18 ms·

>> seismic interpretation here Strong disagree here. Lets put aside the math and focus on money. I dont know much about seismic interpretation, but I know a l

>> seismic interpretation here Strong disagree here. Lets put aside the math and focus on money. I dont know much about seismic interpretation, but I know a lot about Radiology+CV/ML. I was CTO+CoFounder for three years full time of a venture-backed Radiology+CV/ML startup. From what I can see, there is a huge conflict of interest w/r/t Radiology (and presumably any medical field) in the US. Radiologists make a lot of money -- and given their jobs are not tied to high CoL regions (as coders jobs are), they make even more on a CoL-adjust basis. Automating these jobs is the equivalent of killing the golden goose. Further, Radiologists standards of practice are driven partly by their board (The American Board of Radiology) and the supply of labor is also controlled by them (The American Board of Radiology) by way of limited residency spots to train new radiologists. So Radiologists (or any medical specialist) can essentially control the supply of labor, and control the standards of best practice, essentially allowing continued high salaries by way of artificial scarcity. WHY ON EARTH WOULD THEY WANT THEIR WORK AUTOMATED AWAY? My experience during my startup was lots of radiologists mildly interested in CV/ML/AI, interested in lots of discussions, interested in paid advisory roles, interested in paid CMO figurehead-positions, but mostly dragging their feet and hindering real progress, presumably because of the threat it posed. Every action item was hindered by a variety of players in the ecosystem. In fact, most of our R&D and testing was done overseas in a more friendly single payer system. I dont see how the US's fee-for-service model for Radiology is ever compatible with real progress to drive down costs or drive up volume/value. Not surprisingly, we made a decision to mostly move on. You can see Enlitic (a competitor) didnt do well either despite the star-studded executive team. Another competitor (to be unnamed) appears to have shifted from models to just licensing data. Same for IBM/Merge. Going back to seismic interpretation -- this cant be compared to Radiology from a follow-the-money perspective because seismic interpretation isnt effectively a cartel. Happy to speak offline if anyone is curious about specific experiences. DM me.

grogenaut 5y ago
Would you say this is similar to challenges in other fields such as law?
- TuringNYC 5y ago
  Partly -- law controls standards to some extent, but does not control supply necessarily.
- jplr8922 5y ago
  Its probably a challenge for any profession where there is a legal monopoly where X service must be performed by Y individual, who also get to choose the quality of X and the number of Y in the market.
- xkjkls 5y ago
  Lawyers don't really control their own supply the way doctors do, which is why there is a great overabundance of people with law degrees in the country. AI has actually been used in a number of legal contexts, like building normalized contracts, or paralegal work. It's also because a lot of the highly paid legal work is pretty hard to automate in the same way, because it requires much more understanding of precedent or other nebulous ways of interpretation that AI isn't suited for.
  - dragonwriter 5y ago
    > Lawyers don't really control their own supply the way doctors do Bar associations do control standards for qualifications and acceptable on-ramp paths which directly governs supply (in fact, the oversupply differs in jurisdictions as a direct result of these decisions). A key difference is that the legal pipeline isn’t sensitive to federal funding to govern supply of qualified new lawyers the way the medical pipeline is for doctors, though; there’s nothing analogous in law to the reliance on medicare funding of residency slots in medicine.
    - lavishlatern 5y ago
      The medical pipeline doesn't have to be sensitive to federal funding either. There is nothing preventing residencies from being privately funded (besides the fact that most are currently publicly funded). Medicare funds this out of a broad idea of it being a public good if there are more physicians. Note, there is no obligation that physicians work in public service after residency. This is in contrast to if you go to med school on a military scholarship (in which case, there is an obligation to serve). In other words, if medicine weren't cartel, the government wouldn't need to pay doctors to train new doctors.
tinomaxgalvin 5y ago
I hear this sort of argument a lot in different fields. Usually it's because the IT guy doesn't really understand the business they are trying to automate or where the true pinch points or time savings are.
- TuringNYC 5y ago
  Could you provide some examples of fields where practitioners control both supply and standard of practice where automation is also shunned, perpetuating high costs? Also, note, the largest source of bankruptcy in the US is medical costs https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most... "They dont understand the business" is a great excuse for maintaining status quo. I'm an Engineer, a quant, and a computer scientist by training and I refuse to accept defeat w/o sound reason. I will if I'm given a good reason, but "go away you guys, you dont understand our business" is defeatist. If we all accepted such answers society would never progress. I'm sure horse carriages said the same thing when people tried to invent motor vehicles.
  - xkjkls 5y ago
    As a question, why haven't any of these techniques made waves outside the US? Other countries don't have the same monopoly/monopsony powers in the medical industries that are prevalent in the US.
    - Isinlor 5y ago
      EU seems to have quite a lot of companies offering AI solutions in radiology: https://grand-challenge.org/aiforradiology/companies/ https://grand-challenge.org/aiforradiology/companies/
    - PeterisP 5y ago
      US is exactly the place where those techniques would make waves because of what the US is paying for radiology; in countries where radiologists don't have the same monopoly/monopsony powers it's not nearly as lucrative to replace them. For example, I'm distantly involved in a project with non-US-radiologists about ML support for automating radiology note dictation (which is a much simpler and much "politically cleaner" issue than actual radiology automation), and IMHO they and their organization would be happy to integrate some image analyis ML tools in their workflow to automate part of their work. However, the current methods really aren't ready, and the local market isn't sufficiently large to make the jump and make a startup to make them ready, that would have to wait until further improvements, most likely done by someone trying to get the US radiologists' money.
ssivark 5y ago
To balance that, do you have any comments on the arrogance and incentive problems in deep learning? :-P
pas 5y ago
It takes one group of great radiologists who have a bit of altruistic/capitalistic/venture side, doesn't it?
- TuringNYC 5y ago
  Yes. Or the right economic setup for societal gain where we can compete on value. Going from pay-for-service to value based care will be great. In the meantime, setups like https://www.nighthawkradiology.com/ https://www.nighthawkradiology.com/ are also great because they drive efficiency, I just wish they were more prevalent.
mcguire 5y ago
So you're asserting that the reason your, and other, companies didn't do well is not that you couldn't live up to your promises but rather that there is a grand conspiracy to stop progress? By the way, have you checked out https://timecube.2enp.com/https://timecube.2enp.com/ https://timecube.2enp.com/https://timecube.2enp.com/?
- TuringNYC 5y ago
  >> grand conspiracy Umm, I'm asserting like "Medicine is not perfect competition and thus prices are not competitive." If you want to think it is a "conspiracy" you can, but Economics offers great explanations for such setups. I think many of us in technology think all industries are driven by merit, cutting edge technology, margins, and competition. In reality, not all industries are like this. This shouldnt be surprising. Computers go down in price. So do cloud service costs. So does RAM. But medicine stays expensive. "Conspiracy" is a shallow explanation -- it is just economics, it isnt perfectly competitive. And progress is hindered to maintain scarcity.
- nimithryn 5y ago
  “Grand conspiracy” seems a bit uncharitable IMO. He’s just saying that the incentives aren’t aligned, which legitimately seems like an issue in this space.
amusedcyclist 5y ago
Yeah the article quoted gave very few details on the supposedly inconsistent performance of the model and lots of details on how few radiologists used it. Doctors (and other regulated professions) are a cabal that need to be broken up.
- mikepurvis 5y ago
  > Doctors (and other regulated professions) are a cabal that need to be broken up. What do you see as the alternative to self-regulation? Some government office staffed with bureaucrats who have no idea about the realities of the actual work being done? I got an engineering undergrad degree and had no interest in pursuing professional certification, but I certainly understand the importance of it for those practicing a in way that may harm the public's trust, and it made me appreciate the role that other professional bodies play in regulating who gets to represent themselves to the public as a lawyer, doctor, electrician, etc.
  - amusedcyclist 5y ago
    I am certainly not in favour of government offices staffed with bureaucrats. If anything I'd say that we should reduce the difficulty to be licensed as a doctor/lawyer/electrician. Let universities open more and larger med schools and have them be un-tethered from the self regulating bodies.
    - mikepurvis 5y ago
      But surely regulating the profession is tightly tied to accrediting the education that is the gateway to it. How do you propose to "untether" these?
      - amusedcyclist 5y ago
        The universities handle the accreditation of all other faculties so why not have them also handle medicine law and engineering. As far as I'm aware theres no guild of philosophers who can control the number of students entering philosophy school. Universities would respond to supply and demand just like they do in any other faculty. Secondly make medicine an undergraduate programs , like it is in the most of the world which reduces the financial burden that doctors have to take on to complete the degree. This would also make the supply of doctors more elastic.
nradov 5y ago
The US healthcare system is slowly migrating from a fee-for-service model to a value-based model where at least some of the financial risk is shifted from employers and insurers to providers. The managers running those provider organizations thus have a direct incentive to adopt new technology if it actually works, even over radiologist objections. So far most radiology automation software hasn't generated a clear cost savings. That may change as technology improves.
- danuker 5y ago
  > where at least some of the financial risk is shifted from employers and insurers to providers Do you have any evidence to back that up?
  - colinmhayes 5y ago
    The ACA created a capitated payment system for medicare that providers can opt into. I'm not sure what evidence you're looking for other than the definition of capitation is "fee per patient" as opposed to "fee for service." Some states like California also have capitated plans on from private companies. https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/CapitatedModel https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-...
  - FuriouslyAdrift 5y ago
    Quality of care provisions in Medicare/Medicaid/ACA all help to shift shift costs to the practitioner if care is poor or has bad outcomes.
  - telchar 5y ago
    Here's one for you: https://innovation.cms.gov/innovation-models/bundled-payments https://innovation.cms.gov/innovation-models/bundled-payment...
- verdverm 5y ago
  Cost savings doesn't have to be near term. Imagine a doctor misses something on a reading and doesn't get the care they need... lawsuits are expensive. So you can have software which helps doctors do their job better which results in better patient outcomes. That is something hospitals are buying today for their radiology groups.
JoeAltmaier 5y ago
I don't see this as a response to the previous post at all. It was about the technical issues associated with a professional data interpreter, outside the simple image being interpreted. This is just cynicism about money and motivation. Is Radiology affected by the same external factors as seismology? Does one image area depend deeply on surrounding features? Are there external rules that can override what the image seems to present?
antipaul 5y ago
Good points. But I genuinely wonder what role algorithm brittleness plays here. “Fitting only to the test set” (see Andrew Ng quote in original article) is an acute concern in my circles: digital pathology in cancer research See “Google’s medical AI was super accurate in a lab. Real life was a different story.” https://www.technologyreview.com/2020/04/27/1000658/google-medical-ai-accurate-lab-real-life-clinic-covid-diabetes-retina-disease/ https://www.technologyreview.com/2020/04/27/1000658/google-m...
jofer 5y ago
"...because seismic interpretation isnt effectively a cartel..." I know some people who would disagree with you on that one! Seriously, though, you're making an excellent point that I hadn't considered. Healthcare has a lot of "interesting" incentive structures and are baked-in constraints that would prevent even a perfect solution from being widely deployed. It's not the same as geology, for sure, even though there are some parallels in terms in of image interpretation.
glitchc 5y ago
CTO of a CV+AI/ML startup developing a radiology solution eh? Let me ask you a couple of quick questions: What was your liability insurance like? How much coverage per diagnosis did you carry? Let me make it simpler: How much blame was your company willing to absorb if your algorithm made a faulty diagnosis?
- TuringNYC 5y ago
  Great question! We did our trials at two overseas locations in parallel with doctors. All uses cases were diagnostic for immigration purposes (e.g., detecting Tuberculosis and other chest infections at border points of entry). Given the non-medical use -- no liability insurance. No coverage diagnosis. Also given everything was run in parallel, double-blind with doctors also doing reads, no blame had to be absorbed. Once we got out of parallel, still we wouldn't need liability. The importance here was demonstrating efficacy, which we did fantastically well. Once we prove efficacy for multiple use cases, we can at least remove the "oh you computer scientists dont get it" argument and can have adult conversations about how to progress state of the art rather than continue to bleed patients dry. I'll admit there are definitely barriers like what you mention. But those barriers are not some impenetrable force once we break down real issues and deal with them separately and start treating the problem as one we can solve as a society.
  - readee456 5y ago
    I can't help but think some of the barriers here involved proving the software in a situation decidedly different than a clinical setting. I would not be surprised if an immigration medical officer developed different views about diseases than a GP or ER doctor. They're not treating the person, they're not in a doctor-patient relationship with the person, they're not really even "diagnosing" the person, they're just deciding whether they're "too sick" to come into the country. Maybe if the person looks messed up in some other way, their chest x-ray gets interpreted a little more strictly.
    - TuringNYC 5y ago
      >> I can't help but think some of the barriers here involved proving the software in a situation decidedly different than a clinical setting. Totally agree. But science moves in baby steps and progress builds on progress. We started ML by doing linear regression. Then we moved onto recognizing digits. Then we moved onto recognizing cats. Suddenly, Google Photos can find a friend of mine from 1994 in images it appears to have automatically sucked up. That is amazing progress. Similarly, our viewpoint as co-founders in the space was to solve a single use-case amazingly well and prove AUC and cost/value metrics. The field wont be moved by me or you, it will be moved by dozens of teams building upon each other.
petra 5y ago
>> In fact, most of our R&D and testing was done overseas in a more friendly single payer system. So are CV/ML radiology systems deployed somewhere globally? Where, and how successful are they ? And if not, why ?
teachingassist 5y ago
> WHY ON EARTH WOULD THEY WANT THEIR WORK AUTOMATED AWAY? Because any radiologist directly involved in the work of automating it away could capture multiple salaries. > but mostly dragging their feet and hindering real progress, presumably because of the threat it posed. It sounds more like they were not offered a stake, or were not sufficiently convinced it would work enough to accept a stake.
- prepend 5y ago
  I agree with you and don’t know why people would think radiologists would be against automating their jobs away. Most radiologists aren’t paid by the hour so it’s not like the longer it takes to review and diagnose the better. Having automation tools would allow a radiologist to do even more work and make even more money. Unless someone literally thinks they won’t need an authoritative radiologist in the loop any longer. But that’s pretty silly since we can’t even automate a McDonald’s cook out of the picture.
  - TuringNYC 5y ago
    >>> I agree with you and don’t know why people would think radiologists would be against automating their jobs away...Having automation tools would allow a radiologist to do even more work and make even more money. I'd love to understand your viewpoint here. What you're describing would be awesome to a small segment of radiologists, but then what happens to the rest of them? Further, why would the rest agree to it?!?! This isnt web ad sales or hosting where anyone can come in, do a better job, and win market share and get rich. Rather, here, the limited set of Radiologists would need to agree on standards of practice via the ABR -- why would they do that if it means most of them suffer as a result?
    - prepend 5y ago
      > awesome to a small segment of radiologists, but then what happens to the rest of them? The same thing, they would do more radiology consults. This is just like any other tech that’s improved radiology, it’s reduced the cost so there are more consults done. Let’s say that a review takes 10 minutes without this new tech. With the new tech the review takes 30 seconds. So now a single radiologist can do 120 reviews an hour instead of 6. That’s great, as every radiologist will make way more money. And also more radiology consults will be done because things that are too expensive and time consuming now become quick and cheaper. Most of them don’t suffer, they do better. Again, this isn’t a situation where any radiologists are getting fired and any solution that doesn’t involve radiologists is stupid since you still need humans to confirm and take responsibility for diagnosis or confirmation.
readee456 5y ago
I'm pretty sure people said the same things (nothing will ever change, doctors will never advocate for or accept change) when radiology went from films to digital. I'm sure they said the same things when radiology went from having scribes to using voice recognition software (e.g. Nuance) for reports. There seems to be a misconception that this is some kind of "all or nothing" thing, where AI will "automate away" radiologists. It's like a decade ago when everybody thought we were just about to "automate away" human drivers, except unlike driving, most radiology reads are by definition (i.e. a sick person) exceptional, out-of-baseline scenarios. I think this is missing some things about radiology economics. There are indeed incentives to automate as much as possible, especially for outsourced radiology practices like Radiology Partners or people getting paid by pharma companies for detailed clinical trial reads. Organizations like these are getting paid a certain amount per read. If they can use software to speed up parts of their work while demonstrating effectiveness, they make more money. Eventually this drives down the price. There would still be a human in the loop to review or sign off on whatever the AI does, and to look for any anomalies that it misses. But there can be less time spent on rote work or routine segmentation, and more on the overall disease picture. It's true the amount of imaging going on in the US has increased faster than both the population growth and the number of radiologists. At a certain point, the number of existing radiologists doesn't have time to read the images at any price. This gives the alleged cartel a few choices: graduate more radiologists, outsource reads, or use software to produce more output per radiologist. In the last case, which a self-interested group would obviously choose, they get paid the same but each individual patient pays less.
- deleted 5y ago
  [deleted]
uhhhhhhhhhhhhhh 5y ago
If you do it right, everyone will now to go to Tobago (or wherever) for the AI treatment that Just Works, and the luddites will go extinct (or maybe lobby for a fresh war in that region)
unsrsly 5y ago
Interesting, can you give an example of a radiologist hindering progress? You make an interesting point about radiologists setting practice standards - what alternative do you propose? You may also want to consider that radiologists don't determine practice standards in a vacuum - they have to serve the needs and expectations of their clinical colleagues.
mola 5y ago
For short term oriented VC funded startup any professional who likes to err on the side of caution is immediately looked upon as a corrupt actor hindering progress for personal gain.
- Fomite 5y ago
  "Move fast and break things" is less compelling when the things in question is someone's grandmother.
- TuringNYC 5y ago
  You can just look at this from the outside w/o any startup's opinions: Why are some products and services' costs growthing faster and out of lockset with the rest of the economy. Some example niches come to mind: college textbooks, college tuition, specialty medical costs. No one on the outside has to opine -- you can just look at the prices for some of these and know there are abnormal market forces at work.
  - mola 5y ago
    That's some weird logic. Let's say the market is broken for textbooks. What does it have to do with what I wrote?
mandevil 5y ago
People have been trying to do this with expert systems, flow charts, and every other technology you can imagine, and have for decades. My wife is a pharmacist, and they have software that is supposed to help them out with the bewildering number of medicines that are out there now. This seems like a trivial case, compared to radiology: (here in the US) the FDA publishes guidelines, so just take those and turn them into code, but she finds it "not that much of a help" that mostly gets an override. "Every once in a while I'll get an alert that is helpful, but most of them are not helpful, even a little bit." "Mostly false positives." And that's for a lot easier case than radiology.
- Fomite 5y ago
  Similarly, in infection control and antimicrobial stewardship, at this point pitching Yet Another Decision Support Tool will get you dirty looks.
billjings 5y ago
It's worse than even that. The cartel arrangement is as described, but it's increasingly not even a great deal for the radiologists. The business of radiology is increasingly centralized into teleradiography farms. That means that radiologists are working in shifts, and evaluated according to production metrics, like line workers in a factory. The cartel arrangement will probably continue, as it is advantageous for people at the top of this food chain, but it's not an arrangement that's going to result in a lot of wealth and job security flowing to individual radiologists. Nor will it result in great outcomes for patients.
rossdavidh 5y ago
So, there are lots of countries with a shortage of cardiologists, some of whom could probably use any halfway effective AI solution if the alternative is no radiologist available at all. Perhaps this sort of thing should be started in a medium-income country rather than the wealthiest? Not the ones who cannot afford the equipment at all, but the ones whose trained radiologists keep leaving for wealthier countries.
jollybean 5y ago
Family member worked on a board of a hospital, they raised charitable donations to buy more powerful software for the radiologist. The radiologist can now work 10x faster and still bills the hospital the same amount. The Doctor's Guild is exceedingly powerful. I really wish Wallmart or Amazon would get into providing healthcare services on the long tail - a lot of common stuff. I sounds odd but both those companies are built around ripping margins out of the value chain and not keeping much for themselves. Ok, maybe not either of them ... but something like that: The 'Walmart of Healthcare' that revolutionizes cost. Also - there are enough Medical Practitioners who would work there. Enough of them do care about patient outcomes, cost etc..
- watwut 5y ago
  You would expect the radiologist to be paid less because he/she does more work now? My salary did not went down when we migrated to more efficient tech.
  - bvrstvr 5y ago
    You're misconstruing the parent's point. The radiologist can be paid the same, even more. Their point is that while the cost (at least in time) of the radiologist's work was cut to 1/10, individual patients' bills remained constant.
  - jollybean 5y ago
    They get paid per review. They're now doing considerably more reviews thanks to the new software, paid for by donations. Cost to patients is the same, but processed faster. Doctor making bank.
- unsrsly 5y ago
  There is zero chance the software allowed the radiologists to work 10x faster... what?
  - jollybean 5y ago
    Yeah that's my hyperbole. I should have said 'significantly faster'.
nanidin 5y ago
> Further, Radiologists standards of practice are driven partly by their board (The American Board of Radiology) and the supply of labor is also controlled by them (The American Board of Radiology) by way of limited residency spots to train new radiologists. Perhaps it is time to found the American Board of Computational Radiology (or Medicine)? There seems to be a chilling effect on tech innovation in the medical space in the US. On recent trips to the dentist, it seems like most of the cool new tech is coming out of Israel.
- unsrsly 5y ago
  Interesting, how would the standards of the Board of Computational Radiology be set? Is the implication that the current standards are too high?
  - nanidin 5y ago
    I’m not sure, but it removes the conflict of interest (and subsequent gatekeeping) created by radiologists who don’t want technology to automate away some of their work.
    - unsrsly 5y ago
      There's a lot to unpack here! In the USA, the ABR regulates human radiologists via board certification. Medical technology is traditionally regulated by the 510K, PMA, and de novo pathways at the FDA. Of course, these products still have to demonstrate value in order for major stakeholders (hospitals, radiology practices) to purchase them. And using these products does not absolve the ordering doctor, the radiologist, or the hospital of legal liability for misdiagnosis. In fact, IANAL and this is a somewhat novel area of the law, but any AI product that functions as a drop-in replacement for a radiologist might be held liable for misdiagnosis that leads to harm. These liabilities could become quite large for a product deployed at scale (a single misdiagnosis causing death can lead to a settlement in excess of 10 million dollars). In summary, there's quite a bit more to the issue than simple "gatekeeping." It might be appealing to blame radiologists for these issues, but there's a much larger system at work that's designed to ensure quality and safety for patients. This is not AdTech - lives are at stake and people can get hurt. Now, this definitely comes with a cost to innovation, but it's going to take more than just a few MD's to reinvent the economics and law of computers practicing medicine on people.
rscho 5y ago
Well, I am guessing you are not an MD and as such you do not understand what radiology really is as a profession. You certainly have a very advanced technical knowledge about it, even much more than most radiologists. And that's precisely the catch: why are radiologists (mostly) non-technical people? The only possible answer is 'because what's asked of them as professionals is not technical'. As many (all) other specialties, radiology is more art than science. Its the science of interpreting images in context, and you can't separate the two. So actually, radiology startups all fail on this crucial issue: to do a good job, you'll not only have to automate image interpretation, but really automate that of the whole EHR. And given the amount of poorly encoded information in there, machines fail now and will continue to do so in the foreseeable future.
- TuringNYC 5y ago
  No, Im not an MD, but my co-founder was. Globally, hundreds of thousands of radiologists have been trained over the years have have collectively achieved generally consistent practices. Radiology is pattern matching and a set of very complex decision trees. They arent magic, because we consistently churn out more practitioners who achieve the same consistent outputs given inputs. Anyone trying to improve things is like every other scientist, they aren't trying to figure out the entire decision tree or every single thing, they are trying to chip away on complex problems little by little. I also strongly disagree with "radiology is more art than science" because if it was, radiologists wouldn't be able to agree on diagnoses.
  - rscho 5y ago
    Trivial radiology is pattern matching. Radiology for which you need a radiologist for is not. Yes, you could replace part of radiology and some radiologists with algorithms today. Unfortunately, those are also mostly the cases where we don't need radiologists. I'm sorry, but in many cases and even many important diagnoses that impact the patient, 2 radiologists that aren't allowed to communicate will sometimes reach widely different conclusions. Additionally, if you've interacted with radiologists you were certainly able to see that their analytical and logical thinking capabilities are often far below that of a CS major. A complex problem in radiology is not: "this patient has TB because [chest X-ray]". It's more like: "take this patient that had 30+ surgeries in the past 5y and tell me if his problem is more likely to be diagnosis 1 or diagnosis 2". And the problem for those cases is that you will never reach the critical mass of training data required (within the capabilities of a single startup) because those cases are too rare. You'll need the collaboration of the health system as a whole for that, _i.e._ state policies. So you can't really chip away at the complex problems on your own.
WalterBright 5y ago
> fee-for-service model for Radiology It's not exactly a fee for service model that's the problem. It's the monopoly over the supply of labor. Any business and union that manages to get its competition outlawed is guaranteed to abuse that position.
cogman10 5y ago
I see a lot of parallels to this and airline control towers. I think most can see that what control towers are doing is highly automatable (It's a queue) yet the industry has sabotaged it at every turn. Because the jobs it will eliminate are the ones that need to verify the system works correctly. A similar thing happens with train operators. We are busy setting up self driving cars, yet a self driving train is almost a trivial implementation that we don't do because the train conductors would never get on board with such a system.
- bonoboTP 5y ago
  Self-driving subways do exist in a number of cities. But generally, train operator aren't a huge cost. While taxi driver serves 1-2 customers at a time, a conductor can easily move around a thousand people in a train. Or compared with trucks, freight trains can be ridiculously long and so paying one guy is really nothing in comparison.
- shakow 5y ago
  > because the train conductors would never get on board with such a system. The train conductors wouldn't have any say in the operation.
  - TripleH 5y ago
    Conductors union could clearly organize a strong opposition to this change. At least in France they proved they know how to do it.
    - shakow 5y ago
      “We will stop replacing leaving conductors” is nothing they can oppose to.
- jmcqk6 5y ago
  >Because the jobs it will eliminate are the ones that need to verify the system works correctly. I don't understand how you recognize that, but still blame them. I don't ever want to trust pure algorithms or "machine learning" for my health. I believe there is just too much variability in humans, and the costs for outliers is going to be immense.
ping_pong 5y ago
It's sad you decided to give up because it wouldn't make money easily in the US. As you said, there are plenty of countries around the world that would have loved to lower medical costs without kowtowing to the doctors. Once it was a proven technology in places like Asia, I'm sure you would have been able to make it back into the US a lot easier.
yoden 5y ago
The problem with your thesis is that many radiologists are paid per read. They're essentially contractors. These independent radiologists would gladly pay 100k/year for an AI that could do their jobs. Even if the tool didn't do diagnosis, just made them 50% faster, they would gladly pay a huge amount of money. Contrast this with the field of Radiation Oncology. There are already AI auto-contouring solutions that you can buy today. It's a better fit given the limitations of AI: 1) Contouring can take hours per patient, so more value is gained by automating it 2) Normal structures are, well, normal; that is that they are not the diseased part of the patient. If the AI can't quite figure out where the kidney is and fills it out with an average looking kidney, hey that's probably an alright guess! 3) The AI doesn't have to be perfect; dosimetrists and docs can quickly check and update the result if the algorithm fails. Everyone is already familiar with this workflow due to the atlas segmentation algorithms that were state-of-the-art before. 4) Similarly, the output is easy to understand. If the AI did something crazy because of a failure to generalize, it will be obvious. Not so for a diagnostic AI. 5) Clinicians have the final say on which contours are used for treatment. The liability for contour assistance is lower for the software vendor.

grogenaut 5y ago

Would you say this is similar to challenges in other fields such as law?

TuringNYC 5y ago
Partly -- law controls standards to some extent, but does not control supply necessarily.
jplr8922 5y ago
Its probably a challenge for any profession where there is a legal monopoly where X service must be performed by Y individual, who also get to choose the quality of X and the number of Y in the market.
xkjkls 5y ago
Lawyers don't really control their own supply the way doctors do, which is why there is a great overabundance of people with law degrees in the country. AI has actually been used in a number of legal contexts, like building normalized contracts, or paralegal work. It's also because a lot of the highly paid legal work is pretty hard to automate in the same way, because it requires much more understanding of precedent or other nebulous ways of interpretation that AI isn't suited for.
- dragonwriter 5y ago
  > Lawyers don't really control their own supply the way doctors do Bar associations do control standards for qualifications and acceptable on-ramp paths which directly governs supply (in fact, the oversupply differs in jurisdictions as a direct result of these decisions). A key difference is that the legal pipeline isn’t sensitive to federal funding to govern supply of qualified new lawyers the way the medical pipeline is for doctors, though; there’s nothing analogous in law to the reliance on medicare funding of residency slots in medicine.
  - lavishlatern 5y ago
    The medical pipeline doesn't have to be sensitive to federal funding either. There is nothing preventing residencies from being privately funded (besides the fact that most are currently publicly funded). Medicare funds this out of a broad idea of it being a public good if there are more physicians. Note, there is no obligation that physicians work in public service after residency. This is in contrast to if you go to med school on a military scholarship (in which case, there is an obligation to serve). In other words, if medicine weren't cartel, the government wouldn't need to pay doctors to train new doctors.

tinomaxgalvin 5y ago

I hear this sort of argument a lot in different fields. Usually it's because the IT guy doesn't really understand the business they are trying to automate or where the true pinch points or time savings are.

TuringNYC 5y ago
Could you provide some examples of fields where practitioners control both supply and standard of practice where automation is also shunned, perpetuating high costs? Also, note, the largest source of bankruptcy in the US is medical costs https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most... "They dont understand the business" is a great excuse for maintaining status quo. I'm an Engineer, a quant, and a computer scientist by training and I refuse to accept defeat w/o sound reason. I will if I'm given a good reason, but "go away you guys, you dont understand our business" is defeatist. If we all accepted such answers society would never progress. I'm sure horse carriages said the same thing when people tried to invent motor vehicles.
- xkjkls 5y ago
  As a question, why haven't any of these techniques made waves outside the US? Other countries don't have the same monopoly/monopsony powers in the medical industries that are prevalent in the US.
  - Isinlor 5y ago
    EU seems to have quite a lot of companies offering AI solutions in radiology: https://grand-challenge.org/aiforradiology/companies/ https://grand-challenge.org/aiforradiology/companies/
  - PeterisP 5y ago
    US is exactly the place where those techniques would make waves because of what the US is paying for radiology; in countries where radiologists don't have the same monopoly/monopsony powers it's not nearly as lucrative to replace them. For example, I'm distantly involved in a project with non-US-radiologists about ML support for automating radiology note dictation (which is a much simpler and much "politically cleaner" issue than actual radiology automation), and IMHO they and their organization would be happy to integrate some image analyis ML tools in their workflow to automate part of their work. However, the current methods really aren't ready, and the local market isn't sufficiently large to make the jump and make a startup to make them ready, that would have to wait until further improvements, most likely done by someone trying to get the US radiologists' money.

ssivark 5y ago

To balance that, do you have any comments on the arrogance and incentive problems in deep learning? :-P

pas 5y ago

It takes one group of great radiologists who have a bit of altruistic/capitalistic/venture side, doesn't it?

TuringNYC 5y ago
Yes. Or the right economic setup for societal gain where we can compete on value. Going from pay-for-service to value based care will be great. In the meantime, setups like https://www.nighthawkradiology.com/ https://www.nighthawkradiology.com/ are also great because they drive efficiency, I just wish they were more prevalent.

mcguire 5y ago

So you're asserting that the reason your, and other, companies didn't do well is not that you couldn't live up to your promises but rather that there is a grand conspiracy to stop progress? By the way, have you checked out https://timecube.2enp.com/https://timecube.2enp.com/ https://timecube.2enp.com/https://timecube.2enp.com/?

TuringNYC 5y ago
>> grand conspiracy Umm, I'm asserting like "Medicine is not perfect competition and thus prices are not competitive." If you want to think it is a "conspiracy" you can, but Economics offers great explanations for such setups. I think many of us in technology think all industries are driven by merit, cutting edge technology, margins, and competition. In reality, not all industries are like this. This shouldnt be surprising. Computers go down in price. So do cloud service costs. So does RAM. But medicine stays expensive. "Conspiracy" is a shallow explanation -- it is just economics, it isnt perfectly competitive. And progress is hindered to maintain scarcity.
nimithryn 5y ago
“Grand conspiracy” seems a bit uncharitable IMO. He’s just saying that the incentives aren’t aligned, which legitimately seems like an issue in this space.

amusedcyclist 5y ago

Yeah the article quoted gave very few details on the supposedly inconsistent performance of the model and lots of details on how few radiologists used it. Doctors (and other regulated professions) are a cabal that need to be broken up.

mikepurvis 5y ago
> Doctors (and other regulated professions) are a cabal that need to be broken up. What do you see as the alternative to self-regulation? Some government office staffed with bureaucrats who have no idea about the realities of the actual work being done? I got an engineering undergrad degree and had no interest in pursuing professional certification, but I certainly understand the importance of it for those practicing a in way that may harm the public's trust, and it made me appreciate the role that other professional bodies play in regulating who gets to represent themselves to the public as a lawyer, doctor, electrician, etc.
- amusedcyclist 5y ago
  I am certainly not in favour of government offices staffed with bureaucrats. If anything I'd say that we should reduce the difficulty to be licensed as a doctor/lawyer/electrician. Let universities open more and larger med schools and have them be un-tethered from the self regulating bodies.
  - mikepurvis 5y ago
    But surely regulating the profession is tightly tied to accrediting the education that is the gateway to it. How do you propose to "untether" these?
    - amusedcyclist 5y ago
      The universities handle the accreditation of all other faculties so why not have them also handle medicine law and engineering. As far as I'm aware theres no guild of philosophers who can control the number of students entering philosophy school. Universities would respond to supply and demand just like they do in any other faculty. Secondly make medicine an undergraduate programs , like it is in the most of the world which reduces the financial burden that doctors have to take on to complete the degree. This would also make the supply of doctors more elastic.

nradov 5y ago

The US healthcare system is slowly migrating from a fee-for-service model to a value-based model where at least some of the financial risk is shifted from employers and insurers to providers. The managers running those provider organizations thus have a direct incentive to adopt new technology if it actually works, even over radiologist objections. So far most radiology automation software hasn't generated a clear cost savings. That may change as technology improves.

danuker 5y ago
> where at least some of the financial risk is shifted from employers and insurers to providers Do you have any evidence to back that up?
- colinmhayes 5y ago
  The ACA created a capitated payment system for medicare that providers can opt into. I'm not sure what evidence you're looking for other than the definition of capitation is "fee per patient" as opposed to "fee for service." Some states like California also have capitated plans on from private companies. https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/CapitatedModel https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-...
- FuriouslyAdrift 5y ago
  Quality of care provisions in Medicare/Medicaid/ACA all help to shift shift costs to the practitioner if care is poor or has bad outcomes.
- telchar 5y ago
  Here's one for you: https://innovation.cms.gov/innovation-models/bundled-payments https://innovation.cms.gov/innovation-models/bundled-payment...
verdverm 5y ago
Cost savings doesn't have to be near term. Imagine a doctor misses something on a reading and doesn't get the care they need... lawsuits are expensive. So you can have software which helps doctors do their job better which results in better patient outcomes. That is something hospitals are buying today for their radiology groups.

JoeAltmaier 5y ago

I don't see this as a response to the previous post at all. It was about the technical issues associated with a professional data interpreter, outside the simple image being interpreted. This is just cynicism about money and motivation. Is Radiology affected by the same external factors as seismology? Does one image area depend deeply on surrounding features? Are there external rules that can override what the image seems to present?

antipaul 5y ago

Good points. But I genuinely wonder what role algorithm brittleness plays here. “Fitting only to the test set” (see Andrew Ng quote in original article) is an acute concern in my circles: digital pathology in cancer research See “Google’s medical AI was super accurate in a lab. Real life was a different story.” https://www.technologyreview.com/2020/04/27/1000658/google-medical-ai-accurate-lab-real-life-clinic-covid-diabetes-retina-disease/ https://www.technologyreview.com/2020/04/27/1000658/google-m...

jofer 5y ago

"...because seismic interpretation isnt effectively a cartel..." I know some people who would disagree with you on that one! Seriously, though, you're making an excellent point that I hadn't considered. Healthcare has a lot of "interesting" incentive structures and are baked-in constraints that would prevent even a perfect solution from being widely deployed. It's not the same as geology, for sure, even though there are some parallels in terms in of image interpretation.

glitchc 5y ago

CTO of a CV+AI/ML startup developing a radiology solution eh? Let me ask you a couple of quick questions: What was your liability insurance like? How much coverage per diagnosis did you carry? Let me make it simpler: How much blame was your company willing to absorb if your algorithm made a faulty diagnosis?

TuringNYC 5y ago
Great question! We did our trials at two overseas locations in parallel with doctors. All uses cases were diagnostic for immigration purposes (e.g., detecting Tuberculosis and other chest infections at border points of entry). Given the non-medical use -- no liability insurance. No coverage diagnosis. Also given everything was run in parallel, double-blind with doctors also doing reads, no blame had to be absorbed. Once we got out of parallel, still we wouldn't need liability. The importance here was demonstrating efficacy, which we did fantastically well. Once we prove efficacy for multiple use cases, we can at least remove the "oh you computer scientists dont get it" argument and can have adult conversations about how to progress state of the art rather than continue to bleed patients dry. I'll admit there are definitely barriers like what you mention. But those barriers are not some impenetrable force once we break down real issues and deal with them separately and start treating the problem as one we can solve as a society.
- readee456 5y ago
  I can't help but think some of the barriers here involved proving the software in a situation decidedly different than a clinical setting. I would not be surprised if an immigration medical officer developed different views about diseases than a GP or ER doctor. They're not treating the person, they're not in a doctor-patient relationship with the person, they're not really even "diagnosing" the person, they're just deciding whether they're "too sick" to come into the country. Maybe if the person looks messed up in some other way, their chest x-ray gets interpreted a little more strictly.
  - TuringNYC 5y ago
    >> I can't help but think some of the barriers here involved proving the software in a situation decidedly different than a clinical setting. Totally agree. But science moves in baby steps and progress builds on progress. We started ML by doing linear regression. Then we moved onto recognizing digits. Then we moved onto recognizing cats. Suddenly, Google Photos can find a friend of mine from 1994 in images it appears to have automatically sucked up. That is amazing progress. Similarly, our viewpoint as co-founders in the space was to solve a single use-case amazingly well and prove AUC and cost/value metrics. The field wont be moved by me or you, it will be moved by dozens of teams building upon each other.

petra 5y ago

>> In fact, most of our R&D and testing was done overseas in a more friendly single payer system. So are CV/ML radiology systems deployed somewhere globally? Where, and how successful are they ? And if not, why ?

teachingassist 5y ago

> WHY ON EARTH WOULD THEY WANT THEIR WORK AUTOMATED AWAY? Because any radiologist directly involved in the work of automating it away could capture multiple salaries. > but mostly dragging their feet and hindering real progress, presumably because of the threat it posed. It sounds more like they were not offered a stake, or were not sufficiently convinced it would work enough to accept a stake.

prepend 5y ago
I agree with you and don’t know why people would think radiologists would be against automating their jobs away. Most radiologists aren’t paid by the hour so it’s not like the longer it takes to review and diagnose the better. Having automation tools would allow a radiologist to do even more work and make even more money. Unless someone literally thinks they won’t need an authoritative radiologist in the loop any longer. But that’s pretty silly since we can’t even automate a McDonald’s cook out of the picture.
- TuringNYC 5y ago
  >>> I agree with you and don’t know why people would think radiologists would be against automating their jobs away...Having automation tools would allow a radiologist to do even more work and make even more money. I'd love to understand your viewpoint here. What you're describing would be awesome to a small segment of radiologists, but then what happens to the rest of them? Further, why would the rest agree to it?!?! This isnt web ad sales or hosting where anyone can come in, do a better job, and win market share and get rich. Rather, here, the limited set of Radiologists would need to agree on standards of practice via the ABR -- why would they do that if it means most of them suffer as a result?
  - prepend 5y ago
    > awesome to a small segment of radiologists, but then what happens to the rest of them? The same thing, they would do more radiology consults. This is just like any other tech that’s improved radiology, it’s reduced the cost so there are more consults done. Let’s say that a review takes 10 minutes without this new tech. With the new tech the review takes 30 seconds. So now a single radiologist can do 120 reviews an hour instead of 6. That’s great, as every radiologist will make way more money. And also more radiology consults will be done because things that are too expensive and time consuming now become quick and cheaper. Most of them don’t suffer, they do better. Again, this isn’t a situation where any radiologists are getting fired and any solution that doesn’t involve radiologists is stupid since you still need humans to confirm and take responsibility for diagnosis or confirmation.

readee456 5y ago

I'm pretty sure people said the same things (nothing will ever change, doctors will never advocate for or accept change) when radiology went from films to digital. I'm sure they said the same things when radiology went from having scribes to using voice recognition software (e.g. Nuance) for reports. There seems to be a misconception that this is some kind of "all or nothing" thing, where AI will "automate away" radiologists. It's like a decade ago when everybody thought we were just about to "automate away" human drivers, except unlike driving, most radiology reads are by definition (i.e. a sick person) exceptional, out-of-baseline scenarios. I think this is missing some things about radiology economics. There are indeed incentives to automate as much as possible, especially for outsourced radiology practices like Radiology Partners or people getting paid by pharma companies for detailed clinical trial reads. Organizations like these are getting paid a certain amount per read. If they can use software to speed up parts of their work while demonstrating effectiveness, they make more money. Eventually this drives down the price. There would still be a human in the loop to review or sign off on whatever the AI does, and to look for any anomalies that it misses. But there can be less time spent on rote work or routine segmentation, and more on the overall disease picture. It's true the amount of imaging going on in the US has increased faster than both the population growth and the number of radiologists. At a certain point, the number of existing radiologists doesn't have time to read the images at any price. This gives the alleged cartel a few choices: graduate more radiologists, outsource reads, or use software to produce more output per radiologist. In the last case, which a self-interested group would obviously choose, they get paid the same but each individual patient pays less.

deleted 5y ago
[deleted]

uhhhhhhhhhhhhhh 5y ago

If you do it right, everyone will now to go to Tobago (or wherever) for the AI treatment that Just Works, and the luddites will go extinct (or maybe lobby for a fresh war in that region)

unsrsly 5y ago

Interesting, can you give an example of a radiologist hindering progress? You make an interesting point about radiologists setting practice standards - what alternative do you propose? You may also want to consider that radiologists don't determine practice standards in a vacuum - they have to serve the needs and expectations of their clinical colleagues.

mola 5y ago

For short term oriented VC funded startup any professional who likes to err on the side of caution is immediately looked upon as a corrupt actor hindering progress for personal gain.

Fomite 5y ago
"Move fast and break things" is less compelling when the things in question is someone's grandmother.
TuringNYC 5y ago
You can just look at this from the outside w/o any startup's opinions: Why are some products and services' costs growthing faster and out of lockset with the rest of the economy. Some example niches come to mind: college textbooks, college tuition, specialty medical costs. No one on the outside has to opine -- you can just look at the prices for some of these and know there are abnormal market forces at work.
- mola 5y ago
  That's some weird logic. Let's say the market is broken for textbooks. What does it have to do with what I wrote?

mandevil 5y ago

People have been trying to do this with expert systems, flow charts, and every other technology you can imagine, and have for decades. My wife is a pharmacist, and they have software that is supposed to help them out with the bewildering number of medicines that are out there now. This seems like a trivial case, compared to radiology: (here in the US) the FDA publishes guidelines, so just take those and turn them into code, but she finds it "not that much of a help" that mostly gets an override. "Every once in a while I'll get an alert that is helpful, but most of them are not helpful, even a little bit." "Mostly false positives." And that's for a lot easier case than radiology.

Fomite 5y ago
Similarly, in infection control and antimicrobial stewardship, at this point pitching Yet Another Decision Support Tool will get you dirty looks.

billjings 5y ago

It's worse than even that. The cartel arrangement is as described, but it's increasingly not even a great deal for the radiologists. The business of radiology is increasingly centralized into teleradiography farms. That means that radiologists are working in shifts, and evaluated according to production metrics, like line workers in a factory. The cartel arrangement will probably continue, as it is advantageous for people at the top of this food chain, but it's not an arrangement that's going to result in a lot of wealth and job security flowing to individual radiologists. Nor will it result in great outcomes for patients.

rossdavidh 5y ago

So, there are lots of countries with a shortage of cardiologists, some of whom could probably use any halfway effective AI solution if the alternative is no radiologist available at all. Perhaps this sort of thing should be started in a medium-income country rather than the wealthiest? Not the ones who cannot afford the equipment at all, but the ones whose trained radiologists keep leaving for wealthier countries.

jollybean 5y ago

Family member worked on a board of a hospital, they raised charitable donations to buy more powerful software for the radiologist. The radiologist can now work 10x faster and still bills the hospital the same amount. The Doctor's Guild is exceedingly powerful. I really wish Wallmart or Amazon would get into providing healthcare services on the long tail - a lot of common stuff. I sounds odd but both those companies are built around ripping margins out of the value chain and not keeping much for themselves. Ok, maybe not either of them ... but something like that: The 'Walmart of Healthcare' that revolutionizes cost. Also - there are enough Medical Practitioners who would work there. Enough of them do care about patient outcomes, cost etc..

watwut 5y ago
You would expect the radiologist to be paid less because he/she does more work now? My salary did not went down when we migrated to more efficient tech.
- bvrstvr 5y ago
  You're misconstruing the parent's point. The radiologist can be paid the same, even more. Their point is that while the cost (at least in time) of the radiologist's work was cut to 1/10, individual patients' bills remained constant.
- jollybean 5y ago
  They get paid per review. They're now doing considerably more reviews thanks to the new software, paid for by donations. Cost to patients is the same, but processed faster. Doctor making bank.
unsrsly 5y ago
There is zero chance the software allowed the radiologists to work 10x faster... what?
- jollybean 5y ago
  Yeah that's my hyperbole. I should have said 'significantly faster'.

nanidin 5y ago

> Further, Radiologists standards of practice are driven partly by their board (The American Board of Radiology) and the supply of labor is also controlled by them (The American Board of Radiology) by way of limited residency spots to train new radiologists. Perhaps it is time to found the American Board of Computational Radiology (or Medicine)? There seems to be a chilling effect on tech innovation in the medical space in the US. On recent trips to the dentist, it seems like most of the cool new tech is coming out of Israel.

unsrsly 5y ago
Interesting, how would the standards of the Board of Computational Radiology be set? Is the implication that the current standards are too high?
- nanidin 5y ago
  I’m not sure, but it removes the conflict of interest (and subsequent gatekeeping) created by radiologists who don’t want technology to automate away some of their work.
  - unsrsly 5y ago
    There's a lot to unpack here! In the USA, the ABR regulates human radiologists via board certification. Medical technology is traditionally regulated by the 510K, PMA, and de novo pathways at the FDA. Of course, these products still have to demonstrate value in order for major stakeholders (hospitals, radiology practices) to purchase them. And using these products does not absolve the ordering doctor, the radiologist, or the hospital of legal liability for misdiagnosis. In fact, IANAL and this is a somewhat novel area of the law, but any AI product that functions as a drop-in replacement for a radiologist might be held liable for misdiagnosis that leads to harm. These liabilities could become quite large for a product deployed at scale (a single misdiagnosis causing death can lead to a settlement in excess of 10 million dollars). In summary, there's quite a bit more to the issue than simple "gatekeeping." It might be appealing to blame radiologists for these issues, but there's a much larger system at work that's designed to ensure quality and safety for patients. This is not AdTech - lives are at stake and people can get hurt. Now, this definitely comes with a cost to innovation, but it's going to take more than just a few MD's to reinvent the economics and law of computers practicing medicine on people.

rscho 5y ago

Well, I am guessing you are not an MD and as such you do not understand what radiology really is as a profession. You certainly have a very advanced technical knowledge about it, even much more than most radiologists. And that's precisely the catch: why are radiologists (mostly) non-technical people? The only possible answer is 'because what's asked of them as professionals is not technical'. As many (all) other specialties, radiology is more art than science. Its the science of interpreting images in context, and you can't separate the two. So actually, radiology startups all fail on this crucial issue: to do a good job, you'll not only have to automate image interpretation, but really automate that of the whole EHR. And given the amount of poorly encoded information in there, machines fail now and will continue to do so in the foreseeable future.

TuringNYC 5y ago
No, Im not an MD, but my co-founder was. Globally, hundreds of thousands of radiologists have been trained over the years have have collectively achieved generally consistent practices. Radiology is pattern matching and a set of very complex decision trees. They arent magic, because we consistently churn out more practitioners who achieve the same consistent outputs given inputs. Anyone trying to improve things is like every other scientist, they aren't trying to figure out the entire decision tree or every single thing, they are trying to chip away on complex problems little by little. I also strongly disagree with "radiology is more art than science" because if it was, radiologists wouldn't be able to agree on diagnoses.
- rscho 5y ago
  Trivial radiology is pattern matching. Radiology for which you need a radiologist for is not. Yes, you could replace part of radiology and some radiologists with algorithms today. Unfortunately, those are also mostly the cases where we don't need radiologists. I'm sorry, but in many cases and even many important diagnoses that impact the patient, 2 radiologists that aren't allowed to communicate will sometimes reach widely different conclusions. Additionally, if you've interacted with radiologists you were certainly able to see that their analytical and logical thinking capabilities are often far below that of a CS major. A complex problem in radiology is not: "this patient has TB because [chest X-ray]". It's more like: "take this patient that had 30+ surgeries in the past 5y and tell me if his problem is more likely to be diagnosis 1 or diagnosis 2". And the problem for those cases is that you will never reach the critical mass of training data required (within the capabilities of a single startup) because those cases are too rare. You'll need the collaboration of the health system as a whole for that, _i.e._ state policies. So you can't really chip away at the complex problems on your own.

WalterBright 5y ago

> fee-for-service model for Radiology It's not exactly a fee for service model that's the problem. It's the monopoly over the supply of labor. Any business and union that manages to get its competition outlawed is guaranteed to abuse that position.

cogman10 5y ago

I see a lot of parallels to this and airline control towers. I think most can see that what control towers are doing is highly automatable (It's a queue) yet the industry has sabotaged it at every turn. Because the jobs it will eliminate are the ones that need to verify the system works correctly. A similar thing happens with train operators. We are busy setting up self driving cars, yet a self driving train is almost a trivial implementation that we don't do because the train conductors would never get on board with such a system.

bonoboTP 5y ago
Self-driving subways do exist in a number of cities. But generally, train operator aren't a huge cost. While taxi driver serves 1-2 customers at a time, a conductor can easily move around a thousand people in a train. Or compared with trucks, freight trains can be ridiculously long and so paying one guy is really nothing in comparison.
shakow 5y ago
> because the train conductors would never get on board with such a system. The train conductors wouldn't have any say in the operation.
- TripleH 5y ago
  Conductors union could clearly organize a strong opposition to this change. At least in France they proved they know how to do it.
  - shakow 5y ago
    “We will stop replacing leaving conductors” is nothing they can oppose to.
jmcqk6 5y ago
>Because the jobs it will eliminate are the ones that need to verify the system works correctly. I don't understand how you recognize that, but still blame them. I don't ever want to trust pure algorithms or "machine learning" for my health. I believe there is just too much variability in humans, and the costs for outliers is going to be immense.

ping_pong 5y ago

It's sad you decided to give up because it wouldn't make money easily in the US. As you said, there are plenty of countries around the world that would have loved to lower medical costs without kowtowing to the doctors. Once it was a proven technology in places like Asia, I'm sure you would have been able to make it back into the US a lot easier.

yoden 5y ago

The problem with your thesis is that many radiologists are paid per read. They're essentially contractors. These independent radiologists would gladly pay 100k/year for an AI that could do their jobs. Even if the tool didn't do diagnosis, just made them 50% faster, they would gladly pay a huge amount of money. Contrast this with the field of Radiation Oncology. There are already AI auto-contouring solutions that you can buy today. It's a better fit given the limitations of AI: 1) Contouring can take hours per patient, so more value is gained by automating it 2) Normal structures are, well, normal; that is that they are not the diseased part of the patient. If the AI can't quite figure out where the kidney is and fills it out with an average looking kidney, hey that's probably an alright guess! 3) The AI doesn't have to be perfect; dosimetrists and docs can quickly check and update the result if the algorithm fails. Everyone is already familiar with this workflow due to the atlas segmentation algorithms that were state-of-the-art before. 4) Similarly, the output is easy to understand. If the AI did something crazy because of a failure to generalize, it will be obvious. Not so for a diagnostic AI. 5) Clinicians have the final say on which contours are used for treatment. The liability for contour assistance is lower for the software vendor.