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> Three things explain this. First,... Second, attempts to give models more tasks have run into legal hurdles: regulators and medical insurers so far are reluct
by djoldman 1y ago
> Three things explain this. First,... Second, attempts to give models more tasks have run into legal hurdles: regulators and medical insurers so far are reluctant to approve or cover fully autonomous radiology models. Third, even when they do diagnose accurately, models replace only a small share of a radiologist’s job. Human radiologists spend a minority of their time on diagnostics and the majority on other activities, like talking to patients and fellow clinicians.
Everything else besides the above in TFA is extraneous. Machine learning models could have absolute perfect performance at zero cost, and the above would make it so that radiologists are not going to be "replaced" by ML models anytime soon.
- deleted 1y ago[deleted]
- addcommitpush 1y agoIf they had absolute perfect performance at zero cost, you would not need a radiologist. The current "workflow" is primary care physician (or specialist) -> radiology tech that actually does the measurement thing -> radiologist for interpretation/diagnosis -> primary care physician (or specialist) for treatment. If you have perfect diagnosis, it could be primary care physician (or specialist) -> radiology tech -> ML model for interpretation -> primary care physician (or specialist.
- bilbo0s 1y agoNope. To understand why, you would really need to take a good read of the average PCP's malpractice policy. The policy for a specialist would be even more strict. You would need to change insurance policies before your workflow was even possible from a liability perspective. Basically, the insurer wants, "a throat to choke", so to speak. Handing up a model to them isn't going to cut it anymore than handing up Hitachi's awesome new whiz-bang proton therapy machine would. They want their pound of flesh.
- bigfudge 1y agoDoesnt this become the developer? Or perhaps a specialist insurer who develops expertise and experience to indemnify them?
- bilbo0s 1y agoOh that could indeed happen in that hypothetical timeline. But in that timeline the developer would be paying the malpractice premium. And it would be the developer's throat that gets choked when something goes awry. I'm betting developers will want to take on neither the cost of insurance, nor the increased risk of liability.
- tnel77 1y agoThey didn’t say there wouldn’t need to be change related to insurance. They obviously mean that, change included, a perfect model would move to their described workflow (or something similar). HackerNews is often too quick to reply with a “well actually” that they miss the overall point.
- addcommitpush 1y agoIn that scenario, the "throat to choke" would be the primary care physician. We won't think of it as an "ML radiologist", just as getting some kind of physical test done and bringing it to the doctor for interpretation. If you're getting a blood test, the pipeline might be primary care physician -> lab with a nurse to draw blood and machines to measure blood stuff -> primary care physician to interpret the test results. There is no blood-test-ologist (hematologist?) step, unlike radiology. Anyway, "there's going to be radiologists around for insurance reasons only but they don't bring anything else to patient care" is a very different proposition from "there's going to be radiologists around for insurance reasons _and_ because the job is mostly talking to patients and fellow clinicians".
- philwelch 1y agoLet’s suppose I go to the doctor and get tested for HIV. There isn’t a specialist staring at my blood through a microscope looking for HIV viruses, they put my blood in a machine and the machine tells them, positive or negative. There is a false positive rate and a false negative rate for the test. There’s no fundamental reason you couldn’t put a CT scan into a machine the same way.
- MengerSponge 1y agoIf we're talking utopian visions, we can do better than dreaming of transforming unstructured data into actionable business insights. Let's talk about what is meaningfully possible: Who assumes legal liability? The ML vendor? PCPs don't have the training and aren't paid enough for that exposure.
- vel0city 1y agoAs a patient I don't think I've ever even talked to any radiologist that actually analyzed my imaging. Most of the times my family or I have had imaging done the imaging is handled by a tech who just knows how to operate the machines while the actual diagnostic work gets farmed out to remote radiologists who type up an analysis. I don't even think the other doctors I actually see ever directly talk to those radiologists. Is this uncommon in the rest of the US?
- theOGognf 1y agoNo, that is the norm. Radiologists speak with their colleagues the most, and patients rarely
- stevenbedrick 1y agoIt really depends on the specifics of the clinical situation; for a lot of outpatient radiology scenarios the patient and radiologist don't directly interact, but things can be different in an inpatient setting and then of course there are surgical and interventional radiology scenarios.
- stonemetal12 1y ago>Human radiologists spend a minority of their time on diagnostics and the majority on other activities, like talking to patients and fellow clinicians. How often do they talk to patients? Every time I have ever had an x-ray, I have never talked to a radiologist. Fellow clinicians? Train the xray tech up a bit more. If the mote is 'talking to people' that is a mote that doesn't need an MD, or at least not a full specialization MD. ML could kill radiologist MD, radiologist could become the job title of a nurse or x-ray tech specialized in talking to people about the output.
- bilbo0s 1y agoTrain the xray tech up a bit more. That's fine. But then the xray tech becomes the radiologist, and that becomes the point in the workflow that the insurer digs out the malpractice premiums. In essence, your xray techs would become remarkably expensive. Someone is talking to the clinicians about the results. That person, whatever you call them, is going to be paying the premiums.
- sarchertech 1y agoI don’t think they talk to patients all that often but my wife is an ER doctor and she says she talks to them all the time.
- roncesvalles 1y agoI only came to this thread to say that this is completely untrue: >Human radiologists spend a minority of their time on diagnostics and the majority on other activities, like talking to patients and fellow clinicians. The vast majority of radiologists do nothing other than: come in (or increasingly, stay at home), sit down at a computer, consume a series of medical images while dictating their findings, and then go home. If there existed some oracle AI that can always accurately diagnose findings from medical images, this job literally doesn't need to exist. It's the equivalent of a person staring at CCTV footage to keep count of how many people are in a room.
- daxfohl 1y agoAre these the ones making 500K? Sounds like more of an assistance job than an MD.
- quadragenarian 1y agoRadiologists are often the ones who are the "brains" of medical diagnosis. The primary care or ER physician gets the patient scanned, and the radiologist scrolls through hundreds if not thousands of images, building a mental model of the insides of the patient's body and then based on the tens of thousands of cases they've reviewed in the past, as well as deep and intimate human anatomical knowledge, attempts to synthesize a medical diagnosis. A human's life and wellness can hinge on an accurate diagnosis from a radiologist. Does that sounds like an assistance's job?
- daxfohl 1y agoMakes sense. Knowing nothing about it, I was picturing a tech sitting at home looking at pictures saying "yup, there's a spot", "nope, no spot here".
- 1718627440 1y agoFor this job a decade of studies would be a bit wasteful though.