7 ms·

Working radiologist here, 20 years experience. This article is surprisingly accurate. I fully expect to finish my career without being 'replaced' by AI. Happy

Working radiologist here, 20 years experience. This article is surprisingly accurate. I fully expect to finish my career without being 'replaced' by AI. Happy to debate/answer questions :-)

janice1999 1y ago
Are AI models able to detect abnormalities that even an experienced radiologist can't see? i.e. something that would look normal to a human eye but AI correctly flags it for investigation? Or are all AI detections 'obvious' to human eyes and simply a confirmation? I suspect the latter since it was human annotated images the model was trained on.
- seesthruya 1y ago
  Depends on what you mean by 'see'. For example, let's say I'm looking at a chest x-ray. There is a pneumonia at the left lung base and I am clever enough to notice it. 'Aha', I think, congratulating myself at making the diagnosis and figuring out why the patient is short of breath. But, in this example, I stop looking closely at the X-ray after noticing the pneumonia, so I miss a pneumothorax at the right lung apex. I have made a mistake radiologists call 'satisfaction of search'. My 'search' for the patient's problem was 'satisfied' by finding the pneumonia, and because I am human and therefore fundamentally flawed, I stopped looking for a second clinically relevant diagnosis. An AI module that detects a pneumothorax is not prone to this type of error. So it sees something I did not. But it doesn't see something that I can't see. I just didn't look.
  - ceejayoz 1y ago
    This is definitely a thing. https://www.npr.org/sections/health-shots/2013/02/11/171409656/why-even-radiologists-can-miss-a-gorilla-hiding-in-plain-sight https://www.npr.org/sections/health-shots/2013/02/11/1714096... I'm skeptical to the claim that AI isn't prone to this sort of error, though. AI loves the easy answer.
    - the_sleaze_ 1y ago
      AI is overloaded. An LLM loves the easy answer, but that's not what is underlying an image classification model.
  - alabastervlog 1y ago
    > I have made a mistake radiologists call 'satisfaction of search'. Ah, now I have a name for it. When I've chased a bug and fixed a problem I found that would cause the observed problem behavior, but haven't yet proven the behavior is corrected, I'm always careful to specify that "I fixed a problem, but I don't know if I fixed the problem". Seems similar: found and fixed a bug that could explain the issue, but that doesn't mean there's not another one that, independently, would also cause the same observed problem.
    - ceejayoz 1y ago
      It's also called inattentional blindness. https://en.wikipedia.org/wiki/Inattentional_blindness https://en.wikipedia.org/wiki/Inattentional_blindness
- bilbo0s 1y ago
  I've been going to RSNA for over 25 years, in all that time, the best I've seen from any model presented to me was the smack the radiologist on the head and say, "you dummy, you should have seen that!" model. That is, the models spot pathologies that 99.9999% of rads would spot anyway if not overworked, tired, or in a hurry. But, addressing the implication of your question, the value is actually in spotting a pathology that 99.9999% of rads would never spot. In all my years developing medical imaging startups and software, I've never seen it happen. I don't expect to see it in my lifetime.
  - seesthruya 1y ago
    I have a fairly strong background in tech, and I've been programming computers since 1979 when my dad bought me a TRS-80. Tape drives FTW! I agree with almost everything you've said here. Except 'not in my lifetime', because I plan on living for a very long time, and who knows what those computer nerds will come up with eventually ;-)
  - SketchySeaBeast 1y ago
    I'm sure it's a matter of training data, but I don't know if it's a surmountable problem. How do you get enough training data for the machine to learn and reliably catch those exceptions?
  - nearbuy 1y ago
    One Harvard study trained an AI that could reliably determine someone's race from a chest X-ray. AIs can be trained to see things we can't. The difficulty is likely in making a good training dataset of labeled images with pathologies radiologists couldn't see. I imagine in some cases (like cancer), you may happen to have an earlier CT scan or X-ray from the patient where the pathology is not quite yet detectable to the human eye.
    - devilbunny 1y ago
      I suspect that radiologists could identify race from a plain chest x-ray if they were given the patient’s race and asked to start noticing the difference. They just aren’t doing it because, if it’s important, you can just look at the patient. There are a lot of things in medicine that aren’t in literature, but are well-known among certain practitioners. I’m an anesthesiologist and practice in an area with a large African-American population. About 10-15% (rough guess) of people of West African descent will have a ridiculously strong salivary response to certain drugs (muscarinic agonists). As in, after one dose their mouths will be full of saliva in seconds. We don’t have East Africans for comparison, so I can’t say it’s a pan-Bantu thing, but I have seen it in a Nigerian who lived here. Not in the literature, but we all know it. I had a (EDIT: non-anesthesia) colleague ask me about a hypersecretory response from such a drug. I said, oh, was he black? Yes, how did I know? Because we give those drugs all the time and have eyes. It’s very rare to see in European-descended populations.
bilbo0s 1y ago
Medical Imaging tech entrepreneur here. Been going to RSNA for longer than you've been a radiologist. In all that time, I've never come across an AI that I felt was fit for purpose. I wholeheartedly agree with you. Many many reasons for this, and I'm happy to chime in from the tech side of things and fill in any blanks outside your knowledge domain.
- deleted 1y ago
  [deleted]
- seesthruya 1y ago
  Basically, they are all currently hot garbage. In my practice we have: 1. Mammography CAD 2. Pulmonary nodule CAD 3. Intracranial hemorrhage CAD 4. Intracranial vessel CAD They all stink! I would love it if they were useful, radiology is insanely difficult and I could use the help!
- lostlogin 1y ago
  > Medical Imaging tech entrepreneur here I initially read this as ‘Medical Imaging tech who is an entrepreneur.’ I now think you’re a radiologist? Any particular interests? Fixing the shiite RIS/PACS world and the hell of hl7 would make me happy. I’m an MR tech, and just finished trying to make a scan description ‘MRI Cervical Spine + Right Brachial Plexis’ You can’t. Description too long.
M95D 1y ago
Respectfully, it doesn't matter what you expect or think. What matters is this: - If the law allows AI to replace you. - If the hospital/company thinks [AI cost + AI-caused law suits] will be less expensive that [your salary + law suites caused by you]. I'm almost in the same situation as you are. I have 22 years left until retirement and I'm thinking I should change my career before I'm too old to do it.
- candiddevmike 1y ago
  What career would you change to that would be safe, given the conditions you provided and your time horizon?
  - deleted 1y ago
    [deleted]
  - jerf 1y ago
    The original author of the paper about the technological singularity [1] defines it as simply the point where predictions break down. If AI gets to the point where it is truly replacing radiologists and programmers wholesale, it is difficult to tell anyone what to do about it today, because that's essentially on the other side of the singularity from here. Who knows what the answer will be? (Ironically, the author of that paper, being also a science fiction author, is also responsible for morphing the singularity into "the rapture for nerds" in his own sci-fi writing. But I find the original paper's definition to have more utility in the current world.) [1]: https://accelerating.org/articles/comingtechsingularity https://accelerating.org/articles/comingtechsingularity
    - LPisGood 1y ago
      I think that if AI can replace software engineers then AI can replace any job because the domain of software engineering is pretty much everything.
      - FeteCommuniste 1y ago
HelloMcFly 1y ago
As my wife says: "Until it's as easy to sue AI as it is doctors, we probably won't see AI replacing doctors."
- candiddevmike 1y ago
  AI in healthcare is going to add so many layers of indirection for malpractice lawsuits. You'll spend years and lots of $$$ trying to figure out who the defendant would ultimately be, only for it to end up being a LLC that unfortunately just filed for bankruptcy.
- ogogmad 1y ago
  What if ppl just bought the equipment and did the scans at home?
  - ceejayoz 1y ago
    Have you priced out a CT scanner and MRI? Will you be able to source a radioactive source for your x-rays?
    - ogogmad 1y ago
      Fair. But what if ppl instead got scans in "radiology shops" without waiting for a specialist? Specialists are expensive.
      - SketchySeaBeast 1y ago
        Isn't that 90% of going to get scan is right now? You'll still need the "shop" to provide the equipment and the tech with the training to know what/where to scan, but you might get the results a bit faster? Are the radiologists the chokepoint now, or is it the techs?
      - eitally 1y ago
        That's the way it already works in many cases, just like with outpatient surgery clinics and other outpatient specialist practices. There is a critical difference, though, because radiology also has sub-specialities and someone focused on orthopedics probably isn't the one you'd want reading your cardiology images, nor would you want your ophthalmologic radiologist trying to diagnose a brain CT.
stackedinserter 1y ago
What's accurate in this article? It's very vague, it can be tldred into "we won't go anywhere, although AI does more and more of our work" > Radiologists do far more than study images. They advise other doctors and surgeons, talk to patients, write reports and analyze medical records. After identifying a suspect cluster of tissue in an organ, they interpret what it might mean for an individual patient with a particular medical history, tapping years of experience. AI will do that more efficiently, and probably already does. "tapping years of experience" is just data in training set. > A.I. can also automatically identify images showing the highest probability of an abnormal growth, essentially telling the radiologist, “Look here first.” Another program scans images for blood clots in the heart or lungs, even when the medical focus may be elsewhere. > “A.I. is everywhere in our workflow now,” Dr. Baffour said. > “Five years from now, it will be malpractice not to use A.I.,” he said. “But it will be humans and A.I. working together.” Maybe you'll be able to happily retire because inertia, but overall it looks like elevator operator job. What's so special about radiology?
- seesthruya 1y ago
  There's nothing special about radiology. And I do believe inertia will carry me through the end of my career, which has approximately 10 years left. However, it's my opinion that my job takes general intelligence, not just pattern matching. Therefore, when I lose my job to AI, so does everyone else.
  - doctorpangloss 1y ago
    On the one hand, you’re totally right. The job takes general intelligence. On the other hand, a lot of jobs take general intelligence. You’re right about that too. It’s difficult to guess the specifics of your life, but: maybe you’ve engaged a real estate agent. Some people use no real estate agent. Some have a robo agent. No AI involved. Maybe you have written a will. Some people go online and spend $500 on templates from Trust & Will, others spend $3,000 on a lawyer to fill in the templates for them, some don’t do any of that at all. Even in medicine, you know, a pharma rep has to go and convince someone to add their thing to the guidelines, and you can look back at the time between the study and adoption as, well people were intelligent and there was demand, but doctors were not doing so and so thing due to lack of essentially sales. I mean you don’t have to be generally intelligent to know that flossing is good for you, and yet: so few people floss! That would maybe not put tons of dentists out of business. But people are routinely doing (or not doing) professional services stuff not for any good (or bad) reason at all. Clearly the thing going on in the professional services economy isn’t about general intelligence - there’s already lots of stuff that is NOT happening long before AI changes the game. It’s all cultural. If you’ve gotten this far without knowing what I am talking about… listen, who knows what’s going to happen? Clearly a lot of behavior is not for any good reason. How do you know where the ball is going to go for culture? Personally I think it’s a kind of arrogant position: “I’m a member of the guild, and from my POV, if my profession is replaced, so is everyone else’s.” Arrogance is not an attractive culture, it’s an adversarial one! And you could say inertia, and yet: look who’s running the HHS! There are kids right now, that I know in my real life, who look like you or me, who went to fancy Ivy League school, and they are vaccine skeptical. What about inertia and general intelligence then? So I’ll just say, you know, putting yourself out here on this forum, being all like, “I will AMA, I am the voice,” and then to be so arrogant: you are your own evidence for why maybe it won’t last 10 years.
Al-Khwarizmi 1y ago
If (as acknowledged in the article) AI automates at least part of the work of radiologists (e.g. tool that "saves her 15 to 30 minutes each time she examines a kidney image"), don't you fear that the demand of radiologists will decline? Even if some are still needed, surely if a hospital needs X reports per day and now Y radiologists are sufficient to provide them rather than the current Z (Y<Z), that should be something for people considering your career to take into account? On the other hand, how much of your confidence in not being replaced stems from AI not being able to do the work, and how much from legal/societal issues (a human needing to be legally responsible for the diagnoses)? Honestly the description in the article of what a radiologist does "Radiologists do far more than study images. They advise other doctors and surgeons, talk to patients, write reports and analyze medical records. After identifying a suspect cluster of tissue in an organ, they interpret what it might mean for an individual patient with a particular medical history, tapping years of experience" doesn't strike me as anything impossible for AI within a few years, now that models are multimodal and they can work with increasing amounts of text (e.g. medical histories).
- dingnuts 1y ago
  if the cost for preventative scans goes down, demand will rise. medical demand is incredibly constrained by price. people skip all kinds of tests they need because they can't afford it. the radiologists will have more work to do, not less.
- seesthruya 1y ago
  There is a national shortage of radiologists in the US, with many hospital systems facing a backlog of unread cases measuring in the thousands. And, the baby boomers are starting to retire, it's only going to get worse. We aren't training enough new radiologists, which is a different discussion. Askl to your question on where my confidence stems from, there are both legal reasons and 'not being able to do the work' reasons. Legal is easy, the most powerful lobby in most states are trial attorneys. They simply won't allow a situation where liability cannot be attached to medical practice. Somebody is getting sued. As to what I do day to day, I don't think I'm just matching patterns. I believe what I do takes general intelligence. Therefore, when AI can do my job, it can do everyone else's job as well.
deleted 1y ago
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belly_joe 1y ago
I would say generally speaking that people who assume AI will replace somebody else's job believe that these jobs are merely mechanical and there is no high-level reasoning involved that would basically require AGI (when that comes about nobody is safe). So the model of the AI radiologist assumes the only job of a radiologist is to classify images, which is pretty vulnerable to near-future disruption. I imagine, given the training involved, the job involves more than just looking at pictures? This is what I would like to see explained. The analogy would be the "95% of code is written by AI" stat that gets trotted out, replacing code with image evaluation. Yes AI will write the code but someone has to tell the AI what to write which is the tricky part.
- seesthruya 1y ago
  100%
- tbrownaw 1y ago
  We already have AI taxis (in specific limited areas, but still). Driving isn't something I'd usually call "merely mechanical".
  - tintor 1y ago
    Driving (in US) is considered unskilled labor.
  - cess11 1y ago
    That is such a contrived phenomenon, it has taken decades of lobbying and destruction of political accountability to create the conditions where a person considered sane would touch that idea instead of immediately skipping over to driverless trains. Incredibly wasteful gimmick, I don't get why the usians are still struggling away at it now that the chinese seem to have already done it.
    - SpicyLemonZest 1y ago
      I don't know where you've gotten the idea that cars are something you can "skip over" on the way to trains. Public transit is great, and the US should do it better, but it doesn't obsolete every other form of transit. The vast majority of people in every country who can afford access to cars use them regularly.
tarunkotia 1y ago
I worked on an autocontouring model but we could not get very high accuracy for it to be adopted commercially. The algorithm would work for some organs but would totally freak-out on the others. And if the anatomy was out of norm then it would not work at all. This was 5 years ago, I see Siemens [0] has a similar tool. I remember shadowing a dosimetrist contouring all the Organs-At-Risk (OAR) and it took about 3-4 hours to contour one CT image of thoracic region. Do you know how much better the autocontouring tools have become? [0] https://www.siemens-healthineers.com/en-us/radiotherapy/software-solutions/autocontouring https://www.siemens-healthineers.com/en-us/radiotherapy/soft...
- justlikereddit 1y ago
  Segmenting algorithms is massively improved from 5 years ago. How much the actual SOTA is used on the work floor though is always a hit and miss.
  - seesthruya 1y ago
    Agreed, and from what I understand radiation oncology treatment planning has benefited from this.
jjtheblunt 1y ago
(great username: a radiologist with "seesthruya")
LanceH 1y ago
At the same time it can be a handy tool to be a first cut at triage. It's really not a matter of "full replacement or bust".
- seesthruya 1y ago
  This is true!
TuringNYC 1y ago
>> Happy to debate/answer questions :-) Curious -- do you think that is because 1. the technology isnt there, or 2. because it isnt a competitive market (basically, the American Board of Radiologists controls standards of practice and can slow down technologies seen as competitive to human doctors)? 3. or perhaps 1 doesnt happen because outsiders know the market is guarded by the market itsself?
bko 1y ago
I don't think it will go away as long as we have third party paying for the costs and AMA controlling competition. If I had to pay $500 or whatever to get a scan, and instead I could get my data, send it to a model and only follow up if it came back bad, I would. But now someone else pays and there are laws and regulations that prevent people from controlling their data, or at least make it difficult. Kind of weird I have a file on me that I have never seen.
- lostlogin 1y ago
  > Kind of weird I have a file on me that I have never seen. Can’t you ask for it?
- nradov 1y ago
  Nope. You have an absolute legal right to obtain copies of your medical images and other data. Who paid for it is irrelevant. The provider can charge you a nominal fee for copying the files but they can't keep it from you. https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html https://www.hhs.gov/hipaa/for-individuals/guidance-materials...

Working radiologist here, 20 years experience. This article is surprisingly accurate. I fully expect to finish my career without being 'replaced' by AI. Happy to debate/answer questions :-)

janice1999 1y ago

Are AI models able to detect abnormalities that even an experienced radiologist can't see? i.e. something that would look normal to a human eye but AI correctly flags it for investigation? Or are all AI detections 'obvious' to human eyes and simply a confirmation? I suspect the latter since it was human annotated images the model was trained on.

seesthruya 1y ago
Depends on what you mean by 'see'. For example, let's say I'm looking at a chest x-ray. There is a pneumonia at the left lung base and I am clever enough to notice it. 'Aha', I think, congratulating myself at making the diagnosis and figuring out why the patient is short of breath. But, in this example, I stop looking closely at the X-ray after noticing the pneumonia, so I miss a pneumothorax at the right lung apex. I have made a mistake radiologists call 'satisfaction of search'. My 'search' for the patient's problem was 'satisfied' by finding the pneumonia, and because I am human and therefore fundamentally flawed, I stopped looking for a second clinically relevant diagnosis. An AI module that detects a pneumothorax is not prone to this type of error. So it sees something I did not. But it doesn't see something that I can't see. I just didn't look.
- ceejayoz 1y ago
  This is definitely a thing. https://www.npr.org/sections/health-shots/2013/02/11/171409656/why-even-radiologists-can-miss-a-gorilla-hiding-in-plain-sight https://www.npr.org/sections/health-shots/2013/02/11/1714096... I'm skeptical to the claim that AI isn't prone to this sort of error, though. AI loves the easy answer.
  - the_sleaze_ 1y ago
    AI is overloaded. An LLM loves the easy answer, but that's not what is underlying an image classification model.
- alabastervlog 1y ago
  > I have made a mistake radiologists call 'satisfaction of search'. Ah, now I have a name for it. When I've chased a bug and fixed a problem I found that would cause the observed problem behavior, but haven't yet proven the behavior is corrected, I'm always careful to specify that "I fixed a problem, but I don't know if I fixed the problem". Seems similar: found and fixed a bug that could explain the issue, but that doesn't mean there's not another one that, independently, would also cause the same observed problem.
  - ceejayoz 1y ago
    It's also called inattentional blindness. https://en.wikipedia.org/wiki/Inattentional_blindness https://en.wikipedia.org/wiki/Inattentional_blindness
bilbo0s 1y ago
I've been going to RSNA for over 25 years, in all that time, the best I've seen from any model presented to me was the smack the radiologist on the head and say, "you dummy, you should have seen that!" model. That is, the models spot pathologies that 99.9999% of rads would spot anyway if not overworked, tired, or in a hurry. But, addressing the implication of your question, the value is actually in spotting a pathology that 99.9999% of rads would never spot. In all my years developing medical imaging startups and software, I've never seen it happen. I don't expect to see it in my lifetime.
- seesthruya 1y ago
  I have a fairly strong background in tech, and I've been programming computers since 1979 when my dad bought me a TRS-80. Tape drives FTW! I agree with almost everything you've said here. Except 'not in my lifetime', because I plan on living for a very long time, and who knows what those computer nerds will come up with eventually ;-)
- SketchySeaBeast 1y ago
  I'm sure it's a matter of training data, but I don't know if it's a surmountable problem. How do you get enough training data for the machine to learn and reliably catch those exceptions?
- nearbuy 1y ago
  One Harvard study trained an AI that could reliably determine someone's race from a chest X-ray. AIs can be trained to see things we can't. The difficulty is likely in making a good training dataset of labeled images with pathologies radiologists couldn't see. I imagine in some cases (like cancer), you may happen to have an earlier CT scan or X-ray from the patient where the pathology is not quite yet detectable to the human eye.
  - devilbunny 1y ago
    I suspect that radiologists could identify race from a plain chest x-ray if they were given the patient’s race and asked to start noticing the difference. They just aren’t doing it because, if it’s important, you can just look at the patient. There are a lot of things in medicine that aren’t in literature, but are well-known among certain practitioners. I’m an anesthesiologist and practice in an area with a large African-American population. About 10-15% (rough guess) of people of West African descent will have a ridiculously strong salivary response to certain drugs (muscarinic agonists). As in, after one dose their mouths will be full of saliva in seconds. We don’t have East Africans for comparison, so I can’t say it’s a pan-Bantu thing, but I have seen it in a Nigerian who lived here. Not in the literature, but we all know it. I had a (EDIT: non-anesthesia) colleague ask me about a hypersecretory response from such a drug. I said, oh, was he black? Yes, how did I know? Because we give those drugs all the time and have eyes. It’s very rare to see in European-descended populations.

bilbo0s 1y ago

Medical Imaging tech entrepreneur here. Been going to RSNA for longer than you've been a radiologist. In all that time, I've never come across an AI that I felt was fit for purpose. I wholeheartedly agree with you. Many many reasons for this, and I'm happy to chime in from the tech side of things and fill in any blanks outside your knowledge domain.

deleted 1y ago
[deleted]
seesthruya 1y ago
Basically, they are all currently hot garbage. In my practice we have: 1. Mammography CAD 2. Pulmonary nodule CAD 3. Intracranial hemorrhage CAD 4. Intracranial vessel CAD They all stink! I would love it if they were useful, radiology is insanely difficult and I could use the help!
lostlogin 1y ago
> Medical Imaging tech entrepreneur here I initially read this as ‘Medical Imaging tech who is an entrepreneur.’ I now think you’re a radiologist? Any particular interests? Fixing the shiite RIS/PACS world and the hell of hl7 would make me happy. I’m an MR tech, and just finished trying to make a scan description ‘MRI Cervical Spine + Right Brachial Plexis’ You can’t. Description too long.

M95D 1y ago

Respectfully, it doesn't matter what you expect or think. What matters is this: - If the law allows AI to replace you. - If the hospital/company thinks [AI cost + AI-caused law suits] will be less expensive that [your salary + law suites caused by you]. I'm almost in the same situation as you are. I have 22 years left until retirement and I'm thinking I should change my career before I'm too old to do it.

candiddevmike 1y ago
What career would you change to that would be safe, given the conditions you provided and your time horizon?
- deleted 1y ago
  [deleted]
- jerf 1y ago
  The original author of the paper about the technological singularity [1] defines it as simply the point where predictions break down. If AI gets to the point where it is truly replacing radiologists and programmers wholesale, it is difficult to tell anyone what to do about it today, because that's essentially on the other side of the singularity from here. Who knows what the answer will be? (Ironically, the author of that paper, being also a science fiction author, is also responsible for morphing the singularity into "the rapture for nerds" in his own sci-fi writing. But I find the original paper's definition to have more utility in the current world.) [1]: https://accelerating.org/articles/comingtechsingularity https://accelerating.org/articles/comingtechsingularity
  - LPisGood 1y ago
    I think that if AI can replace software engineers then AI can replace any job because the domain of software engineering is pretty much everything.
    - FeteCommuniste 1y ago

HelloMcFly 1y ago

As my wife says: "Until it's as easy to sue AI as it is doctors, we probably won't see AI replacing doctors."

candiddevmike 1y ago
AI in healthcare is going to add so many layers of indirection for malpractice lawsuits. You'll spend years and lots of $$$ trying to figure out who the defendant would ultimately be, only for it to end up being a LLC that unfortunately just filed for bankruptcy.
ogogmad 1y ago
What if ppl just bought the equipment and did the scans at home?
- ceejayoz 1y ago
  Have you priced out a CT scanner and MRI? Will you be able to source a radioactive source for your x-rays?
  - ogogmad 1y ago
    Fair. But what if ppl instead got scans in "radiology shops" without waiting for a specialist? Specialists are expensive.
    - SketchySeaBeast 1y ago
      Isn't that 90% of going to get scan is right now? You'll still need the "shop" to provide the equipment and the tech with the training to know what/where to scan, but you might get the results a bit faster? Are the radiologists the chokepoint now, or is it the techs?
    - eitally 1y ago
      That's the way it already works in many cases, just like with outpatient surgery clinics and other outpatient specialist practices. There is a critical difference, though, because radiology also has sub-specialities and someone focused on orthopedics probably isn't the one you'd want reading your cardiology images, nor would you want your ophthalmologic radiologist trying to diagnose a brain CT.

stackedinserter 1y ago

What's accurate in this article? It's very vague, it can be tldred into "we won't go anywhere, although AI does more and more of our work" > Radiologists do far more than study images. They advise other doctors and surgeons, talk to patients, write reports and analyze medical records. After identifying a suspect cluster of tissue in an organ, they interpret what it might mean for an individual patient with a particular medical history, tapping years of experience. AI will do that more efficiently, and probably already does. "tapping years of experience" is just data in training set. > A.I. can also automatically identify images showing the highest probability of an abnormal growth, essentially telling the radiologist, “Look here first.” Another program scans images for blood clots in the heart or lungs, even when the medical focus may be elsewhere. > “A.I. is everywhere in our workflow now,” Dr. Baffour said. > “Five years from now, it will be malpractice not to use A.I.,” he said. “But it will be humans and A.I. working together.” Maybe you'll be able to happily retire because inertia, but overall it looks like elevator operator job. What's so special about radiology?

seesthruya 1y ago
There's nothing special about radiology. And I do believe inertia will carry me through the end of my career, which has approximately 10 years left. However, it's my opinion that my job takes general intelligence, not just pattern matching. Therefore, when I lose my job to AI, so does everyone else.
- doctorpangloss 1y ago
  On the one hand, you’re totally right. The job takes general intelligence. On the other hand, a lot of jobs take general intelligence. You’re right about that too. It’s difficult to guess the specifics of your life, but: maybe you’ve engaged a real estate agent. Some people use no real estate agent. Some have a robo agent. No AI involved. Maybe you have written a will. Some people go online and spend $500 on templates from Trust & Will, others spend $3,000 on a lawyer to fill in the templates for them, some don’t do any of that at all. Even in medicine, you know, a pharma rep has to go and convince someone to add their thing to the guidelines, and you can look back at the time between the study and adoption as, well people were intelligent and there was demand, but doctors were not doing so and so thing due to lack of essentially sales. I mean you don’t have to be generally intelligent to know that flossing is good for you, and yet: so few people floss! That would maybe not put tons of dentists out of business. But people are routinely doing (or not doing) professional services stuff not for any good (or bad) reason at all. Clearly the thing going on in the professional services economy isn’t about general intelligence - there’s already lots of stuff that is NOT happening long before AI changes the game. It’s all cultural. If you’ve gotten this far without knowing what I am talking about… listen, who knows what’s going to happen? Clearly a lot of behavior is not for any good reason. How do you know where the ball is going to go for culture? Personally I think it’s a kind of arrogant position: “I’m a member of the guild, and from my POV, if my profession is replaced, so is everyone else’s.” Arrogance is not an attractive culture, it’s an adversarial one! And you could say inertia, and yet: look who’s running the HHS! There are kids right now, that I know in my real life, who look like you or me, who went to fancy Ivy League school, and they are vaccine skeptical. What about inertia and general intelligence then? So I’ll just say, you know, putting yourself out here on this forum, being all like, “I will AMA, I am the voice,” and then to be so arrogant: you are your own evidence for why maybe it won’t last 10 years.

Al-Khwarizmi 1y ago

If (as acknowledged in the article) AI automates at least part of the work of radiologists (e.g. tool that "saves her 15 to 30 minutes each time she examines a kidney image"), don't you fear that the demand of radiologists will decline? Even if some are still needed, surely if a hospital needs X reports per day and now Y radiologists are sufficient to provide them rather than the current Z (Y<Z), that should be something for people considering your career to take into account? On the other hand, how much of your confidence in not being replaced stems from AI not being able to do the work, and how much from legal/societal issues (a human needing to be legally responsible for the diagnoses)? Honestly the description in the article of what a radiologist does "Radiologists do far more than study images. They advise other doctors and surgeons, talk to patients, write reports and analyze medical records. After identifying a suspect cluster of tissue in an organ, they interpret what it might mean for an individual patient with a particular medical history, tapping years of experience" doesn't strike me as anything impossible for AI within a few years, now that models are multimodal and they can work with increasing amounts of text (e.g. medical histories).

dingnuts 1y ago
if the cost for preventative scans goes down, demand will rise. medical demand is incredibly constrained by price. people skip all kinds of tests they need because they can't afford it. the radiologists will have more work to do, not less.
seesthruya 1y ago
There is a national shortage of radiologists in the US, with many hospital systems facing a backlog of unread cases measuring in the thousands. And, the baby boomers are starting to retire, it's only going to get worse. We aren't training enough new radiologists, which is a different discussion. Askl to your question on where my confidence stems from, there are both legal reasons and 'not being able to do the work' reasons. Legal is easy, the most powerful lobby in most states are trial attorneys. They simply won't allow a situation where liability cannot be attached to medical practice. Somebody is getting sued. As to what I do day to day, I don't think I'm just matching patterns. I believe what I do takes general intelligence. Therefore, when AI can do my job, it can do everyone else's job as well.

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belly_joe 1y ago

I would say generally speaking that people who assume AI will replace somebody else's job believe that these jobs are merely mechanical and there is no high-level reasoning involved that would basically require AGI (when that comes about nobody is safe). So the model of the AI radiologist assumes the only job of a radiologist is to classify images, which is pretty vulnerable to near-future disruption. I imagine, given the training involved, the job involves more than just looking at pictures? This is what I would like to see explained. The analogy would be the "95% of code is written by AI" stat that gets trotted out, replacing code with image evaluation. Yes AI will write the code but someone has to tell the AI what to write which is the tricky part.

seesthruya 1y ago
100%
tbrownaw 1y ago
We already have AI taxis (in specific limited areas, but still). Driving isn't something I'd usually call "merely mechanical".
- tintor 1y ago
  Driving (in US) is considered unskilled labor.
- cess11 1y ago
  That is such a contrived phenomenon, it has taken decades of lobbying and destruction of political accountability to create the conditions where a person considered sane would touch that idea instead of immediately skipping over to driverless trains. Incredibly wasteful gimmick, I don't get why the usians are still struggling away at it now that the chinese seem to have already done it.
  - SpicyLemonZest 1y ago
    I don't know where you've gotten the idea that cars are something you can "skip over" on the way to trains. Public transit is great, and the US should do it better, but it doesn't obsolete every other form of transit. The vast majority of people in every country who can afford access to cars use them regularly.

tarunkotia 1y ago

I worked on an autocontouring model but we could not get very high accuracy for it to be adopted commercially. The algorithm would work for some organs but would totally freak-out on the others. And if the anatomy was out of norm then it would not work at all. This was 5 years ago, I see Siemens [0] has a similar tool. I remember shadowing a dosimetrist contouring all the Organs-At-Risk (OAR) and it took about 3-4 hours to contour one CT image of thoracic region. Do you know how much better the autocontouring tools have become? [0] https://www.siemens-healthineers.com/en-us/radiotherapy/software-solutions/autocontouring https://www.siemens-healthineers.com/en-us/radiotherapy/soft...

justlikereddit 1y ago
Segmenting algorithms is massively improved from 5 years ago. How much the actual SOTA is used on the work floor though is always a hit and miss.
- seesthruya 1y ago
  Agreed, and from what I understand radiation oncology treatment planning has benefited from this.

jjtheblunt 1y ago

(great username: a radiologist with "seesthruya")

LanceH 1y ago

At the same time it can be a handy tool to be a first cut at triage. It's really not a matter of "full replacement or bust".

seesthruya 1y ago
This is true!

TuringNYC 1y ago

>> Happy to debate/answer questions :-) Curious -- do you think that is because 1. the technology isnt there, or 2. because it isnt a competitive market (basically, the American Board of Radiologists controls standards of practice and can slow down technologies seen as competitive to human doctors)? 3. or perhaps 1 doesnt happen because outsiders know the market is guarded by the market itsself?

bko 1y ago

I don't think it will go away as long as we have third party paying for the costs and AMA controlling competition. If I had to pay $500 or whatever to get a scan, and instead I could get my data, send it to a model and only follow up if it came back bad, I would. But now someone else pays and there are laws and regulations that prevent people from controlling their data, or at least make it difficult. Kind of weird I have a file on me that I have never seen.

lostlogin 1y ago
> Kind of weird I have a file on me that I have never seen. Can’t you ask for it?
nradov 1y ago
Nope. You have an absolute legal right to obtain copies of your medical images and other data. Who paid for it is irrelevant. The provider can charge you a nominal fee for copying the files but they can't keep it from you. https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html https://www.hhs.gov/hipaa/for-individuals/guidance-materials...