In this issue

Jonathan Tobin: Defending the Right to a Jewish State

Heather Hale: Compliment your kids without giving them big heads

Megan Shauri: 10 ways you are ruining your own happiness

Carolyn Bigda: 8 Best Dividend Stocks for 2015

Kiplinger's Personal Finance editors: 7 Things You Didn't Know About Paying Off Student Loans

Samantha Olson: The Crucial Mistake 55% Of Parents Are Making At Their Baby's Bedtime

Densie Well, Ph.D., R.D. Open your eyes to yellow vegetables

The Kosher Gourmet by Megan Gordon With its colorful cache of purples and oranges and reds, COLLARD GREEN SLAW is a marvelous mood booster --- not to mention just downright delish
April 18, 2014

Rabbi Yonason Goldson: Clarifying one of the greatest philosophical conundrums in theology

Caroline B. Glick: The disappearance of US will

Megan Wallgren: 10 things I've learned from my teenagers

Lizette Borreli: Green Tea Boosts Brain Power, May Help Treat Dementia

John Ericson: Trying hard to be 'positive' but never succeeding? Blame Your Brain

The Kosher Gourmet by Julie Rothman Almondy, flourless torta del re (Italian king's cake), has royal roots, is simple to make, . . . but devour it because it's simply delicious

April 14, 2014

Rabbi Dr Naftali Brawer: Passover frees us from the tyranny of time

Greg Crosby: Passing Over Religion

Eric Schulzke: First degree: How America really recovered from a murder epidemic

Georgia Lee: When love is not enough: Teaching your kids about the realities of adult relationships

Cameron Huddleston: Freebies for Your Lawn and Garden

Gordon Pape: How you can tell if your financial adviser is setting you up for potential ruin

Dana Dovey: Up to 500,000 people die each year from hepatitis C-related liver disease. New Treatment Has Over 90% Success Rate

Justin Caba: Eating Watermelon Can Help Control High Blood Pressure

The Kosher Gourmet by Joshua E. London and Lou Marmon Don't dare pass over these Pesach picks for Manischewitz!

April 11, 2014

Rabbi Hillel Goldberg: Silence is much more than golden

Caroline B. Glick: Forgetting freedom at Passover

Susan Swann: How to value a child for who he is, not just what he does

Cameron Huddleston: 7 Financial Tasks You Should Tackle Right Now

Sandra Block and Lisa Gerstner: How to Profit From Your Passion

Susan Scutti: A Simple Blood Test Might Soon Diagnose Cancer

Chris Weller: Have A Slow Metabolism? Let Science Speed It Up For You

The Kosher Gourmet by Diane Rossen Worthington Whitefish Terrine: A French take on gefilte fish

April 9, 2014

Jonathan Tobin: Why Did Kerry Lie About Israeli Blame?

Samuel G. Freedman: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Jessica Ivins: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Kim Giles: Asking for help is not weakness

Kathy Kristof and Barbara Hoch Marcus: 7 Great Growth Israeli Stocks

Matthew Mientka: How Beans, Peas, And Chickpeas Cleanse Bad Cholesterol and Lowers Risk of Heart Disease

Sabrina Bachai: 5 At-Home Treatments For Headaches

The Kosher Gourmet by Daniel Neman Have yourself a matzo ball: The secrets bubby never told you and recipes she could have never imagined

April 8, 2014

Lori Nawyn: At Your Wit's End and Back: Finding Peace

Susan B. Garland and Rachel L. Sheedy: Strategies Married Couples Can Use to Boost Benefits

David Muhlbaum: Smart Tax Deductions Non-Itemizers Can Claim

Jill Weisenberger, M.S., R.D.N., C.D.E : Before You Lose Your Mental Edge

Dana Dovey: Coffee Drinkers Rejoice! Your Cup Of Joe Can Prevent Death From Liver Disease

Chris Weller: Electric 'Thinking Cap' Puts Your Brain Power Into High Gear

The Kosher Gourmet by Marlene Parrish A gift of hazelnuts keeps giving --- for a variety of nutty recipes: Entree, side, soup, dessert

April 4, 2014

Rabbi David Gutterman: The Word for Nothing Means Everything

Charles Krauthammer: Kerry's folly, Chapter 3

Amy Peterson: A life of love: How to build lasting relationships with your children

John Ericson: Older Women: Save Your Heart, Prevent Stroke Don't Drink Diet

John Ericson: Why 50 million Americans will still have spring allergies after taking meds

Cameron Huddleston: Best and Worst Buys of April 2014

Stacy Rapacon: Great Mutual Funds for Young Investors

Sarah Boesveld: Teacher keeps promise to mail thousands of former students letters written by their past selves

The Kosher Gourmet by Sharon Thompson Anyone can make a salad, you say. But can they make a great salad? (SECRETS, TESTED TECHNIQUES + 4 RECIPES, INCLUDING DRESSINGS)

April 2, 2014

Paul Greenberg: Death and joy in the spring

Dan Barry: Should South Carolina Jews be forced to maintain this chimney built by Germans serving the Nazis?

Mayra Bitsko: Save me! An alien took over my child's personality

Frank Clayton: Get happy: 20 scientifically proven happiness activities

Susan Scutti: It's Genetic! Obesity and the 'Carb Breakdown' Gene

Lecia Bushak: Why Hand Sanitizer May Actually Harm Your Health

Stacy Rapacon: Great Funds You Can Own for $500 or Less

Cameron Huddleston: 7 Ways to Save on Home Decor

The Kosher Gourmet by Steve Petusevsky Exploring ingredients as edible-stuffed containers (TWO RECIPES + TIPS & TECHINQUES)

Jewish World Review

Get the whole picture before a CT; doctors, patients must weigh risks vs. rewards of medical imaging

By Judith Graham

http://www.JewishWorldReview.com | (MCT) After an imaging test revealed a small nodule in Dr. Len Lichtenfeld's lung, his doctor ordered a series of CT scans. But Lichtenfeld turned them down.

As deputy chief medical officer of the American Cancer Society, Lichtenfeld knew the tiny nodule probably wasn't dangerous and that new research has documented an increased risk of cancer from CT scans.

"The reality is, I thought the radiation dose from those follow-up scans represented more of a threat than the nodule," he said.

As physicians find new ways to use diagnostic imaging to discover and deal with disease, concern is growing about Americans' increased exposure to potentially cancer-causing radiation. Annual radiation doses from medical imaging have soared sevenfold since the early 1980s, according to a report last year from the National Council on Radiation Protection and Measurements.

Meanwhile, as many as 14,500 people may end up dying annually from radiation-induced cancers caused by CT scans, new research suggests.

Late last month, Congress held hearings on the subject, and medical equipment makers announced changes designed to help prevent patients from getting overly high radiation doses. A few weeks earlier, the Food and Drug Administration launched an effort to reduce unnecessary exposure to radiation from medical tests.

Scrutiny is focusing primarily on more than 70 million computerized tomography scans performed in the U.S. every year, up from 3 million in the early 1980s. The scans help doctors identify brain tumors, kidney stones, and obstructed bowels and have revolutionized medicine, virtually eliminating exploratory surgery and aiding millions of patients.

People often ask for the tests, and for some doctors they've become an important source of income. For most, they're an essential medical tool. "You can run a patient through in just a few minutes, get amazing information about what's going on inside their body, and they don't glow green — so why not?" said Dr. Steven Birnbaum, staff radiologist at Southern New Hampshire Medical Center.

Ionizing radiation is the reason; CT scans shower patients with far more of it than other diagnostic tests. For example, a routine head CT produces the same dose as 400 dental X-rays while the dose from a chest CT equals to more than 100 X-rays. That radiation can wreak havoc at the cellular level, breaking or altering DNA strands and causing mutations that spin out of control, generating cancers many years later.

Yet patients' exposure to radiation from diagnostic imaging exams isn't regulated, with the exception of mammography. By contrast, regulations limit U.S. workers to no more than 50 millisieverts of radiation a year from nuclear materials. Someone who gets multiple medical scans can easily exceed that level, said Fred Mettler, a professor of radiology at the University of New Mexico.

The risks were highlighted in a recent study in the Archives of Internal Medicine warning that 29,000 radiation-induced cancers — half of them deadly — could result from the CT scans performed in 2007 alone.

Two years earlier, Columbia University researchers suggested that up to 2 percent of new cancers in the coming decades could be attributable to radiation exposure from CT imaging.

Letter from JWR publisher

These conclusions are far from universally accepted, however, as no study has directly shown that CT scans cause cancer. Instead, scientific understanding of the link between radiation and cancer is drawn largely from studies of survivors of the atomic bombs dropped in Japan, as well as studies on workplace exposure.

"All the numbers are based on models," said Dr. James Thrall, radiology chairman at Massachusetts General Hospital.

In a landmark 2005 review of the data, the National Academy of Sciences concluded that even "the smallest dose has the potential to cause a small increase in (cancer) risk to humans." But many experts insist that risks from individual imaging studies are exceedingly small and shouldn't frighten people away from necessary tests.

"The risk of death by drowning is greater than the risk of death from a cardiac or body CT exam," noted Cynthia McCollough, professor of radiological physics at the Mayo Clinic, in testimony before Congress.

The biggest problem, McCollough said, is that operators of CT machines often don't have adequate education or training and "have not kept up with the rapid developments in the technology." As a result, some patients may get higher-than-recommended radiation doses.

Also, most doctors are poorly educated about the radiation risks associated with medical imaging — two-thirds or more underestimate the doses, according to several studies. There is little standardization, and doses patients receive can vary by a factor of 13, according to a recent research report.

Though the American College of Radiology has created criteria for when imaging tests are medically appropriate, these aren't widely followed. Several studies find that as many as a third of CT scans probably aren't warranted because they don't answer a pressing medical question, because they duplicate earlier exams or for other reasons.

As an example, Dr. Edward Michals of the University of Illinois at Chicago Medical Center said many patients with lower back pain undergo CT scans even though these rarely yield valuable medical information.

Thrall said: "Someone who has a simple headache without other neurological signs is very unlikely to have a serious medical problem that could be discovered with a CT scan. And yet tens of thousands of people are scanned for headaches of this kind every year."

Responding to such concerns, the FDA may require equipment makers to display and record radiation doses from imaging scans and sound an alert when doses exceed certain thresholds. The agency also said it would work with groups around the country to standardize doses associated with various scans. Manufacturers, meanwhile, plan to create a registry to track patients' radiation exposure and expand reporting of radiation-related medical errors.

UIC Medical Center this year created a committee that will closely examine protocols for imaging patients. One new protocol has reduced radiation doses for CT coronary angiograms by 80 percent. At the University of Chicago Medical Center, radiologists interpreting scans now review the radiation doses administered to patients and add the information to medical records.

Congress is under pressure to increase oversight. Some experts say that, at minimum, all facilities providing diagnostic imaging should be accredited and standards should be set for medical staff who perform and interpret scans. The government will require accreditation for imaging centers serving Medicare patients starting in 2012.

Still, as long as doctors fear missing an important medical complication and being sued, practices are unlikely to change, said Dr. Leonard Berlin, vice chair of radiology at Skokie Hospital.

And some doctors who own scanning equipment have a financial stake in diagnostic imaging. Research shows that doctors who own machines perform two to seven times more imaging tests than those who don't, said Dr. Vijay Rao, chair of radiology at Thomas Jefferson University Hospital in Philadelphia.

Moreover, "the physicians who own this equipment and order the tests have generally had no training in radiology and little understanding of the complexities of radiation dosing" and its attendant health risks, Rao said. "For patients, this is absolutely the perfect storm."



Experts say patients should not request an unnecessary imaging test just to be on the safe side. Nor should they let unwarranted fear scare them away from a test. Questions to ask:

Why have you suggested this test? What do you hope to learn?

Do you expect the results might change your medical recommendations? How?

Are there alternatives that involve less radiation exposure? Could an MRI or an ultrasound substitute?

What's the average radiation dose associated with this kind of test? How many times will I be scanned?

Is there a way to perform this test that involves fewer scans and less radiation exposure?

Are you keeping a record of my scans and my radiation exposure?

Do you have an ownership stake in the machines used to scan me? (This applies if the scan occurs in a doctor's office.)

Are the technicians licensed or certified? Do you have a quality assurance program for diagnostic imaging? Are the machines checked routinely?

Is the facility where the scan takes place accredited? Will an expert radiologist interpret the test?

Note: It's also important to tell doctors about scans received elsewhere. If possible, provide copies.

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