[HN Gopher] The story behind the NeuralRad organ and tumor segme...
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The story behind the NeuralRad organ and tumor segmentation cloud
service
Here is a follow-up media news story on my project of organ and
tumor segmentation platform for radiation therapy. The original
article is in Chinese at
https://mp.weixin.qq.com/s/vDzyKIKxuP7jCfmx6FPE4w. I hope more
doctors and physicists learn about NeuralRad, allowing the most
advanced radiotherapy AI to benefit more patients and extend the
lives of many. I have decided to open user registration for use.
Now, after signing up, you can start using this AI service
immediately. If you don't have the corresponding Dicom data for
testing, you can click the Demo button on the platform, which will
automatically open a case of a brain tumor MRI.
Author : coolwulf
Score : 122 points
Date : 2024-02-12 16:13 UTC (1 days ago)
(HTM) web link (howardchen.substack.com)
(TXT) w3m dump (howardchen.substack.com)
| coolwulf wrote:
| Dear Hacker News Readers, this is the continuation of my
| radiology/radiotherapy project which was posted here about two
| years ago. Thank you!
| accrual wrote:
| This is extremely cool, thanks for your work in this area,
| coolwulf. It's very important work and has the ability to help
| a lot of people. I work in an adjacent field and greatly
| appreciate seeing an open source approach to this problem.
| brysonreece wrote:
| This is amazing work! Can you divulge what institutions in
| Oklahoma are currently using NeuralRad? As someone in the state
| who often has MRIs looked at, this would definitely move a
| given medical provider higher on my list!
| coolwulf wrote:
| In Oklahoma, OUHSC is using NeuralRad
| yorwba wrote:
| This is great, but unfortunately the current title doesn't do a
| good job convincing people that the article is worth reading, in
| my opinion.
|
| Maybe a title like "The story behind the NeuralRad organ and
| tumor segmentation cloud service" would be better.
|
| (I see that the previous post you're referring to
| https://news.ycombinator.com/item?id=31449147 had a similar title
| and did extremely well, but maybe you just got lucky then.)
| LorenDB wrote:
| Yeah, I expected this to be an article describing how we can
| get more bang for the buck from 1080 TI GPUs.
| coolwulf wrote:
| Thanks for your suggestion. The title has been changed to your
| suggestion :p
| dang wrote:
| (Submitted title was "After switching from 1080ti to 4090, this
| programmer wants to save people")
| dang wrote:
| Related:
|
| _"Amateur" programmer fought cancer with 50 Nvidia Geforce
| 1080Ti_ - https://news.ycombinator.com/item?id=31449147 - May
| 2022 (329 comments)
| cancerhacker wrote:
| A naive question, maybe? I have about 5 years worth of CT, MRI,
| and PET data of my diagnosis (stage iv colon cancer) - to NED. I
| wouldn't care about contributing it to any research if there was
| some way of anonymizing it. Or, does that kind of data
| automatically get contributed somehow? Some of the imaging was
| UCSF and some at Memorial Sloan-Kettering in New York.
| tmellon2 wrote:
| Data would not get automatically contributed to research unless
| you explicitly gave informed consent for research studies. All
| researchers now require to maintain official records of
| informed consent given by patients or research participants.
| You could anonymize your data via DICOM anonymizer tools and
| offer them to UCSF or Memorial Sloan Kettering [or] you could
| host them on a website and offer to sign informed consent
| documents for researchers.
| medimikka wrote:
| Speaking as a physician who works with both interventional and
| diagnostic radiology -- the self promotion and style of the post
| is offputting to say the least.
|
| In addition, I'd never, ever, not in a million years, consider
| any interventional or diagnostic strategy from a blog post, most
| of which is written in a language, any language, I can not
| readily understand. Not to mention, I'd like to see names, not
| 1337 h4xx0r handles ("coolwulf" is great if you're 12 and playing
| WoW as a Worgen Deathknight, it's not cool if you'd like to
| convince me to add more tools to my workflow), when I consider
| modalities.
|
| As a sidenote: modalities like this one are common in modern
| radio diagnostics. Harvard, MIT, Cambridge with King's, Paris
| Cite, and a few more are working on evidence based (and Open
| Source/Open Algorithm) approaches to AI diagnostics, all of which
| seem to have their ups and downs in outcomes. All their services
| are HIPAA compliant and certified as such, run in-house, do not
| require me to upload vast amounts of radiographic data to a
| website operated in a country I wouldn't trust with my daily egg
| consumption stats.
|
| We're not talking funsies at the 7/11 here. We're talking
| diagnostic and therapeutic decisions. Basing those on a black box
| "pinky promise, it works" approach, is pretty much how people get
| killed. Not to mention, it's a 1980s view of things, the "if I
| can see it, I can cure it" approach. Modern oncology means to
| diagnose based on genetic and sequential markers, develop
| individualized strategies, long before imaging modalities become
| important. And if they do, there's plenty of hard- and software
| out there to make our lives so insanely easy, why send our stuff
| to a graphics card in China?
| eighto wrote:
| It sounds like he's sold this system to several hospitals in
| the US though? According to the article anyway.
|
| Does that not indicate that he might have something useful
| here? Even if he has a gamer nickname and is based in China.
| yorwba wrote:
| Also according to the article, those hospitals run the
| software HIPAA-compliant in-house, whereas the free online
| service is intended for people who literally couldn't afford
| anything else.
| medimikka wrote:
| The resolution and planes in modalities that are useful for
| visual diagnostics (which, again, are outdated as hell) are
| so expensive, I don't think the little AI script drawing
| over suspected lesions (something a PET can do much better,
| including staging and grading) is the cost factor here.
|
| But, hey, you do you. If you're comfortable subjecting
| yourself or your loved ones to this, by all means, do it.
| Without a decent sensitivity and specificity review,
| without an actual review in general, and without a
| corporation whose jugular I can cut if they screw up and
| murder my patient through a misdiagnosis, I'll stay away
| from someone's home grown shoe box medicine as far as I
| can. And I know all my serious colleagues will and are as
| well. It's not like that's the first person this week (or
| even today) trying to sell us one of those.
| yorwba wrote:
| From the article:
|
| "Currently, many countries cannot operate Treatment
| Machines (radiation therapy machines) and CT scanners
| simultaneously due to insufficient power supply.
|
| This might be hard to imagine for countries like China or
| the USA, but hospitals in these countries do not have
| hardware with sufficient computing power, nor do they
| have the funds to purchase AI service software. There's
| also a lack of understanding about AI technology, and
| even the performance of computers used by doctors can't
| be guaranteed."
|
| By all means if you can afford it, sign an actual
| contract with the company developing this product; the
| free plan wasn't meant for you.
| medimikka wrote:
| > "Currently, many countries cannot operate Treatment
| Machines (radiation therapy machines) and CT scanners
| simultaneously due to insufficient power supply.
|
| Yes, I know. I worked in Ghana. And, know what? Unless
| you're running a $5m/month Cyberknife or similar, you
| don't do those dual modality approaches. Most, literally
| all except five or six research hospitals in the US and
| EU, treatments still work (very well) with lead marker
| lines on patients. We image, we look at the image we
| stage, we localize, we take out a tape measure, we draw.
| It might sound archaic, but it works extremely well,
| especially in places like Ghana.
|
| I'd seriously love to see "coolwolf"s experience in
| developing country cancer treatments. I mean, in
| developing countries we deal 95% with cervix, breast,
| liver and prostate. Neither are hard to image and
| localize/stage. In the case of higher stages, exploratory
| imaging is also done, but those lesions aren't of
| initially surgical or radioherapeutic concern. Those who
| are, can be localized by eye only. And that's the ones,
| that software outlines.
| coolwulf wrote:
| I am talking in terms of my experience Treating multiple
| brain Mets patients. They have lesions as small as 0.01cc
| which we treat using either GammaKnife or CyberKnife with
| zero margin for CTV. This accuracy won't be achieved
| easily with tape measurements AFAIK.
| medimikka wrote:
| It indicates, that he has sold a solution. It neither
| indicates that this solution is used[1], nor that those
| solutions are used for diagnostics.
|
| And if Chinese single-individual solutions with gamer
| nicknames don't worry you, someone who frequents Hacker News
| and is probably not dumb, I understand many of the issues we
| have with medicine and medical communication much better. I'm
| sure you're confident that you, or a loved one, will be
| correctly diagnosed by this thing. I am not.
|
| [1]: these hospitals are conglomerate hospitals who will buy
| things to try them out. I have dozens of bullshit solutions
| my bosses bought in storage. Why do you think you're getting
| raked over the coals for every small issue? Why do you think
| health care in the US is that expensive)
| eighto wrote:
| Thanks for your insights and sharing your expertise. I
| found it interesting to learn that these hospitals will
| purchase a solution just to test it out, possibly to then
| just shelve it. If that's what's happened here it seems
| quite dishonest of the author to imply that his software is
| being used there in actual clinical practice.
| coolwulf wrote:
| NeuralRad is being used during the clinic practice
| workflow at the moment. The platform currently is not FDA
| 510k cleared so we had to establish an IRB with the
| clinics which are building the platform into their
| clinical workflow.
| alwa wrote:
| You're handling all the skepticism and hostility here
| with much more grace than I would be able to. I admire
| your tenacity and the scope of your effort-your hacker
| ethos, as it were.
|
| I understand _why_ the audience's instinct is to judge
| you by the standards they'd judge a clinician or a formal
| medical device manufacturer, in that history of medical
| tech is littered with examples of well-meaning
| engineering efforts unintentionally causing harm.
|
| As a counterbalance, though, I'd like to speak to the
| charitable interpretation: after all, how many times have
| I as a tech guy relied on practitioners in other fields
| to tell me what they could use, and whether what I built
| was helping them? It seems like you're being judged on
| your skills as a practicing oncologist or full-scale US-
| market medical device manufacturer, when maybe a more
| fair frame might be that of a person who tries to help
| professionals whose work they admire by building tools
| they ask for.
|
| I feel like just as it's somebody else's job to know how
| to doctor cancer, it will be somebody else's job to prove
| that the tech is safe and appropriate to commercialize or
| popularize (what else is regulation for?).
|
| From one person who likes making stuff to another person
| who makes stuff, though, I appreciate your good
| intentions, your creativity, and your follow through-and
| I admire your grace handling criticism here!
| coolwulf wrote:
| Thank you!
| hef19898 wrote:
| Welly he is working at the point where clinicians and
| medical device manufacturers meet. Hence, those are the
| only standards to measure against.
|
| If those standards are met, great, more power to
| NeuralRad. It just rubs some people wrong to market this
| in classic SV start-up fashion, using the latest, in this
| case AI, hype. It just rubs people in more serious
| industrues the wrong way sometimes. Which, by the way, is
| valid feedback for everyone on HN with a B2B start-up
| targeting clients in very mature and risk averse
| indistries.
| coolwulf wrote:
| I'm actually based in US.
|
| To clarify, we have several research collaborations on-going
| in US clinics.
| hef19898 wrote:
| Yeah, that's where the serious business and online culture
| meet. And I know which one I prefer. That being said, with
| diagnostics becoming better each and every year, it is less
| straight forward to know which, if any treatment, to use
| against which tumor at a given time.
|
| Generally, I do very much oreder if projects like this,
| regardless of the field, do include a healthy number of very
| experienced people in the actual domain, here that would be
| oncologists and radiologists specialized in oncology.
| Otherwise, I always assume it is some potentially dangerous
| almost-right first principle thinking at play. IMHO there is
| not a lot that is more dangerous than this.
| medimikka wrote:
| Not so much business, as real medicine. The reason people get
| pissed at medicine is that it moves "slow" by their
| standards. But Jason M Somebody in his garage already built a
| cryo scalpel, why are you not using it?
|
| Well, Thalidomide, the aforementioned cryo scalpel, Paolo
| Macchiarini, and others have taught us, that that's never a
| good idea.
|
| It's 2024. We're throwing our lot in with serodiagnostics
| over anatomical localization, a PET scan being the only thing
| we need these days. If we know it's a lesion and we can FNA
| it, we will, else there's enough serodiagnostically we can
| do, to build individualized treatment plans (or determine if
| there's even a reason to use them).
|
| It's pretty fun to see the computer draw little circles
| around lesions. The Bruker solution (also Open Source and
| free, by the by) does this admirably well. But it's neither
| useful in diagnostics nor in therapy, since both don't really
| hinge on a circle around a lesion.
| hef19898 wrote:
| But is an AI-generated circle! For sure there is a billion
| dollar start-up in there somewhere, right? /s
|
| I see a lot of parallels between what you just wrote and
| big data and AI applications in a field I know a thing or
| two about: Logistics and Supply Chains. Same things happen
| there, a smart system highlighting a problematic order or
| time period. Great, but identifying those never was the
| real problem to begin with. At the same time, all the
| potential of using better planning tools to enable people
| or to automate repetitice tasks to free up peoples time get
| somewhat ignored because those use cases are less sexy than
| automating, and solving, all those "problems" using AI...
| But tjis hype cycle will ultimately be replaced with new
| one, like those before it. And I will yell at some other
| hype cloud!
| alwa wrote:
| Out of curiosity- the blog leans heavily on examples of
| clinicians operating in the developing world. Would the
| same lines of serodiagnostic techniques tend to be
| realistic in lower-resourced settings like that?
|
| It seems plausible to argue that if you can afford a CT and
| a radiation therapy machine, then you probably meet the
| resource bar for the new family of techniques, but I just
| don't have much of a reference point to judge.
| medimikka wrote:
| > It seems plausible to argue that if you can afford a CT
| and a radiation therapy machine, then you probably meet
| the resource bar for the new family of techniques
|
| Pretty much. The thing, though, is that places like Ghana
| (were I worked, I am a bit less educated about other
| places) get second hand machines from the US, Israel, UK,
| and Russia, so it'll take a few years until
| serodiagnostic and serotherapy labs "trickle down." So
| here he's right, not everyone has those resources.
|
| However, the _imaging_ and _localization_ of lesions was
| never the issue.
|
| Neither is the radiotherapeutic treatment. If you don't
| have enough power to do both at the same time, you won't
| have enough power to do his approach, since neither AI
| nor human eye can see through tissues. Humans move.
| Humans breathe. Either you take those movements as given,
| and live with the wider consequences, or you spend
| millions of cyber knives (https://med.stanford.edu/neuros
| urgery/divisions/radiosurgery...) that detect movement
| and counteract it. Having a more colorful version of the
| initial imaging won't change that. A radiologist's eye
| can do the same, and unless I see compelling evidence
| that the AI can do it better, something I have not seen,
| yet, any of the now 30+ solutions for AI analysis (as I
| said, Bruker and others are also offering theirs for free
| and open, and behind them stand massive research
| apparatuses) should especially not be used in developing
| countries.
|
| Seriously, finding tumors and staging them is the easiest
| part of this job. And the rest can't be done by AI (yet.)
| coolwulf wrote:
| Thanks for your comment. However I don't think finding
| lesions is trivia especially if you are dealing with a
| patient with multiple brain Metastasis of more than 10 or
| even 20, 30 in counts.
|
| For SRS, accurate localization and contour, label are
| crucial for the better outcome.
| coolwulf wrote:
| Thank you for your comment and I would like to clarify a few
| things:
|
| 1) NeuralRad could be running locally inside your own clinic.
| Currently, Stanford hospital, UTSW, Jefferson and several other
| clinics in the US are using it in house. In this configuration,
| the data never transferred outside the clinic.
|
| 2) The whole platform is HIPAA-complaint. All Dicom data are
| anonymized before submitting to NeuralRad server for inference
| if using the NeuralRad cloud server.
|
| 3) NeuralRad server is within US, not in "other" country.
|
| Thanks.
| medimikka wrote:
| > Stanford hospital
|
| No. Know how I know this?
| coolwulf wrote:
| At Stanford, the platform is used to help Physicians and
| Medical Physicists to contour Brain Mets. In addition, the
| platform never approves any dicom RT Structures. Physicians
| can use the generated RT structure to assist their SRS
| workflow.
| dekhn wrote:
| If you can't spell HIPAA right, how am I supposed to trust
| you that you are "HIPAA-compliant" (whatever that means)?
| coolwulf wrote:
| Thank you for pointing out the typo. I am on mobile with
| fat fingers :p
| jph00 wrote:
| You're reacting to the style and medium of the post, and the
| handle and race of the author.
|
| Maybe consider looking at the science too?
|
| (FWIW, I've started working on AI for radiology nearly a decade
| ago, and Chinese researchers have been leaders in the field for
| most of that time.)
| joconne wrote:
| As a medical physicist in radiation oncology who looks at
| segmentations generated like these I think you are missing the
| application slightly. The application of these segmentations is
| not in diagnosis or intervention, they are used mostly by a
| treatment planning algorithm.
|
| The radiation oncologist will outline the tumour and a few
| organs at risk manually. This segmentation algorithm would then
| steps in and outlines organs that the doctor would not have
| traditionally contoured. For a lung lesion the RO may contour
| the lesion and the heart but might not contour both lungs and
| the diaphragm.
|
| We can then input these segmentations into a treatment planning
| optimization algorithm that sets the radiation beam angles and
| collimation to meet constraints that minimize organ dose and
| maximize tumour dose. So in effect the application of this sort
| of segmentation is to give more information to an optimizer.
|
| Not that it doesn't have its problems! But I think it's
| important to note that the application is not diagnostic
| coolwulf wrote:
| I was interviewed by one Chinese news media on the follow-up of
| the project. The original interview article was in Chinese at
| here: https://mp.weixin.qq.com/s/vDzyKIKxuP7jCfmx6FPE4w
| coolwulf wrote:
| All patient data are anonymized locally inside user's browser
| before sending to NeuralRad server for deep learning inference.
| sniperjoe360 wrote:
| Really very cool, the time savings alone for places without
| autocontours is perhaps an hour per patient. Would be cool to see
| the following features in the next update - please dm if you want
| to collab!
|
| 1. Longitudinal comparison of images over time for response
| assessment 2. Prediction of radionecrosis vs. brain metastases 3.
| Flags for hypertrophy or atrophy of normal organs (i.e.
| cardiomegaly, splenomegaly) Easy to do based on volume
| coolwulf wrote:
| Thanks for the reply.
|
| 1. We have already developed the module for the longitudinal
| comparisons of the follow-up MR images. The module is not yet
| published but you can see the follow-up tab on the top of the
| dashboard (now grayed)
|
| 2. There's an on-going research between us and Stanford
| hospital on the prediction of radiation necrosis vs. brain
| mets. Our publication could be found in last year's AAPM
| conference.
|
| 3. Sure that's a function could be added soon.
|
| Thanks.
|
| Hao
| coolwulf wrote:
| Also I don't think you could DM on HN (maybe I'm missing
| something). But if your side wants to collaborate or implement
| this into your clinical workflow (We do provide free local
| installation of the whole platform inside your clinic
| network.), you could email me at coolwulf@gmail.com or
| hao.jiang@neuralrad.com
|
| Best,
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