5 ms·

Two reasons I think this is not the way to go: First, the cost would be insane. A century of monthly MRIs is 1200 scans per person, or 1.2B scans to finish yo

Two reasons I think this is not the way to go: First, the cost would be insane. A century of monthly MRIs is 1200 scans per person, or 1.2B scans to finish your hypothetical dataset. We pay about $US 550/hr for scanner time, using a research scanner that's subsidized (i.e., we're just covering costs, not making a profit). The article doesn't say how long the scan is. You can burn as much scanner time as you want chasing resolution/quality, but an hour seems reasonable. That comes out to $660B, which is...a lot, and we haven't even paid staff yet! Second, we have sorta tried this already. There's a massive neuroscience project to scan tons of brains called the Human Connectome Project. They have 1200 subjects, some scanned multiple times, behavioral measures, health outcomes, the works.... People have certainly found stuff in the data (I'm using some of it right now), but it hasn't lead to wild breakthroughs. There's a ongoing debate about whether this money would have been better spent on hypothesis-driven research instead.

briandear 7y ago
At that scale, scans wouldn’t cost $550 per hour. “Because it’s too expensive,” seems like a great opportunity for some clever startup to figure out a way to make it less expensive. Computers used to take up entire rooms. Flying across the country used to be insanely expensive. Cell phones used to cost a ton of money per minute. Reducing the cost of scanning, or developing entirely new scanning tech isn’t science fiction, it’s the future.
- D_Alex 7y ago
  $98/scan in Japan. https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/ikegami.html https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/...
  - mattkrause 7y ago
    The doctor gets $98. The $550/hr price I quoted is for a research scanner where no one is even trying to turn a profit; they just want to pay off the machine and its operating costs. The machines themselves are not magically cheaper in Japan; they're just being paid for through some other route. If the scanner were somehow free (gov't grant?), 98$ seems pretty reasonable for the labor.
    - flemhans 7y ago
      $105 in Romania then, for most body parts. <http://www.hiperdia.ro/servicii-medicale/> http://www.hiperdia.ro/servicii-medicale/>
      - mattkrause 7y ago
        Again, that’s what you pay (near as I can tell), but that’s not what it costs. They’re also “free” (at the point of service) in the UK, but the scanner and helium are not a generous gift from the fey folk, nor does the Queen volunteer as a tech. These things cost money. Any study you do is going to have to cover expenses—-including their share of a temperamental, multimillion dollar machine (or find a way to dip into the same accounts that cover its clinical use).
        flemhans 7y ago
        It is actually what I paid at the front desk in cash :) Totally anonymous. I visited as a tourist. It is not a subsidized government hospital.
    - D_Alex 7y ago
      A medical grade MRI scanner costs around $1 million, and maintenance costs are circa $100,000/year. With good utilisation, say 3000 hrs/year, the machine costs might be around $70/hr. The $550/hr you are paying may be because you are using a particularly fancy scanner, or because utilisation rate is low, or because the amount is loaded with overheads, or w/e.
      - mattkrause 7y ago
        What does “medical grade” mean? That’s in the ballpark for a 1.5T, but those are fairly old. About $1M per Tesla used to be a decent rule of thumb, but it’s come down a little at the low end. Still, I would be amazed to see a 3T for anything below $2M. As for the $550/hr, it’s probably true that research scanners have lower utilization and higher costs to support all the weird stuff researchers want to do. An outpatient clinic specializing in knees can run much leaner. That said, that rate seems to be pretty standard across universities and I maintain that it's a very reasonable estimate of the cost. For example: * Hopkins $668/hr (3T) or $538 (1.5T) during prime time; cheaper nights and weekend http://www.mri.jhu.edu/div_mri_res/ServCentPolicyFY17.pdf http://www.mri.jhu.edu/div_mri_res/ServCentPolicyFY17.pdf * Yale: $539/hr (3T) https://medicine.yale.edu/mrrc/users/charges.aspx https://medicine.yale.edu/mrrc/users/charges.aspx * Harvard/MGH: $640/hr https://www.nmr.mgh.harvard.edu/core https://www.nmr.mgh.harvard.edu/core * WUSTL: $710/hr (3T) https://www.mir.wustl.edu/Portals/0/Documents/Uploads/CCIR/FY19%20CCIR%20Price_6.20.18_dw_v4.pdf https://www.mir.wustl.edu/Portals/0/Documents/Uploads/CCIR/F... * McGill: $500/hr (3T) or $500-700/hr (7T) https://mcgill.ca/bic/files/bic/bic-rates-03052018.pdf https://mcgill.ca/bic/files/bic/bic-rates-03052018.pdf Most of these do not include F&A. It’s already coming out of the grants and external users pay a "Dean's Tax" on top of that to cover the missing overhead (which can often double the price).
  - petschge 7y ago
    That is just for your neck. So a tiny imaging volume on a cheaper machine. Using that as a price point for full body imageing is disingenuous.
Aeolun 7y ago
6B per year to figure out which cancers are malignant with one scan seems like a fairly decent price.
- mattkrause 7y ago
  For comparison, the entire NSF budget for next year is around $7B. That would just about cover the imaging component of building a speculative and ethically-questionable data set, assuming someone else pays for the biopsies, analysis, and staff. (The NIH does have more money, but also funds trials, vaccines, and other stuff that we probably don't want to cancel for a century).
  - Aeolun 7y ago
    Why would this be ethically questionable? It is not as if you are scanning people against their will.
D_Alex 7y ago
> You can burn as much scanner time as you want chasing resolution/quality, but an hour seems reasonable. Out of curiosity, what determines the speed of the MRI scan? Are massive improvements theoretically possible?
- npunt 7y ago
  ML & better imaging algorithms should help a lot. Times could be reduced from 45min to 15min [1]. Scanning a beating heart can be reduced from 4min+ to 25sec [2]. Also ML can aid in comparing past images to current ones [3], which would give you quick insights into what changed. Two ideas for time reduction I haven't seen discussed but perhaps might also help: 1. Don't scan at the same resolution across the whole body each time. Instead, focus on anomalous places that you wanted to monitor from the first high-res scan, or places that look anomalous in low res in the latest scan. Then dial up the resolution in those areas. 2. If better imaging algorithms existed that could account for very slight movements of the body (ala the heartbeat one above), perhaps prep time could be reduced by changing the physical layout of the scanner itself. The whole process of lying down and getting your head or whatever mounted in their plastic frame, then lifting the gurney and slowly sliding it into the machine.. it's all very slow. Instead of laying down, what if you could just walk in and be upright and get scanned relatively quickly - basically a slightly longer but similar experience to a chest X-ray. There's upright MRIs right now but they're not very high res (0.7tesla instead of 1-3), very few exist, and I'm sure they still take some time to complete scans and have lots of error correction extra scans to correct for patient movement. However, even with less time in scanner, there's a lot of fixed time cost of scheduling and patient prep (remove all metal things, wear this gown and these ear plugs, please don't freak out its really claustrophobic patient messaging), as well as still needing technicians. I'm just a patient who's gotten some MRIs but it definitely feels like there's ways to cut the time down significantly. [1] http://news.mit.edu/2011/better-mri-algorithm-1101 http://news.mit.edu/2011/better-mri-algorithm-1101 [2] https://phys.org/news/2017-10-technology-mri-scan.html https://phys.org/news/2017-10-technology-mri-scan.html [3] http://news.mit.edu/2018/faster-analysis-of-medical-images-0618 http://news.mit.edu/2018/faster-analysis-of-medical-images-0...
  - 7y ago

briandear 7y ago

At that scale, scans wouldn’t cost $550 per hour. “Because it’s too expensive,” seems like a great opportunity for some clever startup to figure out a way to make it less expensive. Computers used to take up entire rooms. Flying across the country used to be insanely expensive. Cell phones used to cost a ton of money per minute. Reducing the cost of scanning, or developing entirely new scanning tech isn’t science fiction, it’s the future.

D_Alex 7y ago
$98/scan in Japan. https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/ikegami.html https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/...
- mattkrause 7y ago
  The doctor gets $98. The $550/hr price I quoted is for a research scanner where no one is even trying to turn a profit; they just want to pay off the machine and its operating costs. The machines themselves are not magically cheaper in Japan; they're just being paid for through some other route. If the scanner were somehow free (gov't grant?), 98$ seems pretty reasonable for the labor.
  - flemhans 7y ago
    $105 in Romania then, for most body parts. <http://www.hiperdia.ro/servicii-medicale/> http://www.hiperdia.ro/servicii-medicale/>
    - mattkrause 7y ago
      Again, that’s what you pay (near as I can tell), but that’s not what it costs. They’re also “free” (at the point of service) in the UK, but the scanner and helium are not a generous gift from the fey folk, nor does the Queen volunteer as a tech. These things cost money. Any study you do is going to have to cover expenses—-including their share of a temperamental, multimillion dollar machine (or find a way to dip into the same accounts that cover its clinical use).
      - flemhans 7y ago
        It is actually what I paid at the front desk in cash :) Totally anonymous. I visited as a tourist. It is not a subsidized government hospital.
  - D_Alex 7y ago
    A medical grade MRI scanner costs around $1 million, and maintenance costs are circa $100,000/year. With good utilisation, say 3000 hrs/year, the machine costs might be around $70/hr. The $550/hr you are paying may be because you are using a particularly fancy scanner, or because utilisation rate is low, or because the amount is loaded with overheads, or w/e.
    - mattkrause 7y ago
      What does “medical grade” mean? That’s in the ballpark for a 1.5T, but those are fairly old. About $1M per Tesla used to be a decent rule of thumb, but it’s come down a little at the low end. Still, I would be amazed to see a 3T for anything below $2M. As for the $550/hr, it’s probably true that research scanners have lower utilization and higher costs to support all the weird stuff researchers want to do. An outpatient clinic specializing in knees can run much leaner. That said, that rate seems to be pretty standard across universities and I maintain that it's a very reasonable estimate of the cost. For example: * Hopkins $668/hr (3T) or $538 (1.5T) during prime time; cheaper nights and weekend http://www.mri.jhu.edu/div_mri_res/ServCentPolicyFY17.pdf http://www.mri.jhu.edu/div_mri_res/ServCentPolicyFY17.pdf * Yale: $539/hr (3T) https://medicine.yale.edu/mrrc/users/charges.aspx https://medicine.yale.edu/mrrc/users/charges.aspx * Harvard/MGH: $640/hr https://www.nmr.mgh.harvard.edu/core https://www.nmr.mgh.harvard.edu/core * WUSTL: $710/hr (3T) https://www.mir.wustl.edu/Portals/0/Documents/Uploads/CCIR/FY19%20CCIR%20Price_6.20.18_dw_v4.pdf https://www.mir.wustl.edu/Portals/0/Documents/Uploads/CCIR/F... * McGill: $500/hr (3T) or $500-700/hr (7T) https://mcgill.ca/bic/files/bic/bic-rates-03052018.pdf https://mcgill.ca/bic/files/bic/bic-rates-03052018.pdf Most of these do not include F&A. It’s already coming out of the grants and external users pay a "Dean's Tax" on top of that to cover the missing overhead (which can often double the price).
- petschge 7y ago
  That is just for your neck. So a tiny imaging volume on a cheaper machine. Using that as a price point for full body imageing is disingenuous.

Aeolun 7y ago

6B per year to figure out which cancers are malignant with one scan seems like a fairly decent price.

mattkrause 7y ago
For comparison, the entire NSF budget for next year is around $7B. That would just about cover the imaging component of building a speculative and ethically-questionable data set, assuming someone else pays for the biopsies, analysis, and staff. (The NIH does have more money, but also funds trials, vaccines, and other stuff that we probably don't want to cancel for a century).
- Aeolun 7y ago
  Why would this be ethically questionable? It is not as if you are scanning people against their will.

D_Alex 7y ago

> You can burn as much scanner time as you want chasing resolution/quality, but an hour seems reasonable. Out of curiosity, what determines the speed of the MRI scan? Are massive improvements theoretically possible?

npunt 7y ago
ML & better imaging algorithms should help a lot. Times could be reduced from 45min to 15min [1]. Scanning a beating heart can be reduced from 4min+ to 25sec [2]. Also ML can aid in comparing past images to current ones [3], which would give you quick insights into what changed. Two ideas for time reduction I haven't seen discussed but perhaps might also help: 1. Don't scan at the same resolution across the whole body each time. Instead, focus on anomalous places that you wanted to monitor from the first high-res scan, or places that look anomalous in low res in the latest scan. Then dial up the resolution in those areas. 2. If better imaging algorithms existed that could account for very slight movements of the body (ala the heartbeat one above), perhaps prep time could be reduced by changing the physical layout of the scanner itself. The whole process of lying down and getting your head or whatever mounted in their plastic frame, then lifting the gurney and slowly sliding it into the machine.. it's all very slow. Instead of laying down, what if you could just walk in and be upright and get scanned relatively quickly - basically a slightly longer but similar experience to a chest X-ray. There's upright MRIs right now but they're not very high res (0.7tesla instead of 1-3), very few exist, and I'm sure they still take some time to complete scans and have lots of error correction extra scans to correct for patient movement. However, even with less time in scanner, there's a lot of fixed time cost of scheduling and patient prep (remove all metal things, wear this gown and these ear plugs, please don't freak out its really claustrophobic patient messaging), as well as still needing technicians. I'm just a patient who's gotten some MRIs but it definitely feels like there's ways to cut the time down significantly. [1] http://news.mit.edu/2011/better-mri-algorithm-1101 http://news.mit.edu/2011/better-mri-algorithm-1101 [2] https://phys.org/news/2017-10-technology-mri-scan.html https://phys.org/news/2017-10-technology-mri-scan.html [3] http://news.mit.edu/2018/faster-analysis-of-medical-images-0618 http://news.mit.edu/2018/faster-analysis-of-medical-images-0...
- 7y ago