4 ms·

I've always felt the "could be harmful" was a rationalization by radiologists worried about their job security since it's easily mitigated with a warning and mu

I've always felt the "could be harmful" was a rationalization by radiologists worried about their job security since it's easily mitigated with a warning and multiple tests. And especially because in the future, most radiology work will be done by software. It's just a matter of whether it's 10 years or 100 years from now.

deleted 4y ago
[deleted]
quasarj 4y ago
Yeah, I've read all the arguments about harm, and I just don't buy it. I'd get a CT scan every year if I could convince someone to sign off on it. There is absolutely no substitute for knowing.
- themantalope 4y ago
  Until you've had an unnecessary biopsy that kills you :)
- kashunstva 4y ago
  > I'd get a CT scan every year You would choose annual body CT even if outcomes-based evidence showed no benefit? Even among those at highest risk for lung carcinoma, studies of annual screening chest CT do not uniformly show improved disease-specific survival as compared to an unscreened but otherwise matched cohort.
  - themantalope 4y ago
    https://www.nejm.org/doi/full/10.1056/nejmoa1102873 https://www.nejm.org/doi/full/10.1056/nejmoa1102873 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762603/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762603/ What I found mind blowing when I first read these studies (particularly the second link) is that the positive-predictive value of the CT screen was only 3.8% for lung nodules that were 4mm or larger in size. Basically just means we find all kinds of lung abnormalities all the time that "could be cancer" but aren't. Keep in mind, that the screening criteria was people over age 65 who had a 30+ pack-year smoking history (1 pack-year = smoking 1 pack of cigarettes per day in one year), and had to have smoked within the last 15 years. I can also tell you from doing CT lung biopsies that it's not a procedure to take lightly. Lot of important structures in the chest.
  - quasarj 4y ago
    Absolutely. Those studies show no improved survival across cohorts. Not for individuals. My only chance of living is to know. That's worth it for me. I mean, plus I have extreme health anxiety, and I've had doctors say "nah you're too young, we don't need to test for that" and later it turned out I did have kidney failure at 35.
- selectodude 4y ago
  You’d dramatically raise your risk of cancer from x-ray exposure for almost zero clinical benefit.
  - quasarj 4y ago
    Yeah, that is the only concern. I guess whole-body MR would be fine too. I'd be willing to lay in the tube for 20 hours a year to know that I'm at least structurally normal still.
    - ska 4y ago
      > Yeah, that is the only concern. It really isn't. Your chances of negative consequence for unnecessary follow up procedures would rapidly become significant.
- KennyBlanken 4y ago
  > Yeah, I've read all the arguments about harm, and I just don't buy it. "I have no medical background whatsoever but I do not buy undisputed medical science." > I'd get a CT scan every year if I could convince someone to sign off on it 20mSv of unnecessary ionizing radiation exposure a year, what could possibly go wrong? That whole-body CT scan is equivalent to getting at least EIGHTY chest x-rays, and ten times what a uranium miner receives in a year, and well within the range where an increased risk of cancer is noticeable in epidemiological data. Case and point why this tool should not be generally available.
kashunstva 4y ago
> I've always felt the "could be harmful" was a rationalization by radiologists worried about their job security Surely concern for the well-being of the patient figures in there somewhere... Or imagine this: A liver lesion is incidentally discovered on your abdominal CT performed for unrelated reasons. Its radiographic characteristics are equivocal. Additional imaging studies fail to completely exclude the possibility of a liver malignancy. You undergo a biopsy. But the biopsy is complicated by hemorrhage. Surgery is required. You develop a post-operative nosocomial infection. etc. etc. To the extent that risks along this chain of unfortunate events is known, yes, warnings could put some of the quantified decision making in the patient's hands. Well, except for the rampant innumeracy in the general population...
- themantalope 4y ago
  This is a real scenario that happens regularly.
- anamax 4y ago
  Perhaps a better example is prostate biopsies. They have a significant risk of producing incontinence or impotence.
ska 4y ago
> "could be harmful" was a rationalization This topic (breast screening) is a good example due to the sheer scale. If you increase the work-up rate by even a smallish amount, you are statistically pretty much guaranteed to kill people who did not have the disease. How this balances about gain (i.e. save other lives) is not obvious. Figuring out the "right" way to do this is real work.
- themantalope 4y ago
  Extremely important, and is the most important question to ask in any screening scenario. It's not the case the more screening is always better. There are plenty of screening regimes that you've never heard about because the trial data didn't support it.
- lhl 4y ago
  Also a good example because there's actually been recent push back on mammography because the risks may outweigh the rewards (especially in younger age brackets). More testing does not automatically equal better outcomes. Here's one summary from the Nordic Cochrane Center (for those that don't know Cochrane is one of the gold standard organizations for evaluating the quality of biomedical research via systematic reviews https://en.wikipedia.org/wiki/Cochrane_(organisation) https://en.wikipedia.org/wiki/Cochrane_(organisation) ): Gøtzsche PC. Mammography screening is harmful and should be abandoned. J R Soc Med. 2015;108(9):341-345. doi:10.1177/0141076815602452 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582264/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582264/
  - deleted 4y ago
    [deleted]
throwaway4220 4y ago
That’s not true. I would love to have someone check my work. It’s just got so many false positives. Would you trust the radiologist if a report shows a suspicious lesion marked by the software that the radiologist dismisses? CAD in mammography has been there since the 90s. rads don’t put up a fight. Do you want a whole FSD/Autopilot level of blame absolution if software missed a cancer/critical finding? I sure as hell won’t be apart of that.

deleted 4y ago

[deleted]

quasarj 4y ago

Yeah, I've read all the arguments about harm, and I just don't buy it. I'd get a CT scan every year if I could convince someone to sign off on it. There is absolutely no substitute for knowing.

themantalope 4y ago
Until you've had an unnecessary biopsy that kills you :)
kashunstva 4y ago
> I'd get a CT scan every year You would choose annual body CT even if outcomes-based evidence showed no benefit? Even among those at highest risk for lung carcinoma, studies of annual screening chest CT do not uniformly show improved disease-specific survival as compared to an unscreened but otherwise matched cohort.
- themantalope 4y ago
  https://www.nejm.org/doi/full/10.1056/nejmoa1102873 https://www.nejm.org/doi/full/10.1056/nejmoa1102873 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762603/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762603/ What I found mind blowing when I first read these studies (particularly the second link) is that the positive-predictive value of the CT screen was only 3.8% for lung nodules that were 4mm or larger in size. Basically just means we find all kinds of lung abnormalities all the time that "could be cancer" but aren't. Keep in mind, that the screening criteria was people over age 65 who had a 30+ pack-year smoking history (1 pack-year = smoking 1 pack of cigarettes per day in one year), and had to have smoked within the last 15 years. I can also tell you from doing CT lung biopsies that it's not a procedure to take lightly. Lot of important structures in the chest.
- quasarj 4y ago
  Absolutely. Those studies show no improved survival across cohorts. Not for individuals. My only chance of living is to know. That's worth it for me. I mean, plus I have extreme health anxiety, and I've had doctors say "nah you're too young, we don't need to test for that" and later it turned out I did have kidney failure at 35.
selectodude 4y ago
You’d dramatically raise your risk of cancer from x-ray exposure for almost zero clinical benefit.
- quasarj 4y ago
  Yeah, that is the only concern. I guess whole-body MR would be fine too. I'd be willing to lay in the tube for 20 hours a year to know that I'm at least structurally normal still.
  - ska 4y ago
    > Yeah, that is the only concern. It really isn't. Your chances of negative consequence for unnecessary follow up procedures would rapidly become significant.
KennyBlanken 4y ago
> Yeah, I've read all the arguments about harm, and I just don't buy it. "I have no medical background whatsoever but I do not buy undisputed medical science." > I'd get a CT scan every year if I could convince someone to sign off on it 20mSv of unnecessary ionizing radiation exposure a year, what could possibly go wrong? That whole-body CT scan is equivalent to getting at least EIGHTY chest x-rays, and ten times what a uranium miner receives in a year, and well within the range where an increased risk of cancer is noticeable in epidemiological data. Case and point why this tool should not be generally available.

kashunstva 4y ago

> I've always felt the "could be harmful" was a rationalization by radiologists worried about their job security Surely concern for the well-being of the patient figures in there somewhere... Or imagine this: A liver lesion is incidentally discovered on your abdominal CT performed for unrelated reasons. Its radiographic characteristics are equivocal. Additional imaging studies fail to completely exclude the possibility of a liver malignancy. You undergo a biopsy. But the biopsy is complicated by hemorrhage. Surgery is required. You develop a post-operative nosocomial infection. etc. etc. To the extent that risks along this chain of unfortunate events is known, yes, warnings could put some of the quantified decision making in the patient's hands. Well, except for the rampant innumeracy in the general population...

themantalope 4y ago
This is a real scenario that happens regularly.
anamax 4y ago
Perhaps a better example is prostate biopsies. They have a significant risk of producing incontinence or impotence.

ska 4y ago

> "could be harmful" was a rationalization This topic (breast screening) is a good example due to the sheer scale. If you increase the work-up rate by even a smallish amount, you are statistically pretty much guaranteed to kill people who did not have the disease. How this balances about gain (i.e. save other lives) is not obvious. Figuring out the "right" way to do this is real work.

themantalope 4y ago
Extremely important, and is the most important question to ask in any screening scenario. It's not the case the more screening is always better. There are plenty of screening regimes that you've never heard about because the trial data didn't support it.
lhl 4y ago
Also a good example because there's actually been recent push back on mammography because the risks may outweigh the rewards (especially in younger age brackets). More testing does not automatically equal better outcomes. Here's one summary from the Nordic Cochrane Center (for those that don't know Cochrane is one of the gold standard organizations for evaluating the quality of biomedical research via systematic reviews https://en.wikipedia.org/wiki/Cochrane_(organisation) https://en.wikipedia.org/wiki/Cochrane_(organisation) ): Gøtzsche PC. Mammography screening is harmful and should be abandoned. J R Soc Med. 2015;108(9):341-345. doi:10.1177/0141076815602452 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582264/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582264/
- deleted 4y ago
  [deleted]

throwaway4220 4y ago

That’s not true. I would love to have someone check my work. It’s just got so many false positives. Would you trust the radiologist if a report shows a suspicious lesion marked by the software that the radiologist dismisses? CAD in mammography has been there since the 90s. rads don’t put up a fight. Do you want a whole FSD/Autopilot level of blame absolution if software missed a cancer/critical finding? I sure as hell won’t be apart of that.