
Can I give you documented evidence of some child being misdiagnosed? You’d have to talk to radiologists who have been practicing forever and are now worried because images taken at lower doses may become nondiagnostic. Or they feel too pressured or constrained to recommend a CT, for example, and instead must choose MR or an ultrasound, which may not be as good for the study they need to get done.
HCB News: Your perspective on radiation can seem controversial for someone who has been hearing for years that reducing pediatric CT utilization is important for curbing cancer rates. Is it a challenge to convey your message without upsetting people?
JS: Of course it’s a challenge, but what’s controversial to me is that people believe that low doses are harmful. I would ask the question, what’s the proof? Where’s the evidence that low dose, not high doses from an atomic bomb blast, but low doses from everyday life such as airline travel and imaging involve a risk?
The Fukushima nuclear accident of 2011 is a modern example of radiophobia’s danger. They immediately evacuated 150,000 residents from the area. The doses that they would have gotten had they remained were so small that the United Nations subcommittee, UNSCEAR, publicly pronounced that nobody would have had any detrimental effect had they been allowed to stay in place rather than be forced to evacuate.
But what happened as a result of the evacuation? People got uprooted needlessly from their homes without any planning. They didn’t have access to the drugs or doctors they needed. Of the 150,000 people evacuated and not allowed to return home for years, 1,600 people died as a result of the evacuation, not the radiation exposure. They were old. They didn’t have their meds. They couldn’t go to their doctors. They became alcoholic. They committed suicide. Yet, that story hasn’t gotten out. Where’s that story?
HCB News: Is there any proven link whatsoever between administering multiple PET/CT or CT exams and the development of cancer?
JS: There is no documented evidence below 100 to 200 millisieverts. A CT scan is about 10. Can it happen? Is it probable? Could it possibly happen to someone among the billions of people who live in this world? Perhaps, but it is much more likely that the suspicion of cancer in the individual caused the CT rather than the other way around (known as reverse causation).
