Could Our Obsession with Dose Be Risking Lives?

04/17/25 • 37 min

In this illuminating episode of Frame by Frame, host Chris St John continues his in-depth conversation with Dr. Ehsan Samei to explore how we define and measure quality in medical imaging. Dr. Samei emphasizes that radiation dose, while important, tells only part of the story. Instead, quality should be viewed through a multi-dimensional lens that includes task-based performance, image clarity, contrast, and diagnostic relevance.
Drawing on examples like breast and lung cancer screening, Dr. Samei shows how imaging can improve outcomes when guided by validated metrics and clinical collaboration. He also highlights the challenges of creating standardized measurements that can be applied across institutions, stressing the importance of stakeholder involvement—from physicists to clinicians and regulatory bodies.
Whether you're navigating imaging guidelines, optimizing protocols, or advocating for patient-centered care, this episode delivers the tools to help you rethink what makes imaging truly valuable.
Chapters:

[00:00] Intro: Understanding Medical Imaging Benefits[01:49] Measurands vs Measurements: The Science of Quantification[07:15] Beyond Radiation Dose: Why Single Metrics Can Mislead[12:30] Validating Quality Measurements in Radiology[19:24] The Importance of Personalized Imaging Approaches[22:47] Task-Based Performance in Medical Imaging[29:05] Designing Studies to Prove Imaging's Value[32:53] The Real Impact: Mammography Success Story[36:24] Closing Thoughts: Balancing Benefits and Risks
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Previous Episode

'The Real Harm Is in Missing the Diagnosis' with Dr. Ehsan Samei

In this episode of Frame by Frame, host Chris St John is joined by Dr. Ehsan Samei, a leading medical physicist and advocate for patient-centered imaging.
Dr. Samei challenges long-held assumptions about radiation risk, urging a shift away from fear-based thinking. He critiques the limitations of population-based radiation thresholds and emphasizes why shared decision-making should drive medical imaging practices.
Through accessible examples, Dr. Samei explains why delayed or denied imaging can often pose a greater risk than the radiation itself. He also breaks down the widely debated Linear No-Threshold model and how it’s frequently misunderstood in clinical contexts.
As Chief Imaging Physicist at Duke University and a Distinguished Professor, Dr. Samei offers insights that are both scientifically grounded and deeply human. Whether you’re a clinician or simply someone curious about your healthcare, this episode provides a vital rethink of how we talk about imaging, risk, and patient trust.
Chapters:

[00:00] Intro & Welcome with Dr. Ehsan Samei[02:24] Medical Imaging: A Gift to Modern Healthcare[06:46] Patient Autonomy and Shared Decision-Making[11:04] Understanding the Linear No-Threshold Model[17:30] Cancer Risk: Separating Facts from Fear[25:20] Radiation Doses: High vs Low Exposure Data[29:52] Thresholds vs Clinical Guidance in Practice[39:13] Communicating Benefits to Patients[44:59] Key Takeaways & Preview of Part 2
Frame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so

Next Episode

Post-Mortem CT: How Radiology Is Rewriting the Autopsy

In this episode of Frame by Frame: Rethink Imaging, host Chris St. John is joined by Dr. Kalpana Kanal, Diagnostic Medical Physics Trustee at the American Board of Radiology and professor at the University of Washington, to discuss how CT scanning is transforming the field of forensic pathology.
Dr. Kanal highlights her pioneering work developing a forensic CT program that can eliminate the need for traditional autopsies in nearly 50% of cases. From our first episode with her, she explains how CT imaging offers a non-invasive, culturally sensitive alternative to conventional post-mortem procedures—helping address the growing shortage of forensic pathologists while improving diagnostic accuracy.
Beyond her innovations in forensics, Dr. Kanal also highlights the unique imaging protocols and physiological considerations required in post-mortem scans, the global trends in forensic CT adoption, and the collaborative work between radiologists and forensic pathologists.
This episode is a must-listen for medical imaging professionals, pathologists, and educators interested in how imaging continues to push the boundaries of medicine, investigation, and care for the deceased.
Frame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so