The system in this article is not interpreting mammograms, which is something that radiologists do. This is looking at tissue samples on slides, the domain of pathologists.
These exist, google for "mammogram computer aided detection". While the data on their efficacy is equivocal at best, I well tell you that they are useless. I do get to bill more for reading a mammogram if I run it through a CAD machine, which my group owns, so of course I do it.
Strangely enough, patients are reassured when the learn that the computer didn't detect any problems. And, more importantly, ignorant juries can be swayed by this piece of information. "The computer didn't detect anything? Then there is no way the radiologist should be held liable for missing that little tumor!" I'm not joking.
Have you seen a typical medical school class recently? The people getting in these days is almost shocking. I have a hard time believing that qualified people are being shut out of admission.
> it's one of those areas where the problem is a lot harder than it seems.
Yes, exactly. To computer savvy people unfamiliar with radiology it looks like something a computer might be good at, but I suspect the best we can hope for is a computer to aid me in my work, not replace me.
This guy gets it. Many replies in this thread are asking about computers interpreting scans, assuming I know nothing about the underlying technology, or am blinded by some form of bias.
I have been programming computers since I was 5 years old. I have a MS in neuroscience, and I am a board certified radiologist, so I think I'm qualified to understand the problem.
Believe it or not, nothing would make me happier than a magical black box that could spit out accurate radiology reports. Someday I'm going to get sick, and I would benefit from the technology.
If my job was replaced tomorrow I would be OK. I'm smart and hard working, and I'm good at almost everything I try, eventually. Also, I'm saving every last penny I earn, so I can keep things up for a few more years I should be financially secure.
Having said all that, I still think the problem is not solvable. On any given day I read xrays, CT scans, MRIs, ultrasounds, PET scans, mammograms, nuclear medicine studies, or live flouroscopic studies, and using CT or ultrasound guidance I can get a needle into just about any part of your body to take a biopsy. Doctors talk to me and our discussion influences the differential diagnosis, and the interventions planned. I am not just matching patterns, I am thinking and using my hard worn judgement.
Wishful thinking aside, computers cannot do this now, if ever. And if / when we reach the point that computers can do this, my guess is every other job will have fallen, with the exception of plumbing.
I use this software when we perform a CT scan looking at the coronary arteries. Under perfect conditions it can correctly idenitfy the coronary arteries, and subtract away the rib cage, heart, and lungs.
It sounds like you already understand what it does. It helps me read a study quicker by automatically processing the data, a step I used to do by hand. Many times the processing fails due to an artifact while scanning ( patient moves, ectopic heart beat, poor contrast injection timing, variation in anatomy), and I need to process it manually.
When it works well it is very helpful, but to be clear, it does not interpret the studies. I think many people replying in this thread don't understand the enormous complexity to accurate radiology reporting.
I've sort of answered this problem above. I happen to think the problem is not solvable any time soon. If you or someone you know would like to prove me wrong, I will invest in your venture.
I'm not sure if you've ever seen a CT stroke study, which typically includes 4,000 images. If you think a computer can accurately interpret one of these any time soon, I would say you are poorly informed.
See my response below, and look into "CAD" and mammography.
I don't have any hard evidence, but I insist that it is true.
Bright and determined baby-boomers became doctors and lawyers and accountants. Today smart and determined people aren't even going to college. The HN demographic is a perfect example of this.
Sorry, but I wanted to be completely honest. There were a few guys like me in my medical school. There needs to be a counterpoint to the doom and gloom reports of "no life" and "living hell".
Final interpretations must be performed by a radiologist residency trained in the USA, licensed in the state there are reading from, and credentialed for the facility and the insurance company.
Why? Well, I guess it's supposed to be to ensure quality. In general, it is probably good that every hospital in the USA has an independent credentialing process. You could debate the fact that doctors in the USA are better trained, but in fact that has overwhelmingly been my experience.
Cynically, I believe that the lawyers need someone to sue. Like I said, most doctors complain about malpractice, but not me. The trial lawyers can't sue doctors overseas, but they can sue me. So, in a sense they are my ally, they ensure that no one else ( except people they can sue ) can read the studies.
That being said, there are companies that take USA trained radiologists and station them overseas. Australia and Geneva are both popular. They take advantage of the time difference to read hospital cases that occur overnight, when I am home in bed. They usually provide a preliminary read, something like "no appendicitis." The next day I do a final read, look for mistakes in the preliminary read, and in general do a more thorough job. Sure, there's no appendicitis, but the preliminary read didn't mention the small tumor in your left kidney that kind of looks like a cyst, but isn't.
FYI - overseas reads by USA trained radiologists tend to be more expensive, not less.
I don't know any secrets. It's hard to get a radiology residency. You need good grades. I don't think research experience matters. It also helps to be somewhat normal. The people interviewing you for residency have to be willing to sit next to you for four years, so if you're a "closet case" they might pass on you, even if you look good on paper.
In fact, the medical licensing exams and board exams are too lenient. The general quality of people going to medical school in the US has been dropping for a generation. The standards are sliding, to our detriment.
Of course, I cannot prove that the tests insure quality. In fact, this is not what the radiology board exam does.
The board exam is designed to weed out dangerous doctors, which is probably the best we can hope for. So, I guess you can take my word for it or not, but dropping the bar at all would let dangerous people practice, which I see as a mistake. The people that I know who failed the exam should not be working in Radiology.
If you read my other comments, I state that I make twice the average salary, because I read twice as many films.
> increasingly radiology has been outsourced overseas with mostly technicians required stateside (scan during the day, radiologist in India examines at night, results available the next morning).
This is not true. Some "preliminary reads" are read overseas at night, but the doctors reading the studies are trained and certified in the USA. "Final reads", the CT scan report that counts, cannot be read elsewhere.
True, but I knew about the lifestyle when I picked radiology, and it is a very hard residency to get. There are others with a similar lifestyle, like Dermatology, Ophthalmology, and Radiation Oncology. Guess what? They are the hardest residencies to get into when you finish medical school.
I should make clear why I'm replying in this thread. The world needs good doctors, and I want bright and ambitious readers of this site to know that there is a potential upside.
Radiology is a very difficult field to get into after medical school, something like 2/3 of American grads who apply get turned away. Additionally, for those who get in, up to 1/3 never pass all the board exams. It almost seems like you want to lower the bar, and I'm telling you it needs to be raised.
My guess is that if your system was developed and worked, the intelligence and drive required to complete it, the time spent studying and working to become competent in radiology would end up being no different than the current system. There are no short cuts.