During the 56th National Conference on Radiation Control of state regulators in May, the honorary John C. Villforth Lecture will be delivered by M. Mahesh, MS, PhD, FAAPM, FACR, FACMP, FSCCT, FIOMP, who will focus on understanding negative biases about radiation and exploring methods for effective communication about it with patients, physicians, the media and the public. Mahesh was nominated as the lecture presenter by both the ACR and the American Association of Physicists in Medicine (AAPM). 

A diagnostic medical physicist and professor of radiology and radiological science at the Johns Hopkins University School of Medicine, Mahesh currently serves as a member of the ACR BOC, chair of the ACR Commission on Medical Physics, and the JACR^® associate editor of physics. He was elected to be AAPM President in 2025. 

To learn more about his goal for the lecture, as well as his involvement with advocacy at federal and state level over the years, the ACR Bulletin sat down with the longtime advocate about navigating the complexities of policy development and translating scientific data into actionable recommendations to enhance radiation safety standards. 

The ACR has had a decades-long relationship with state regulators and the Conference of Radiation Control Program Directors (CRCPD). In your opinion, what are the most tangible benefits of keeping a strong partnership together?

I believe this longstanding relationship between the two organizations has been very important and mutually beneficial. Data sharing and research come to mind right away. The ACR has provided financial support in the past for the National Evaluation of X-ray Trends (NEXT) surveys, which yield important benchmarking results that the radiation protection community uses to analyze the trends and techniques employed across the U.S. In Sweden and other countries with universal healthcare, such information about X-ray trends can be easily obtained. However, here in the U.S., it is not so. 

Therefore, we rely on surveys from CRCPD and others, and the process of training inspectors and conducting surveys has its own challenges due to its scale. When it comes to the collection of data and research, the CRCPD has been a strong partner to the ACR and other stakeholders in setting up nationwide evaluations of trends. The CRCPD takes on the training of its inspectors to collect data from various states to create an authentic snapshot of X-ray trends for the nation.

From the perspective of physicists and radiologists, what key messages will you aim to deliver during your John C. Villforth Lecture?

I feel very fortunate to have been selected with distinguished honor to deliver the Villforth Lecture. For almost 30 years, Villforth was a commissioned officer in the U.S. Public Health Service in the Department of Health and Human Services, and for 19 years of his career, he was assigned to the FDA. As you can imagine, he had a very active career and is often remembered for his contributions during the Three Mile Island accident, when he was tasked to provide information to the public. 

There are always challenges, and challenges can provide opportunities.

I am drawing a parallel to the expertise of communicating about radiation to the public in my Villforth lecture. The topic itself, “Communication About Radiation Events — Challenges and Solutions,” can be a daunting task. There is a translational effect between the technical experts and the public, and the experts speak in a way that is, in some ways, opposite to what the public wants to hear. I advocate for communicating the truth, figures, and facts of the message in such a way that they are not diluted but are “in tune” with the audience. 

The best way I look at it is this: A goal with complicated topics is that you should be able to share a concept with even your grandmother in a way she understands even if she doesn’t speak the same language or lingo, and I hope to do the same with communications about radiation. Often the person speaking should be a trusted authority among peers, and how he or she communicates is very critical considering the different target audiences. 

Can you elaborate more about communications between the experts in the radiological field and the media?

Over the years, interacting with media, I believe it is of great importance to build and maintain effective relationships with media outlets so when an issue related to radiation arises, they can reach out through ACR’s PR department to experts like us in the radiological field. When such circumstances occur, I do my best to provide a timely response and accurate feedback so that correct information can be conveyed to the general public. It takes time to build the trust and relationship with the media so that when the general public reads the communication coming from experts through the College, they are well received. It is important for the experts to explain about radiation without creating fear. 

The ACR’s public relations team has been essential in providing accurate information for years. Timing is critical when it comes to the 24-hour news cycle. You cannot wait two days to answer. 

Most recently, the American Dental Association came out with a statement about the use of lead aprons. The ACR PR department received an inquiry from a media outlet and wanted a quick response. The PR department reached out to ask me if I would respond to that query, which I did. I was able to speak with the reporter at 2 p.m. so by 5 p.m. the information was in the news. This is one example why it is important to respond to queries in a timely fashion, so that they can convey the right information to the general public. By providing timely responses over the  years, I have found that the media staff are confident in reaching out to us to get the correct information in a timely fashion.

In your experience, what are some of the toughest parts about working with regulatory bodies? And how do you deal with those challenges?

There are always challenges, and challenges can provide opportunities. Especially with regulations, once something becomes a law, it’s difficult to change, so it is best to be engaged during the rule-making process for the best outcomes. A recent example is the doing away with gonadal shielding, a widespread practice of using radioprotective (more familiarly “lead”) shielding of the male and female reproductive organs from the primary X-ray beam. To change the federal guidance, it may take years, but because of strong existing relationships with the FDA and the CRCPD, the state regulators were able to secure exemptions via rulemakings or via issuance of radiation protection board guidance documents. A good working relationship with state and federal regulators makes the regulatory process smoother.

Do you find there are differences between advocating within regulatory bodies versus advocating within legislative bodies?

Collaborative policy development is critical regardless of whether you pursue regulatory or legislative advocacy. All the stakeholders must be working collaboratively to develop evidence-based policies and regulations that prioritize public health while considering the needs and perspectives of healthcare providers.  

Often ACR is asked to provide advisors by regulatory bodies or by CRCPD during drafting of new rules or regulations. In such circumstances, we need to answer the call and find subject matter experts within the college to help with such processes. I believe the best time to get involved is when regulations are first drafted. 

Advocating within regulatory bodies typically involves influencing the implementation and enforcement of existing laws and regulations related to a specific issue, such as radiation safety standards. 

On the other hand, advocating within legislative bodies has a focus on shaping new laws or amending existing ones through the legislative process. This often involves lobbying elected officials, building coalitions and testifying at hearings to advance specific policy objectives. 

In Maryland, we had a radiation dose badge issue when procedures that ran close to the limit of the exposure badge values allowed would trigger heavy fines. Through the Maryland Radiological Society, we tried repeatedly to appeal to the regulators, but we learned that the law needed to be changed. This was my opportunity to serve as an expert, and I testified in the state Capitol in Annapolis. However, in the end, a compromise was reached that allowed “high-end users” to continue their practice safely without any regulatory holdup. 

The compromise that we worked out through the legislative route made sure that we were not diluting the radiation protection statute since most of the users will continue to use the same standard. However, the conversion factor, accepted by the National Council on Radiation Protection and Measurements (NCRP), can now be used for “high-end” users. Successful advocacy for an exception to the rule saved a lot of headaches for all of us who work in hospitals in Maryland.

How do you tailor advocacy messaging when it comes to science-driven data?

When advocating within regulatory agencies, the focus is often on technical expertise, scientific evidence, and regulatory compliance. As experts and advocates, we always emphasize the need for evidence-based decision-making, especially when we propose revisions to regulations or provide feedback on enforcement actions. 

In contrast, advocacy within legislative bodies typically requires a broader strategy that includes building political support, mobilizing stakeholders and framing issues in a way that resonates with policymakers and the public.

I know you are very involved with joint research initiatives. Can you speak about your collaborative work on research initiatives to address emerging issues in radiation safety and efficacy, and translating research findings into actionable recommendations?

I strongly believe that strong and valid data drive the best policy development, and data sourcing relies on active involvement from many different organizations, the ACR and CRCPD among them. For example, in the development of the NCRP 160 Report back in 2009 (Ionizing radiation exposure of the population of the United States), stakeholders from different fields were engaged. ACR’s CT dose registry data was used as one of the sources for estimating CT doses. In a follow-up report (NCRP 184), as co-chair of the report, I worked with both CRCPD and ACR. The ACR CT dose index registry data was used and ACR’s Executive Vice President of Quality and Safety Mythreyi Chatfield, PhD, actively participated in the report, Medical radiation exposure of patients in the United States (NCRP 184), which showed a slight decrease in the dose in the U.S. 

It seems there is a strong commitment to continuous improvement of policy among stakeholders when it comes to data collection and research.

Absolutely! Committing to ongoing evaluation and improvement of radiation control policies and practices through regular dialogue, assessment of outcomes, and incorporation of best practices is the main goal. The CRCPD is tasked with development of suggested state regulations, and during this process they seek input from the ACR, AAPM, the EPA, the FDA, and others. The regulations are not written in a vacuum, and of course all stakeholders are aware that these regulations impact patient care as well. 

One of the effective uses of regulatory relationships is maximizing the feedback mechanisms. Workgroups and advisory committees are about establishing feedback mechanisms to gather input from physicians regarding the practical implications of radiation control policies and regulations in clinical settings. Often the states adopt suggested state regulations in their entirety, so it is important to have a good product. 

In Maryland, for the past 20 years, I have served as an advisor to the radiation control board, and because some regulations are archaic, there is a critical time to provide feedback as physicists, as physicians and as patient advocates. Additionally, my colleagues represent the ACR in CRCPD workgroups and it ensures that suggested state regulations are informed by expert feedback, ultimately enhancing patient care and regulatory effectiveness.

In your experience of working with regulatory bodies, both federal and state, how do you handle the maze of rules and regulations when you're trying to get changes made?

I got comfortable navigating the system after decades of involvement, and any chance I get, I try to motivate younger colleagues to understand that advocacy is very important for the field. Physicists within the ACR are very active, and I’ve been a part of the process for 30 years. 

I very much hope to leverage knowledge of what I have learned in my various roles at the ACR during my tenure as the AAPM president starting next year. I want to raise the profile of advocacy in all issue areas. I especially hope younger members understand that job creation is also wrapped up in advocacy. 

I proudly tell the example of Medicare Improvement for Patients and Providers Act of 2008 (MIPPA). The measure was a 2,000-page document, and the ACR advocated for accreditation of CT, MR, NM and PET with every imaging center needing to be tested by a medical physicist. Not only did we raise the quality bar when it comes to diagnostic imaging, but we were also able to generate jobs for medical physicists. I believe it is a great example of where advocacy translates into good patient care and also new employment opportunities.

When you're talking to fellow experts, how do you balance all the technical stuff with real-life concerns?

Balancing science with real-life applications can be a challenge. I remember a few years ago while serving on an advisory committee for the FDA, there was a proposal to label tanning booths with “long-term exposure may lead to cancer.” As you can imagine, many businesses were represented, and although the experts had the data, the proof, and the numbers, fighting with business interests was still very difficult. 

In a way, one may think that arguing the technical side is straightforward, especially given that we are experts in the radiation field, but it is not so in real-life scenarios. The people who have business interests might object to all rational suggestions, but we still must hold our position and find compromises to be worked out. 

The best advice I can give anyone wanting to do advocacy is that when you do get to a compromise, stick to it. A unified message has a lot more weight. It holds especially true when it comes to unity among experts. You do not want to dilute messaging with two similar but different messages coming from the experts in the field.

What helps you get people on board to help with advocacy and interacting with regulatory bodies?

A good place to start is to become active in the state radiological society and to volunteer to be on an ACR committee of interest. Advocacy is a longtime involvement, whether for regulatory or legislative areas. I hope our members stay motivated to participate in advocacy. 

I have “drunk the Kool-Aid.” I strongly believe in advocacy. But we need more young professionals to get involved and to stay involved.