4 ms·

It's not that MRIs suck at cancer. They provide fantastic structural and functional data. The problem is the specificity of the results and the prior. A full

It's not that MRIs suck at cancer. They provide fantastic structural and functional data. The problem is the specificity of the results and the prior. A full body MRI by definition will provide detailed views of areas where the pretest probability for cancer is negligible. That means even a specific test would result in a high risk of false positives. As a counter point, MRS means that you can now MRI someone's prostate and do NMR on lesions you find. Lets say someone has lower urinary tract symptoms. And is 60 years old. An MRI could visualize as well as do a analysis that would otherwise require a biopsy. With the raised prior you can be quite sure suspicious lesions are cancerous. Similarly for CNS tumours. Where fine detail. Subtle diffusion defects can mark csncers you couldn't even see if you cut the person open. No sensible doctor would give you a whole body CT unless there was a very good reason. That very good reason is probably "we already think you have disseminated cancer". That pushes the prior up. And less so for a PET/CT. Lets flood you with x-rays and add some beta radiation and gamma to boot! The danger of an unnecessary CT/PET is causing cancer, the danger of an unnecessary MRI chasing non existent cancer.

ErroneousBosh 8mo ago
> The danger of an unnecessary CT/PET is causing cancer You'd have to be massively overexposed to CT or PET scanning to cause cancer, like in the region of spending months being scanned continuously with it at full beam current.
- rustyhancock 8mo ago
  Even if you don't agree with linear no threshold models for cancers induced by radiation (I don't think LNT is accurate). It comes down to the scan and the age. 3 scans for a 1 year old? Strongly associated with cancers later in life. 5 scans of a 50 year old? Less so. The 1 year old has an 80 year run way to develop cancer, along with cells already set in a state of rapid division, and a less developed immune system. But the association is quite strong. https://www.sciencedirect.com/science/article/pii/S0720048X25005571 https://www.sciencedirect.com/science/article/pii/S0720048X2...
  - pfdietz 8mo ago
    > I don't think LNT is accurate There's excellent reason to think LNT is accurate: at low doses, almost every cell is exposed to at most one radiation event. The dose affects how many cells experience a (single) event, but does not affect the level of damage to those exposed cells. Linearity naturally falls out of this. To abandon linearity you have to imagine some sort of signalling system (not observed) that kicks in at just the dose we're talking about (not lower, not higher) to allow exposure to one cell to affect other cells. There's also no good evidence that LNT is wrong. The typical things that are pointed to by anti-LNT cranks are cherrypicked, often involving interim results from studies the full results from which do support LNT, which is evidence it was statistical noise.
  - ErroneousBosh 8mo ago
    > 3 scans for a 1 year old? Strongly associated with cancers later in life. 5 scans of a 50 year old? Less so. Someone being born with no legs is strongly associated with them using a wheelchair in later life. Why are you giving a one-year-old three CT scans? For shits and giggles? Or because you think they might have cancer?
  - pedalpete 8mo ago
    I think the bigger point you are making is that the 50 year old is also more likely to have developed cancer. Maybe a full body MRI once a decade is fine until your 30s, then once every 5 years until 50, then once ever 2 years beyond 50. The test should scale with the probability of cancer.
    - deleted 8mo ago
      [deleted]
    - bondarchuk 8mo ago
      They were not talking about MRI, there is a significant difference.
    - bondarchuk 8mo ago
      They were not talking about MRI, there is a significant difference (purported).
- lostlogin 8mo ago
  > You'd have to be massively overexposed to CT or PET scanning to cause cancer The mean effective dose for all patients from a single PET/CT scan was 20.6 mSv. For males aged 40 y, a single PET/CT scan is associated with a LAR of cancer incidence of 0.169%. This risk increased to 0.85% if an annual surveillance protocol for 5 y was performed. For female patients aged 40 y, the LAR of cancer mortality increased from 0.126 to 0.63% if an annual surveillance protocol for 5 y was performed. https://pubmed.ncbi.nlm.nih.gov/36856709/ https://pubmed.ncbi.nlm.nih.gov/36856709/
  - ErroneousBosh 8mo ago
    > 0.126 to 0.63% So, a just-about-measurable increase, if you pick and choose your values carefully? You are not going to die from cancer caused by getting a PET scan. This will not happen. You're going to die of heart disease or as a not-too-distant second in a car accident.
    - lostlogin 8mo ago
      That data is for one scan, ever. Continuous scanning for months would give a dose many orders of magnitude higher.
- azan_ 8mo ago
  Approx. 5% of all cancers in US are caused by CTs
  - ErroneousBosh 8mo ago
    [citation needed]
    - lostlogin 8mo ago
      5% seems a bit high, but we are nearly there. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/acs-brief/may-13-2025-issue/ct-imaging-increases-lifetime-cancer-risks/ https://www.facs.org/for-medical-professionals/news-publicat...
      - ErroneousBosh 8mo ago
        I think they're reading too much into it. How are they determining "this cancer was caused by the CT scan" versus "this cancer was caused by the cancer we were originally looking for that was there all along"?
        lostlogin 8mo ago
        Radiation doesn’t label the cancers it causes. Other than comparing population groups, what method do we have?
        ErroneousBosh 8mo ago
        Well, you could work backwards and look at your assumptions. Why is "We think this person has cancer so we gave them a CT scan and look! Now they've got cancer! It must be because of the CT scan!" the conclusion to jump to?
        azan_ 8mo ago
        Please just read this article - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2832778 https://jamanetwork.com/journals/jamainternalmedicine/fullar... It's funny that you instantly assumed that authors are stupid and did not think about this obvious pitfall. It's extra funny that you also accuse them of jumping to conclusion without actually reading the article.
bell-cot 8mo ago
> Lets say someone has lower urinary tract symptoms. And is 60 years old. An MRI could visualize as well as ... Not a doctor - but maybe start with some quick & cheap tests of their blood & urine, polite questions about their sexual partners, and possibly an ultrasound peek at things? At least in America, high-tech scans are treated as a cash cow. And cheap & reasonable tests, if done, are merely an afterthought - after the patient has been milked for all the scan-bucks that their insurance will pay out. Source: Bitter personal experience.
- blincoln 8mo ago
  > At least in America, high-tech scans are treated as a cash cow. And cheap & reasonable tests, if done, are merely an afterthought - after the patient has been milked for all the scan-bucks that their insurance will pay out. Maybe it's a regional thing, but that hasn't been my experience. I've had one MRI and one CT scan in the 25+ years that I've been a full-time employed adult with insurance. I'd have been happy to sign up for more so I could have proactive health information and the raw data to use for hobby projects.

ErroneousBosh 8mo ago

> The danger of an unnecessary CT/PET is causing cancer You'd have to be massively overexposed to CT or PET scanning to cause cancer, like in the region of spending months being scanned continuously with it at full beam current.

rustyhancock 8mo ago
Even if you don't agree with linear no threshold models for cancers induced by radiation (I don't think LNT is accurate). It comes down to the scan and the age. 3 scans for a 1 year old? Strongly associated with cancers later in life. 5 scans of a 50 year old? Less so. The 1 year old has an 80 year run way to develop cancer, along with cells already set in a state of rapid division, and a less developed immune system. But the association is quite strong. https://www.sciencedirect.com/science/article/pii/S0720048X25005571 https://www.sciencedirect.com/science/article/pii/S0720048X2...
- pfdietz 8mo ago
  > I don't think LNT is accurate There's excellent reason to think LNT is accurate: at low doses, almost every cell is exposed to at most one radiation event. The dose affects how many cells experience a (single) event, but does not affect the level of damage to those exposed cells. Linearity naturally falls out of this. To abandon linearity you have to imagine some sort of signalling system (not observed) that kicks in at just the dose we're talking about (not lower, not higher) to allow exposure to one cell to affect other cells. There's also no good evidence that LNT is wrong. The typical things that are pointed to by anti-LNT cranks are cherrypicked, often involving interim results from studies the full results from which do support LNT, which is evidence it was statistical noise.
- ErroneousBosh 8mo ago
  > 3 scans for a 1 year old? Strongly associated with cancers later in life. 5 scans of a 50 year old? Less so. Someone being born with no legs is strongly associated with them using a wheelchair in later life. Why are you giving a one-year-old three CT scans? For shits and giggles? Or because you think they might have cancer?
- pedalpete 8mo ago
  I think the bigger point you are making is that the 50 year old is also more likely to have developed cancer. Maybe a full body MRI once a decade is fine until your 30s, then once every 5 years until 50, then once ever 2 years beyond 50. The test should scale with the probability of cancer.
  - deleted 8mo ago
    [deleted]
  - bondarchuk 8mo ago
    They were not talking about MRI, there is a significant difference.
  - bondarchuk 8mo ago
    They were not talking about MRI, there is a significant difference (purported).
lostlogin 8mo ago
> You'd have to be massively overexposed to CT or PET scanning to cause cancer The mean effective dose for all patients from a single PET/CT scan was 20.6 mSv. For males aged 40 y, a single PET/CT scan is associated with a LAR of cancer incidence of 0.169%. This risk increased to 0.85% if an annual surveillance protocol for 5 y was performed. For female patients aged 40 y, the LAR of cancer mortality increased from 0.126 to 0.63% if an annual surveillance protocol for 5 y was performed. https://pubmed.ncbi.nlm.nih.gov/36856709/ https://pubmed.ncbi.nlm.nih.gov/36856709/
- ErroneousBosh 8mo ago
  > 0.126 to 0.63% So, a just-about-measurable increase, if you pick and choose your values carefully? You are not going to die from cancer caused by getting a PET scan. This will not happen. You're going to die of heart disease or as a not-too-distant second in a car accident.
  - lostlogin 8mo ago
    That data is for one scan, ever. Continuous scanning for months would give a dose many orders of magnitude higher.
azan_ 8mo ago
Approx. 5% of all cancers in US are caused by CTs
- ErroneousBosh 8mo ago
  [citation needed]
  - lostlogin 8mo ago
    5% seems a bit high, but we are nearly there. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/acs-brief/may-13-2025-issue/ct-imaging-increases-lifetime-cancer-risks/ https://www.facs.org/for-medical-professionals/news-publicat...
    - ErroneousBosh 8mo ago
      I think they're reading too much into it. How are they determining "this cancer was caused by the CT scan" versus "this cancer was caused by the cancer we were originally looking for that was there all along"?
      - lostlogin 8mo ago
        Radiation doesn’t label the cancers it causes. Other than comparing population groups, what method do we have?
        ErroneousBosh 8mo ago
        Well, you could work backwards and look at your assumptions. Why is "We think this person has cancer so we gave them a CT scan and look! Now they've got cancer! It must be because of the CT scan!" the conclusion to jump to?
        azan_ 8mo ago
        Please just read this article - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2832778 https://jamanetwork.com/journals/jamainternalmedicine/fullar... It's funny that you instantly assumed that authors are stupid and did not think about this obvious pitfall. It's extra funny that you also accuse them of jumping to conclusion without actually reading the article.

bell-cot 8mo ago

> Lets say someone has lower urinary tract symptoms. And is 60 years old. An MRI could visualize as well as ... Not a doctor - but maybe start with some quick & cheap tests of their blood & urine, polite questions about their sexual partners, and possibly an ultrasound peek at things? At least in America, high-tech scans are treated as a cash cow. And cheap & reasonable tests, if done, are merely an afterthought - after the patient has been milked for all the scan-bucks that their insurance will pay out. Source: Bitter personal experience.

blincoln 8mo ago
> At least in America, high-tech scans are treated as a cash cow. And cheap & reasonable tests, if done, are merely an afterthought - after the patient has been milked for all the scan-bucks that their insurance will pay out. Maybe it's a regional thing, but that hasn't been my experience. I've had one MRI and one CT scan in the 25+ years that I've been a full-time employed adult with insurance. I'd have been happy to sign up for more so I could have proactive health information and the raw data to use for hobby projects.