[HN Gopher] The A.I. Radiologist Will Not Be with You Soon
___________________________________________________________________
The A.I. Radiologist Will Not Be with You Soon
Author : voxadam
Score : 102 points
Date : 2025-05-14 12:52 UTC (10 hours ago)
(HTM) web link (www.nytimes.com)
(TXT) w3m dump (www.nytimes.com)
| voxadam wrote:
| https://archive.is/e2phZ
| seesthruya wrote:
| Working radiologist here, 20 years experience.
|
| This article is surprisingly accurate. I fully expect to finish
| my career without being 'replaced' by AI.
|
| Happy to debate/answer questions :-)
| janice1999 wrote:
| Are AI models able to detect abnormalities that even an
| experienced radiologist can't see? i.e. something that would
| look normal to a human eye but AI correctly flags it for
| investigation? Or are all AI detections 'obvious' to human eyes
| and simply a confirmation? I suspect the latter since it was
| human annotated images the model was trained on.
| seesthruya wrote:
| Depends on what you mean by 'see'.
|
| For example, let's say I'm looking at a chest x-ray. There is
| a pneumonia at the left lung base and I am clever enough to
| notice it. 'Aha', I think, congratulating myself at making
| the diagnosis and figuring out why the patient is short of
| breath.
|
| But, in this example, I stop looking closely at the X-ray
| after noticing the pneumonia, so I miss a pneumothorax at the
| right lung apex.
|
| I have made a mistake radiologists call 'satisfaction of
| search'.
|
| My 'search' for the patient's problem was 'satisfied' by
| finding the pneumonia, and because I am human and therefore
| fundamentally flawed, I stopped looking for a second
| clinically relevant diagnosis.
|
| An AI module that detects a pneumothorax is not prone to this
| type of error. So it sees something I did not. But it doesn't
| see something that I can't see. I just didn't look.
| ceejayoz wrote:
| This is definitely a thing.
|
| https://www.npr.org/sections/health-
| shots/2013/02/11/1714096...
|
| I'm skeptical to the claim that AI isn't prone to this sort
| of error, though. AI _loves_ the easy answer.
| the_sleaze_ wrote:
| AI is overloaded. An LLM loves the easy answer, but
| that's not what is underlying an image classification
| model.
| alabastervlog wrote:
| > I have made a mistake radiologists call 'satisfaction of
| search'.
|
| Ah, now I have a name for it.
|
| When I've chased a bug and fixed a problem I found that
| would cause the observed problem behavior, but haven't yet
| proven the behavior is corrected, I'm always careful to
| specify that "I fixed _a_ problem, but I don 't know if I
| fixed _the_ problem ". Seems similar: found and fixed a bug
| that could explain the issue, but that doesn't mean there's
| not _another_ one that, independently, would also cause the
| same observed problem.
| ceejayoz wrote:
| It's also called inattentional blindness.
|
| https://en.wikipedia.org/wiki/Inattentional_blindness
| bilbo0s wrote:
| I've been going to RSNA for over 25 years, in all that time,
| the best I've seen from any model presented to me was the
| smack the radiologist on the head and say, "you dummy, you
| should have seen that!" model.
|
| That is, the models spot pathologies that 99.9999% of rads
| would spot anyway if not overworked, tired, or in a hurry.
| But, addressing the implication of your question, the value
| is actually in spotting a pathology that 99.9999% of rads
| would never spot. In all my years developing medical imaging
| startups and software, I've never seen it happen.
|
| I don't expect to see it in my lifetime.
| seesthruya wrote:
| I have a fairly strong background in tech, and I've been
| programming computers since 1979 when my dad bought me a
| TRS-80. Tape drives FTW!
|
| I agree with almost everything you've said here.
|
| Except 'not in my lifetime', because I plan on living for a
| very long time, and who knows what those computer nerds
| will come up with eventually ;-)
| SketchySeaBeast wrote:
| I'm sure it's a matter of training data, but I don't know
| if it's a surmountable problem. How do you get enough
| training data for the machine to learn and reliably catch
| those exceptions?
| nearbuy wrote:
| One Harvard study trained an AI that could reliably
| determine someone's race from a chest X-ray. AIs can be
| trained to see things we can't.
|
| The difficulty is likely in making a good training dataset
| of labeled images with pathologies radiologists couldn't
| see. I imagine in some cases (like cancer), you may happen
| to have an earlier CT scan or X-ray from the patient where
| the pathology is not quite yet detectable to the human eye.
| devilbunny wrote:
| I suspect that radiologists could identify race from a
| plain chest x-ray if they were given the patient's race
| and asked to start noticing the difference. They just
| aren't doing it because, if it's important, you can just
| look at the patient.
|
| There are a lot of things in medicine that aren't in
| literature, but are well-known among certain
| practitioners. I'm an anesthesiologist and practice in an
| area with a large African-American population. About
| 10-15% (rough guess) of people of West African descent
| will have a ridiculously strong salivary response to
| certain drugs (muscarinic agonists). As in, after one
| dose their mouths will be full of saliva in seconds. We
| don't have East Africans for comparison, so I can't say
| it's a pan-Bantu thing, but I have seen it in a Nigerian
| who lived here. Not in the literature, but we all know
| it. I had a (EDIT: non-anesthesia) colleague ask me about
| a hypersecretory response from such a drug. I said, oh,
| was he black? Yes, how did I know? Because we give those
| drugs all the time and have eyes. It's very rare to see
| in European-descended populations.
| bilbo0s wrote:
| Sigh.
|
| Rads _can_ see a person 's race. We look at them.
|
| That's the reason rads never train to determine race from
| a chest x-ray.
|
| BTW, models don't need to train that either. Because if
| it's important, it's recorded, along with a picture, in
| the guy's medical record.
|
| I'd just like to gently suggest that determining
| someone's race from an X-Ray instead of, say, their
| photograph, is maybe not how we should be burning
| training cycles if we want to push medical imaging
| forward. Human radiologists had that figured out ages
| ago.
| bilbo0s wrote:
| Medical Imaging tech entrepreneur here.
|
| Been going to RSNA for longer than you've been a radiologist.
| In all that time, I've never come across an AI that I felt was
| fit for purpose.
|
| I wholeheartedly agree with you.
|
| Many many reasons for this, and I'm happy to chime in from the
| tech side of things and fill in any blanks outside your
| knowledge domain.
| seesthruya wrote:
| Basically, they are all currently hot garbage.
|
| In my practice we have:
|
| 1. Mammography CAD
|
| 2. Pulmonary nodule CAD
|
| 3. Intracranial hemorrhage CAD
|
| 4. Intracranial vessel CAD
|
| They all stink! I would love it if they were useful,
| radiology is insanely difficult and I could use the help!
| lostlogin wrote:
| > Medical Imaging tech entrepreneur here
|
| I initially read this as 'Medical Imaging tech who is an
| entrepreneur.' I now think you're a radiologist?
|
| Any particular interests?
|
| Fixing the shiite RIS/PACS world and the hell of hl7 would
| make me happy. I'm an MR tech, and just finished trying to
| make a scan description 'MRI Cervical Spine + Right Brachial
| Plexis'
|
| You can't. Description too long.
| HelloMcFly wrote:
| As my wife says: "Until it's as easy to sue AI as it is
| doctors, we probably won't see AI replacing doctors."
| candiddevmike wrote:
| AI in healthcare is going to add so many layers of
| indirection for malpractice lawsuits. You'll spend years and
| lots of $$$ trying to figure out who the defendant would
| ultimately be, only for it to end up being a LLC that
| unfortunately just filed for bankruptcy.
| ogogmad wrote:
| What if ppl just bought the equipment and did the scans at
| home?
| ceejayoz wrote:
| Have you priced out a CT scanner and MRI?
|
| Will you be able to source a radioactive source for your
| x-rays?
| ogogmad wrote:
| Fair. But what if ppl instead got scans in "radiology
| shops" without waiting for a specialist? Specialists are
| expensive.
| SketchySeaBeast wrote:
| Isn't that 90% of going to get scan is right now? You'll
| still need the "shop" to provide the equipment and the
| tech with the training to know what/where to scan, but
| you might get the results a bit faster? Are the
| radiologists the chokepoint now, or is it the techs?
| eitally wrote:
| That's the way it already works in many cases, just like
| with outpatient surgery clinics and other outpatient
| specialist practices. There is a critical difference,
| though, because radiology also has sub-specialities and
| someone focused on orthopedics probably isn't the one
| you'd want reading your cardiology images, nor would you
| want your ophthalmologic radiologist trying to diagnose a
| brain CT.
| lostlogin wrote:
| The X-Ray source is the X-ray machine. You may be
| referring to nuclear medicine which injects radioactive
| stuff, or radiation therapy.
|
| DIY radiation therapy would be a whole new level.
| ceejayoz wrote:
| > The X-Ray source is the X-ray machine.
|
| Healthcare-grade x-ray tubes to put _in_ your (expensive)
| x-ray machine are not something you easily can obtain
| without a license.
| lostlogin wrote:
| Here in New Zealand you get a licence _after_ purchasing
| the equipment, and require the machine spec, date of
| manufacture and serial number to get the licence.
|
| It does require a radiologist name on the paperwork as
| they are the one with the radiation licence. However it
| is possible to get one if not a radiologist (dentists do,
| and radiographers have).
|
| Being licensed to use the equipment is the hard bit, as
| insurance companies require accreditation which is hard
| to get.
| mikestew wrote:
| So the question is, "what if people bought an x-ray machine
| (affordably available on Amazon)and started using it
| without training on radiological safety"?
| SketchySeaBeast wrote:
| I assume followed shortly by "what is this weird red
| splotch on my skin?"
| newyankee wrote:
| May be in the West. However more practical countries like
| China with a huge population and clear incentive to provide
| healthcare to a large population at reduced cost will have
| incentives to balance accuracy and usefulness in a better
| way.
|
| My personal opinion is that a lot of Medical professionals
| are simply gatekeeping at this point of time and using legal
| definitions to keep changing goalposts.
|
| However this is a theme that will keep on repeating in all
| domains and I do feel that gradual change is better than
| sudden, disruptive change.
| educasean wrote:
| The worry isn't that you'll find an AI sitting on the chair
| that a radiologist used to sit. It's that the entire field of
| radiology gets reduced down to a button click on a software.
|
| The other doctors will still be there for you to sue.
| stackedinserter wrote:
| What's accurate in this article? It's very vague, it can be
| tldred into "we won't go anywhere, although AI does more and
| more of our work"
|
| > Radiologists do far more than study images. They advise other
| doctors and surgeons, talk to patients, write reports and
| analyze medical records. After identifying a suspect cluster of
| tissue in an organ, they interpret what it might mean for an
| individual patient with a particular medical history, tapping
| years of experience.
|
| AI will do that more efficiently, and probably already does.
| "tapping years of experience" is just data in training set.
|
| > A.I. can also automatically identify images showing the
| highest probability of an abnormal growth, essentially telling
| the radiologist, "Look here first." Another program scans
| images for blood clots in the heart or lungs, even when the
| medical focus may be elsewhere. > "A.I. is everywhere in our
| workflow now," Dr. Baffour said. > "Five years from now, it
| will be malpractice not to use A.I.," he said. "But it will be
| humans and A.I. working together."
|
| Maybe you'll be able to happily retire because inertia, but
| overall it looks like elevator operator job.
|
| What's so special about radiology?
| seesthruya wrote:
| There's nothing special about radiology. And I do believe
| inertia will carry me through the end of my career, which has
| approximately 10 years left.
|
| However, it's my opinion that my job takes general
| intelligence, not just pattern matching.
|
| Therefore, when I lose my job to AI, so does everyone else.
| doctorpangloss wrote:
| On the one hand, you're totally right. The job takes
| general intelligence.
|
| On the other hand, a lot of jobs take general intelligence.
| You're right about that too.
|
| It's difficult to guess the specifics of your life, but:
| maybe you've engaged a real estate agent. Some people use
| no real estate agent. Some have a robo agent. No AI
| involved. Maybe you have written a will. Some people go
| online and spend $500 on templates from Trust & Will,
| others spend $3,000 on a lawyer to fill in the templates
| for them, some don't do any of that at all. Even in
| medicine, you know, a pharma rep has to go and convince
| someone to add their thing to the guidelines, and you can
| look back at the time between the study and adoption as,
| well people were intelligent and there was demand, but
| doctors were not doing so and so thing due to lack of
| essentially sales. I mean you don't have to be generally
| intelligent to know that flossing is good for you, and yet:
| so few people floss! That would maybe not put tons of
| dentists out of business. But people are routinely doing
| (or not doing) professional services stuff not for any good
| (or bad) reason at all.
|
| Clearly the thing going on in the professional services
| economy isn't about general intelligence - there's already
| lots of stuff that is NOT happening long before AI changes
| the game. It's all cultural.
|
| If you've gotten this far without knowing what I am talking
| about... listen, who knows what's going to happen? Clearly
| a lot of behavior is not for any good reason.
|
| How do you know where the ball is going to go for culture?
| Personally I think it's a kind of arrogant position: "I'm a
| member of the guild, and from my POV, if my profession is
| replaced, so is everyone else's." Arrogance is not an
| attractive culture, it's an adversarial one! And you could
| say inertia, and yet: look who's running the HHS! There are
| kids right now, that I know in my real life, who look like
| you or me, who went to fancy Ivy League school, and they
| are vaccine skeptical. What about inertia and general
| intelligence then? So I'll just say, you know, putting
| yourself out here on this forum, being all like, "I will
| AMA, I am the voice," and then to be so arrogant: you are
| your own evidence for why maybe it won't last 10 years.
| seesthruya wrote:
| All good points! Nobody knows the future!
|
| I jumped into this thread to share my thoughts, and my
| thoughts alone, because I'm not sure there are a lot of
| radiologists on HN. I certainly don't speak for all
| radiologists.
|
| But, I would submit to you, that rapid, radical changes
| to the practice of medicine are rare, if not impossible.
| TuringNYC wrote:
| >> Therefore, when I lose my job to AI, so does everyone
| else.
|
| Not quite right? Some fields are licensed, regulated, and
| have appointments -- and others are not. AI is most keenly
| focused on fields w/o licensure barriers
| seesthruya wrote:
| You are correct!
|
| I should have said when an AI can do my job it can do
| anyone's job.
| M95D wrote:
| Respectfully, it doesn't matter what you expect or think. What
| matters is this: - If the law allows AI to
| replace you. - If the hospital/company thinks [AI cost +
| AI-caused law suits] will be less expensive that [your salary +
| law suites caused by you].
|
| I'm almost in the same situation as you are. I have 22 years
| left until retirement and I'm thinking I should change my
| career before I'm too old to do it.
| candiddevmike wrote:
| What career would you change to that would be safe, given the
| conditions you provided and your time horizon?
| jerf wrote:
| The original author of the paper about the technological
| singularity [1] defines it as simply the point where
| predictions break down.
|
| If AI gets to the point where it is truly replacing
| radiologists and programmers wholesale, it is difficult to
| tell anyone what to do about it today, because that's
| essentially on the other side of the singularity from here.
| Who knows what the answer will be?
|
| (Ironically, the author of that paper, being also a science
| fiction author, is also responsible for morphing the
| singularity into "the rapture for nerds" in his own sci-fi
| writing. But I find the original paper's definition to have
| more utility in the current world.)
|
| [1]:
| https://accelerating.org/articles/comingtechsingularity
| LPisGood wrote:
| I think that if AI can replace software engineers then AI
| can replace any job because the domain of software
| engineering is pretty much everything.
| FeteCommuniste wrote:
| I don't think robotics is progressing at nearly the same
| pace as AI so for a while there will still be a bunch of
| manual labor for us to fight over. :-)
| tintor wrote:
| Not really. AI advances are boosting progress in
| robotics. Many US and China robot companies are
| developing general androids.
| pc86 wrote:
| Crime?
| seesthruya wrote:
| I agree with you fully.
|
| And, I didn't say I would never be replaced. I said I would
| finish my career, which is approximately 10 more years at
| this point.
| dang wrote:
| > _it doesn 't matter what you expect or think_
|
| Can you please edit out swipes like that from your HN posts?
| (Prepending "respectfully" doesn't help much.) This is in the
| site guidelines:
| https://news.ycombinator.com/newsguidelines.html.
|
| The rest of your comment is just fine of course.
| Al-Khwarizmi wrote:
| If (as acknowledged in the article) AI automates at least part
| of the work of radiologists (e.g. tool that "saves her 15 to 30
| minutes each time she examines a kidney image"), don't you fear
| that the demand of radiologists will decline? Even if some are
| still needed, surely if a hospital needs X reports per day and
| now Y radiologists are sufficient to provide them rather than
| the current Z (Y<Z), that should be something for people
| considering your career to take into account?
|
| On the other hand, how much of your confidence in not being
| replaced stems from AI not being able to do the work, and how
| much from legal/societal issues (a human needing to be legally
| responsible for the diagnoses)? Honestly the description in the
| article of what a radiologist does _" Radiologists do far more
| than study images. They advise other doctors and surgeons, talk
| to patients, write reports and analyze medical records. After
| identifying a suspect cluster of tissue in an organ, they
| interpret what it might mean for an individual patient with a
| particular medical history, tapping years of experience"_
| doesn't strike me as anything impossible for AI within a few
| years, now that models are multimodal and they can work with
| increasing amounts of text (e.g. medical histories).
| dingnuts wrote:
| if the cost for preventative scans goes down, demand will
| rise. medical demand is incredibly constrained by price.
| people skip all kinds of tests they need because they can't
| afford it. the radiologists will have more work to do, not
| less.
| seesthruya wrote:
| There is a national shortage of radiologists in the US, with
| many hospital systems facing a backlog of unread cases
| measuring in the thousands. And, the baby boomers are
| starting to retire, it's only going to get worse. We aren't
| training enough new radiologists, which is a different
| discussion.
|
| Askl to your question on where my confidence stems from,
| there are both legal reasons and 'not being able to do the
| work' reasons.
|
| Legal is easy, the most powerful lobby in most states are
| trial attorneys. They simply won't allow a situation where
| liability cannot be attached to medical practice. Somebody is
| getting sued.
|
| As to what I do day to day, I don't think I'm just matching
| patterns. I believe what I do takes general intelligence.
| Therefore, when AI can do my job, it can do everyone else's
| job as well.
| 6stringmerc wrote:
| A big wrinkle in AI evangelism is that proponents don't
| understand the concept of human judgment as a "learned"
| skill - it takes practice and AI models / systems do not
| suffer consequences the way humans do. They have no
| emotions and therefore can not "understand" the
| implications of their decisions.
|
| For context, generative AI music is basically unlistenable.
| I've yet to come across a convincing song, let alone 30
| seconds worth of viable material. The AI tools can help
| musicians in their workflow, but they have no concept of
| human emotion or expression and it shows. Interpreting a
| radiology problem is more like an art form than a jigsaw
| puzzle, otherwise it would've been automated long ago (like
| a simple blood test). Like you note, the legal system in
| the US prides itself on "accountability" (said tongue in
| cheek) and AI suffers no consequences.
|
| Just look how well AI worked in the United Healthcare
| deployment involving medical care and money. Hint: stock is
| still falling.
| ToValueFunfetti wrote:
| >For context, generative AI music is basically
| unlistenable. I've yet to come across a convincing song,
| let alone 30 seconds worth of viable material.
|
| This one pops into my head every couple months:
|
| https://youtube.com/watch?v=4gYStWmO1jQ
|
| It's not really my genre, so my judgment is perhaps
| clouded. Also, I find the dumb lyrics entertaining and
| they were probably written by a human (though obviously
| an AI could be prompted to do just as well). I am a fan
| of unique character in vocals and I love that it
| pronounces "A-R-A" as "ah-ahr-ah", but the little bridge
| at 1:40 does nothing for me.
| mullingitover wrote:
| You may have missed the month or so where this[1] AI-
| generated track (remixed by a person, but nonetheless)
| dominated pop culture.
|
| [1] https://www.youtube.com/watch?v=1uW_AUwEv-0
| marcusb wrote:
| > A big wrinkle in AI evangelism is that proponents don't
| understand the concept of human judgment as a "learned"
| skill
|
| Which is ironic given how much variation in output
| quality there is based on the judgement of the person
| using the LLM (work scope, domain, prompt quality, etc.)
| mullingitover wrote:
| > We aren't training enough new radiologists, which is a
| different discussion.
|
| About that, I think the AMA is ultimately going to be a
| victim of its own success. It achieved its goal of creating
| a shortage of medical professionals and enriching the
| existing ones. I don't think any of their careers are in
| danger.
|
| However, long term, I think magic (in the form of
| sufficiently advanced technology) is going to become cost
| effective at the prices that the health care market is
| operating at. First the medical professionals will become
| wholly dependent on it, then everyone will ask why we need
| to pay these people eye-watering sums of money to ask the
| computers questions when we can do that ourselves, for
| free.
| seesthruya wrote:
| I agree with you on all points. The only question is how
| long will it take?
| reissbaker wrote:
| The trial lawyer angle doesn't seem accurate. Did trial
| lawyers prevent pregnancy tests from rolling out? COVID
| tests? Or any other automatic diagnostic, as long as it was
| reasonably accurate?
|
| Not as far as I know. Once an automated diagnostic is
| reasonably accurate, it replaces humans doing the work
| manually. The same would be true of anything else that can
| be automatically detected.
|
| No comment on whether radiology is close to that yet,
| although I don't think a few-million-param neural network
| would tell us much one way or another.
| seesthruya wrote:
| Are you aware of any states in the US that have made it
| harder to sue doctors for malpractice?
|
| My point, which I made poorly, is this: There's a reason
| doctors that went to medical school in India and trained
| as Radiologists in India can't read US cases remotely for
| a fraction of the cost of US trained and licensed
| radiologists.
|
| It's not because the systems to read remotely don't
| exist.
|
| It's not because they're poorly trained or bad doctors.
|
| Itsty because they can't be sued.
| radiologist72 wrote:
| You say "Legal is easy, the most powerful lobby in most
| states are trial attorneys."
|
| The most powerful lobby in this case is the ABR which
| carefully constricts coveted residency spots in Radiology
| to create an artificial scarcity and keep up incomes. It is
| the opposite of, say, technology, where we have no
| gatekeeper and supply increases.
|
| The ABR will say that Medicare doesnt fund enough residency
| spots, but all you need to do is look at an EoB and see
| that a week of residency billings covers the entire cost of
| the resident.
| seesthruya wrote:
| IMHO the ABR isn't quite as powerful as you're
| indicating, but in general I agree.
|
| For what it's worth, I started a new residency program to
| train more radiologist, so I do have some skin in the
| game.
| nradov wrote:
| If a teaching hospital with an existing radiology
| residency program wanted to add one more spot, does the
| ABR have any power to stop them? If Medicare offered more
| funding to a teaching hospital to add more spots would
| the hospital turn it down?
| seesthruya wrote:
| Basically, the ABR needs to approve a residency program
| for the residents that graduate from the program to be
| eligible to sit for the boards.
|
| I don't think they would ever do it, but technically the
| ABR could stop them.
| postexitus wrote:
| No. There is no area of medicine where a boost in
| productivity will cause doctors to have idle time. The wait
| times may decrease, throughput may increase, diagnosis
| accuracy may improve, even costs may decrease (press x to
| doubt) but no, there will never be a case where we will need
| less radiologists.
| whynotminot wrote:
| Which may take us to a sort of "Jevens Paradox" kind of
| place except for medical care.
|
| Like there are times already where I've put off or not
| sought medical care because of the hassle involved.
|
| If I could just waltz into the office and get an
| appointment and have an issue seen to same day I would
| probably do it more often.
| KerrAvon wrote:
| To be clear, we also need more medical professionals in
| general -- they're not keeping up with the population and
| it's making us all less healthy. Three to six months, or
| more, in the SF bay area for some critical appointments
| is really unacceptable, but there's not really an option
| given supply and demand.
|
| I'm sure this will all get better with captain brainworms
| at the helm.
| perrygeo wrote:
| Wonderful insight that I'd never considered. Talk to
| almost anyone in America and they'll tell you about a
| health issue that they or their family are deferring due
| to lack of access. Waiting months or years to simply talk
| to a specialist, let alone find one that can help, is
| sadly the norm. Patients rightly feel it's a waste of
| their time so won't even seek treatment.
|
| Remove that barrier to access and we won't see a shiny
| new streamlined medical system but rather a flood of new
| patients requiring even more bureaucracy to manage.
| 98codes wrote:
| 100% why I bothered to stick w/ OneMedical after the
| Amazon acquisition. I tried to get a "New Dr/New Patient"
| appointment with any local doctor I could find that took
| my insurance, and the closest I could get was 3 weeks
| away.
|
| I'm not worried about medical folks having "time to
| clean" any time soon.
| TuringNYC wrote:
| >> No. There is no area of medicine where a boost in
| productivity will cause doctors to have idle time. The wait
| times may decrease, throughput may increase, diagnosis
| accuracy may improve, even costs may decrease (press x to
| doubt) but no, there will never be a case where we will
| need less radiologists.
|
| I dont think this is how market participants may think
| about it. If costs decrease, some group of radiologists
| will drop out of the market. We may not "need" less
| radiologists, but we're signaling we need less of them by
| not paying them as much as before.
|
| Much like I still "need" a photographer, but short of
| weddings, I'm not willing to pay as much as before. I may
| well acquire a photogrpher for a portrait, but it would
| have to be priced competitively to a selfie.
| postexitus wrote:
| Faster CPUs, better screens, helpful IDEs, heck even Gen-
| AI itself did not reduce the need for software engineers
| let alone decrease the costs. As mentioned in another
| comment, The Jevons Paradox implies that in certain
| industries, increased productivity may actually lead to
| more consumption (therefore propping up the demand /
| cost) despite not being intuitive so.
|
| The only industries that has observed the opposite effect
| I can think of so far are translators and stock
| photographers. Maybe also proof readers - but is that gen
| Ai or did spellcheckers already kill that branch?
| vjvjvjvjghv wrote:
| Software engineers could spread out into new areas and
| find new things to do. Unless I am mistaken, the work of
| radiologists is more defined.
| lostlogin wrote:
| > Software engineers could spread
|
| This is key. Radiologists that can program (or software
| engineers that do medicine) make a massive difference.
|
| When someone explains what they want and it's built for
| them, you get a very different product to that built by
| the user.
|
| I want more radiologists that can write software please.
| seesthruya wrote:
| I'm a radiologist that can program!
|
| I've authored and contributed to several open source
| projects over the years, and I'm currently doing a deep
| dive in CAD/CAM after buying a CNC machine.
|
| I help my practice where I can, and have written a little
| utility to make generating reports easier, but I would
| have to quit my job if I was trying to take on the
| absolutely enormous task of radiology computer aides
| diagnosis. And I need my job!
| TuringNYC wrote:
| >> The only industries that has observed the opposite
| effect I can think of so far are translators and stock
| photographers. Maybe also proof readers - but is that gen
| Ai or did spellcheckers already kill that branch?
|
| Voice-over performers. Sketch artists. Audiobook actors.
| Tutors (see:
| https://www.google.com/finance/quote/CHGG:NYSE?window=5Y)
| nradov wrote:
| You're making the common mistake of thinking that
| healthcare is some sort of normal market subject to
| simple supply-and-demand economics rules. The reality
| that supply is heavily constrained by CMS funding for
| residency slots, prices are (mostly) fixed by a few large
| payers, and patient demand is effectively infinite. There
| is a serious shortage of radiologists already and it's
| getting worse as the population grows older and sicker.
| If AI tools make radiologists more productive then more
| imaging studies will be ordered.
| TuringNYC wrote:
| >> supply is heavily constrained by CMS funding for
| residency slots
|
| I keep hearing this argument. Then I look at an Insurance
| Explanation of Benefits statement. A Radiologist might
| make $1-2k/day in billings. If you are in a balance-
| billing state, whatever insurance doesnt pay gets forward
| billed to the patient. On a standard 252 day workyear,
| that is $250-500k/yr in billings. The average resident
| salary is 70k, lets assume 100k with benefits.
|
| Of course there is plenty of overhead, but from the math
| i'm seeing, the average Radiology Resident is a 150-400k
| net revenue center. Is the overhead really greater than
| 150-400k/yr/resident?
|
| What am I missing, why would a profit center need "CMS
| funding"? From what my doctor friends tell me, the real
| bottleneck is the unwillingness of AMA and ABR to open up
| more radiology residency spots (artificial supply
| constraint) with "CMS funding" a boogeyman and red
| herring.
| seesthruya wrote:
| You cannot bill for a resident's work, without an
| attending signing off on it.
|
| I like residents, I actually started a new radiology
| residency program.
|
| They are a net drain on productivity in radiology, due to
| the teaching obligations
| nradov wrote:
| Contrary to what your doctor friends might have told you,
| the AMA has no power to restrict the number of residency
| slots. They are a private membership organization with no
| regulatory or accreditation authority. At one time they
| did lobby Congress to restrict graduate medical education
| funding but have since reversed that position.
|
| https://savegme.org/
|
| A minority of funding does come from sources other than
| CMS. Teaching hospitals are largely free to add more
| residency slots if they want to. The fact that most
| hospitals don't do this indicates that GME programs are
| largely unprofitable.
| bparsons wrote:
| There is a perpetual shortage of these types of technicians,
| so it is unlikely that demand for those jobs will drop.
| belly_joe wrote:
| I would say generally speaking that people who assume AI will
| replace _somebody else 's_ job believe that these jobs are
| merely mechanical and there is no high-level reasoning involved
| that would basically require AGI (when that comes about nobody
| is safe). So the model of the AI radiologist assumes the only
| job of a radiologist is to classify images, which is pretty
| vulnerable to near-future disruption.
|
| I imagine, given the training involved, the job involves more
| than just looking at pictures? This is what I would like to see
| explained.
|
| The analogy would be the "95% of code is written by AI" stat
| that gets trotted out, replacing code with image evaluation.
| Yes AI will write the code but someone has to tell the AI what
| to write which is the tricky part.
| seesthruya wrote:
| 100%
| tbrownaw wrote:
| We already have AI taxis (in specific limited areas, but
| still). Driving isn't something I'd usually call "merely
| mechanical".
| tintor wrote:
| Driving (in US) is considered unskilled labor.
| cess11 wrote:
| That is such a contrived phenomenon, it has taken decades
| of lobbying and destruction of political accountability to
| create the conditions where a person considered sane would
| touch that idea instead of immediately skipping over to
| driverless trains.
|
| Incredibly wasteful gimmick, I don't get why the usians are
| still struggling away at it now that the chinese seem to
| have already done it.
| SpicyLemonZest wrote:
| I don't know where you've gotten the idea that cars are
| something you can "skip over" on the way to trains.
| Public transit is great, and the US should do it better,
| but it doesn't obsolete every other form of transit. The
| vast majority of people in every country who can afford
| access to cars use them regularly.
| mbrameld wrote:
| Can you describe a driving scenario where the correct
| action couldn't be determined "mechanically"? Are you
| thinking of something like the trolley problem?
| TuringNYC wrote:
| >> jobs are merely mechanical and there is no high-level
| reasoning involved
|
| This is a very binary way of thinking about it. More usual is
| that components of many professions are mechanical and can be
| automated, while other components are not mechanical and thus
| harder to automate. Regardless, if some % of the mechanical
| work goes away, it is unlikely that human workers just work
| less. Instead, they will work just as much and the overall
| demand for workers is reduced by %
| ido wrote:
| Between 1985 and 2025 we went from programming in 8086
| assembly language to high level languages like python,
| typescript and go. These automate a lot of the drudgery of
| programming in asm, so why has the overall demand for
| programmers not diminish (in fact it increased massively)?
| tarunkotia wrote:
| I worked on an autocontouring model but we could not get very
| high accuracy for it to be adopted commercially. The algorithm
| would work for some organs but would totally freak-out on the
| others. And if the anatomy was out of norm then it would not
| work at all. This was 5 years ago, I see Siemens [0] has a
| similar tool. I remember shadowing a dosimetrist contouring all
| the Organs-At-Risk (OAR) and it took about 3-4 hours to contour
| one CT image of thoracic region. Do you know how much better
| the autocontouring tools have become?
|
| [0] https://www.siemens-healthineers.com/en-
| us/radiotherapy/soft...
| justlikereddit wrote:
| Segmenting algorithms is massively improved from 5 years ago.
| How much the actual SOTA is used on the work floor though is
| always a hit and miss.
| seesthruya wrote:
| Agreed, and from what I understand radiation oncology
| treatment planning has benefited from this.
| jjtheblunt wrote:
| (great username: a radiologist with "seesthruya")
| LanceH wrote:
| At the same time it can be a handy tool to be a first cut at
| triage.
|
| It's really not a matter of "full replacement or bust".
| seesthruya wrote:
| This is true!
| TuringNYC wrote:
| >> Happy to debate/answer questions :-)
|
| Curious -- do you think that is because
|
| 1. the technology isnt there, or
|
| 2. because it isnt a competitive market (basically, the
| American Board of Radiologists controls standards of practice
| and can slow down technologies seen as competitive to human
| doctors)?
|
| 3. or perhaps 1 doesnt happen because outsiders know the market
| is guarded by the market itsself?
| bko wrote:
| I don't think it will go away as long as we have third party
| paying for the costs and AMA controlling competition.
|
| If I had to pay $500 or whatever to get a scan, and instead I
| could get my data, send it to a model and only follow up if it
| came back bad, I would. But now someone else pays and there are
| laws and regulations that prevent people from controlling their
| data, or at least make it difficult. Kind of weird I have a
| file on me that I have never seen.
| lostlogin wrote:
| > Kind of weird I have a file on me that I have never seen.
|
| Can't you ask for it?
| nradov wrote:
| Nope. You have an absolute legal right to obtain copies of
| your medical images and other data. Who paid for it is
| irrelevant. The provider can charge you a nominal fee for
| copying the files but they can't keep it from you.
|
| https://www.hhs.gov/hipaa/for-individuals/guidance-
| materials...
| xnx wrote:
| Glad to hear that this is one area that AI is conclusively
| useful.
|
| Still not clear that the already superhuman capabilities of AI
| won't still fully supplement radiologist interpretive skills with
| every additional bit of training data that comes in.
| pj_mukh wrote:
| "The staff has grown 55 percent since Dr. Hinton's forecast of
| doom, to more than 400 radiologists."
|
| Wonder what other forecasts of doom he is wrong about :|.
| yread wrote:
| They are also all driving themselves to the hospital instead of
| using self-driving cars. Different forecaster though
| 29athrowaway wrote:
| For an ML model, a sofa with a tiger pattern might be a tiger, if
| in its training dataset tiger stripes always means tiger.
|
| It does not have common sense.
| qgin wrote:
| For small models, yes. But for the kind of massive multimodal
| models getting trained these days, the concept of "a pattern on
| an object" will exist. It doesn't need to have seen a tiger
| sofa before. But tiger + sofa + patterns on an object is enough
| to not run from the tiger print.
| roenxi wrote:
| This reminds me of the idea that Human-Chess partnerships would
| be the ultimate manifestation of Chess genius. I'm not sure
| whether the idea is still holding on but engines are so far ahead
| of human play that I doubt a human in the loop can add anything
| these days given how devastatingly far ahead the engines are and
| the advent of machine learning techniques.
| husarcik wrote:
| Chess reminds me more of programming given the set of defined
| rules in each. However, I'm biased as I work in radiology and
| program more as a hobby. So far I've seen way more tools to
| help me code than to accurately detect radiologic findings.
| ogogmad wrote:
| So far. Computer vision is currently lagging NLP, but I
| wouldn't expect that to last.
| johnmaguire wrote:
| > but I wouldn't expect that to last
|
| Do you have any links to research or work being done on
| computer vision that leads you to this conclusion? Would
| love to check it out!
| startupsfail wrote:
| You can compare best image synthesis and image
| understanding from two decades ago (SIFT / HOG), from a
| decade ago (CNN, SdA) and now (Transformer). Very rapid
| progress that went from being able to unreliability
| recognize a face to getting to outperforming human
| professionals (see MMMU) is quite remarkable.
| johnmaguire wrote:
| AIUI, and I may be wrong, but each of the mentioned
| technologies was a "breakthrough" technology - not
| iterative improvement. Along this vein, I was wondering
| if there was some promising, novel research OP was aware
| of for image understanding.
|
| The most recent of which you mentioned, Transformers, is
| used by both LLMs and image synthesis/understanding. The
| parent posits that while computer vision lags behind NLP,
| this may not continue. While your comment points out that
| image synthesis and understanding has improved over time,
| I'm not sure I follow the argument that it may soon
| leapfrog or even catch up with LLMs (i.e. text
| understanding and synthesis.)
| michaelbuckbee wrote:
| My understanding is that the way that chess.com and other
| online services detect cheating is by comparing the human-made
| moves to a "perfect" version of what the chess engine would
| play.
|
| Which gives credence to your theory that people aren't bringing
| much to the table.
| bobowzki wrote:
| The thing I find most interesting about ML in radiology is that a
| computer can observe the entire dynamic range of the sensor at
| once. A human will only look at a window or a compressed window.
| husarcik wrote:
| This is a very key point. Perhaps that discrepancy can be
| leveraged in image generation to save time.
| bilbo0s wrote:
| It already is, which is why rads input window/level settings.
| sulam wrote:
| "Radiologists do far more than study images. They advise other
| doctors and surgeons, talk to patients, write reports and analyze
| medical records. After identifying a suspect cluster of tissue in
| an organ, they interpret what it might mean for an individual
| patient with a particular medical history, tapping years of
| experience."
|
| Now think about how much of software development is typing out
| the code vs talking to people, getting a clear definition of the
| problem, debugging, etc. (I would love an LLM that could debug
| problems in production -- but all they can do is tell me stuff I
| already know). Then layer on that there are far more ideas for
| what should be built than you have time to actually build in
| every organization I've ever worked in.
|
| I'm not worried about my job. I'm more worried my coworkers won't
| realize what a great tool this is and my company will be left in
| the dust.
| agos wrote:
| that great tool does not need ten years of experience to use.
| your coworkers will be able to catch up quite easily
| EcommerceFlow wrote:
| So are datasets/currently available data the limitation here?
|
| Let's say a major healthcare leak occurred, involving millions of
| images and associated doctor notes, diagnostics, etc... would
| this help advance the field or is it some algorithmic issue?
| d_burfoot wrote:
| The key to the power of the LLM is that the training process can
| learn effectively from vast corpora of unlabelled text.
| Unfortunately, there is no comparably vast database of medical
| images.
|
| In order to "crack" radiology, the AI companies would need to
| launch an enormous data collection program involving thousands of
| hospitals across the world. Every time you got an MRI or X-Ray,
| you would sign some disclosure form that allowed your images to
| be anonymously submitted to the central data repository. This
| kind of project is very easy to describe, but very difficult to
| execute.
| physicsguy wrote:
| They'll have better luck in countries like the U.K. where
| medical data is at least somewhat more organised by virtue of
| being under the NHS umbrella
| nradov wrote:
| I don't think the UK NHS has a single centralized PACS or
| EHR.
| seesthruya wrote:
| I agree with you, but here is where things get tricky:
|
| Everyday I see something on a scan yhat I've never seen before.
| And, possibly, no one has ever seen before. There is tremendous
| variation in human anatomy and pathology.
|
| So what do I do? I use general intelligence. I talk to the
| patient. I talk to the referring doctor. I compare with other
| studies, across modalities and time.
|
| I reason. I synthesize. I think.
|
| So my point is, basically, radiology takes AGI.
| ACCount36 wrote:
| "Takes AGI?" It's the same argument people used to make about
| NLP. By now, it's proven wrong.
| danjl wrote:
| Another way of saying this that might not trigger your
| alarm bells is that even a perfect image analyzer is not
| enough to replace a radiologist. The job consists of much
| more than just analyzing images.
| justlikereddit wrote:
| >Unfortunately, there is no comparably vast database of medical
| images.
|
| Even a tiny hospital with radiology services will produce many
| thousands of images with accompanying descriptions every year.
| And you are allowed to anonymize and do research on these
| things in many places as neither image nor accompanying
| description is a personal identifier.
|
| So this is yet another Hinton-ish prediction, any time soon
| radiologist are going dodo. This time LLMs will crack the nut
| that image recognition have failed at for 20 years.
|
| Where LLMs have succeeded is in doing hot takes that miss the
| mark, they should be really good at cornering the "prematurely
| predicting demise of radiologist"-market
| Workaccount2 wrote:
| I just want to point out that the term "A.I." gets used pretty
| loosely in these articles, as if A.I. is a monolithic commodity
| that you plugin to your software to make it do chatGPT.
|
| The example in the article is an in house developed "A.I." to
| help radiologists assess images. Digging a bit deeper it seems
| they are using mostly old CNN type architectures with a few
| million parameters.[1]
|
| I think it still remains to be seen what a 1T+ parameter
| transformer trained specifically for radiology will do. I think
| anyone would be confident that a locally run CNN will not hold a
| candle to it.
|
| [1]https://mayo-radiology-informatics-
| lab.github.io/MIDeL/index...
| seesthruya wrote:
| Agreed
| heyitsguay wrote:
| There are many, many papers and projects out there about tuning
| foundation models on various types of medical imaging data, and
| many organized efforts to produce large medical imaging
| datasets to feed that training. This stuff is well-known in the
| trenches and can improve on the older, smaller CNNs in some
| ways, but not in a way that's produced any step change in
| automated capabilities. People are certainly working on it!
| bko wrote:
| > I think it still remains to be seen what a 1T+ parameter
| transformer trained specifically for radiology will do
|
| Does image processing of something like this scale with
| parameters?
|
| It makes sense that language continues to scale as the vector
| space is huge. Even models that generate images scale as the
| problem space is so large.
|
| But here there are only so many pixels in the image and they
| are a lot more uniform. You likely can't have 1T images to
| train on, so wouldn't the model just overfit and basically
| memorize every image it has ever seen?
| throwuxiytayq wrote:
| If the meat machine can learn it, then the silicon machine
| can learn it.
| Workaccount2 wrote:
| You are right, but I meant it more as a total radiologist,
| scans the images and can put it into medical context.
| CGMthrowaway wrote:
| "The radiologist will be with you soon" also gets used pretty
| loosely in this article, since a radiologist is not someone you
| are likely to speak with. They sit in their home office in
| Montana clicking through images all day, and send thru their
| diagnosis to a different practitioner at the office you are
| visiting.
| fred_is_fred wrote:
| Which means the field has a larger issue since they can just
| as easily sit in the Philippines or Brazil or India.
| seesthruya wrote:
| There's a reason they can't.
| lostlogin wrote:
| Why not? Where I work scans are reported overseas. The
| radiologists are qualified in the country they are
| reporting for however.
| seesthruya wrote:
| Ok, I should have been more clear.
|
| A radiologist practicing in the USA can live anywhere in
| the world, but they must be trained in the USA, licensed
| in the state(s) where they read from, credentialed at the
| hospitals or facilities they read from, and carry medical
| malpractice insurance.
|
| The point being, hospitals can't throw cheap Indian or
| Filipino radiologists at the worklist.
| jfengel wrote:
| Can a certified radiologist farm out work to cheap
| assistants in other countries, and then put their stamp
| on the result?
| CGMthrowaway wrote:
| Not sure about other countries, but RAs do outsource work
| to RRAs(1) and then sign the final product. This is
| relatively new as Medicare/Medicaid didn't recognize RRAs
| as mid-level practitioners until 2019. I suspect the
| answer is yes for ARRT-certified RRAs, but it will be
| state-specific (similar to the answer above about RAs).
|
| (1)https://www.arrt.org/pages/earn-arrt-
| credentials/credential-...
| seesthruya wrote:
| This is illegal, and you will go to jail if you do this
| with a Medicare or Medicaid patient and it is discovered.
| CamperBob2 wrote:
| So what you're saying is they _can_ , they just don't at
| the moment for temporary, localized legal reasons.
| darth_avocado wrote:
| Medical records remain a walled garden mostly because of HIPAA.
| Unlike all the AI development that has managed to skirt the
| copyright law to train large models, training a 1T+ parameter
| transformer on a large enough dataset will need a lot of
| consumers to give up their medical records.
| 98codes wrote:
| When it comes to test results, does HIPAA prevent
| anonymization, such that all would be provided is test input
| & eventual result?
| SOTGO wrote:
| From a summary on HHS.gov it says "De-Identified Health
| Information. There are no restrictions on the use or
| disclosure of de-identified health information." Maybe
| someone with more knowledge could expand on the limitations
| of what counts as "De-Identified" but I think that might
| work. I followed the reference and nothing in the CFR jumps
| out at me, but I'm not a lawyer so who knows.
| nradov wrote:
| HHS has published clear guidelines on de-identification.
|
| https://www.hhs.gov/hipaa/for-professionals/special-
| topics/d...
| SoftTalker wrote:
| China won't have an issue with it.
| maeil wrote:
| The US won't have an issue with it. You haven't realized
| what the US has become.
| CamperBob2 wrote:
| A place where it's still possible to innovate, despite
| the best efforts of the copyright lobby?
| __loam wrote:
| I've noticed a funny trend where people will bring up an
| ethical concern and some dweeb will immediately roll out
| the Chinese strawman like it justifies their incredibly
| dubious position.
|
| "We should violate medical privacy laws on an enormous
| scale because China" Okay buddy.
| ToucanLoucan wrote:
| The Red Scare never ended for a whole lot of Americans.
| And my foot is more communist than modern China is. But
| you know, being afraid of Communism is just as, if not in
| fact easier, when you have no clue what Communism
| actually is.
| nxm wrote:
| Is that worse than being worse off technologically than
| China and the consequences that bears
| illiac786 wrote:
| Do you really feel life has been horrible in all these
| countries which have been worse off technologically than
| the US for the past decades?
|
| Being first is not the same as being happy.
| Workaccount2 wrote:
| Because the end result is either paying China to eval
| scans, buy models from China that do it, or settle for
| inferior scan reading by humans.
| SoftTalker wrote:
| I wasn't suggesting that we should, but in my lifetime we
| went from hospital admissions and discharges being
| published in the local paper, to that information being
| some of the most closely guarded with (theoretically)
| severe penalties for disclosure.
|
| I think it was AIDS and people not wanting to be outed
| that changed things.
|
| But whatever the reason, we now have HIPAA and it adds a
| huge amount of complexity to the management of medical
| records, and a huge amount of complexity to any research
| that needs access to a broad spectrum of medical case
| histories (such as training AI). Other countries don't
| have these concerns, and will outcompete the US on
| developing these capabilities.
| nradov wrote:
| Concerns about HIPAA as an obstacle to research are
| largely a red herring. Almost no clinically useful
| research can be accomplished by just processing large
| volumes of historical patient charts. In practice the
| researchers will have to gather additional data from
| study subjects so they're going to need to obtain consent
| anyway.
|
| People keep claiming that other countries will out
| compete us in medical research and it keeps not
| happening.
| devilbunny wrote:
| Epic probably has enough breadth on their own to do it,
| although they don't actually have an image display system
| that I know of, so perhaps they don't have access to the raw
| images - only the written reports.
| darth_avocado wrote:
| Epic does not have the ability to use the data as they see
| fit, even if they have the data available. That is why I
| brought up HIPAA.
| nradov wrote:
| Right, some of that data is in Epic Cosmos.
|
| https://cosmos.epic.com/
| bookofjoe wrote:
| UK's doing it:
|
| >Concerns raised over AI trained on 57 million NHS medical
| records
|
| https://www.newscientist.com/article/2479302-concerns-
| raised...
| diamondage wrote:
| Underreported competitive advantage of NHS is their unified
| and comprehensive data
| getnormality wrote:
| For a while it seemed that "AI" topics were treated as niche
| and news articles used relatively specific terms of art like
| deep learning or machine learning. Somehow ChatGPT changed that
| and now everything is just AI.
| wormius wrote:
| I do my best to filter ai topics here using ublock, and it's
| blocked about a third of the posts, and yet every day there's
| a new variation, whether a new technique/technology, a new
| product (open source or commercial), etc... that I have to
| add to the filter. It's really offputting. Yet apparently
| this is the only site besides lobste.rs that has programming
| related content that is of any depth that I know of. I really
| wish hacker news had the ability to tag posts and let me
| filter (and tag them generally not have to get specific on
| each new buzzword or product).
| SpicyLemonZest wrote:
| ChatGPT changed that because it, along with other current
| advances, brought AI out of its niche and into widespread
| mainstream usage. The laboratory the source article covers
| (https://www.mayo.edu/research/labs/radiology-
| informatics/ove...) publishes some of the technical detail
| you're interested in, but in 2025 it's also interesting to
| people less familiar with theoretical computer science. The
| doctors quoted in the source article, using programs that can
| calculate kidney volume or detect blood clots, don't
| necessarily want or need to know the difference between
| "artificial intelligence" and "deep learning".
| airstrike wrote:
| So will it cost me less than $1.5k the next time I need an x-ray?
| agos wrote:
| of course not, that would be silly. it will cost $1.5k + the AI
| analysis fee
| qgin wrote:
| People get tripped up by thinking "there is a subset of what I do
| that only humans can do and so that means AI will not eliminate
| my profession entirely and my job is safe".
|
| Let's assume for now that it's true that AI can't do a certain
| subset of your work. Your profession won't be eliminated from the
| earth, that's true. But if 80% of your work can be done by AI,
| 80% of your work will be done by AI. There will still be humans
| kept around for that remaining 20%, but fewer of them will be
| needed.
| nradov wrote:
| The demand for radiologists is effectively infinite. Right now
| the healthcare system is supply constrained. If AI tools reduce
| the work of reading an image then more imaging studies will be
| ordered.
|
| Also, many radiologists do interventional procedures directly
| with patients. We're a long, long way from being able to
| significantly automate that work.
| seesthruya wrote:
| This is 100% true and very insightful, but not obvious to
| people who don't work in healthcare.
| SoftTalker wrote:
| So I recently needed an MRI to evaluate a rotator cuff
| injury. Because MRIs are expensive, insurnace required that I
| do 6 weeks of physical therapy first to see if that would
| resolve it.
|
| Is this because the imaging process is so expensive, or
| because the radiologist who reads the image is so expensive?
|
| If demand for an expensive imaging process increases, it will
| get even more expensive.
| nradov wrote:
| MRI machines and radiologist reads are both expensive.
| These are among the largest areas of medical spending for
| most health plans (and those costs are largely passed on to
| subscribers and employers).
|
| Many rotator cuff injuries do improve to some extent with
| targeted physical therapy. You can accomplish a lot by
| strengthening the stabilizer muscles, and by learning how
| to set your shoulder joint in the correct position before
| taking a load. So the insurer's position is reasonable for
| most cases. If the injury is more severe then your doctor
| can submit a request to skip the normal step therapy
| process.
| seesthruya wrote:
| When you get a medical test like an MRI, there is both a
| technical fee and a professional fee that is paid.
|
| For a shoulder MRI, the technical fee, which goes to the
| facility that performs the scan, maybe $1,500.
|
| The professional fee, that goes to the radiologist that
| interprets the scan, maybe $80.
|
| Patients often only see a global fee.
| qwertox wrote:
| TL;DR: "Five years from now, it will be malpractice not to use
| A.I.," he said. "But it will be humans and A.I. working
| together."
| epistasis wrote:
| For a more technical dive into startups that have been chugging
| along with AI in pathology for ~decade, check out this:
|
| https://www.owlposting.com/p/what-happened-to-pathology-ai-c...
|
| > One pathology AI founder told me that it wasn't hospitals or
| diagnostic labs that showed the most promise. It was R&D groups
| within Big Pharma. Those scientists and executives wanted new
| tooling. They were often sitting on massive internal datasets,
| had real budget allocated to experimental tech, and -- critically
| -- had a clear ROI if your model helped shave months off a study
| or more precisely target the right patient cohort. Most
| importantly, pharma didn't care as much about the regulatory
| headaches, as they weren't using your model to diagnose patients
| abhishaike wrote:
| <3
| yread wrote:
| Really nice article, thanks for sharing. With digital pathology
| ai startups going bust left and right it's quite an accurate
| analysis. One thing it's missing in the "product" path is
| preanalytical differences - same tissue processed in different
| labs can produce wildly different pixels.
| MrBuddyCasino wrote:
| Reminder that according to https://openai.com/index/healthbench/,
| not only do current AI models provide far better recommendations
| than doctors, but even if doctors know the AI recommendations as
| a starting point, human revision does not bring any improvement.
|
| Honestly this doesn't surprise me, considering the quality of the
| average doctor.
| pseudocomposer wrote:
| I formerly worked at https://corista.com, dealing specifically
| with integrations with AI pathology algorithm vendors like
| https://www.qritive.com and https://visiopharm.com. (Note: we
| dealt specifically with microscopy rather than radiology.)
|
| I really think we were doing things the "right way" before I
| left: providing AI analyses from various vendors as overlays for
| slides, and being able to pre-flag slides with obvious cases of
| cancer or other infection. (These analyses typically being custom
| algorithms provided by vendors through APIs we collaborate on,
| not LLM output.)
|
| With things like this simply built into an existing, established
| pathology platform, I'm pretty confident a team of 4-5
| pathologists could do the work of 6-8, with better quality
| output, similar to how Copilot and other tooling speeds us up as
| developers. At $300-400k/yr/doctor, that's considerable savings
| (and the opportunity to allocate more doctors in specialties that
| aren't easily automated).
|
| However, for lots of reasons, it seems the market doesn't
| necessarily agree with me on the value potential of this approach
| in this field (which can certainly be a self-fulfilling
| prophecy).
| ProllyInfamous wrote:
| >the value potential of this approach in this field
|
| As a medical school dropout, I think the largest "negative" in
| value assessment would be the inability to shift malpractice
| liability over to a human practitioner (i.e. can you insure a
| company's faulty AI/LLM?) -- yet today I just read a HN article
| on insurers offering a new product: insuring chat/LLM fuck-ups.
|
| As exciting as this all is, I'm still so glad I didn't become a
| radiologist!
| seesthruya wrote:
| For what it's worth, I almost dropped out of medical school
| in my second year to go back to a career in tech. It was a
| close thing.
|
| Still, I have enjoyed my time in radiology. It is insanely
| challenging to do well, and has been very rewarding.
| jmward01 wrote:
| If there is one thing that NN can do amazingly well it is pattern
| recognition. The biggest blockers to adoption are the EHR
| providers, regulations and just inertia. It will happen, the only
| question is when and to a small degree, how.
| nradov wrote:
| EHR vendors aren't the major blocker here. Most of them have
| pretty good APIs now (at least for reading USCDI data from
| patient charts). But the data quality as entered by users is
| often crap: when you're training it's going to be garbage in /
| garbage out unless you put enormous efforts into cleansing. And
| the raw images are often not in the EHR but rather in a
| separate PACS.
| jmward01 wrote:
| From what I have seen trying to build out new features into
| this area, EHR vendors often act like monopolies blocking a
| lot of competition by controlling any data exchange. The
| vendor lock-in is strong and very harmful to improving
| process and, ultimately, harms patient care.
| nradov wrote:
| What specifically are they blocking? The most popular EHRs
| from vendors like Epic and Oracle have extensive
| interoperability APIs for multiple open industry standards.
| In general you can read all USCDI data pretty easily.
| Writing data is more limited, for understandable reasons.
| And if you want to distribute a SMART on FHIR app then
| you'll have to go through some sort of approval process.
|
| The strong vendor lock-in is unavoidable given how deeply
| an EHR gets embedded into any provider organization. No
| matter what regulators and standards bodies do, it will
| never be easy to switch.
| kazinator wrote:
| AI is not easily going to "steal" any properly gatekept jobs that
| require a licensed practitioner.
|
| Machine learning technology can be used to search for artifacts
| in medical diagnostic images that humans might miss. The flagged
| situations still have to be interpreted by a radiologist.
| joshdavham wrote:
| > "People should stop training radiologists now," Geoffrey Hinton
| said, adding that it was "just completely obvious" that within
| five years A.I. would outperform humans in that field.
|
| I'm starting to notice a strong trend where non-domain experts
| will confidently assert that X field will be replaced by AI.
| godelski wrote:
| Isn't this a common trend with CS? It seems like there's just
| constant over hype that drives booms and crashes, even to such
| a degree that if something was there it can't even be built. We
| have billionaires and hundred millionaires that made their
| money on VR, blockchain, and Web3. The wealth comes even when
| no product does and that seems like a big issue that's being
| exploited
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