Are CT Scans Safe? What Most People Get Wrong About Radiation

Speaker A: The headline caught in every newspaper and every media was radiation dose to the US population increased by 600% because earlier report had 0.56 millisievert. The new one has 3 millisievert. So ratio is 3 or 6. 300. 600 six times of 600. Every newspaper article had this big article. 600 people were horrified. Congress had a hearing. FD had a hearing.

Speaker B: Welcome to Frame by Frame, Rethink Imaging, a podcast by imlogix. Here we explore the intricate world of medical imaging, aiming to dissect the field and inspire both professionals and curious minds alike. I'm your host, Chris St. John. Welcome back to Rethink Imaging. I'm, um, Chris St. John. My guest today is Dr. Mahadevapa Mahesh. Dr. Mahesh is a renowned medical physicist, professor of radiology at Johns Hopkins, and chair of the Radiation Control Committee for Johns Hopkins Health System. He is the former president and current board chair of the American association of Medical Physics and also serves as vice president of the internal organization for Medical Physics. With decades of experience in radiation safety and public education, Dr. Mahesh is a leading voice in making complex imaging science understandable and accessible. Today, we explore the role of social media in shaping public understanding of healthcare and how clinicians can step beyond academic circles to combat disinformation and connect more deeply with patients. When I first engaged with Mahesh to discuss the subject matter for this episode, I was a little bit taken back when one of the subjects he threw out was social media. I know that Mahesh is super active on socials. It was exciting to engage with him on subject matter outside of the medical physics sphere. In this conversation, we get into topics of misinformation, AI and how medical professionals and the things that they post online feed into it some real world stories and why public communication might just be part of the job now. Enjoy the episode. Mahesh, it's great to have you here today.

Speaker A: Thank you for inviting me. I'm looking for this conversation very much and thank you.

Speaker B: Yeah, of course. I've been just super excited to have you here for our listeners. Mahesh and I have, you know, we met each other a few times in the past, but recently when we were able to have like a longer conversation talking about preparing for this show. I don't know, I just felt like I got to know you a lot better, uh, and your personality and your, your fun and I'm just excited to talk.

Speaker A: You're very kind. Thank you, Don. Thank you, Chris.

Speaker B: Yeah, of course. And so, I mean, like you, you wear so many different hats. You're, you're a professor, you're a clinical leader, you're a global policy contributor, but you also take the time to make the effort to engage with the public. Right. You, you post on social media, you're, you're always trying to get information out there. What drives you specifically to prioritize public communication in your work?

Speaker A: The first and foremost is as a medical physicist, you deal with lot of the issues related directly with the patient care. And I feel that the patient or public often do not have the right information or uh, do not know where to reach for that information. So I feel as a professional I feel it my obligation to share my knowledge and also make myself available. So, so that if I can help to provide answer or some comforting answer, the right answer, I feel that um, it's part of my profession. That is one of the things which drives me. The second thing is like generally, often we in the academic field we publish publication papers and uh, reports. However, we also know that is only reached to very select audience are a small group of audience and even among those audience, hardly few people will read. On the other hand, by engaging in a social media, you are not only sharing what you are doing, plus you are also doing uh, information out to people which you don't even know who may find it very useful if you connect to that type of thing. I feel that is really an engaging attitude which will also give me a fulfillment of what my profession as a professional I'm doing.

Speaker B: Yeah. And can you, can you tell me how your, your relationship to providing public information has changed with the rise of the social media landscape, Especially to where we are now, where it feels like a lot of people are using social media and large language models to get a lot of their health information, right?

Speaker A: That's correct. Because what happened is like uh, there is still some inherent resistance among the academicians professionals not to engage in the social media. But I was always curious right from the time when Twitter started back in 2009 or something, I opened an account, started engaging and started liking issues and sharing information. Initially, the reason why I got engaged is for multiple things. One is to share information. Second is to have my own repository of information. For example, if I link, if I like an article, I post it, that post will remain in my account forever. So if I don't find it in my computer, I can immediately reach to Twitter account my account and find it. But over the period of time there are other social media platform I'm engaging and with all the things happening. And uh, that is one reason why I'm doing. Plus the reason is like one is for my own self interest of keeping myself knowledgeable about what's going on. And then in the social media environment I'm also exposed to a lot of new things in my field. For example, best example is if you order an item from Amazon bookstore, you only go and order what book you want. On the other end if you go to a bookstore you are also going to the other aisles like travel, fiction, romance or mystery. You accidentally find across articles. I see similar analogy social media with social media. I find very useful article in psychology, emotional intelligence, uh, kindness and history. I would not be exposed if I'm remaining in my own lane and very much cocooned in my field. I find that to be a really um, a uh, good opportunity to learn new things and then if I can also connect and bring that information to my field, how I can share that has also improved my communication skill to convey the message which can be in a language that is reachable to the audience, to the public. So we are usually talk. One of the characteristics of medical physicists is we are required to have the talent to communicate our information in multiple languages. What I meant is not generally geographically multiple languages like Germany, East German, Spanish. No, what I meant is like we need to communicate with not only medical physicist, we have to communicate with the radiologist, with the nurses, with the technologist, and even with the grandmother about radiation. So I call that as a uh, different language. We need to know the skill. So I'm strongly advocating every medical physicist to develop this way to express the same concept in multiple ways so it can reach the audience. And in that regard social media, I find it to be very helpful. At the same time it has also allowed me to engage with new contacts, uh, new colleagues, uh, not only within my institution but around the world. And I find that to be really, really advantageous for professionals.

Speaker B: Yeah, and so I like your comment about obvious, you know, not, not different languages, different languages but you know, within, within the context of at least right now, the English language, you know, the different sub languages and different vocabularies and different understandings that we all share and the pieces that we maybe don't know or don't recognize. I'm curious, when you are writing articles or posting online, like uh, what is your approach to writing and language specifically that allows you to, to feel like you can reach the right people in a way that they can understand?

Speaker A: So two things like I'll tell you two examples, one example Is if I find an article very interesting. Yesterday I found an article published in radiology artificial intelligence. Not everybody get access to that article but the article is about a uh, publication about deep fake images. Oh, I saw this. Exactly. So this article, this is a very nice article about deep fakes. So the investigator that uh had done a very nice there they created some deep fake images clinically almost exactly like flooded m with actual images and then scaled with the radiologist. How will they be able to identify? It's not an easy task. They found a uh, lot of people the artificial intelligence defects could not be recognized when I saw that article. The article is quite deep but I could synthesize in a few sentences. That's one of the reason why I like engaged in the Twitter because even though I don't like all the aspect of going with Twitter but right. But still I got used to writing in Twitter because you are limited by the word character because of that, whatever I want to express it has to be within the 240 characters. And I feel that is quite sufficient right now with a link to the article if anybody's interested to attach and an image by doing so. What happens is like uh, everybody is flooded with information, more information. We don't have time to read the lengthy posting. We do. Whereas this is a two or three page sentences which you can synthesize in your own words uh the essence of the article. Either you take from the summary statement or you can reword yourself in a way but you have to write it in a way it fits within that 240 character. I find that to be very engaging for myself. Plus I also attach a good image because I uh, usually what I post on Twitter I automatically transport it to Instagram, LinkedIn, everything. I don't rewrite anything. Once I write in one platform the same thing get message to other platform. By doing so I have a good image because that's what is important for Instagram. And there is also notes and the link to the article. If a student is interested around somewhere else in the world they can link it in this article. They also send me a link to a archive of how to test yourself whether you are able to identify deep fake versus regular one. I like that one. I went and tested myself. Um, I was almost 50 50. It is not that easy to. But it is very engaging to see what but this engagement. I enjoyed this article. I want to share it to my colleagues. Not if I don't know all the colleagues around me physically may not be interested but my colleagues or any Other brother in the world may be interested. So when I share this, this is in the inter, in the uh, in the, in the Internet. So that way you're engaging people like students in Southeast Asia or somewhere in South America, somebody working on deep fake article they will come to know. That's how I come to know a lot of the articles newer area out of my area. So I find that to be one example. The second example is because of that I don't write very lengthy post which is again time consuming. But this gives me a chance to quickly browse the article and save it to my library. I can read it more later sometime. I download it and print it and read it. That's a different question. But posting really engages me to quickly read the article, post the important essence and get going. Now after 10 days if I come back, I'm searching for the article, I can go back to my social media feed and go through and find it. That's the best part of it.

Speaker B: Yeah. I'm thinking about your comment on like the, the constraints and also benefits with a character limit. Right. And it gets me thinking about how you know, I, I, I try and quit, I've tried to quit a bunch of times but you know, I, I occasionally scroll the Internet, I scroll on Reddit, that's, that's like the last bastion of the Internet that I find myself scrolling on some of the times. And I very uh, I mean and Reddit is social media, right? It is. I, I often find the way that people will, you know, post a slight variation of a headline, right? And then you go into the comments and all the comments are reactionary to the headline itself. And then if you actually read the article, not a single comment actually addresses what was actually addressed in the article. And I'm curious, just, just you know, you are out there trying to provide positive information. But I'm curious about your, your take on kind of the other piece of it, right? How using small snippets of language can totally misconstrue an article and due to our low attention spans people will just take it as go reading a headline and move on.

Speaker A: And that exactly happens sometime when an article published in JAMA Internal Medicine, let's say or New England Journal announced in a local TV channel in 30 seconds. So there's an article with a high impact. They have a local news channel announcing it and it is the only eye catching headlines they do and it has lot of disservice. For example mammography, screening, mammography. We all know it's Very essential. Saved a lot of women's help. However, when an article comes out telling, um, telling the screening mammogram can also cause cancer or something. There are a lot of limitations in the article, but the local media or the news example here is of the TV television, 30 Minutes news channel. They would have a health input and they only use the headline. So today you are sitting in your room with your uh, family and your wife or girlfriend. Anybody sitting there, they see day one, screening mammography is good for health. That's the headline. Day 2 Screening Mammography can cause cancer. That is the one which is growing lot of confusion to the general public. So I am not. So one thing which I've been really strongly proponent is like I don't like to engage reading comments, any posting, but because I can go into Alice in Wonderland, kind of spiral, um, into this one I don't like. And especially the reason why I don't like to engage is there is so much false information. Plus when very negative comments are written by those who doesn't even show the face of them, they're like some bot or somebody hiding behind a screen and spreading misinformation. Fortunately, most of my comments, most of the posting which I have done have not got any negative comments which is really good. Probably people are not interested or those who want to make are not engaged with the trolls so much. So I'm good. But I like to make sure to minimize your things from reading the comments too much unless they're really a good one. Otherwise most of them are really misinformation. And that also applies for CT radiation, which is again public are really going to be uh, misled by wrong information. I think that's where we in the field have an obligation to provide the right information.

Speaker B: Yeah, and I, I wonder like, you know, you're talking about this, this mammal example, right? Day one, it's good for your health. Day two, it's going to give you cancer. I can tell you without you know, having this, this is a hypothetical article and I can still tell you that day two mammal gives you cancer is going to have 10 times the views, 100 times the comments. And even if you know, like, you know, a uh, breast cancer organization, highly respected scientifically, comes out to make a counter argument, counter statement to this hypothetical, that's not going to get traction either. And so I'm curious, like what is your thought on trying to combat this, the clickbaitiness of fear tactics and how we as a community can more effectively combat this misinformation?

Speaker A: This is an important one. It's not an easy answer. I'll tell you example, we did experience that one few years ago. In 2009 we published a big report, NCRP report on radiation exposure to US population. It was a report updated after from 1982. Nobody had done. We had put it together. It's a committee work, Very big article, very big one. It has lot of implication downstream. But the headline caught in every newspaper and every media was radiation dose to the US population increased by 600% because earlier report had 0.56millisecond. The new one has 3 millisievert. So ratio is 306. 300, 600 six times the 600. Every newspaper article had this big item. 600 people were horrified. Congress had a hearing, FDA had a hearing. There are a lot of other fallbacks. We can discuss it. However, after 10 years NCRP again engaged all of us to look into what is there any changes happened in the radiation exposure to US population from medical exposure? So we published another report by in 2019 which is based in uh, 10 years afterwards. In that one we showed that we see a slight decrease in the overall radiation exposure to U.S. population by about 20%. Guess where this headlines went? It went in the fourth page or fifth page. But that's the reality we are facing having faced that we cannot simply get discouraged by that. We had to constantly engage. In fact I'm telling my colleague both at the APM or ACR every time we get a chance, we had to be there, push back on these real signs. And I have many, many examples trying to engage in doing so, irrespective of how many people read or not. Because even if you're able to reach the one person who are scared of getting a CT imaging next day, if you're able to reach that person and you are available to answer the question, I feel that work is done. Uh, so unfortunately we cannot fight back on the bait issue or the rating issue. But we need to engage multiple ways. People like you, like you're doing a podcast, people like in the media, news people. We need to start having a relationship and engage them and provide the right information. And generally uh, it gets up. But we have to keep doing. We cannot be discouraged and stop and hide back to our labs and telling like my God, I'll do my work, I don't want to engage. That's the wrong notion.

Speaker B: Yeah. And I mean especially there's almost like a societal pushback towards the trust of the medical establishment right now to some degree too. Right. I mean like you, you, you see it with anti vaccination people. There's, there's you know all sorts of stuff going in the background in the US government right now kind of retackling American healthcare. There's some quotes there. I'm just curious like especially like it makes your job harder. Right?

Speaker A: It is true. Let me tell you an example. I was recently was in a conference. Um. Uh. It was a couple of data was provided that they had a heat map of the US and then done a survey of the general public. Who do you trust or who do you distrust? The hottest area was around the capitol building. The next hottest region is around the universities.

Speaker B: Mhm.

Speaker A: Unfortunately we are in this cocoon of people don't trust us. And there are a couple of reasons. One is we have not successfully engaged with the general public all these days. There is always this ivory tower academician. What do they know? I know everything. What do they know? They don't understand what I say. That mentality has been within our academic field for a long time. In fact uh, the person there are a couple of um. Good health science reporters writers had mentioned that long time back I think so Elliot Siegel, the very famous physician physicist Siegel who did this uh, uh. About cosmos and all those things Even back in 80s he mentioned that if you guys don't. If the scientist and South Academy if you don't reach to public, general public and this one your trust will be gone. And now we are realizing that after 20 years. So right now that is a situation. But at the positive side on the other hand even among the majority of the people who are loudly opposing or distrusting about a CT scan or imaging or scientist, if he or she have a close family or them having a question about radiation, they still like to go back to the real authentic person to get the answer. Mhm. And my question, my answer is at that time he or she should be know where to reach and where to reach is what how we engage on a constant basis that way. This person may have opposed my tweet, he may have disliked my comments about radiation and everything. But when it comes to individual one he or she will be. Should feel comfortable to reach out to me. And when they reach out we as a professional have an obligation to ask the right. I think that is. It is a long. It's a long game. It's not a overnight game. It's a long game. Especially in this current environment where there's a lot of distrust. We cannot go back and remain in our shell. This is the time more to reach out to the general public and uh, in some way if we engage the right group, they will be on our spokesperson. One example patient advocacy group. They are really strong and I have some experience uh here seeing this very close and in the American College of Radiology, the journal called Journal of American College of Radiology. I'm currently one of the associate editor of the journal. Few years ago the editor brought in a patient advocate onto the board. They have done such a wonderful job. Um, she's a very engaging person about lung cancer because she had some. Her husband had an issue and all those things. She was a patient advocate. So the way she has engaged us is like the complex appropriateness criteria articles. She and her group develop a one page patient friendly conversion translation and that is also published. So they have become a spokesperson for who Radiology is what we do. So we have to find ways to engage with them and connect with them. That is the only way because we cannot remain ourselves. Unfortunately we sometimes we think it's too much work. Plus it's not my lane. I do my work. Forget it. I don't want to handle with this one. If that happens, then whatever knowledge you are providing does not reach scalable. It is not scalable. It cannot reach the. So that is my philosophy of engaging. It's also extra work. I know but sometimes some people are asking like how come are you, how come you're engaged? So much like I engage with them. I also find two things. One is I don't read every article, say every social media. I'm not engaged. As I mentioned earlier, I don't have any notification. Then I'm interested. When I find something, I share it. Plus when I'm walking or doing something else, I also do some of this tweeting. So I try to manage this sometime at most that's the only way I find it engaging. And it has given me multiple folds of comfort of what I'm doing. Uh, so that is, that is the, that is the. At the end of the day you feel that you have done something to my. Not only my. As a professional but you are trying to answer somebody their question which is very difficult for people to reach.

Speaker B: So yeah, I feel like we, we need to touch a little bit. Right on. Specifically.

Speaker A: Sure.

Speaker B: The misinformation going on within, you know, within this field, within medical imaging, specifically regarding CT or M. MRI contrast agents. I mean, uh, you know, I think everybody listening probably can take a decent guess at what some of the more prevalent scary stories are about imaging today. But you know what I'M curious what you are coming in contact with in your day to day information. Disinformation that feel, you know, dangerous, uh, or hard to counter.

Speaker A: You'll be surprised because uh, last December I was asked to speak on this subject at the iaea, uh, conference. My talk title was dealing with MIS and disinformation. Mhm, exactly. First and foremost, what there are a lot of myths about radiation common myth which is easily can be resolved. Like you know, X ray rooms. Once you come out of the X ray, once the X ray is off, there is no X ray in the room that is easy to engage. And the one best way to answer is like. It's like a light bulb. You turn the light bulb, X rays are turned on. Otherwise the same thing. Uh, nuclear medicine, that's a different question. The other question is one of the aspect is important to engage the public because public doesn't know the difference between 1 millisievert or 10,000 millisievert. Both of them seem same. And the moment you say radiation, then mitre conjures up to Hiroshima, Nagasaki bomb,

Speaker B: of course atomic bomb. It's our only reference point. Right.

Speaker A: And then the second thing which I use in my teaching purpose why people have this concept because there are a lot of comic books we read when we are younger days. Like a lot of the comic books like Fantastic Four, Incredible Hulk, they all had location very accurate. But the scientific fiction tells about radiation resulted in the Incredible Hulk phenomena. So we have in the back of mind. Plus since we cannot quantify, see, smell or touch, the word radiation can conjure a lot of information. So we need to uh, dispel the unfamiliarity by giving the right information. So that is one thing. Second is especially patients, they already have other tension and uh, issues going on in the mind. On top of it, when they're coming to the office in the outpatient area where they're sitting there, they read a magazine, open the page and there is an article telling like ct, uh, cast CT scans can cause future cancer. There's an article recently last year. From next year onwards we can exchange additional hundred thousand cancers because of cte. That is a catchy headline. But we have pushed back on that one. In fact, one of the ways to push back is either individually engaging and writing articles, uh, posting in the submission. The second is using the strength of the professional societies. So last year I served as the president of the American association of Physicists in Medicine. During the year we had three or four times we had to engage within 24 hours to provide public statement Pushing back some of these limitations. Best example was that Jamaica article talking about the future cancers. There'll be an increased um, 5% additional cancer because the CT imaging done now. So that is a statistical calculation. I'm not going to detail, I'm not going to push back on the details of the calculation but there are a couple of limitations. I'm going to highlight the way they have done the calculation is same thing as they had done all these years. The same group have ah published consistently negatively about CT imaging over the period of time. There is a lot of improvement happened in the technology. We are doing much less radiation dose delay needed for a particular CT compared to 20, 30 years ago that is not accounted in these things. So because of that this, this exaggeration is going to be like over exaggerated without taking into account the only thing which can serve there is like is allowing us to re look back. And the societies have done really well, professional societies have done well and we have engaged with our vendors to optimize the protocol. So all those things has to be taken. So simply making the general statement can really scare the patient and not provide the right information. And that we had done many times and we had to do that. Then when this article came APM and ACR we put out public statement pushback. Plus we were able to engage on some podcast. I did uh, a podcast with Diagnostic Imaging two podcasts along with the radiologist to discuss this paper. Not that it reached millions of people compared to the article but it is out there. The reason these days I find it one more advantageous of uh being there on the social media providing this pushback. The reason is two things. One is everybody is using AI. What does AI do? It basically taking what's there and putting it down. Answer I seen that there are consistent article in a particular subject and it shows us on my server when I do the AI, uh open GT whatever. So if more right information you keep putting outside that will also come into the AI answers so that can reach a lot more people. I realized that recently like wait a

Speaker B: minute such a good point.

Speaker A: When bad information get rolled into the AI answer the good information will also be picked up by the AI. So more we flood the good information into the Internet sphere the chances that coming up on the top is higher. So I realized that in only a few days ago and I'm like I'm going to hit on this point multiple times with my students or anybody why we need to engage. Because now this has given me one additional point what I am doing or engaging in the social media is important because it is providing a pixel of value to the ah, AI. When it digests all the pixels, my pixel is also there. If it is 10 times the pixel that might come up with the first. That's my point.

Speaker B: Oh, that's such a good point too. Right. I mean I am not above, you know, using AI for a little bit of health, health care information here and there. Right. Uh, you know, I, of course I want to be double checking it and stuff but you know, I, I talked about this on the show briefly in a previous episode, but my, you know, my, my partner had, you know, a neurological thing happen. Right, sure. We were, we were in the ER for 16 hours while they were doing imaging, while they were waiting for things. Claude successfully diagnosed what it ended up being within the first hour and a half of being in the er. Right. Uh, it was, it was, you know, glad, you know, it was just interesting because by the time I was actually speaking to a doctor and saying, hey, this is what it is. It's, you know, it's called this, this is what you. I was like, oh, I've, I've been, I know all about that. I've been reading about it all day.

Speaker A: But in fact our physicians are now experiencing that because the patients are coming to us with more and more information ready and especially with radiation. I have seen many times patient will go and Google it, I got a head ct, blah, blah, blah. Now here comes the human interaction. I'm again, this is another point I'm going to make more about what is our role because in fact next month I'm giving a talk to, I think in Southeast Asia in a webinar on what's the essential skills for effective communication in the AIA era. And I'm going to engage these aspects because when patients are coming with this information, rather than simply discouraging or discrediting, we may have a conversation to explain to them properly. Because if it is correct, fine, that they know that I would enrich my knowledge also. But if they are incorrect, I can at least have an opportunity to tell what is incorrect. Even now in the Google these days, whenever I Google something there is an AI outprint comes the first layer is the AI stuff and that's what people are going to use it because I would use it for something which I'm not in my field. But that's where we want to be there by having information engaged in the public. So more we put out the AI, ah will pick up our information.

Speaker B: I especially like the circling back to Communicating in person. Right. As human beings. I think certainly post pandemic, you know, we have as a society, we just don't engage personally with people in the same capacity. But I'm curious more specifically, like, you know, I think within imaging, it's, it's potentially fair to say that technologists often have a lot of access, if not the closest contact with patients. I'm curious, what role do you think they could possibly play in improving the public's understanding of imaging?

Speaker A: I consider that their role to be very key because they, I consider them to be the window for radiology because they are the spokesperson meeting with the patient when they do an imaging. And because the patients engage, they are comfortable to asking them question. So we in our field, like medical physicists, everyone, uh, there are not everywhere available. We cannot scalable. There are thousands of technologies, are there? Our field should engage with the SRT or technology to provide as much information as possible. There's one solution. I like it, which I've been always talking about. When a new equipment is brought in, like a CT scanner, they have an apps person coming application person to show the technologies how to use it. I've often engaged with the apps person when I'm doing acceptance testing to telling them here are things share with the technologies, not just pushing the button, share with them. So they're equipped with this information. So one is we need to educate or provide more information to our technologists so they can answer. Second is if they cannot answer, if they are not comfortable answering, they should know who to reach. And not everywhere there are medical physicists who are available to answering. But again it can be scalable. For example, Health Physics Society or aapm, we have a group of people who can engage. We are ready to engage. They should be able to reach them and they can answer it. So that is multiple ways we have to. But their role is very key because, you know, often patients think that radiologists are uh, technologists. There is a confusion because they hardly meet with a radiologist. Hardly. They never meet with a medical physicist here at Hopkins because of my relationship with my radiologist. If they have a patient, a uh, technologist, if they have a patient ask the question, they usually try to engage me. And I have found multiple time where I go and directly talk with the patient, which is good for me plus also good for them providing all the answers. Every time I engage a patient answering this question, within a week I get a couple more call from the relatives because they know now who to reach the reachable point and where to reach the Resource is essential and I think the technologies plays a very important role. We need to give credit and we are to equip them with all the information we have.

Speaker B: Yeah, you know, it's funny you, you say that too because like, once again I'm, I've only been around for a couple years. I, you know, if I had questions about imaging and there was a technologist imaging me, I wouldn't know to ask for a physicist. I didn't know, I didn't know medical physics existed.

Speaker A: Exactly. And even now, even today, we are working very hard to tell who we are because, um, for the first time last year during our annual meeting in dc, we had an advocacy day. We took our members for the first time to the Congress. This is the first time our members went and met with their respective congressmen and senators, basically telling what we are, who we are and what are we engaged. And uh, we are decided at a societal level to do more often. A.C. american College of Radiology does it every year. Because of that they have an engaging pathway with the legislators and therefore we can advocate for the right regulation. And I feel the same thing here. We need to engage and advocate and I'm trying to do the same thing in other countries through my umbrella of this IOMP also.

Speaker B: You know, I, I, you know, we're primarily a US focused show. But you know, I, I am curious, you, you have such vast international leadership experience and I am just curious about how you see specifically like the US's relationship to disinformation versus maybe other countries. Right? Is it, is it worldwide? Do we all have the same relationship to it? Are we just a bunch of suckers in the us? Like, I'm curious what you've seen.

Speaker A: So what I've seen is two things. One is the same amount of level of imaging is not done worldwide, it's increasing now. For example, in 2008 the CTS number of CTS we were doing accounted for nearly 30 to 40% of all the CT scanners images done in the worldwide. Now the latest UNSCARE report which has part of the UNSCARE report, we see that now, even though the number of cities done in the US is now close to 100 million, we account now only for 18%. That means lot more imaging done worldwide. However, the concern about imaging radiation is still not so wide outside because outside the us, the patients really trust their physician. They don't question them, they will just simply do what they're asked to do. And a lot of the time they are not asking this question only area Where I see among the European colleagues they are a little bit more worried about radiation. They're a lot more concerned about radiation and they always blame us. Like you guys are doing so much imaging. But that's where. But otherwise I would not say there is disinformation. There is no information sometime and they don't even have that information sometime. And last year I was in China where the China healthcare is growing so big but the concepts are now slowly trickling into patients to ask this question but it's not engaged so much but it's going to come up. But there's not more information and disinformation over there but here because the way the media picks up negative aspect it is amplified and that can cause a lot of concern globally.

Speaker B: Yeah. You have suggested creating short summaries of complex medical papers for public consumption. I am curious what your ideal version of that looks like. Whether or not it's YouTube or short form podcasts or newsletters.

Speaker A: So I have done short youtubes. Um, uh, there is a website which uh. I was part of involved with called RadiologyInfo.org this is a public facing website managed by the American College of Radiology and also RSNA and I had worked uh representing ACR on that one. On the patient safety there the website is done for patients coming and finding answers of the radiological procedure. And there is also a page on radiation safety there we have dose tables with respect to natural background radiation explaining. Plus I had done a short video 2 minutes videos on CT dose and other things. So I like those short videos. I've done many for Hopkins also it's on the public YouTube short videos, 2 minutes 3 minutes videos. In addition I've also done long term um podcast or short video cast on CT only but that's only for like you know, palatable for radiology residents. And that's under ctss uh dot com. The fun thing which I want to tell you is about there was an issue about patient shielding few years ago APM we put out a position statement which was also co signed by the ACR RS and everything that with the current technology we should not be shielding patient when we're doing an X ray imaging or anything. Because this has been such an ingrained concept of shielding the patient for many, many many years. But now we have scientific evidence why we should not be doing. Because with all the digital radiology technology if the shield comes in the path of the primary beam that can cause a lot more radiation.

Speaker B: Right. The automatic exposure control.

Speaker A: Automatic exposure control. Sometime it can also Obscure the object providing plus the radiation outside the main field is purely because of internal scatter, not for any external scatter. So lot of the time this shielding was giving a psychological comfort rather than real stuff. So having that done, the position statement came out. There was some miscommunication, misunderstanding and that caused lot of issue with it. The funny thing is two things. One is we did a. There was a New York Times article going into details of this particular one. When the New York Times articles had some um, statement done there. But in the same day, myself and my colleague, a radiologist here who is well known, Elliot Fishman, he did a Facebook live with me about talking about this particular topic. You'll be surprised. This Facebook live within 24 hours had about 60,000 views around the world. And then within the next few months we also did another Facebook live on Covid and how the X ray imaging has to be done and all this. So what we have, um, in fact we have published a paper on how Facebook Live can be used to disseminate good information scalable globally in a very short period of time. I will be sharing that article. It's published in gac. That's one thing. The second thing was fun. Regarding the patient shielding, there is a lot of confusion because we had to separate it. We came out against shielding the patient, but we are not telling not to shield the person working around the radiation. That is the confusion the staff. So how do we do? So I thought one way to engage is writing comic stories. So if you have a comic story written up, like a comic conversation, comic strip. And I want to create a comic book. And I had an artist here who started working on it, but then she had to leave. Luckily, at Hopkins we have a medical illustration student master's program. And one of the student took up this comic book strip and converted into a video animation. Five minutes, video animation. And we engaged the technologist asking about a couple of questions before showing the video. And we did the analysis afterwards. Because the publication journal store, like if we have that information, we'll be able to publish. So we were able to publish it. Now the video animation is only five minutes. It's an engaging conversation between two technologists why we have come against the shielding. So I find this is another way of engaging the public. So I have a couple more comic books or uh, some songs. But I need to have artists to engage these things. But I find that to be the right way, at least one of the ways to engage the public. So I'll send you the article both on the Facebook Live and also on the animation which we published in jac those article I'll send you which is again uh, public facing articles to engage complex concepts in a simple terms. M still maintaining the accuracy of the whole thing.

Speaker B: And to our listeners we are going to publish the links to those in our show notes. So you can just scroll down to the description and find those linked right there.

Speaker A: Yes, beautiful.

Speaker B: I love the idea of comics. That's such a great little approach.

Speaker A: You will be surprised some of the very high impact journals. Actually there is an article from archival of Internal Medicine they are beginning to publish uh, uh, comics stories on complex concepts. And that is on IRB approval. It was a very nice patient consent and I find that to be very engaging and very fast. And this animation will tell you that our comic uh artist almost finished it but she had to leave. But I could not engage anybody else. So we convert that into an animation. And she did such a wonderful job as part of her master's thesis. So it was a two win for the student. It was a project and for us to provide this animation now it's available for anybody to use it.

Speaker B: You know it's so interesting. I think very often like the format of a comic itself can be some like can be societally or culturally construed as like a tier below reading. Just language, right? Exactly. I think you know people, people see that you know there's, there's like people will make a comment about like oh this. Did the book have pictures in it like implying that it's for children or that it's juvenile. But you know you also look at these incredible works of literature in the form of comic and graphic novel like the Watchmen series or you know, mouse or what. Whatever it is. But then I like I tying it into the world of medicine where visualization and illustration is not just helpful but it's, it's borderline necessary. And so it's, it is, it's a very interesting sort of dichotomy to like have this like culturally juvenile form of, of conveying uh, information. But here it's actually like it almost seems like the most prudent option.

Speaker A: Actually it's more penetrating. And see that's what I'm trying to say. Sometime I try to navigate between two worlds. One is our high level academic ivory tower people which is. I'm also have one foot there. The other side is the general public. For them they think I'm very juvenile putting this all this comic story. But I personally feel like it is reachable people engaging. Let Me give you another example which is really I came across on a Netflix show. It's really funny. It's called Radiation House. It is actually I found out who the author was and author actually has written this book about um. A life of a technologist in a hospital. How he or she he's an expert radiologist but he want to be a technologist because of his girlfriend blah blah blah there about each episode. It's so nicely done. I went and binge watched the whole thing. It is kind of funny because they talk about it's a small hospital they're trying to diagnose and only one thing mammography that day diagnosing something with cardiac uh, catheter. So you want to engage the public. This is the best way. We need to be on the social media and engage it. Now I've um, added to my advantage list is one is the AI we can help make sure to re engineer the AI solution by providing the right information. So I want to tell you one other story. This is a very interesting story which you don't come across with medical physicists. Back in 24, uh, two or three years ago there is a big news uh, every news article covered about contamination in the funeral home probably might have heard about it. So what happened is like it's kind of funny because this came out as a one small case study in a jama. Then it was exploited immediately it becomes catchy. So a patient had a radioactive seeds implanted in a place in one hospital. A the patient left the hospital a discharged himself, went home. Then he kind of died. He went back to another hospital for something else and he died there. He had some inherent seeds still in his body like prostate. I don't know the details. So the body was sent to crematorium and in the crematorium picked up some contamination radiation. So this kind of created such a havoc around the country here NBC News Nightline News covered everybody covered. They went and showed outside the funeral home the radiation. Then we did a Facebook Live immediately here at Hopkins myself with my engaged. So we wanted to dispel this whole thing. This is because what has happened why is there how it needs to be deal and the contamination is not that high and all those things NRC nuclear regulatory mission has documents on that. But again nobody reads that immediately. So we did this webinar or the Facebook Live article. Fine. It reached out to a lot of people. Meanwhile, the implication of this shielding this contamination the funeral home created havoc in one area in Canada. In this town the daughter could not Find her father to be buried or uh, cremated in the 24 hours. Because all the funeral home in that area would not take her father's body because they knew they thought that body was that person had a radiation treatment long time back Again, radiation treatment long time back should not have any implication. But there is a misunderstanding. If we take a patient who had a radiation treatment, their funeral home will be contaminated. They didn't want to. Luckily the next day there was our article. Our Facebook live was covered in the media. Their article there even here Aunt Mini and diagnostic imaging covered it because of that the newspaper told like okay, here is um, the Facebook the professor at Hopkins say it's all safe and then they change the law whatever it is. But what I'm trying to connect here is like the interaction where we can provide the public service. And you'll be surprised that even I got a call that funeral home directors have their own national association meetings. So I even got an invitation to come and talk to them. But I didn't take up on that time. I was busy. But this is a very interesting in my profession getting involved publicly in the social media leading to one one from one thing to another one.

Speaker B: Mahesh, we are coming to the end of our conversation our time today. But you know, before I let you go, I'm curious what advice you would give to health care professionals and not limiting to one specific sphere in imaging, right? Radiologists, technologists, physicists. What would advice would you give to those who you know, want to join you in your initiative and start engaging with the public. But don't you know, either social media is not their thing or they, you know, they don't know how to get started.

Speaker A: So my, my one advice to this like as a professional feel this is an obligation to engage with the public, with the surroundings, even with the local community, if you can. In fact I had I. I even gave a talk about radiation in a free market one time because of the uh. Some other group had invited me. That's a different stretch. But what I meant is like if you want to start engaging social media, start slowly and be comfortable in the sense once you're comfort I would start engaging like liking a posting and then once in a while posting what you like it and then be consistent on that aspect. There are two things. There are people professionals who can engage. Either keep everything professional and they don't share anything personal. That is fine too. But for me and a couple of my other colleagues, we share everything. So one of the advantage I found that by doing that the people who are engaging with me feel that I'm a real person, not just an iy ah, professor because I share some goofy comics to the food I cook, to the travel diaries I do when I travel. That has kept quite engaging and I've heard a lot of positive remarks on that and I'm comfortable doing that. I'm not saying that is the only way, but at any time, especially younger students or anybody early in the careers, others will only know what you're doing when you share what you're doing. And one of the tagline of my which I have in my email is be curious. You are curious. You be curious in a positive way. By curious you are not only sharing what you know, but you are also learning and you'll be exposed to a lot of new things which I was never engaged. There was a very good article about AI which came across um, fewer two years ago, written in New England Journal of Medicine, very nice article. And the authors have nothing to do with the AI. One is a psychologist, the second one is an anthropologist. And they have written this article how we should engage with AI. And there are a couple of concept in three pages. I would not have known if I had not been reading on the social media, um, some of this article. So that is the plus side of being engaged because you're going to expand your horizon and you can apply that back to your field to enable you to communicate better way. And I have learned, I feel that I have learned a lot and I've improved my communication skill because more and more you engage. You don't have to worry, you have to be perfect. Even if you are wrong sometime, then you can correct yourself back. So that's what I would say, engage. And that will also in a way makes you happy with your own sharing this like uh, insight. Inherently you feel like you are doing something for the good of the people, especially when there is so many this confusion and negativity around. We try to do at least one small things in our field.

Speaker B: Oh, uh, I love that. I feel like that's uh, a great place to end. Dr. Mahesh is a renowned medical physicist, professor of radiology at Johns Hopkins and chair of the Radiation Control Committee for the Johns Hopkins Health System. Dr. Mahesh, if people want to follow you on socials, continue to be curious and hear all of these little gems. Where can people find you and your resources online?

Speaker A: So I engage in almost all the media. So I'll send you the link of all my tags. You can share it these days, even though I write in Twitter and but then I migrate all the text to Instagram and LinkedIn because right now LinkedIn is quite widely popular. So I use that and I also have a blue sky. So I'll send you this one TikTok. I'm not encountered in the engage no trouble. And I, in fact I told my students uh, one time like I wanted to engage the student to create a TikTok videos as part of the classroom anyway. But that's where I do this social media and I'm happy to engage or answer anything I can. So that's why I'm quite open to these, uh, platforms. And I appreciate Chris in giving me this, having this wonderful conversation. This is one of the areas which I really like. Have more conversation and hopefully advocate or proponent, motivate others to join.

Speaker B: Absolutely. And I, uh, hope to have you back on the show. Mahesh.

Speaker A: Thank you very much.

Speaker B: Thank you. Frame by Frame, Rethink Imaging is brought to you by imlogix. Here you'll find engaging interviews with thought leaders, experts and patients sharing stories that showcase the transformative power of medical imaging. To discover how Imalogix is rethinking imaging in healthcare, visit imalogix. Com. Be sure to subscribe to Frame by Frame Rethink Imaging on Apple Podcasts, Spotify or wherever you listen. And from all of us here at Imlogix, thanks for tuning in.