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One whole-body MRI could replace multiple cancer scans
- eutropia 7y agoWith sufficient software and computational horsepower, a single whole-body MRI could replace most diagnostic imaging systems, I'd wager. Computer models regularly outperform radiologists in diagnosing several conditions involving structural abnormalities.
- toomuchtodo 7y agoOn to driving down the cost of MRIs and eliminating their need for helium.
- mattkrause 7y agoPhillips and GE both have new models that use a lot less (10-20L vs. 1000L) of helium. I think they're only 1.5T though. The Phillips model is called "BlueSeal"; I can't remember GE's, but it's something goofy.
- ohithereyou 7y agoGE's name for this tech is Freelium[1]. [1] https://www3.gehealthcare.com/~/media/rsna-2016-press-kit-assets/press%20releases/press%20release_setting%20helium%20free-revolutionary%20mri%20tech%20from%20gehc.pdf?Parent=%7B1FFF8A39-2AC6-4EA6-9119-7458819CB4F7%7D https://www3.gehealthcare.com/~/media/rsna-2016-press-kit-as...
- mattkrause 7y agoYes! Thanks! (I knew it was slightly goofy)
- nradov 7y agoCT scans still have higher resolution than MRI for certain vascular and cardiac imaging studies. The down side is radiation exposure.
- dmead 7y agothey could still probably do a whole hell of a lot better with automated diagnosis.
- mattkrause 7y agoThe new digital CTs are crazy. We have one that goes down to 90 µm resolution for the whole head.
- mattkrause 7y agoGonna have a hard time with bones....
- sampleinajar 7y ago> The average cost of a WB-MRI scan for NSCLC patients was £317 Wow! $3000+ here in the US. Ever get the feeling you've been cheated?
- dillonmckay 7y agoIf you prepay, costs around $400 to $500, but that is not involving private insurance. https://www.mdsave.com/ https://www.mdsave.com/ Not affiliated, just interesting to see prices of various diagnostics around the US.
- rladd 7y agoThere are others that are less expensive if you do some searching, like https://radiologyassist.com/ https://radiologyassist.com/ (depending on where you live). Also, if you call independent MRI centers they will usually give you a much lower cash price (but then insurance won't reimburse). Another point to consider is that hospital MRIs can cost 10x (ten times) more than independent MRI centers. And while we're talking about MRIs, it's important to mention that the safer contrast agents are the macrocyclics. Avoid the linear agents if you are concerned about possible gadolinium deposits in your brain and other organs, and potential kidney damage.
- jmhmd 7y agoRegarding gadolinium, linear agents are almost never used anymore (and shouldn't be), at least in the US. Also, macrocyclics do also deposit in your brain in very small amounts, however there has never been any negative effect from this shown to date. And lastly, gadolinium is not known to cause any kidney damage. The problem in the past (in particular with linear agents) was nephrogenic systemic fibrosis, which was shown to occur in patients with pre-existing poor kidney function, probably as a result of being unable to quickly clear the gadolinium, which could then deposit in tissues. There is very little risk (if any) of NSF with newer macrocyclic agents.
- fma 7y agoI've seen Groupons for MRI scans and thought surely it must be a scam. From the reviews, sometimes they pressure you to get a package for periodic scans and use the first as a base line. But interesting indeed!
- nknealk 7y agoMany doctors hate full body scans. Every individual has a handful of anomalies which are almost always benign. They show up on full body scans and chasing them down comes with cost and patient risk. I have a hard time with reporting like this that doesn't quantify cost of biopsy on false-positives as well as cost of complications from examining false-positives. Source: worked in clinical research for 2 years.
- chongli 7y agoThis sounds to me like doing a full workup on blood chemistry. Individuals vary so much that you can get false positives. Wouldn't it be more useful as a baseline? Scan once and store it, then scan every few years and compare. If any of the "anomalies" has grown or new ones have appeared between scans, then they might be worth a second look?
- petschge 7y agoGetting a baseline is harder than it sounds. In the case of blood chemistry that is caused by fluctuations due to time of day, time of month, season, what you recently ate and so one. In the case of MRI the problem is that internal organs shift to the point that it is impossible to automatically compare. And a experienced doctor comparing the scan millimeter for millimeter takes hours and would be very expensive. Even just tracking the volume of a known tumor in the brain (that shifts very little) to track the effect of radiation is tedious, time consuming and error prone.
- duxup 7y ago> internal organs shift to the point that it is impossible to automatically compare I didn't even know that is a thing, I just sorta assumed they stayed put.
- rolleiflex 7y agoYou are a wet squishy clump of really advanced bacteria trying their damned best to physically hold together, barely alive. Don’t expect much. Human politics is the literal definition of shipping the org chart.
- anujbatra 7y ago> preferred by patients and involving less exposure to radiation I thought MRIs didn't have any radiation exposure as opposed to X-Rays and CT scans; unsure about this benefit of less exposure to radiation from 1 whole-body MRI vs multiple MRIs (should be the same IMO)
- chris_va 7y agoNot the greatest article. From another one: "Standard NHS pathways often involve different imaging techniques - such as CT, PET-CT or focused MRI scans - which vary in accuracy in different organs." ... so they do targeted scans (with radiation risk) as their normal practice. That kind of makes sense, since the resolution of those scans is much better than WB-MRI.
- mbell 7y agoI'm curious what affects this will have on false diagnosis and well...patient sanity. It seems like the majority of people have some sort of benign growth: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008738/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008738/
- rozza 7y agoMy wife has had full body scans every 3 months for the past 3 years. She currently has multiple active sites of bone mets, from the spine to shoulders and hips. A single scan is much more convenient and keeps the oncologist up to date with the state of her cancer. In our experience sometimes a new cancer site isn't diagnosed quickly, especially if it's asymptomatic and slow growing. Having past scans and reviewing them overtime has found multiple tumors so far. Seems the radiographers err on the side of caution when feeding back to the Oncologist. Her last cancer in her neck (c2) had been tracked over 3 scans (because it was small and slow growing), before it was reported back to us and subsequently treated with cyberknife.
- lighttower 7y agoWhat's the primary Cancer type? I'm assuming multiple myeloma?
- rozza 7y agoBreast Cancer HER2+ Currently being treated with Trastuzumab and Pertuzumab every 3 weeks. Seems to be doing its job keeping down the cancer growth rate. She also used to have Zoledronic acid at the same time but that caused osteonecrosis of the jaw, so has been stopped. Strangely, we're relatively happy with the bone mets. The two times the cancer hit soft tissue it grew alarmingly quickly. First in the breast, then when it came back and broke out the L2 vertebrae and wrapped the nerve. At least in the bone it grows slowly. When it eventually starts to break out, the next treatment is Trastuzumab emtansine, which is a chemo drug, so will have many more side effects to manage.
- amelius 7y agoWhat is the state of cancer detection through blood samples?
- jszymborski 7y agoThere are some cancers where blood biomarkers give us more information than others, but save for leukemia, I'm unaware of any that are sufficient for diagnosis. While still widely, the effectiveness of some blood biomarkers like PSA (prostate cancer) can be controversial. So, while I could be wrong since this isn't my area of expertise, there's a long way to go for most cancers when it comes to blood testing.
- mattkrause 7y agoThe buzzword you want is 'liquid biopsy', though the results are currently underwhelming.
- wolfi1 7y agoThere is no mentioning of exposure during MRIs. Is there none? I would have thought, CTs as well as MRIs are a problem because of exposure.
- mparlane 7y agoBecause CT scans and MRI scans are very different technologies.... CT = xray MRI = Magnetic resonance imaging There is no exposure in an MRI to radiation. The only danger would be having bits of metal on you or inside you.
- ohithereyou 7y agoSpecifically ferromagnetic metal. Surgical implants are largely okay, but there are some neurostimulators that can be a problem.
- jedberg 7y agoI've had this idea floating in my head for a while. Provide free annual full body MRIs to people, including being read by a radiologist, which they can take to anyone they want (doctor, lawyer, whatever). In exchange, they agree to send the org a copy of all their past and future medical records. The records are anonymized and tied to the MRIs. The MRIs and medical data is then pumped through machine learning algorithms to attempt to identify early signs of disease. The data of course would be most useful to future people, because we won't know someone has something until a doctor diagnoses it, but if the AI model can look at the MRI from five years ago on everyone with disease X and find a common early warning sign, then we could apply it to future cases where it might be possible someone has X and catch X much earlier. Basically, I want to create a charity that gives free full body MRIs in exchange for a bunch of medical data for training an AI.
- DanBC 7y ago> annual full body MRIs to people So, these are not medically indicated scans which means you're going to be causing huge amounts of over-diagnosis and thus over-treatment, which cause harm. Hypothetical Bob has his first scan, and it returns a few shadows on his lung. The doctors ask if he's ever had chicken pox and he doesn't think so but he's not sure. So, these shadows are probably just scaring from chicken pox. But maybe they're cancer. The only sure way to tell is for a biopsy. Every medical intervention carries risk, and because you've increased the numbers of interventions you've increased the numbers of people falling victim to that risk. Bob got a scare; he got an unnecessary medical intervention; he was subjected to risk: what did Bob gain from this? The only thing this extra data tells us is "chicken pox sometimes scars the lungs and they sometimes show up on MRI", which is something we already know. You do have a good point about the difficulty in getting hold of data to train AI. Sadly, because of recent missteps in England that's going to continue to be difficult unless the company can show rigorous protections.
- jedberg 7y ago> So, these are not medically indicated scans which means you're going to be causing huge amounts of over-diagnosis and thus over-treatment, which cause harm. What if we did something like set up a system where Bob's doctor can put in other symptoms, and only if one shows up that would indicate a lung MRI would the doctor be told, "Oh hey, we already did that, here's the MRI, and there was some shadow on the lung"?
- DanBC 7y agoHere's the NIHR blog: https://www.nihr.ac.uk/blogs/does-how-we-detect-the-spread-of-cancer-need-to-change/11492 https://www.nihr.ac.uk/blogs/does-how-we-detect-the-spread-o... And here's the paper: https://www.journalslibrary.nihr.ac.uk/programmes/hta/106801/#/ https://www.journalslibrary.nihr.ac.uk/programmes/hta/106801... These are worth reading, they're in more detail than the submitted site. I recommend NIHR because they're usually short and very readable.
- jlpom 7y agoMRI are generaly considered safe but my personnal experience contradict this. I passed a 3T brain MRI (with gadolinium injection for angiography) ~80 days ago and my life has been seriously painful since then. I have experienced hypertension (often >170 of systole, seem unrelated but never had high tension of my life and like the rest of theses issues it appeared exactly after the MRI), sleep issues, head difficulties to think and head "rigidity", sexual/erectile disfunction (other side-effets started to dim a bit since then, but not this one), continuous heat on of my face up to 3 weeks after the exam. I am not trying to spread FUD but this has unfortunately been my experience. I'm a fragile kind of person, though I didn't expected it would be (so) unsettling. YMMV but you may reconsider passing one if you don't have confidence it would help you diagnosis or find issues (stenosis, neoplasm...).
- refurb 7y agoReaction to the contrast agent?
- jlpom 7y agoA general practitioner redirected me to a neurologist, hopefully he will find out.
- ohithereyou 7y agoMake sure you report this to both your GP and to the company that makes the machine. All major MRI machine makers watch for adverse reactions like hawks, and if there's any way that your experience is an adverse reaction to either the contrast or the scan they are going to want the details to prevent it from happening to somebody else.
- jlpom 7y agoThanks for the advice, I will send an email to GE.
- ohithereyou 7y ago
- joshu 7y agoi actually did this a month ago. found no cancer but some surprises that i have had to react to... you have to be very careful because they can pick up irrelevant stuff, but i think this will be a huge field in the future.
- HyperTalk2 7y agoHow can I get a full body exploratory MRI done? Is this even possible? I've tried bribing with tens of thousands of dollars and I still get denied.
- mattkrause 7y agoIf you're likely to benefit from one (e.g., you had cancer), your doctor should be able to make that happen. Otherwise, it's unlikely to do much for your health. If you're just curious to see what your own brain (liver, etc) looks like, you might want to volunteer for a study at a local university and ask them if you can get a copy of your own scan. I know one lab that will even show you how to 3D print your brain, if you want.
- choppaface 7y agoFriend of mine recently got diagnosed with cancer. Has over a dozen golf-ball sized tumors in his brain, bones, lungs, liver, etc. After 6 months of nagging pain and pneumonia they finally did a small MRI and saw something odd. Then they did a full-body MRI and it was very very obvious. Taking an image can help catch things? No shit Sherlock! I don't care if doctors can't agree imaging diagnoses sometimes. Time to get better at doing that. Computers can help. Yes there's a helium shortage, but since when does healthcare get short-changed? Aside: there's at least one company looking to make whole-body imaging more available: https://q.bio/ https://q.bio/ The founder is a little crazy, but a good kind of crazy.
- jasonhansel 7y agoSomeone should start a 23andMe but for whole body MRIs (To be clear: I'm kidding, this is a joke and a terrible idea.)
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