[HN Gopher] Demand for human radiologists is at an all-time high
___________________________________________________________________
Demand for human radiologists is at an all-time high
Author : bensouthwood
Score : 217 points
Date : 2025-09-25 13:19 UTC (9 hours ago)
(HTM) web link (www.worksinprogress.news)
(TXT) w3m dump (www.worksinprogress.news)
| palmotea wrote:
| What we need is a mandate for AI transformation of Radiology:
| Radiologists must be required to use AI every day on X% of scans,
| their productivity must double with the use of AI or they'll get
| fired, etc. To quote CEOs everywhere: AI is a transformative
| technology unlike any we've ever seen in our careers, and we must
| embrace it in a desperate FOMO way, anything else is
| unacceptable.
| lm28469 wrote:
| I can't even tell if it's sarcasm anymore
| GoatInGrey wrote:
| > we must embrace it in a desperate FOMO way
|
| It's clearly satire with the little jabs like this.
| simonw wrote:
| I wouldn't trust a non-radiologist to safely interpret the
| results of an AI model for radiology, no matter how well that
| model performs in benchmarks.
|
| Similar to how a model that can do "PhD-level research" is of
| little use to me if I don't have my own PhD in the topic area
| it's researching for me, because how am I supposed to analyze a
| 20 page research report and figure out if it's credible or not?
| naasking wrote:
| Why, ask another deep research model to critique it of course!
| ;-)
| tanaros wrote:
| The notion of "PhD-level research" is too vague to be useful
| anyways. Is it equivalent to a preprint, a poster, a workshop
| paper, a conference paper, a journal submission, or a book? Is
| it expected to pass peer review in a prestigious venue, a mid-
| tier venue, or simply any venue at all?
|
| There's wildly varying levels of quality among these options,
| even though they could all reasonably be called "PhD-level
| research."
| matthewdgreen wrote:
| I'm a professor who trains PhDs in cryptography, and I can
| say that it genuinely does have knowledge equivalent to a PhD
| student. Unfortunately I've never gotten it to produce a
| novel result. And occasionally it does frightening stuff,
| like swapping the + and * in a polynomial evaluation when I
| ask it to format a LaTeX algorithm.
| lomase wrote:
| In 2016, Geoffrey Hinton - computer scientist and Turing Award
| winner - declared that 'people should stop training radiologists
| now'.
|
| If we had followed every AI evengelist sugestion the world would
| have collapsed.
| lnenad wrote:
| Let's assume the last person that entered their radiologist
| training started then and the training lasts 5 years. At the
| end of their training the year is 2021 and they are around 31.
| So that means they will practice medicine for cca 30 years
| which would put the calendar at around 2051. I'd wager in 25
| years we'd get there so I think his opinion still has a large
| percentage of being correct.
| lomase wrote:
| Why you write 2021? It clearly says 2016.
|
| I mean if you change the data to fit your argument you will
| always make it look correct.
|
| Lets assume we stop in 2016 like he said, where do we get the
| 1000 radiologist the US needs a year?
| stonemetal12 wrote:
| > the training lasts 5 years. At the end of their training
| the year is 2021
|
| The training lasts 5 years, 2021 - 5 = 2016 If they stopped
| accepting people into the radiologist program but let
| people already in to finish, then you would stop having new
| radiologist in 2021.
| lomase wrote:
| 'people should stop training radiologists now'
|
| That sentence and what you wrote are not 100% the same.
| nick__m wrote:
| Training is a lot longer than that in Quebec, radiology
| is a specialty, so they must first do their 5 years in
| medicine, followed by a 5 year diagnostic radiology
| residency program. And it's frequently followed by a 2
| years fellowship.
|
| So 5 + 5 + [0,2] is [10,12] years of training.
| sarchertech wrote:
| Residents are working doctors, so we'd start losing
| useful work the year we stop taking new residents.
| padjo wrote:
| So all the current radiologists are going to live until 2051?
| nenenejej wrote:
| Even Marie Curie would have.
| lm28469 wrote:
| And if it doesn't work out ?
|
| People can't tell what they'll eat next sunday but they'll
| predict AGI and singualrity in 25 years. It's comfy because
| 25 years seems like a lot of time, it isn't.
|
| https://en.wikipedia.org/wiki/List_of_predictions_for_autono.
| ..
|
| > I'd wager in 25 years we'd get there so I think his opinion
| still has a large percentage of being correct.
|
| What percent, and which maths and facts let you calculate it
| ? The only percent you can be sure about is that it's 100%
| wishful thinking
| nenenejej wrote:
| Radiologists can retrain to do something else adjacent
| surely? Not like they'll suddenly be like an 18 year old with
| no degree trying to find a job.
| GoatInGrey wrote:
| Why do we assume that radiologists would have literally 0%
| involvement in the radiology workflow?
|
| I could see the assumption that one radiologist supervises
| a group of automated radiology machines (like a worker in
| an automated factory). _Maybe_ assume that they 'd be
| delegated to an auditing role. But that they'd go
| completely extinct? There's no evidence of, even
| historically, a service being consumed that has zero human
| intervention.
| timeon wrote:
| > I'd wager
|
| Maybe don't?
| sarchertech wrote:
| Let's say we do manage to develop a model that can replace
| radiologists in 20 years. But we stop training them today.
| What happens 15 years from now when we don't have nearly
| enough radiologists.
| jonas21 wrote:
| People love to bring this up, and it was a silly thing to say
| -- particularly since he didn't seem to understand that
| radiologists only spend a small part of their time reading
| scans.
|
| But he said it in the context of a Q&A session that happened to
| be recorded. Unless you're a skilled politician who can give
| answers without actually saying anything, you're going to say
| silly things once in a while in unscripted settings.
|
| Besides that, I'd hardly call Geoffrey Hinton an AI evangelist.
| He's more on the AI doomer side of the fence.
| lomase wrote:
| Many of us have changed opinions after seeing how the tech
| does not scale.
|
| At the time? I would say he was a AI evangelist.
| queuebert wrote:
| The tech scales, but accessing the training data is a real
| problem. It's not like scraping the whole internet. And
| most of it is unlabeled.
| lomase wrote:
| If you need more data to scale, and there is no data, it
| literally can't scale.
|
| Scale is not always about trougput. You can be
| constrained by many things, in this case, data.
| lanstin wrote:
| I think in general this lack affects almost all areas of
| human endeavor. All my speech teaching my kids how to
| think clearly, to young software engineers about how to
| build software in a some giant ass bureaucracy, how to
| debug some tricky problem, none of that sort of
| discovering truth one step at a time or teaching new
| stuff is in blogs or anything outside the moment.
|
| When I do write something up, it is usually very
| finalized at that time; the process of getting to that
| point is not recorded.
|
| The models maybe need more naturalistic data and more
| data from working things out.
| catoc wrote:
| No, this was not an off-hand remark. He made a whole story
| comparing the profession to the coyote from road runner
| "they've already run of the cliff but don't even realize it".
| It was callous, and showed a total ignorance of the fact that
| medicine might be more than pixel classification.
| nick__m wrote:
| Radiologists, here, mostly sit at home, read scan and dictate
| reports. They rarely talk to other doctors and talking to a
| patient is beyond them. They are some of the specialists with
| the best salary.
|
| With interventional radiologists and radio-oncologists it's
| different but were talking about radiologists here...
| duchef wrote:
| I'm a radiologist and spend 50% of my time either talking
| to patients or other clinicians.
| nick__m wrote:
| You practice in Quebec ? If so I am quite surprised,
| because my wife had a lot of scans and we never met a
| radiologists who wasn't a radio-oncologist. And her
| oncologist never talked with the radiologists either. The
| communication between them was always through written
| demands and reports. And the situation is similar between
| her neurologist and the radiologists.
|
| By the way, even if I sound dismissive I have great
| respect for the skills required by your profession.
| Reading an IRM is really hard when you have the
| radiologist report in hand and to my untrained eyes it's
| impossible without it!
|
| And since you talk to patients frequently, I have an even
| greater respect of you as a radiologist.
| sarchertech wrote:
| My wife's an ER doctor and she talks to radiologists all
| the time.
|
| I also recently had surgery and the surgeon consulted with
| the radiologist that read my MRI before operating.
| nick__m wrote:
| Then it's an organizational problem (or choice) in the
| specific hospital where my wife is treated/followed and I
| apologize to all radiologists that actually talk to
| peoples in a professional capacity!
|
| Or maybe it's related to socialized Healthcare because in
| the article there is a breakdown of the time spent by a
| radiologists in Vancouver and talking to patients isn't
| part of it.
| GoatInGrey wrote:
| It's the power of confidence and credentials in action. Which
| is why you should, when possible, look at the underlying
| logic and not just the conclusion derived from it. As this
| catches a lot of fluff that would otherwise be Trojan-Horsed
| into your worldview.
| billisonline wrote:
| I would argue an "AI doomer" is a negatively charged type of
| evangelist. What the doomer and the positive evangelist have
| in common is a massive overestimation of (current-gen) AI's
| capabilities.
| nenenejej wrote:
| Too damn hard to predict the future! We live in an age where 20
| years is unseeable for a lot of things.
| nextworddev wrote:
| Look, if we were okay with tolerating less regulation in
| medicine, and dismantled AMA, Hinton would have proven to be
| right by now and everyone would have been happier
| ModernMech wrote:
| Every use of AI has its own problem of "person with 10 fingers"
| that AI image generation faces and can't seem to solve. For
| programmers, it's code that calls made up libraries and makes up
| language semantics. In prose, it's completely incoherent
| narratives that forget where they are going halfway through. For
| programmers it's making up case law and citations. Same for
| scientists, making up authorities and papers and results.
|
| AI art is getting better but still it's very easy for me to
| quickly distinguish AI result from everything else, because I can
| visually inspect the artifacts and it's usually not very subtle.
|
| I'm not a radiologist, but I would imagine AI is doing the same
| thing here, making up things that are cancer, missing things that
| aren't cancer, and it takes an expert to distinguish the false
| positives from true. So we're back at square one, except the
| expertise has shifted from interpreting the image to interpreting
| the image and also interpreting the AI.
| KittenInABox wrote:
| > AI art is getting better but still it's very easy for me to
| quickly distinguish AI result from everything else, because I
| can visually inspect the artifacts and it's usually not very
| subtle.
|
| I actually disagree in that it's not easy for me at all to
| quickly distinguish AI images from everything else. But I think
| we might differ what we mean by "quickly". I can quickly
| distinguish AI if I am looking. But if I'm mindlessly
| doomscrolling I cannot always distinguish 'random art of an
| attractive busty woman in generic fantasy armor that a streamer
| I follow shared' as AI. I cannot always distinguish 'reply-guy
| profile picture that's like a couple dozen pixels in
| dimensions' as AI. I also cannot always tell if someone is
| using a filter if I'm looking for maybe 5 seconds tops while I
| scroll.
| GoatInGrey wrote:
| AI art is easy to pick out when no effort was made to deviate
| from the default style that the models use. Where the person
| put in a basic prompt of the desired contents ("man freezing
| on a bed") and calls it a day. When some craftsmanship is
| applied to make it more original, _that 's_ when it gets
| progressively harder to catch it at first glance. Though I'd
| argue that it's more transformative and thus warrants less
| criticism than the lazy usage.
|
| As a related aside, I've started seeing businesses clearly
| using ChatGPT for their logos. You can tell from the style
| and how much random detail there is contrasted with the fact
| that it's a small boba tea shop with two employees. I am
| still trying to organize my thoughts on that one.
|
| Edit:
|
| Example: https://cloudfront-us-
| east-1.images.arcpublishing.com/brookf...
| maz1b wrote:
| As a doctor and full stack engineer, I would never go into
| radiology or seek further training in it. (obviously)
|
| AI is going to augment radiologists first, and eventually, it
| will start to replace them. And existing radiologists will
| transition into stuff like interventional radiology or whatever
| new areas will come into the picture in the future.
| catoc wrote:
| As a doctor and full stack engineer you'd have a perfect future
| ahead of you in radiology - the profession will not go away,
| but will need doctors who can bridge the full medical-tech
| range
| donnfelker wrote:
| There's a number of you (engineer + doctor), though quite rare.
| I have a few friends who are engineers as well as doctors.
| You're like unicorns in your field. The Neo and Morpheus of the
| medical industry - you can see things and understand things
| that most people cant in your typical field (medicine). Kudos
| to you!
| thevillagechief wrote:
| This was actually my dream career path when I was younger.
| Unfortunately there's just no way I would have afforded the
| time and resources to pursue both, and I'd never heard of
| Biomedical Engineering where I grew up.
| kstrauser wrote:
| What's your take on pharmacists? To my naive eyes, that seems
| like a certainty for replacement. What extra value does human
| judgement bring to their work?
| skadamou wrote:
| I'm not a doc or a pharmacist (though I am in med school) and
| I'm sure there are areas that AI could do some of a
| pharmacists job but on the outpatient side they do things
| like answering questions for patients and helping them
| interpret instructions that I don't think we want AI to do...
| or at least I really doubt an AIs ability to gauge how well
| someone is understanding instructions and augment how it
| explains something based on that assessment... on the
| inpatient side, I have seen pharmacists help physicians
| grapple with the pros and cons of certain treatments and make
| judgement calls about dosing that I think it would be hard to
| trust an AI to do because there is no "right" answer really.
| It's about balancing trade offs.
|
| IDK, these are just limitations - people that really believe
| in AI will tell you there is basically nothing it can't do...
| eventually. I guess it's just a matter of how long you want
| to wait for eventually to come.
| cko wrote:
| I am a pharmacist who dabbles in web dev. We _should_ easily
| be replaced because all of our work on checking pill images
| and drug interactions are actually already automated, or the
| software already tells us everything.
|
| If every doctor agreed to electronically prescribe (instead
| of calling it in, or writing it down) using one single
| standard / platform / vendor, and all pharmacy software also
| used the same platform / standard, then our jobs are
| definitely redundant.
|
| I worked at a hospital where basically doctors and
| pharmacists and nurses all use the same software and most of
| the time we click approve approve approve without data entry.
|
| Of course we also make IVs and compounds by hand, but that's
| a small part of our job.
| ralusek wrote:
| I work on a kiosk (MedifriendRx) which, to some degree
| "replaces" pharmacists and pharmacy staff.
|
| The kiosk is placed inside of a clinic/hospital setting, and
| rather than driving to the pharmacy, you pick up your
| medications at the kiosk.
|
| Pharmacists are currently still very involved in the process,
| but it's not necessarily for any technical reason. For
| example, new prescriptions are (by most states' boards of
| pharmacies) required to have a consultation between a
| pharmacist and a patient. So the kiosk has to facilitate a
| video call with a pharmacist using our portal. Mind you, this
| means the pharmacist could work from home, or could queue up
| tons of consultations back to back in a way that would allow
| one pharmacist to do the work of 5-10 working at a pharmacy,
| but they're still required in the mix.
|
| Another thing we need to do for regulatory purposes is when
| we're indexing the medication in the kiosk, the kiosk has to
| capture images of the bottles as they're stocked. After the
| kiosk applies a patient label, we then have to take another
| round of images. Once this happens, this will populate in the
| pharmacist portal, and a pharmacist is required to take a
| look at both sets of images and approve or reject the
| container. Again, they're able to do this all very quickly
| and remotely, but they're still required by law to do this.
|
| TL;DR I make an automated dispensing kiosk that could
| "replace" pharmacists, but for the time being, they're
| legally required to be involved at multiple steps in the
| process. To what degree this is a transitory period while
| technology establishes a reputation for itself as reliable,
| and to what degree this is simply a persistent fixture of
| "cover your ass" that will continue indefinitely, I cannot
| say.
| tartoran wrote:
| Pharmacists are not going to be replaced, their jobs like
| most other jobs touched by AI will evolve, possibly shrink
| in demand but won't completely dissapear. AI is a tool that
| some professional has to use after all.
| mandevil wrote:
| My wife is a clinical pharmacist at a hospital. I am a SWE
| working on AI/ML related stuff. We've talked about this a
| lot. She thinks that the current generation of software is
| not a replacement for what she does now, and finds the alerts
| they provide mostly annoying. The last time this came up, she
| gave me two examples:
|
| A) The night before, a woman in her 40's came in to the ER
| suffering a major psychological breakdown of some kind (she
| was vague to protect patient privacy). The Dr prescribed a
| major sedative, and the software alerted that they didn't
| have a negative pregnancy test because this drug is not
| approved for pregnant women and so should not be given.
| However, in my wife's clinical judgement- honed by years of
| training, reading papers, going to conferences, actual work
| experience and just talking to colleagues- the risk to a
| (potential) fetus from the drug was less than the risk to a
| (potential) fetus from mom going through an untreated mental
| health episode and so she approved the drug and overrode the
| alert.
|
| B) A prescriber had earlier in that week written a script for
| Tylenol to be administered "PR" (per-rectum) rather than PRN
| (per requisite need). PR Tylenol is a perfectly valid thing
| that is sometimes the correct choice, and was stocked by the
| hospital for that reason. But my wife recognized that this
| wasn't one of the cases where that was necessary, and called
| the nurse to call the prescriber to get that changed so the
| nurse wouldn't have to give them a Tylenol suppository. This
| time there were no alerts, no flags from the software, it was
| just her looking at it and saying "in my clinical judgement,
| this isn't the right administration for this situation, and
| will make things worse".
|
| So someone- with expensively trained (and probably licensed)
| judgement- will still need to look over the results of this
| AI pharmacist and have the power to override its decisions.
| And that means that they will need to have enough time per
| case to build a mental model of the situation in their brain,
| figure out what is happening, and override if necessary. And
| it needs to be someone different from the person filling out
| the Rx, for Swiss cheese model of safety reasons.
|
| Congratulations, we've just described a pharmacist.
| philwelch wrote:
| > And it needs to be someone different from the person
| filling out the Rx, for Swiss cheese model of safety
| reasons.
|
| This is something I question. If you go to a specialist,
| and the specialist judges that you need surgery, he can
| just schedule and perform the surgery himself. There's no
| other medical professional whose sole job is to second-
| guess his clinical judgment. If you want that, you can
| always get a second opinion. I have a hard time buying the
| argument that prescription drugs always need that second
| level of gatekeeping when surgery doesn't.
| mandevil wrote:
| So, the main reason for the historical separation (in the
| European tradition) between doctor and pharmacist was
| profit motive- you didn't want the person prescribing to
| have a financial stake in their treatment, else they will
| prescribe very expensive medicine for all cases. And
| surgeons in particular _do_ have a profit motive- they
| are paid per service- and it is well known within the
| broader medical community that surgeons will almost
| always choose to cut. And we largely gate-keep this with
| the primary care physician providing a recommendation to
| the specialist. The PCP says "this may be something
| worth treating with surgery" when they recommend you go
| see a specialist rather than prescribing something
| themselves, and then the surgeon confirms (almost
| always).
|
| That pharmacists also provide a safety check is a more
| modern benefit, due to their extensive training and
| ability to see all of the drugs that you are on (while a
| specialist only knows what they have prescribed). And
| surgeons also have a team to double-check them while they
| are operating, to confirm that they are doing the surgery
| on the correct side of the body, etc. Because these
| safety checks are incredibly important, and we don't want
| to lose them.
| cfu28 wrote:
| I feel like I keep running into your comments on HN. There are
| dozens of us!
| jmhmd wrote:
| As a radiologist and full stack engineer, I'm not particularly
| worried about the profession going away. Changing, yes, but not
| more so than other medical or non-medical careers.
| ProllyInfamous wrote:
| >AI is going to augment radiologists first, and eventually, it
| will start to replace them.
|
| I am a medical school drop-out -- in my limited capacity, _I
| concur, Doctor_.
|
| My dentist's AI has already designed a new mouth for me,
| implants &all ("I'm only doing 1% of the finish-work: whatever
| the patient says _doesn 't feel just quite right, yet_"--
| myDMD). He then CNCs in-house on his $xxx,xxx 4-axis.
|
| IMHO: Many classes of physicians are going to be reduced to
| nothing more than malpractice-insurance-paying business owners,
| MD/DO. The liability-holders, _good doctor_.
|
| In alignment with last week's (H)(1)(b) discussion, it's
| interesting to note that ~30% of US physician resident "slots"
| (<$60kUSD salary) are filled by these foreigner visa-holders
| (so: +$100k cost per applicant, amortized over a few years of
| training, each).
| djoldman wrote:
| > Three things explain this. First,... Second, attempts to give
| models more tasks have run into legal hurdles: regulators and
| medical insurers so far are reluctant to approve or cover fully
| autonomous radiology models. Third, even when they do diagnose
| accurately, models replace only a small share of a radiologist's
| job. Human radiologists spend a minority of their time on
| diagnostics and the majority on other activities, like talking to
| patients and fellow clinicians.
|
| Everything else besides the above in TFA is extraneous. Machine
| learning models could have absolute perfect performance at zero
| cost, and the above would make it so that radiologists are not
| going to be "replaced" by ML models anytime soon.
| addcommitpush wrote:
| If they had absolute perfect performance at zero cost, you
| would not need a radiologist.
|
| The current "workflow" is primary care physician (or
| specialist) -> radiology tech that actually does the
| measurement thing -> radiologist for interpretation/diagnosis
| -> primary care physician (or specialist) for treatment.
|
| If you have perfect diagnosis, it could be primary care
| physician (or specialist) -> radiology tech -> ML model for
| interpretation -> primary care physician (or specialist.
| bilbo0s wrote:
| Nope.
|
| To understand why, you would really need to take a good read
| of the average PCP's malpractice policy.
|
| The policy for a specialist would be even more strict.
|
| You would need to change insurance policies before your
| workflow was even possible from a liability perspective.
|
| Basically, the insurer wants, "a throat to choke", so to
| speak. Handing up a model to them isn't going to cut it
| anymore than handing up Hitachi's awesome new whiz-bang
| proton therapy machine would. They want their pound of flesh.
| bigfudge wrote:
| Doesnt this become the developer? Or perhaps a specialist
| insurer who develops expertise and experience to indemnify
| them?
| bilbo0s wrote:
| Oh that could indeed happen in that hypothetical
| timeline. But in that timeline the developer would be
| paying the malpractice premium.
|
| And it would be the developer's throat that gets choked
| when something goes awry.
|
| I'm betting developers will want to take on neither the
| cost of insurance, nor the increased risk of liability.
| tnel77 wrote:
| They didn't say there wouldn't need to be change related to
| insurance. They obviously mean that, change included, a
| perfect model would move to their described workflow (or
| something similar).
|
| HackerNews is often too quick to reply with a "well
| actually" that they miss the overall point.
| addcommitpush wrote:
| In that scenario, the "throat to choke" would be the
| primary care physician. We won't think of it as an "ML
| radiologist", just as getting some kind of physical test
| done and bringing it to the doctor for interpretation.
|
| If you're getting a blood test, the pipeline might be
| primary care physician -> lab with a nurse to draw blood
| and machines to measure blood stuff -> primary care
| physician to interpret the test results. There is no blood-
| test-ologist (hematologist?) step, unlike radiology.
|
| Anyway, "there's going to be radiologists around for
| insurance reasons only but they don't bring anything else
| to patient care" is a very different proposition from
| "there's going to be radiologists around for insurance
| reasons _and_ because the job is mostly talking to patients
| and fellow clinicians".
| philwelch wrote:
| Let's suppose I go to the doctor and get tested for HIV.
| There isn't a specialist staring at my blood through a
| microscope looking for HIV viruses, they put my blood in a
| machine and the machine tells them, positive or negative.
| There is a false positive rate and a false negative rate
| for the test. There's no fundamental reason you couldn't
| put a CT scan into a machine the same way.
| matheusmoreira wrote:
| Pretty much everything has false positives and false
| negatives. Everything can be reduced to this.
|
| Human radiologists have them. They can miss things: false
| negative. They can misdiagnose things: false positive.
|
| Interviews have them. A person can do well, be hired and
| turn out to be bad employee: false positive. A person who
| would have been a good employee can do badly due to
| situational factors and not get hired: false negative.
|
| The justice system has them. An innocent person can be
| judged guilty: false positive. A guilty person can be
| judged innocent: false negative.
|
| All policy decisions are about balancing out the false
| negatives against the false positives.
|
| Medical practice is generally obsessed with stamping out
| false negatives: sucks to be you if you're the doctor who
| straight up missed something. False positives are avoided
| as much as possible by defensive wording that avoids
| outright affirming things. You never say the patient has
| the disease, you merely _suggest_ that this finding
| _could_ mean that the patient has the disease.
|
| Hiring is expensive and firing even more so depending on
| jurisdiction, so corporations want to minimize false
| positives as much as humanly possible. If they ever hire
| anyone, they want to be sure it's absolutely the right
| person for them. They don't really care that they might
| miss out on good people.
|
| There are all sorts of political groups trying to tip the
| balance of justice in favor of false negatives or false
| positivies. Some would rather see guilty go free than
| watch a single innocent be punished by mistake. Others
| don't care about innocents at all. I could cite some but
| it'd no doubt lead to controversy.
| MengerSponge wrote:
| If we're talking utopian visions, we can do better than
| dreaming of transforming unstructured data into actionable
| business insights. Let's talk about what is meaningfully
| possible: Who assumes legal liability? The ML vendor?
|
| PCPs don't have the training and aren't paid enough for that
| exposure.
| vel0city wrote:
| As a patient I don't think I've ever even talked to any
| radiologist that actually analyzed my imaging. Most of the
| times my family or I have had imaging done the imaging is
| handled by a tech who just knows how to operate the machines
| while the actual diagnostic work gets farmed out to remote
| radiologists who type up an analysis. I don't even think the
| other doctors I actually see ever directly talk to those
| radiologists.
|
| Is this uncommon in the rest of the US?
| theOGognf wrote:
| No, that is the norm. Radiologists speak with their
| colleagues the most, and patients rarely
| stevenbedrick wrote:
| It really depends on the specifics of the clinical situation;
| for a lot of outpatient radiology scenarios the patient and
| radiologist don't directly interact, but things can be
| different in an inpatient setting and then of course there
| are surgical and interventional radiology scenarios.
| stonemetal12 wrote:
| >Human radiologists spend a minority of their time on
| diagnostics and the majority on other activities, like talking
| to patients and fellow clinicians.
|
| How often do they talk to patients? Every time I have ever had
| an x-ray, I have never talked to a radiologist. Fellow
| clinicians? Train the xray tech up a bit more.
|
| If the mote is 'talking to people' that is a mote that doesn't
| need an MD, or at least not a full specialization MD. ML could
| kill radiologist MD, radiologist could become the job title of
| a nurse or x-ray tech specialized in talking to people about
| the output.
| bilbo0s wrote:
| _Train the xray tech up a bit more._
|
| That's fine. But then the xray tech becomes the radiologist,
| and that becomes the point in the workflow that the insurer
| digs out the malpractice premiums.
|
| In essence, your xray techs would become remarkably
| expensive. Someone is talking to the clinicians about the
| results. That person, whatever you call them, is going to be
| paying the premiums.
| sarchertech wrote:
| I don't think they talk to patients all that often but my
| wife is an ER doctor and she says she talks to them all the
| time.
| roncesvalles wrote:
| I only came to this thread to say that this is completely
| untrue:
|
| >Human radiologists spend a minority of their time on
| diagnostics and the majority on other activities, like talking
| to patients and fellow clinicians.
|
| The vast majority of radiologists do nothing other than: come
| in (or increasingly, stay at home), sit down at a computer,
| consume a series of medical images while dictating their
| findings, and then go home.
|
| _If_ there existed some oracle AI that can always accurately
| diagnose findings from medical images, this job literally doesn
| 't need to exist. It's the equivalent of a person staring at
| CCTV footage to keep count of how many people are in a room.
| daxfohl wrote:
| Are these the ones making 500K? Sounds like more of an
| assistance job than an MD.
| quadragenarian wrote:
| Radiologists are often the ones who are the "brains" of
| medical diagnosis. The primary care or ER physician gets
| the patient scanned, and the radiologist scrolls through
| hundreds if not thousands of images, building a mental
| model of the insides of the patient's body and then based
| on the tens of thousands of cases they've reviewed in the
| past, as well as deep and intimate human anatomical
| knowledge, attempts to synthesize a medical diagnosis. A
| human's life and wellness can hinge on an accurate
| diagnosis from a radiologist.
|
| Does that sounds like an assistance's job?
| daxfohl wrote:
| Makes sense. Knowing nothing about it, I was picturing a
| tech sitting at home looking at pictures saying "yup,
| there's a spot", "nope, no spot here".
| 1718627440 wrote:
| For this job a decade of studies would be a bit wasteful
| though.
| luma wrote:
| Agreed, I'm not sure where the OP from TFA is working but
| around here, radiologists have all been bought out and rolled
| into Radiology As A Service organizations. They work from
| home or at an office, never at a clinic, and have zero
| interactions with the patient. They perform diagnosis on
| whatever modality is presented and electronically file their
| work into their EMR. I work with a couple such orgs on remote
| access and am familiar with others, it might just be a
| selection bias on my side but TFA does not reflect my first-
| hand experience in this area.
| quadragenarian wrote:
| Interesting - living near a large city, all of the
| radiologists I know work for hospitals, spending more of
| their day in the hospital reading room versus home,
| including performing procedures, even as diagnostic
| radiologists.
|
| I think it may be selection bias.
| justlikereddit wrote:
| >consume a series of medical images while dictating their
| findings, and then go home.
|
| In the same fashion as construction worker just shows up,
| "performs a series of construction tasks", then go home. We
| just need to make a machine that performs "construction
| tasks" and we can build cities, railways and road networks
| for nothing but the cost of the materials!
|
| Perhaps this minor degree of oversimplification is why the
| demise of radiologists have been so frequently predicted?
| nitwit005 wrote:
| What the article suggests is backed up by research, at least
| in hospital settings:
| https://www.jacr.org/article/S1546-1440(13)00220-2/abstract
| sarchertech wrote:
| My wife is an ER doctor. I asked her and she said she talks
| to the radiologists all the time.
|
| I also recently had surgery and the surgeon talked to the
| radiologist to discuss my MRI before operating.
| dmbche wrote:
| Saw radiologists at a recent visit in a hospital.
|
| Do you have some kind of source? This seems unlikely.
| charv wrote:
| I find the radiologist use case an illuminating one for the
| adoption of AI across business today. My takeaway is that when
| the tools get better, radiologists aren't _replaced_ , but take
| up other important tasks that sometimes become second nature when
| reads (unassisted) are the primary goal. In
| particular, doctors appear to defer excessively to assistive AI
| tools in clinical settings in a way that they do not in lab
| settings. They did this even with much more primitive tools than
| we have today... The gap was largest when computer aids failed to
| recognize the malignancy itself; many doctors seemed to treat an
| absence of prompts as reassurance that a film was clean
|
| Reminds me of the "slop" discussions happening right now. When
| the tools _seem_ good, but aren 't, we develop a reliance to
| false negatives, e.g. text that clearly "feels" written by a GPT
| model.
| jasonhong wrote:
| In May earlier this year, the New York Times had a similar
| article about AI not replacing radiologists:
| https://archive.is/cw1Zt
|
| It has similar insights, and good comments from doctors and from
| Hinton:
|
| "It can augment, assist and quantify, but I am not in a place
| where I give up interpretive conclusions to the technology."
|
| "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."
|
| Dr. Hinton agrees. In retrospect, he believes he spoke too
| broadly in 2016, he said in an email. He didn't make clear that
| he was speaking purely about image analysis, and was wrong on
| timing but not the direction, he added.
| donnfelker wrote:
| Oh yes it is. I have worked on projects where highly trained
| specialized doctors have helped train the models (or trained them
| themselves) to catch random very difficult to notice conditions
| via radiology. Some of these systems are deployed at different
| hospitals and medical facilities around the country. The
| radiologist still does there job, but some odd, random hard to
| notice conditions, AI is a literal life saver. For example,
| pancreas divisum, a abnormality in the way the pancreas ducts
| fail to fuse/etc can cause all kinds of insane issues. But its
| not something most people know about or look for. AI can pick
| that up in a second. It can then alert the radiologist of an
| abnormality and they can then verify. It's enhacing the
| capabilties of radiologists.
| random9749832 wrote:
| >Oh yes it is.
|
| >It's enhacing the capabilties of radiologists.
|
| So it is not replacing radiologists?
| bluGill wrote:
| Not yet. Time will tell but they have a long way to go if
| they ever do. They are useful tools now.
| matwood wrote:
| I guess we have to define 'replace' then. If we need fewer
| radiologists, does that count as replacing? IDK.
|
| It seems that with AI in particular, many operate with 0/1
| thinking in that it can only be useless or take over the
| world with nothing in between.
| Mehvix wrote:
| what's the end game here, have a slew of of finetuned models
| for these varying edgecases?
| theOGognf wrote:
| This article is pretty good. My current work is transitioning CV
| models in a large, local hospital system to a more unified
| deployment system, and much of the content aligns with
| conversations we have with providers, operations, etc..
|
| I think the part that says models will reduce time to complete
| tasks and allow providers to focus on other tasks is on point in
| particular. For one CV task, we're only saving on average <30min
| of work per study, so it isn't massive savings from a provider's
| perspective. But scaled across the whole hospital, it's huge
| savings
| asadotzler wrote:
| >reduce time to complete tasks and allow providers to focus on
| other tasks
|
| Or, far more likely, to cut costs and increase profits.
| ViktorRay wrote:
| One thing people aren't talking about is liability.
|
| At the end of the day if the radiologist makes an error the
| radiologist gets sued.
|
| If AI replaces the radiologist then it is OpenAI or some other AI
| company that will get sued each and every time the AI model makes
| a mistake. No AI company wants to be on the hook for that.
|
| So what will happen? Simple. AI will always remain just a tool to
| assist doctors. But there will always be a disclaimer attached to
| the output saying that ultimately the radiologist should use his
| or her judgement. And then the liability would remain with the
| human not the AI company.
|
| Maybe AI will "replace" radiologists in very poor countries where
| people may not have had access to radiologists in the first
| place. In some places in the world it is cheap to get an xray but
| still can be expensive to pay someone to interpret it. But in the
| United States the fear of malpractice will mean radiologists
| never go away.
|
| EDIT: I know the article mentions liability but it mentions it as
| just one reason among many. My contention is that liability will
| be the fundamental reason radiologists are never replaced
| regardless of how good the AI systems get. This applies to other
| specialities too.
| charcircuit wrote:
| >At the end of the day if the radiologist makes an error the
| radiologist gets sued.
|
| Are you sure? Who would want to be a radiologist then when a
| single false negative could bankrupt you? I think it's more
| likely that as long as they make a best effort at trying to
| classify correctly then they would be fine.
| bonoboTP wrote:
| Doctors have malpractice insurance and other kinds of
| insurance for that. They won't go bankrupt in reality.
| charcircuit wrote:
| By that logic you would get malpractice insurance for the
| AI to similarly offload the risk.
| bonoboTP wrote:
| Yeah, I mean it's analogous to car insurance for self
| driving cars. People, including lawyers, insurers and
| courts are just averse to it intuitively. I'm not saying
| they are wrong or right, but it's how it is.
|
| I believe medical AI will probably take hold first in a
| poorer countries where the existing care is too
| bad/unaffordable, then as it proves itself there, it may
| slowly find its way to richer countries.
|
| But probably lobbying will be strong against it, just as
| you can't get cheap generic medications made in India if
| you live in the US.
| Joker_vD wrote:
| So instead of having to train and employ radiologists, we will
| train and employ radiologists _and_ pay for the AI inference.
| Excuse me, but how is this beneficial in any way? It 's trivially
| more expensive, and the result has the same quality? And
| productivity is also the same?
| chrisgd wrote:
| A lot of the tech in the space is workflow related right now.
| The AI scans triage to the top those cases that are deemed
| clinically significant, potentially saving time. I can't tell
| you it isn't solely responding to the referring doctor's urgent
| stamp though.
| theOGognf wrote:
| Not sure about other hospital systems, but the one I work at is
| developing CV systems to help fill workforce gaps in places
| where there isn't as many trained professionals or even
| resources to train professionals
| meken wrote:
| From the article:
|
| > Some products can reorder radiologist worklists to prioritize
| critical cases, suggest next steps for care teams, or generate
| structured draft reports that fit into hospital record systems.
| feverzsj wrote:
| Building a national remote radiology service would be much more
| cost effective and accuracy than these unreliable AIs.
| porridgeraisin wrote:
| AI _is_ replacing radiologists. Where AI stands for "An Indian".
| Search for teleradiology, on Google and on HN too.
| quadragenarian wrote:
| You do realize that in order to interpret imaging for a US
| based patient, any physician needs to have a US medical
| license?
| pessimizer wrote:
| Any physician with a medical license in the US can sign off
| on an Indian physician's work. Or hundreds of them.
| quadragenarian wrote:
| This already does happen for nighthawk coverage for example
| where a non-US radiologist will provide a wet read and then
| a US rad will sign off. The US rad will always bear the
| liability however.
| kklisura wrote:
| When Tesla demoed (via video) self-driving in 2016 with a claim
| "The person in the driver's seat is only there for legal reasons.
| He is not doing anything. The car is driving itself" and then
| when they unveiled Semi in 2017 - I tweeted out and honestly
| thought that trucking industry is changed forever and it doesn't
| make sense to be starting in trucking industry. It's almost end
| of 2025 and either nothing out of it or just a small part of it
| panned out.
|
| I think we all have become hyper-optimistic on technology. We
| want this tech to work and we want it to change the world in some
| fundamental way, but either things are moving very slowly or not
| at all.
| whatever1 wrote:
| No it's just machine learning was always awesome for the 98% of
| the cases. We got fooled that we can easily deal with the
| remaining 2%.
| jgeada wrote:
| It is the usual complexity rule of software: solving 80% of
| the problem is usually pretty easy at only takes about 50% of
| the estimated effort, it is the remaining 20% that takes up
| the remaining 90% of estimated effort (thus the usual
| schedule overruns).
|
| The interesting thing is that there are problems for which
| this rule applies recursively. Of the remaining 20%, most of
| it is easier than the remaining 20% of what is left.
|
| Most software ships without dealing with that remaining 20%,
| and largely that is OK; it is not OK for safety critical
| systems though.
| GoatInGrey wrote:
| The universe has a way with being disappointing. This isn't to
| say that life is terrible and we should have no optimism.
| Rather, that things generally work out for the better, but
| usually not in the way we'd prefer them to.
| goatlover wrote:
| It's also like nobody learns from the previous hype cycles.
| Short term overly optimistic predications followed by
| disillusionment and then long term benefits which deliver on
| some of the early promises.
|
| For some reason, enthusiasts always think this time is
| different.
| innanet-worker wrote:
| well part of the reason why you may have felt mislead by that
| video is because it was staged so i wouldn't feel that bad.
|
| https://www.reuters.com/technology/tesla-video-promoting-sel...
|
| for me i have been riding in waymos the last year and have been
| very pleased with the results. i think we WANT this technology
| to move faster but the some of the challenges at the edges take
| a lot of time and resources to solve, but not fundamentally
| unsolvable.
| lomase wrote:
| Waymo is a 21 year old company that only operates on a small
| part of the US after $10 billions of funding.
| dingnuts wrote:
| it's also widely believed that the cars are remotely
| operated, not autonomous.
|
| they are likely semi autonomous, which is still cool, but I
| wish they'd be honest about it
| treespace8 wrote:
| After learning that the Amazon Go store was power by
| hundreds of people watching video because the AI could
| not handle it was a real eye opener for me.
|
| Is this why Waymo is slow to expand, not enough remote
| drivers?
|
| Maybe that is where we need to be focused, better remote
| driving?
| thewebguyd wrote:
| > Maybe that is where we need to be focused, better
| remote driving?
|
| I think maybe we can and should focus on both. Better
| remote driving can be extended into other equipment
| operations as well - remote control of excavators and
| other construction equipment. Imagine road construction,
| or building projects, being able to be done remotely
| while we wait for better automation to develop.
| mulmen wrote:
| [delayed]
| YeGoblynQueenne wrote:
| They are:
|
| _Much like phone-a-friend, when the Waymo vehicle
| encounters a particular situation on the road, the
| autonomous driver can reach out to a human fleet response
| agent for additional information to contextualize its
| environment. The Waymo Driver does not rely solely on the
| inputs it receives from the fleet response agent and it
| is in control of the vehicle at all times. As the Waymo
| Driver waits for input from fleet response, and even
| after receiving it, the Waymo Driver continues using
| available information to inform its decisions. This is
| important because, given the dynamic conditions on the
| road, the environment around the car can change, which
| either remedies the situation or influences how the Waymo
| Driver should proceed. In fact, the vast majority of such
| situations are resolved, without assistance, by the Waymo
| Driver._
|
| https://waymo.com/blog/2024/05/fleet-response/
|
| Although I think they overstate the extent to which the
| Waymo Driver is capable of independent decisions. So,
| honest, ish, I guess.
| elijaht wrote:
| Is that true? Nearly everything online argues against
| that
| lomase wrote:
| https://waymo.com/blog/2024/05/fleet-response/
|
| It does, they argue cause they are clueless or have veted
| interest.
|
| Sometimes both.
| lomase wrote:
| Waymo employees downvoting you. Pathetic.
| christianqchung wrote:
| Look at Waymo, not Robotaxi. Waymo is essentially the self
| driving vision I had as a kid, and ridership is growing
| exponentially as they expand. It's also very safe if you
| believe their statistics[0]. I think there's a saying about
| overestimating stuff in the short term and underestimating
| stuff in the long term that seems to apply here, though the
| radiologist narrative was definitely wrong.
|
| [0] https://waymo.com/safety/impact/
| pkdpic wrote:
| I agree with both comments here. I wonder what the
| plausibility of fully autonomous trucking is in the next
| 10-30 years...
|
| Is there any saying that exists about overestimating stuff in
| the near term and long term but underestimating stuff in the
| midterm? Ie flying car dreams in the 50s etc.
| basisword wrote:
| I remember Bill Gates said: "We overestimate what we can do
| in one year and underestimate what we can do in ten years".
| jampekka wrote:
| Not Musk. He promised full autonomy within 3 years about
| 10 years ago.
|
| https://en.wikipedia.org/wiki/List_of_predictions_for_aut
| ono...
| nebula8804 wrote:
| Musk and Gates have very different philosophies.
|
| Gates seems more calm and collected having gone through
| the trauma of almost losing his empire.
|
| Musk is a loose cannon having never suffered the
| consequences of his actions (ie. early Gates and Jobs)
| and so he sometimes gets things right but will eventually
| crash and burn having not had the fortune of failing and
| maturing early on in his career(he is now past the
| midpoint of his career with not enough buffer to
| recover).
|
| They are both dangerous in their own ways.
| 1718627440 wrote:
| If it were about the costs for employees, you could ship it
| with the railway. That simply isn't the reason.
| omnicognate wrote:
| > ... but underestimating stuff in the midterm? Ie flying
| car dreams in the 50s etc.
|
| We still don't have flying cars 70 years later, and they
| don't look any more imminent than they did then. I think
| the lesson there is more "not every dream eventually gets
| made a reality".
| basisword wrote:
| It's limited to a few specific markets though. My bet is they
| aren't going to be able to roll it out widely easily.
| Probably need to do years of tests in each location to figure
| out the nuances of the places.
| christianqchung wrote:
| Yeah, I have no idea if Waymo will ever be a rural thing
| honestly, mostly for economic reasons. I'm skeptical it
| would get serious suburban usage this decade too. But for
| major cities where less than 80% of people own cars, test
| time doesn't seem to be making a difference. They've been
| expanding in Austin and Atlanta, seemingly with less prep
| time than Phoenix and San Fran.
| dyauspitr wrote:
| I could see it taking off in the suburbs/rural areas if
| they start having a franchise model when it's more
| mature.
| red_rech wrote:
| Atlanta seems to be a bit contradictory to some of your
| other thoughts.
|
| The city itself is relatively small. A vast majority of
| area population lives distributed across the MSA, and it
| can create hellish traffic. I remember growing up
| thinking 1+ hour commutes were just a fact of life for
| everyone commuting from the suburbs.
|
| Not sure what car ownership looks like, and I haven't
| been in years, but I'd imagine it's still much more than
| just 20%
| dingnuts wrote:
| Austin is also a car city, everyone has a car there.
| Public transit in Austin is a joke, and Waymo can't get
| on the highway so it's only useful for getting back to
| your hotel from Rainey Street, and maybe back to your
| dorm from the Drag, but nobody is using Waymo to commute
| from Round Rock
| shagie wrote:
| They keep expanding in places where it doesn't snow.
|
| They've got testing facilities in Detroit (
| https://mcity.umich.edu/what-we-do/mcity-test-facility/ )
| ... but I want to see it work while it is snowing or
| after it has snowed in the upper midwest.
|
| https://youtu.be/YvcfpO1k1fc?si=hONzbMEv22jvTLFS - has
| suggestions that they're starting testing.
|
| If AI driving only works in California, New Mexico,
| Arizona, and Texas... that's not terribly useful for the
| _rest_ of the country.
| iamdelirium wrote:
| They're testing in Denver and NYC so its coming.
| nebula8804 wrote:
| Define the rest of the country?
|
| If you refer to rural areas, thats 1/7 of the population
| and ~10% of GDP. They can be tossed aside like they are
| in other avenues.
| everforward wrote:
| If I were in charge of Waymo, I'd roll out in snowy
| places last. The odds of a "couldn't be avoided" accident
| is much higher in snow/ice. I'd want an abundance of
| safety data in other places to show that the cars are
| still safe, and it was the snow instead of the tech that
| caused the accident.
| foota wrote:
| I saw this timeline a while ago:
| https://www.reddit.com/r/waymo/s/mSm0E3yYTY that shows
| their timeline in each city. Shows Atlanta at just over a
| year. I think once they've handled similar cities it gets
| easier and easier to add new ones.
| hnav wrote:
| Even though the gulf between Waymo and the next runner up is
| huge, it too isn't quite ready for primetime IMO. Waymos
| still suffer from erratic behavior at pickup/dropoff, around
| pedestrians, badly marked roads and generally jam on the
| brakes at the first sign of any ambiguity. As much as I
| appreciate the safety-first approach (table stakes really,
| they'd get their license pulled if they ever caused a
| fatality) I am frequently frustrated as both a cyclist and
| driver whenever I have to share a lane with a Waymo. The
| equivalent of a Waymo radiologist would be a model that has a
| high false-positive and infinitesimal false-negative rate
| which would act as a first line of screening and reduce the
| burden on humans.
| bsder wrote:
| > Waymos still suffer from erratic behavior at
| pickup/dropoff, around pedestrians, badly marked roads and
| generally jam on the brakes at the first sign of any
| ambiguity.
|
| As do most of the ridesharing drivers I interact with
| nowadays, sadly.
|
| The difference is that Waymo has a trajectory that is
| getting better while human rideshare drivers have a
| trajectory that is getting worse.
| captainkrtek wrote:
| Society accepts that humans make mistakes and considers
| it unavoidable, but there exists a much higher bar
| expected of computers/automation/etc. even if a waymo is
| objectively safer in terms of incidents per miles driven,
| one fatality makes headlines and adds scrutiny about "was
| it avoidable?", whereas humans we just shrug.
|
| I think the theme of this extends to all areas where we
| are placing technology to make decisions, but also where
| no human is accountable for the decision.
| nebula8804 wrote:
| Society only cares about the individual and no one else.
| If Uber/Lyft continue to enshittify with drivers driving
| garbage broken down cars, drivers with no standards (ie.
| having just smoked weed) and ever rising rates,
| eventually people will prefer the Waymos.
| JumpCrisscross wrote:
| > _there exists a much higher bar expected of computers
| /automation/etc. even if a waymo is objectively safer in
| terms of incidents per miles driven, one fatality makes
| headlines and adds scrutiny about "was it avoidable?"_
|
| This doesn't seem to be happening. One, there are
| shockingly few fatalities. Two, we've sort of accepted
| the tradeoff.
| nebula8804 wrote:
| I honestly don't think we will have a clear answer to this
| question anytime soon. People will be in their camps and
| thats that.
|
| Just to clarify, have you ridden in a Waymo? It didn't seem
| entirely clear if you just experienced living with Waymo or
| have ridden in it.
|
| I tried it a few times in LA. What an amazing magical
| experience. I do agree with most of your assertions. It is
| just a super careful driver but it does not have the full
| common sense that a driver in a hectic city like LA has.
| Sometimes you gotta be more 'human' and that means having
| the intuition to discard the rules in the heat of the
| moment (ex. being conscious of how cyclists think instead
| of just blindly following the rules carefully, this is
| cultural and computers dont do 'culture').
| nutjob2 wrote:
| You have to consider that the AVs have their every move
| recorded. Even a human wouldn't drive more aggressively
| under those circumstances.
|
| Probably what will happen in the longer term is that
| rules of the road will be slightly different for AVs to
| allow for their different performance.
| hnav wrote:
| Waymo has replaced my (infrequent) use of Uber/Lyft in
| 80% of cases ever since they opened to the public via
| waitlist. The product is pretty good most of the time, I
| just think the odd long-tail behaviors become a guarantee
| as you scale up.
| code_biologist wrote:
| I've seen a lot of young people (teens especially) cross
| active streets or cross in front of Waymos on scooters
| knowing that they'll stop. I try not to do anything too
| egregious, but I myself have begun using Waymo's
| conservative behavior as a good way to merge into ultra
| high density traffic when I'm in a car, or to cross busy
| streets when they only have a "yield to pedestrian"
| crosswalk rather than a full crosswalk. The way you blip a
| Waymo to pay attention and yield is beginning to move into
| the intersection, lol.
|
| I always wonder if honking at a Waymo does anything. A
| Waymo stopped for a (very slow) pickup on a very busy one
| lane street near me, and it could have pulled out of
| traffic if it had gone about 100 feet further. The 50-ish
| year old lady behind it laid on her horn for about 30
| seconds. Surreal experience, and I'm still not sure if her
| honking made a difference.
|
| I like Waymos though. Uber is in trouble.
| hnav wrote:
| Simultaneously, Waymo is adopting more human-like
| behavior like creeping at red lights and cutting in front
| of timid drivers as it jockeys for position.
|
| I still think that Google isn't capable of scaling a
| rideshare program because it sucks at interfacing with
| customers. I suspect that Uber's long-term strategy of
| "take the money out of investors' and drivers' pockets to
| capture the market until automation gets there" might
| still come to fruition (see Austin and Atlanta), just
| perhaps not with Uber's ownership of the technology.
|
| On the other hand Google has been hard at work trying to
| make its way into cars via Android automotive so I
| totally see it resigning to just providing a reference
| sensor-suite and a car "Operating System" to
| manufacturers who want a turnkey smart-car with L3 self-
| driving
| m0llusk wrote:
| Waymo is very impressive, but also demonstrates limitations
| of these systems. Waymo vehicles are still getting caught
| performing unsafe driving maneuvers, they get stuck alleys in
| numbers, and responders have trouble getting them to
| acknowledge restricted areas. I am very supportive of this
| technology, but also highly skeptical as long as these
| vehicles are directly causing problems for me personally.
| Driving is more than a technical challenge, it involves
| social communication skills that automated vehicles do not
| yet have.
| trebligdivad wrote:
| Waymo still have the ability to remotely deal with locations
| the AI has problems; I'd love to know what type of percentage
| of trips need to do that now. Having that escape together
| with only doing tested areas makes their job a LOT easier.
| (Not that it's bad - it's a great thing and I wish for it
| here!)
| pfdietz wrote:
| > a saying about overestimating stuff in the short term and
| underestimating stuff in the long term
|
| This is exactly what came to my mind also.
| steveklabnik wrote:
| I am a long time skeptic of self-driving cars. However, Waymo
| has changed that for me.
|
| I spend a lot of time as a pedestrian in Austin, and they are
| far safer than your usual Austin driver, and they also follow
| the law more often.
|
| I always accept them when I call an Uber as well, and it's
| been a similar experience as a passenger.
|
| I kinda hate what the Tesla stuff has done, because it makes
| it easier to dismiss those who are moving more slowly and
| focusing on safety and trust.
| calvinmorrison wrote:
| Yeah we don't need to compare robots to the best driver or
| human, just the average, for an improvement.
|
| However, like railroad safety is expensive heavily
| regulated, self driving car companies have the same issue.
|
| Decentralized driving decentralizes risk.
|
| so when I have my _own_ robot to do it, it'll be easy and
| cheap.
| newyankee wrote:
| Honestly, once a traffic island city (like Singapore) or some
| other small nation state adopts self driving only within its
| limits and shows that it is much easier when all are self
| driving I think the opposition to the change will slowly
| reduce.
|
| Rain, Snow etc. are still challenges but needs a bold bet in
| a place that wants to show how futuristic it is. The
| components are in place (Waymo cars), what is needed is high
| enough labor cost to justify the adoption.
| DarkNova6 wrote:
| It's not about optimism. It is well established in the industry
| that Tesla's hardware-stack gives them 98% accuracy at the very
| most. But those voices are drowned by the marketing bravado.
|
| In the case of Musk it has worked out. His lies have earned him
| a fortune and now he asks Tesla to pay him out with a casual 1
| trillion paycheck.
| CodesInChaos wrote:
| > thought that trucking industry is changed forever
|
| What I find really crazy is that most trains are still driven
| by humans.
| tra3 wrote:
| I think it's the matter of scale. Way more truck drivers than
| locomotive engineers.
| blueside wrote:
| only 2 people (engineer and conductor) for an entire train
| that is over a mile long seems about right to me though
| 1718627440 wrote:
| Most work is actually in oversight and getting the train to
| run when parts fail. When running millions of machines 24/7
| there is always a failing part. Also understanding
| gesticulation humans and running wildlife is not yet (fully)
| automatable.
| BurningFrog wrote:
| Much of that is about union power more than tech maturity.
| philwelch wrote:
| For trucking I think self driving can be, in the short term, an
| opportunity for owner-operators. An owner-operator of a
| conventional truck can only drive one truck at a time, but you
| could have multiple self driving trucks in a convoy led by a
| truck manned by the owner-operator. And there might be an even
| greater opportunity for this in Europe thanks to the low
| capacity of European freight rail compared to North America.
| mandevil wrote:
| I used to think this sort of thing too. Then a few years ago
| I worked with a SWE who had experience in the trucking
| industry. His take was that most trucking companies are too
| small scale to benefit from this. The median trucking
| operation is basically run by the owner's wife in a notebook
| or spreadsheet- and so their ability to get the benefits of
| leader/follower mileage like that just doesn't exist. He
| thought that maybe the very largest operators- Walmart and
| Amazon- could benefit from this, but he thought that no one
| else could.
|
| This was why he went into industrial robotics instead, where
| it was clear that the finances could work out today.
| philwelch wrote:
| Yeah, I guess the addressable market of "truck owners who
| can afford to buy another truck but not hire another
| driver" might be smaller than I thought.
| rcpt wrote:
| Trucks are harder. The weight changes a lot, they are off
| grid for huge stretches, mistakes are more consequential.
| dyauspitr wrote:
| Waymo has worked out. I've taken one so many times now I don't
| even think about it. If Waymo can pull this off in NYC I
| believe it will absolutely be capable of long distance trucking
| not that far in the future.
| sarchertech wrote:
| Trucks are orders of magnitude more dangerous. I wouldn't be
| surprised if Waymo is decades away from being able to operate
| a long haul truck on the open interstate.
| 1vuio0pswjnm7 wrote:
| "I think we all have become hyper-optimistic on technology. We
| want this tech to work and we want it to change the world in
| some fundamental way, but either things are moving very slowly
| or not at all."
|
| Who is "we"? The people who hype "AI"?
| moate wrote:
| This story (the demand for Radiologists) really shows a very
| important thing about AI: It's great when it has training data,
| and bad at weird edge cases.
|
| Gee, seems like about the worst fucking thing in the world for
| diagnostics if you ask me, but what do I know, my degree is in
| sandwiches and pudding.
| phkahler wrote:
| I realized long ago that full unattended self driving requires
| AGI. I think Elon finally figured that out. So now LLMs are
| going to evolve into AGI any moment. Um no. Tesla (and others)
| have effectively been working on AGI for 10 years with no luck
| tekno45 wrote:
| So waymo has AGI?
| gf000 wrote:
| They deliberately (and smartly) set their working limits to
| what they can solve - known city, always decent weather
| conditions. And they still added a way for a remote
| operator to solve certain situations.
|
| So no, they don't have AGI and there is a lot to reach
| "working under every condition everywhere" levels of self-
| driving.
| bsder wrote:
| > I realized long ago that full unattended self driving
| requires AGI.
|
| Not even close.
|
| The vast majority of people have a small number of local
| routes completely memorized and do station keeping in between
| on the big freeways.
|
| You can see this when signage changes on some local route and
| _absolute chaos_ ensues until all the locals re-memorize the
| route.
|
| Once Waymo has memorized all those local routes (admittedly a
| big task), it's done.
| zulban wrote:
| > I realized long ago that full unattended self driving
| requires AGI.
|
| Yikes.
|
| I recommend you take some introductory courses on AI and
| theory of computation.
| GOD_Over_Djinn wrote:
| You should either elaborate on your argument, or at least
| provide further reading that clarifies your point of
| contention. This kind of low effort nerd-sniping
| contributes nothing.
| jeremyjh wrote:
| GP's statement is completely unsupported, the burden is
| on them.
| gf000 wrote:
| It's commonly brought up saying, and I don't think it's
| too far from the truth.
|
| Driving _under every condition_ requires a very deep
| level of understanding of the word. Sure, you can get to
| like 60% by a simple robot vacuum logic, and to like 90%
| with what e.g. Waymo does. But the remaining 10% is crazy
| complex.
|
| What about a plastic bag floating around on a highway?
| The car can see it, but is it an obstacle to avoid?
| Should it slam the brakes? And there are a bunch of other
| extreme examples (what about a hilly road on a Greek
| island where people just honk to notify the other side
| that they are coming, without seeing them?)
| zulban wrote:
| Responding to ridiculous uncited wild comments doesn't
| require a phd thesis paper, my friend.
| nutjob2 wrote:
| > I realized long ago that full unattended self driving
| requires AGI.
|
| You can do 99% of it without AGI, but you do need it for the
| last 1%.
|
| Unfortunately, the same is true for AGI.
| tictacttoe wrote:
| Meanwhile, it's my feeling that technology is moving insanely
| fast but people are just impatient. You move the bar and the
| expectations move with it. I think part of the problem is that
| the market rewards execs who set expectations beyond reality.
| If the market was better at rewarding outcomes not promises,
| you'd see more reasonable product pitches.
| achierius wrote:
| How have expectations moved on self driving cars? Yes, we're
| finally getting there, but adoption is still tiny relative to
| the population and the cars that work best (Waymo) are still
| humongously expensive + not available for consumer purchase.
| squigz wrote:
| Fundamental change does indeed happen very slowly. But it does
| happen.
| reaperducer wrote:
| _It 's almost end of 2025 and either nothing out of it or just
| a small part of it panned out._
|
| The truck part seems closer than the car part.
|
| There are several driverless semis running between Dallas,
| Houston, and San Antonio every day. Fully driverless. No human
| in the cab at all.
|
| Though, trucking is an easier to solve problem since the routes
| are known, the roads are wide, and in the event of a closure,
| someone can navigate the detour remotely.
| thenaturalist wrote:
| This is such a stereotypical SF / US based perspective.
|
| Easy to forget the rest of the world does not and never has
| ticked this way.
|
| Don't get me wrong, optimism and thinking of the future are
| great qualities we direly need in this world on the one hand.
|
| On the other, you can't outsmart physics.
|
| We've conquered the purely digital realm in the past 20 years.
|
| We're already in the early years of the next phase were the
| digital will become ever more multi-modal and make more inroads
| into the physical world.
|
| So many people bring an old mindset to a new context, where
| maring of errors, cost of mistakes or optimizing the last 20%
| of a process is just so vastly different than a bit of HTML, JS
| and backend infra.
| mensetmanusman wrote:
| 80/20 rule might be 99/1 for AI.
| dreamcompiler wrote:
| Where we're too optimistic is with technology that demos
| impressively, but which has 10,000 potentially-fatal edge
| cases. Self-driving cars and radiology interpretation are both
| in this category.
|
| When there are relatively few dangerous edge cases, technology
| often works better than we expect. TikTok's recommendation
| algorithm and Shazam are in this category.
| jsight wrote:
| A lot of people in the industry really underestimated the
| difficulty in getting self driving cars be effective. It is
| relatively easy to get a staged demo together, but getting a
| trustworthy product out there is really hard.
|
| We've seen this with all of the players, with many dropping out
| due to the challenges.
|
| Having said that, there are several that are fielded right now,
| with varying degrees of autonomy. Obviously Waymo has been
| operating in small-ish geofences for a while, but they are
| managed >200% annual growth readily. Zoox just started offering
| fully autonomous drives in Vegas.
|
| And even Tesla is offering a service, albeit with safety
| monitors/drivers. Tesla Semi isn't autonomous at all, but
| appears ready to go into volume production next year too.
|
| Your prediction will look a lot better by 2030.
| rahimnathwani wrote:
| Related article from a few weeks ago:
|
| https://www.outofpocket.health/p/why-radiology-ai-didnt-work...
| ineedasername wrote:
| >"they struggle to replicate this performance in hospital
| conditions"
|
| Are there systematic reasons why radiologists in hospitals are
| inaccurately assessing the AI's output? If the AI models are
| better than humans in testing novel data then, well, the thing
| that has changed in a hospital situation compared to the AI-Human
| testing environment is not the AI, it is the human, under less
| controlled constraints, additional pressures, workloads, etc.
| Perhaps the AI's aren't performing as poorly as thought. Perhaps
| this is why they performed better to begin with. Otherwise,
| production ML systems are generally not as highly regarded as
| these models when they perform as significantly below test data
| sets in production. Some is expected, but "struggle to replicate"
| implies more.
|
| >"Most tools can only diagnose abnormalities that are common in
| training data"
|
| Well yes, training on novel examples is one thing. Training on
| something categorically different is another thing all together.
| Also there are thresholds of detection. Detecting nothing, or
| with a a lower confidence, or unknown anomaly, false positive,
| etc. How much of the inaccuracy isn't wrong, but simply something
| that is amended or expanded upon when reviewed? Some details here
| would be useful.
|
| I'm highly skeptical when generalized statements exclude directly
| relevant information to which an is referring. The few sources
| provided don't at all cover model accuracy, and the primary
| factor cited as problematic with AI review, lack of diversity in
| study composition for women, ethnic variation, children, links to
| a a meta study that was not at all related to the composition of
| models and their training data sets.
|
| The article begins as what appears to be a criticism of AI
| accuracy with the thinness outlined above but then quickly moves
| on to a "but that's not what radiologists do anyway", and
| provides a categorical % breakdown of time spent where
| Personal/Meetings/Meals and some mixture of the others combine to
| form at least a third that could be categorized as "Time where
| the human isn't necessary if graphs are being interpreted by
| models."
|
| I'm not saying there aren't points here, but overall, it simply
| sounds like the hand-wavy meandering of someone trying to
| gatekeep a profession whose services could be massively more
| utilized with more automation, and sure-- perhaps at even higher
| quality with more radiologists to boot-- but perfect is the enemy
| of the good etc. on that score, with enormous costs and delays in
| service in the meantime.
| nomel wrote:
| For anomaly systems like this, is it effective to invert the
| problem by _not_ include the ailment /problem in the training
| data, then looking for a "confused" signal rather than a "x%
| probability of ailment" type signal?
| ineedasername wrote:
| On that, I'm not sure. My area of ML & data science practice
| is, thankfully, not so high-stakes. There's a method of
| anomaly detection called one-class SVM (Support Vector
| Machine) that is pretty much this- train on normal, flag on
| "wtf is this you never training me on this 01010##" <-- _Not
| actual ISO standard ML model output or medical jargon_. But I
| 'm not sure if that's what's most effective here. My gut
| instinct in first approaching the task would be to throw a
| bunch of models at it, mixed-methods, with one-class SVM as a
| fall back. But I'm also way out of my depth on medical
| diagnostics ML so that's just a generalist's guess.
| jmhmd wrote:
| Poorer performance in real hospital settings has more to do
| with the introduction of new/unexpected/poor quality data (i.e.
| real world data) that the model was not trained in or optimized
| for. They still do very well generally, but often do not hit
| equivalent performance to what is submitted to the FDA, or in
| marketing materials. This does not mean they aren't useful.
|
| Clinical AI also has to balance accuracy with workflow
| efficiency. It may be technically most accurate for a model to
| report every potential abnormality with associated level of
| certainty, but this may inundate the radiologist with spurious
| findings that must be reviewed and rejected, slowing her down
| without adding clinical value. More data is not always better.
|
| In order for the model to have high enough certainty to get the
| right balance of sensitivity and specificity to be useful, many
| many examples are needed for training, and with some rarer
| entities, that is difficult. It also inherently reduces the
| value of the model it is only expected to identify its target
| disease 3 times/year.
|
| That's not to say advances in AI won't overcome these problems,
| just that they haven't, yet.
| samweb3 wrote:
| It's interesting to see people fighting so hard to preserve these
| jobs. Do people want to work that badly? If a magic wand can do
| everything radiologists can do, would we embrace it or invent
| reasons to occupy 40+ hours a week of time anyway? If a magic
| wand, might be on the horizon, shouldn't we all be fighting to
| find it and even finding ways to tweak our behaviors to maximize
| the amount of free time that could be generated?
| trenchpilgrim wrote:
| Problem: Food, rent, utilities and healthcare cost money.
| Simulacra wrote:
| It's not that so much as no one wants to lose their jobs due to
| innovation. Just look at typewriter repairmen, TV, radio, even
| Taxi drivers at one point etc. One day AI and automation will
| make many jobs redundant, so rather than resisting the march
| forward of technology, prepare for it and find a way to work
| alongside, not against innovation.
| kulshan wrote:
| People enjoy the comfort of consistent food and housing. People
| also enjoy serving their community. Working helps provide that.
| So for folks to be willing to sacrifice their security and
| comfort to get to the horizon of the new day with greater
| leisure time, it can be scary for many. Especially when you
| have to make a leap of belief that AI is a magic wand changing
| your world for the better. Is that supported by the evidence?
| It's quite the leap in belief and life change. Hesitancy seems
| appropriate to me.
| xboxnolifes wrote:
| This isn't going to generate free time. Its going to generate
| homelessness and increasing wealth inequality.
|
| Our current economic system does not support improved
| productivity leading to less working (with equal wealth) for
| the working class.
| simianwords wrote:
| People like the promised stability that comes with certain
| jobs. Some jobs are sold as "study this, get the GPA, apply to
| this university and do these things and you will get a stable
| job at the end". AI plans to disrupt this path.
| snowwrestler wrote:
| It is precisely the attraction of the vision that makes people
| fight so hard to preserve these jobs.
|
| Because we know how well the jobs address a need, and we also
| know how many times throughout history we have been promised
| magic wands that never quite showed up.
|
| And guess who is best equipped to measure the actual level of
| "magic"? Experts like radiologists. We need them the _most_
| along the way, not the least.
|
| If a magic wand actually shows up, it will be obvious to
| everyone and we'll all adopt it voluntarily. Just like
| thousands of innovations in history.
| jmhmd wrote:
| While a lot of this rings true, I think the analysis is skewed
| towards academic radiology. In private practice, everything is
| optimized for throughput, so the idea that most rads spend less
| than half of their time reading studies i think is probably way
| off.
| Simulacra wrote:
| So... is it technically possible?
| ALittleLight wrote:
| The only part of this article I believe is the legal and
| bureaucratic burdens part.
|
| "Human radiologists spend a minority of their time on diagnostics
| and the majority on other activities, like talking to patients
| and fellow clinicians"
|
| I've had the misfortune of dealing with a radiologist or two this
| year. They spent 10-20 minutes talking about the imaging and the
| results with me. What they said was very superficial and they
| didn't have answers to several of the questions I asked.
|
| I went over the images and pathology reports with ChatGPT and it
| was much better informed, did have answers for my questions, and
| had additional questions I should have been asking. I've used
| ChatGPT's information on the rare occasions when doctors deign to
| speak with me and it's always been right. Me, repeating
| conclusions and observations ChatGPT made, to my doctors, has
| twice changed the course of my treatment this year, and the
| doctors have never said anything I've learned from ChatGPT is
| wrong. By contrast, my doctors are often wrong, forgetful, or
| mistaken. I trust ChatGPT way more than them.
|
| Good image recognition models probably are much better than human
| radiologists already and certainly could be vastly better. One
| obstacle this post mentions - AI models "struggle to replicate
| this performance in hospital conditions", is purely a choice. If
| HMOs trained models on real data then this would no longer be the
| case, if it is now, which I doubt.
|
| I think it's pretty clearly doctors, and their various
| bureaucratic and legal allies, defending their legal monopoly so
| they can provide worse and slower healthcare at higher prices, so
| they continue to make money, at the small cost of the sick
| getting worse and dying.
| justlikereddit wrote:
| As the prediction of radiologists going dodo sprung out from
| improvements in image recognition, why don't we see premature and
| hysterically hyped predictions of psychiatrists being unemployed
| due to language models.
|
| Their workday consists of conversations, questions and reading.
| Something LLMs more than excel at doing, tirelessly and in huge
| volumes.
|
| And if radiologists are still the top bet due to image
| recognition being so much hotter, then why not add dermatologists
| to the extinction roster? They only ever look at regular light
| images, it should be a lower hanging fruit.
|
| (I'm aware of the nuances that make automation of these work
| roles hard, I'm just trying to shine some light on the mystery of
| radiologists being perceived as the perennial easy target)
| pjdesno wrote:
| The best story I heard about machine learning and radiology was
| when folks were racing to try to detect COVID in lung X-rays.
|
| As I recall, one group had fairly good success, but eventually
| someone figured out that their data set had images from a low-
| COVID hospital and a high-COVID hospital, and the lettering on
| the images used different fonts. The ML model was detecting the
| font, not the COVID.
|
| [a bit of googling later...]
|
| Here's a link to what I think was the debunking study:
| https://www.nature.com/articles/s42256-021-00338-7
|
| If you're not at a university, try searching for "AI for
| radiographic COVID-19 detection selects shortcuts over signal"
| and you'll probably be able to find an open-access copy.
| CamperBob2 wrote:
| Anecdotes like this are informative as far as they go, but they
| don't say anything at all about the technique itself. Like your
| story about the fonts used for labeling, essentially all of the
| drawbacks cited by the article come down to inadequate or
| inappropriate training methods and data. Fix that, which will
| not be hard from a purely-technical standpoint, and you will
| indeed be able to replace radiologists.
|
| Sorry, but in the absence of _general_ limiting principles that
| rule out such a scenario, that 's how it's going to shake out.
| Visual models are too good at exactly this type of work.
| jmhmd wrote:
| The issue is that in medicine, much like automobiles,
| unexpected failure modes may be catastrophic to individual
| people. "Fixing" failure modes like the above comment is not
| difficult from a technical standpoint, that's true, but you
| can only fix it once you've identified it, and at that point
| you may have a dead person/people. That's why AI in medicine
| and self driving cars are so unlike AI for programming or
| writing and move comparatively at a snails pace.
| CamperBob2 wrote:
| Yet self-driving cars are already competitive with human
| drivers, safety-wise, given responsible engineering and
| deployment practices.
|
| Like medicine, self-driving is more of a seemingly-
| unsolvable political problem than a seemingly-unsolvable
| technical one. It's not entirely clear how we'll get there
| from here, but it _will_ be solved. Would you put money on
| humans still driving themselves around 25-50 years from
| now? I wouldn 't.
|
| These stories about AI failures are similar to calling for
| banning radiation therapy machines because of the
| Therac-25. We can point and laugh at things like the
| labeling screwup that pjdesno mentioned -- and we should!
| -- but such cases are not a sound basis for policymaking.
| lomase wrote:
| Telsa told everybody 10 years ago self driving cars were
| a reality.
|
| Waymo claims to have it. Some hackernews comenters too, I
| started to belive those are Waymo employees or stock
| owners.
|
| Apart from that I know nobody that has even use or even
| seen a self driving car.
|
| Self-driving cars are not a thing so you can't say they
| are more realible than humans.
| sarchertech wrote:
| > Yet self-driving cars are already competitive with
| human drivers, safety-wise, given responsible engineering
| and deployment practices.
|
| Are they? Self driving cars only operate in a much safer
| subset of conditions that humans do. They have remote
| operators who will take over if a situation arises
| outside of the normal operating parameters. That or they
| will just pull over and stop.
| 1718627440 wrote:
| When it weren't for the font it might be anomalies in the
| image taking or even in the encoder software. You can never
| really be sure, what exactly the ML is detecting.
| osrec wrote:
| Exactly. A marginally higher image ISO at one location vs a
| lower ISO at another could potentially have a similar
| effect, and it would be quite difficult to detect.
| CamperBob2 wrote:
| You can give it the same tests the human radiologists take
| in school.
|
| They _do_ take tests, don 't they?
|
| They don't all score 100% every time, do they?
| 1718627440 wrote:
| The point here is that the radiologists has a concept of
| knowing which light patterns are sensible to draw
| conclusions from and which not, because the radiologist
| has a concept of real world 3D objects.
| Avalaxy wrote:
| Why not? That's what Grad-CAM is for right?
| 1718627440 wrote:
| What if the ML takes the conclusion exactly from the
| right pixels, but the cause is a rasterization issue.
| zahlman wrote:
| I remember a claim that someone was trying to use an ML model
| to detect COVID by analyzing the sound of the patient coughing.
|
| I couldn't for the life of me understand how this was supposed
| to work. If the coughing of COVID patients (as opposed to
| patients with other respiratory illnesses) actually sounds
| meaningfully different in a statistically meaningful way (and
| _why did they suppose that it would_? Phlegm is phlegm,
| surely), surely a human listener would have been able to figure
| it out easily.
| bparsons wrote:
| The thing with medical services is that there is never enough.
|
| If you are rich and care about your health (especially as move
| past age 40), you probably have use for a physiotherapist, a
| nutritionist, therapist, regular blood analysis, comprehensive
| cardio screening, comprehensive cancer screening etc. Arguably,
| there is no limit to the amount of medical services that people
| could use if they were cheap and accessible enough.
|
| Even if AI tools add 1-2% on the diagnostic side every year, it
| will take a very, very long time to catch up to demand.
| catigula wrote:
| Can radiology results be instantly fed into pass/fail metrics
| like code can via tests?
|
| Programming is the first job AI will replace. The rest come
| later.
| keeda wrote:
| At the risk of posting memes:
| https://pbs.twimg.com/media/GSXAMJRXkAA-cgI.jpg
|
| Updated for 2025: https://i.imgflip.com/a5ywre.jpg
| whydoineedthis wrote:
| I personally think we are in the pre-broadband era of AI. That
| is, what is currently being built will contribute to some AI dot-
| com 1.0 bubble burst, but after that there will be some
| advancements in it's distribution model that will allow it to
| thrive and infiltrate our society at a core level. Right now it's
| a bunch of dreamers building the pets.com that no one asked for,
| but after all the competition is shaken off, there will
| definitely be some clear winners, and maybe an Amazon.com of
| sorts for AI that people will adopt.
| rapatel0 wrote:
| I lived this previously. The author is missing some important
| context.
|
| Spray-and-Pray Algorithms
|
| After AlexNet, dozens of companies rushed into medical imaging.
| They grabbed whatever data they could find, trained a model, then
| pushed it through the FDA's broken clearance process. Most of
| these products failed in practice because they were junk. In
| mammography, only 2-3 companies actually built clinically useful
| products.
|
| Products actually have to be useful.
|
| There were two products in the space: CAD, and Triage. CAD is
| basically overlay on the screen as you read the case. Rads hated
| this because it was distracting and because the feature-
| engineering based CAD from the 80s-90s was demonstrated to be a
| failure. Users basically ignored "CADs."
|
| Triage is when you prioritize cases (cancers to the top of the
| stack). This has little to no value because when you have a stack
| of 50 cases you have to do today, then why do you care about the
| order? There were some niche use cases but it was largely
| pointless. It could actually detrimental. The algotithm would put
| easy cancer cases on the top, so now the user would spend less
| time on the rest of the stack (where the harder cases would end
| up).
|
| *Side note:* did you know that using CAD was a billable extra to
| insurance. Even through it was proven to not work, for years it
| remained reimbursable up until a few years ago.
|
| Poor Validation Standards
|
| Models collapsed in the real world because the FDA process is
| designed for drugs/hardware, not adaptive software. Validation
| typically = ~300 "golden" cases, labeled by 3 radiologists with
| majority vote arbitration. If 3 rads say it's cancer, it's
| cancer. If they disagree, it's not a good case for the study.
| This filtering ignores the hard cases (where readers disagree),
| which is exactly what models need to handle in the real world.
| Instead of 500K noisy real-world studies, you validate on a
| sanitized dataset. Companies learned how to "cheat" by over
| fitting to these toy datasets. You can explain this to regulators
| endlessly, but the bureaucracy only accepts the previously
| blessed process. Note: The previous process was defined by CAD, a
| product that was cleared in the 80s and shown to fail miserably
| in clinical use. This validation standard that demonstrated grand
| historical regulatory failure is the current standard that you
| MUST use for any devices that look like a CAD in mammography.
|
| Politics Over Outcomes
|
| We ran the largest multi-site prospective (15) trial in the
| space. Results: ~50% reduction in radiologist workload. Increased
| cancer detection rate. 10x lower cost per study. We even caught
| cancers missed in the standard workflow. Clinics still resisted
| adoption--because admitting missed cancers looked bad for their
| reputation. Bureaucratic EU healthcare systems preferred to avoid
| the embarrassment even through it was entirely internal.
|
| I'll leave you with one particularly salient story. I was
| speaking to the head a large US hospital IT/Ops organization. We
| had a 30 minute conversation about how to avoid putting our
| software decision in the EMR/PACS so that they could avoid
| litigation risk. Not once did we ever talk about patient impact.
| Not Once...
|
| Despite all that, our system caught cancers that would have been
| missed. Last I checked at least 104 women had their cancers
| detected by our software and are still walking around. That's the
| real win, even if politics buried the broader impact.
| smartmic wrote:
| Somehow related: Endoscopist deskilling risk after exposure to
| artificial intelligence in colonoscopy: a multicentre,
| observational study
|
| see https://news.ycombinator.com/item?id=44934207
| aabajian wrote:
| I'm an interventional radiologist with a master's in computer
| science. People outside radiology don't get why AI hasn't taken
| over.
|
| Can AI read diagnostic images better than a radiologist? Almost
| certainly the answer is (or will be) yes.
|
| Will radiologists be replaced? Almost certainly the answer is no.
|
| Why not? Medical risk. Unless the law changes, a radiologist will
| _have_ to sign off on each imaging report. So say you have an AI
| that reads images primarily and writes pristine reports. The
| bottleneck will _still_ be the time it takes for the radiologist
| to look at the images and _validate_ the automated report. Today,
| radiologist read very quickly, with a private practice rads
| averaging maybe 60-100 studies per day (XRs, ultrasounds, MRIs,
| CTs, nuclear medicine studies, mammograms, etc). This is near the
| limit of what a human being can reasonably do. Yes, there will be
| slight gains at not having to dictate anything, but still having
| to _validate_ everything takes nearly as much time.
|
| Now, I'm sure there's a cavalier radiologist out htere who would
| just click "sign, sign, sign..." but you know there's a
| malpractice attorney just waiting for that lawsuit.
| cogman10 wrote:
| Doesn't most of the stuff a radiologist does get double checked
| anyways by the doctor that orders the scan in the first place?
| I guess not a more typical screening scan like a mammogram.
| However, for anything else like a CT, MRI, Xray, etc. I expect
| the doctor/NP that ordered it in the first place will want to
| take a look at the image itself and not just the report on the
| image.
| nutjob2 wrote:
| A primary physician (or NP) isn't in a position to validate
| the judgement of a specialist. Even if they had the training
| and skill (doubtful), responsibility goes up, not down. It's
| all a question of who is liable when things go wrong.
| Spooky23 wrote:
| Not meaningfully. Beyond basics like a large tumor, a bone
| break, etc, there's alot too it.
| newyankee wrote:
| But this indicates lack of incentives to reduce healthcare
| costs by optimisation. If AI can do something well enough , and
| AI + humans surpass humans leading to costs reductions/
| increased throughput this should be reflected in the workflows.
|
| I feel that human processes have inertia and for lack of a
| better word, gatekeepers feel that new, novel approaches should
| be adopted slowly and which is why we are not seeing the
| impact, yet. Once a country with the right incentive structure
| (e.g. China ) can show that it can outperform and help improve
| the overall experience I am sure things will change.
|
| While 10 years progress is a lot in ML, AI , in more
| traditional fields it probably is a blip to change this
| institutional inertia which will change generation by
| generation. All that is needed is an external actor to take the
| risk and show a step change improvement. Having experienced how
| healthcare in US I feel people are only scared to take on bold
| challenges
| numpad0 wrote:
| Or, maybe artifacts justify prices less so than amounts of
| souls bothered will. Robotic medical diagnosis could save
| costs, but it could suppress customers' appetite too, in
| which case, like you said, commercial healthcare providers
| would not be incentivized to offer it.
| Spooky23 wrote:
| Remember, the AI doesn't create anything, so you add risk
| potentially to the patient outcome and perhaps make
| advancement more difficult.
|
| My late wife had to have a stent placed in a vein in her
| brain to relieve cranial pressure. We had to travel to to New
| York for an interventional radiologist and team to fish a 7
| inch stent and balloon from her thigh up.
|
| At the time, we had to travel to NYC, and the doctor was one
| of a half dozen who could do the procedure in the US. Who's
| going to train the future physician the skills needed to
| develop the procedure?
|
| For stuff like this, I feel like AI is potentially going to
| erase certain human knowledge.
| dmbche wrote:
| Three things explain this. First, while models beat humans on
| benchmarks, the standardized tests designed to measure AI
| performance, they struggle to replicate this performance in
| hospital conditions. Most tools can only diagnose
| abnormalities that are common in training data, and models
| often don't work as well outside of their test conditions.
| Second, attempts to give models more tasks have run into
| legal hurdles: regulators and medical insurers so far are
| reluctant to approve or cover fully autonomous radiology
| models. Third, even when they do diagnose accurately, models
| replace only a small share of a radiologist's job. Human
| radiologists spend a minority of their time on diagnostics
| and the majority on other activities, like talking to
| patients and fellow clinicians
|
| From the article
| mettamage wrote:
| So you studied like 8 years of med school [1] and 2 years of
| CS? Damn! That's a lot.
|
| [1] I don't know the US system so it's just a guess
| aabajian wrote:
| 4 years undergrad (CS, math, bio)
|
| 4 years med school
|
| 2 years computer science
|
| 6 years of residency (intern year, 4 years of DR, 1 year of
| IR)
|
| 16 years...
| doctorpangloss wrote:
| > Unless the law changes...
|
| That's it?
|
| I don't know. Doesn't sound like a very big obstacle to me. But
| I don't think AI will replace radiologists even if there was a
| law that said like, "blah blah blah, automated reports, can't
| be sued, blah blah."
|
| > This is near the limit of what a human being can reasonably
| do.
|
| Here's a different POV: professionals can choose to (1) work
| more, earn more, (2) work less, earn less. If there is a
| technology where you work less, earn more, it's obvious, it's
| not even a decision, so yes, exactly what you say will happen,
| will happen: "The bottleneck will still be the time it takes
| for the radiologist to look at the images and validate the
| automated report." But! You could also always choose, work
| less, earn less.
|
| Nobody forces radiologists to read 100 studies per day. You
| could choose to read 10 and earn 1/10th as many RVUs as before.
| And maybe you spend the other 9/10ths doing, whatever, raising
| your kids instead of having two au pairs and your 70 year old
| mom do it. This would actually _increase_ the demand for
| radiologists, which is to say, working less can have the
| OPPOSITE effect on the thing that this article is measuring.
|
| And that's what's actually happening: work less, earn less.
| Cultural change. I would argue that the thing people "don't
| get" is that professional culture - not just doctors, but
| lawyers, dentists, CPAs, whatever - people want to work less,
| earn less. AI today doesn't necessarily have anything to do
| with that. But the kind that a ton of people adopt will, and it
| won't look like, reading the images.
|
| People think that the reason healthcare costs rise is
| middlemen, insurance, MDs, or some similar grievance. So
| something something, AI, something something, replace
| radiologists. People who are smart are not so certain if that
| will happen. But listen, lawyers are expensive too, but nobody
| is saying, "legal costs are out of control in this country" -
| that's true, but legal spending is not a crisis.
|
| Health and education spending is a crisis. Why? Because you
| can't have death panels and kids who can't read: saving
| people's lives and daycare so that you can be a radiologist is
| compulsory. You have to save a kid's life, you just have to, so
| if there's a new curative procedure or therapeutic for a
| previously fatal kid's disease, for example, insurance, the
| government, whoever, is going to pay for it. You have to give
| kids a place to be during the day so you can work - eventually
| grandma gets too old. You don't have to sue anybody if you
| don't want to. So it's totally different.
|
| You're talking about legal stuff. It doesn't matter so much.
| There's a small chance that there will be a chatbot that is
| good enough to save someone's life instead of an MD, and in
| that situation, yes, the MD is out of a job. I'm not sure if
| it's going to be specifically radiologists, but focusing on
| this legal stuff, or sign offs or whatever, it's missing the
| bigger picture.
| smrtinsert wrote:
| At some point medical equipment is certified in some way for
| use. Could the same happen for imaging AIs?
| jiggawatts wrote:
| The demand for horses was also at an all time high when the Model
| T Ford was introduced.
| renewiltord wrote:
| The obvious answer is regulation and legal risk. It's the same
| reason retail pharmacists still have jobs despite their currently
| being slow poor-quality vending machines.
| JoeAltmaier wrote:
| My anecdote (not data): I took a friend to the emergency room on
| Sunday,after a back crackup on a bicycle. Big bruise and swelling
| above the left eye socket and on the chin. Both hands sore and
| tender and stabbing pain when any pressure was put on them.
|
| The radiologist said No Fracture! So treat for concussion and
| release. Two days later, back with unendurable head pain.
| Reexamine: oh, sorry, yes, fractures. Morphine.
|
| Wtf? Are the radiologists so overworked they can only glance at a
| test? Or was an AI at fault? I'll never know.
| vkou wrote:
| Could have just been one that sucks at their job. Half of
| people who have one are below average at doing it.
| rendx wrote:
| Huh? Since when does the word 'radiologist' not already imply
| being human? Did I miss a memo? The original title "AI isn't
| replacing radiologists" makes more sense, or why not "Demand for
| radiologists is at an all-time high".
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