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Information, Awareness, Prevention / United to End Cancer

How TRANSPARENCY in SCIENCE would benefit humanity in a significant reduction of cancer deaths and cost

The questions Crosetto asked CERN Director of Research, S. Bertolucci, on January 12, 2011, led Bertolucci to state that CERN was developing components useful for improving medical imaging.

After Crosetto demonstrated that the approach of their Axial-PET component had major conceptual flaws using cables and gaps between crystal detectors that made it incapable of capturing photons and improving sensitivity but rather providing a PET device less efficient and more expensive than current PET, Bertolucci shot from the hip, first declaring his own incompetency in Medical Imaging, then shifting the blame on Christian Joram, the Chief Engineer building the Axial-PET device, and finally putting the responsibility on doctors in Marseille who were requesting the Axial-PET components having those characteristics.

In doing so, Bertolucci revealed he was both the Managing Director of the Axial-PET project and on the committee assigning the first prize to the Axial-PET project during CERN’s “Physics for Health” workshop in February 2010, thus essentially assigning the prize to himself.

Serving on a committee in which there was an obvious conflict of interest reeks of injustice and should never have been allowed, but what is more absurd is that Bertolucci was incompetent in medical imaging and early cancer detection, and Christian Joram, his chief Engineer designing the winning Axial-PET device, publicly stated in an interview with Crosetto that his was not a cancer project.

Clearly, Bertolucci was deceiving the public and cancer associations like the Madame Curie Association, furthermore he and Joram did not comply with the ethics of a physicist and engineer who should be knowledgeable in detectors and in detecting photons and had a duty to explain to doctors unfamiliar with the details of physics and electronics that in order to receive the best information regarding accurately measuring the minimum abnormal biological process from a PET device, improving spatial resolution to the detriment of sensitivity would not help. This is because PET technology has a spatial resolution having an intrinsic error that cannot be reduced because the error is due to a nuclear phenomenon.

One would think that after S. Bertolucci’s revelation he would have either had the dignity to step down from his position as leader out of respect to those who placed him there, or admit his mistakes and fix them. Instead, he arrogantly threatened those who had proposed patiently for two years a collaborative dialogue to fix problems by identifying scientists who are expert in particle detection and in reducing cancer deaths and cost who could explain the inconsistencies to the public and fix them. How many people need to be informed before TRANSPARENCY in SCIENCE is implemented?

Why weren’t scientists asked how their project/approach/idea would reduce cancer deaths and cost and how it would compare to other projects before spending billions of dollars only to find out that cancer deaths were not reduced and the cost for cancer treatment had increased 100 fold during 50 years?

The logical solution would be for large funding agencies, philanthropists, taxpayers, etc., to request scientists who deny TRANSPARENCY in SCIENCE to support their claims in two public workshops on November 9, 2014, at the IEEE-NSS-MIC conference, before Crosetto, senior scientists, young scientists and PhD students who might also propose ideas and question each other.

The benefits to society would be enormous and far reaching if scientists and physicians were serving the public interest rather than their own interest, such as profit or power. This is essential when they are trusted with taxpayers’ money.

Therefore, it is legitimate to ask people who are holding positions of responsibility in science, government funding agencies, and responsible media outlets, to request scientists who use taxpayer money to defend their claims publicly by answering pertinent, legitimate questions posed by other scientists who might challenge them, and not just assign funding based on the number of articles they have published or the decisions of an anonymous review panel who judge merits in secrecy.

If you believe in TRANSPARENCY in SCIENCE when scientists and government funding agencies are using your taxpayer money, write to the people holding positions of power in science, to your government representatives, and to those media outlets who have promised in their mission statement to provide information in your interest, and request the two public forums proposed by Crosetto and support his initiative to always STAND UP FOR TRANSPARENCY IN SCIENCE especially when funding scientific projects using your tax dollars.

For example, I. Gregor and A. Bernstein, Chairmen of the 2014 IEEE-NSS Conference and leaders in HEP need to support their claim in a public debate with Crosetto and other scientists that the FPGA (Field Programmable Gate Array) is the most cost effective solution for the Level-1 Trigger rather than ignoring and not comparing their choice to any other solution which might be superior and save taxpayers money.

The following facts illustrate the advantages and benefits taxpayers and cancer patients can expect if TRANSPARENCY in SCIENCE were implemented where technical questions aimed at maximizing the reduction of cancer deaths and cost could be asked.

Jae Sung Lee, jaes@snu.ac.kr, Chairman, and Craig Levin, cslevin@stanford.edu, Deputy Chairman, of the 2013 IEEE Medical Imaging Conference rejected Crosetto’s article, and then subsequently Levin engaged in a phone and email dialogue with Crosetto, which was copied to a number of leaders, influential people in the field and also to financial supporters of science.

Levin’s statements do not have any scientific ground to support the rejection of Crosetto’s paper, which was very specific in how it can provide the tools and improvements needed to reduce cancer deaths and cost. In fact, Levin’s emails reveal he did not fully understand the purpose of Positron Emission Technology invented 60 years ago, as he is using it to implement instrumentations that are not appropriate with the way the technology works. His ideas would be like developing a new water meter to measure the size of pipes in a house or a new ruler to measure water consumption during one month. It is surprising that none of the scientists copied in the email exchange commented on Levin’s approach to building his detector module (1B) and electronics to measure a parameter from a technique designed to provide doctors with information about minimum abnormal biological processes.

Why weren’t C. Levin, G. Elfakhri, K. Parodi, S. Cherry, W. Moses, J. Karp, S. DeRenzo, M. Phelps, C. Joram, T. Jones asked how their claim that increasing PET spatial and time resolution to the detriment of sensitivity would maximize a reduction in cancer deaths and cost and asked to support their claims in a public debate with Crosetto and other scientists before any more taxpayer money is assigned to them? A simple dialogue like the one between Crosetto and Bertolucci would lead them to realize that their claims do not add up or would force them to test their claims on a sample population so they will be convinced by experimental results that their project is a waste of money.

Levin’s proposal does not add up because, if one uses his “block detector” 1B with millimeter PET spatial resolution described in his article (http://miil.stanford.edu/publications/files/99_PUB.pdf) to build a 3D position-sensitive device with a 20 cm FOV and a 70 cm diameter, it would require: 4,505,600 of the 1x1x1 mm3 crystals, 70,400 connectors and 70,400 sensors (APDs). The sensitivity would be less than 50% of the current PET because the total crystal thickness is only 20 mm, equivalent to about 64% in stopping power efficiency.

Many gaps of non-sensitive detectors between crystals (connectors, cables, etc.) do not absorb photons and further lower the efficiency by capturing less than 50% of the photons hitting the detector.

If one wanted to increase photon sensitivity with a geometry comparable to Crosetto’s 3D-CBS device capturing more photons hitting the detector with a wide angle having a 150 cm FOV and 70 cm in diameter, using Levin’s “block detector” 1B with sub-millimeter PET spatial resolution would require 31,539,200 crystals of 1x1x1 mm3, 492,800 connectors and 492,800 Sensors (APDs). 

Although the FOV is extended, because it captures less than 50% of the photons hitting the detector, it would most likely not be sensitive enough to detect tumors at an early stage and the radiation dose required might still be higher than 1 mSv. Clearly both approaches described above aiming to satisfy Levin’s statement to keep high spatial resolution with his “block detector” and increase efficiency are not practical (an estimate of $1 per crystal and per connector would total over $32 million just in material. Labor to assemble it and the cost of other parts could more than double that figure).

What could explain the fact that the one article submitted by Crosetto to the Medical Imaging Conference which presents a technique that maximizes the reduction of cancer deaths and cost by accurately capturing all possible signals from the tumor markers at the lowest cost per valid signal captured was rejected, while 16 articles submitted by Craig Levin, presenting projects as the one described above, that increases health care costs and cannot provide scientific arguments supporting a reduction of cancer deaths, were accepted?

The answer is that Levin is among “the circle of friends” who approve each other’s articles, and Crosetto is not.

In order to open everyone’s eyes on the uselessness of Levin’s project to improve healthcare, and to crumble his paper castle and deflate a balloon of hot air costing taxpayers millions of dollars and costing researchers many useless years, Crosetto asked Levin publicly four simple questions after he presented his paper (M25-4) at the 2013 IEEE-MIC Conference on November 2, 2013.

Crosetto’s four questions were:

a)  “What is the efficiency of your module in capturing signals from the tumor markers?”

b)  “How much radiation do you need to administer to the patient receiving the breast examination?”

c)  “How much did the entire project cost?”

d)  “Do you see the possibility of commercialization as a better mammogram, and if so, what do you estimate the cancer death rate reduction would be if this project is tested on a sample population?”

Levin’s answers reveal that his project could never be suitable for reducing cancer deaths and cost. His answer to

a)  12% efficiency; his answer to

b)  10 mCi of FDG tracer, equivalent to over 10 times the radiation dose of 1 mSv accepted by the International Commission for Radiation Protection for screening examinations. This rules out the possibility of using Levin’s new device as an improved mammogram for screening and also answers (d) that it would not be useful for reducing cancer death, also because the cost would be prohibitive compared to the cost of a current mammogram. His answer to

c)  was a few million dollars and seven researchers. His answer to

d)  was that he still hopes to commercialize the product; however, he could not explain how it could benefit the patient or improve healthcare and reduce its cost.

The two-minute window of opportunity given Crosetto when he was allowed to ask Levin a few questions regarding his project was long enough to demonstrate the power of TRANSPARENCY in SCIENCE and shows how it can benefit taxpayers and patients. Had these same questions been asked by the funding agencies five years ago before Levin started his project, millions of dollars and years of time from several scientists would not have been wasted.

To fix these inconsistencies it would be necessary to identify the reviewers who assigned the funding to Levin for this project from the National Institute of Health, NIH grant R01CA119056, from the Department of Defense, DOD grant W81XWH-10-1-03-93, from grants received from the National Science Foundation, from funding received from Stanford Graduate Fellowship, from the Department of Electrical Engineering, Bioengineering, Physics and Radiology at Stanford University, as reported by Levin on the first page of his article.

These reviewers should be informed about how Positron Emission Technology works, and what information is most relevant to doctors when measuring abnormal biological processes that this technique provides, so as to facilitate the diagnosis, prognosis, and reduction of false positives and false negatives.

This post is also available in: Italian

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