You're making some very interesting and valid points. You've correctly identified that when receiving bundled services you lose the ability to negotiate or comparison shop on the basis of price. This is unfairly combined with a legal presumption that when the healthcare system generates a bill, the bill is valid until proven otherwise. Now, although we probably need more physicians, I don't think the limited supply of physicians is the primary reason for this situation - it's more due to increasing market concentration of health insurers on one side and hospital systems on the other, leading to regional monopolies that don't compete on price. In fact, with the decline of private practices and the rise of hospital systems, physicians receive less than 10% of all healthcare revenue. I can see that you'd like to unbundle your healthcare and regain control over prices, and I think that's a very reasonable thing to want.
HN user
unsrsly
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.
Still, I'm thinking that as it improves, it's going to show that doctors are not that good at their job on average, and that's going to be fun to watch.
Medical AI is trained on labels generated by doctors. Can you explain how it will exceed the performance of doctors on average? Are you assuming that the labels will be generated by the "top x%" of doctors? If so, how will you identify those individuals? Or is there some other mechanism you're expecting to improve the performance?
Interesting, how would the standards of the Board of Computational Radiology be set? Is the implication that the current standards are too high?
There is zero chance the software allowed the radiologists to work 10x faster... what?
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.
For those interested, here's a nice Tweet and video from a neurosurgeon at the Mayo clinic in Arizona demonstrating the use of both fMRI and intraoperative motor mapping: "Preoperative and Intraoperative mapping help with selection, safety and strategy."
https://twitter.com/BernardBendokMD/status/13785056756894556...
That must have been scary, but I'm glad she had a good outcome.
I respect your experience, and I'll concede that fMRI for pre-surgical planning in neurooncology is used at only some centers. If you worked mainly in neurooncology you may have missed some of the uses of fMRI for epilepsy surgery. Thanks for the discussion.
No such thing exists for fMRI, at minimum you need to buy a 3rd party processing system and may need a research key on your scanner.
This is not the case, for example see the GE BrainWave software.
https://www.gehealthcare.com/products/advanced-visualization...
I'm not on the outside of medicine. Significant practice variation exists, but complex neurosurgical conditions are usually managed at academic centers and fMRI is used for planning in neurooncology [1] and epilepsy surgery [2].
[1] https://thejns.org/focus/view/journals/neurosurg-focus/48/2/...
fMRI is used for planning in neurooncology [1] and epilepsy surgery [2].
[1] https://thejns.org/focus/view/journals/neurosurg-focus/48/2/...
Awake cortical mapping has much better resolution than fMRI, and it avoids image registration issues, but it requires a great deal of planning and patient motivation. If it turns out that the language center is on the opposite side from the area of the surgery, then awake mapping might not even be necessary. This is why fMRI is often used as a planning step before awake cortical mapping during the actual surgery.
Thank you for sharing your story. Although fMRI has low resolution, it can be very useful for surgical planning in certain clinical scenarios. For example, to determine hemispheric dominance: "Although the estimated percentages are of some debate, language is the purview of the left hemisphere in approximately 95% of right-handed people and 70% of left-handed people ... At MSKCC, language lateralization mapping is most often requested in right-handed patients with left hemispheric lesions, left-handed patients with left or right hemispheric lesions, or right-handed patients with right hemispheric lesions and signs or symptoms of aphasia." [1]
fMRI is used to plan procedures that put eloquent cortex at risk. For example, tumor resections. Typically, fMRI is used for initial planning (whether the tumor is in the dominant hemisphere, how to approach the tumor). Then, in the actual surgery, function is confirmed using awake cortical mapping (e.g. stimulating different cortical areas with a bipolar electrode while the patient performs language tasks).
See more: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966674/
Approximately nobody does this. fMRI isn't really even on the radar for most neurosurgeons.
Except at basically any academic neurosurgery center?
https://thejns.org/focus/view/journals/neurosurg-focus/48/2/...
https://osc.universityofcalifornia.edu/uc-publisher-relation...
"All Cell Press and Lancet journals are part of the UC agreement. For these top journals, UC’s shared funding model — where the libraries share the cost of open access publishing with authors — will be phased in, with all Cell Press and Lancet journals integrated no later than 2023, midway through the four-year agreement."
"a limited number of societies that partner with Elsevier for their publishing have chosen to exclude their journals from transformative agreements, so their journals are not eligible for either reading, publishing, or both under the agreement. A list of these exclusions will be available soon and linked from this page."
IANAL but HIPAA compliance comes from following certain policies and procedures (e.g. for encryption and account provisioning). These rules are necessary but not sufficient to guarantee security. As for cameras in hospitals, I have only seen these pointed at beds in specific scenarios (e.g. epilepsy monitoring) but obviously it is important to keep these video feeds secure.
I certainly agree with you. Part of the core MR game is to flirt with right wing talking points but keep on playing both sides to get attention. This is really unfortunate and distracting when it comes to something like covid that is already so politicized. Their actual analysis of the pandemic has been hopelessly naive and lacking in rigor. If there's one good contribution they've made, it's been pointing out the ways in which certain regulations have hindered the response without adding value. Otherwise, it's only good for the links.
As dramatized in Bad Blood? https://en.wikipedia.org/wiki/Bad_Blood_(TV_series)
I am almost certain this will fail.
How can you identify brain trauma with ultrasound? The ultrasound waves cannot pass through the skull.
80 years later, knowing what we know now, the Hanford site should be managed better. The fact that it hasn't been cleaned up by now is probably the sort of problem that OP is referring to.
Fire burning through grass and vineyards has been a feature of the latest fire season in northern CA. Given how dry and hot the climate is, only dirt is a sure thing. However with high enough winds, embers can carry long distances and cross fire breaks. For example in 2017, the Tubbs fire crossed highway 101. But I still agree that living close to trees is worse.
Disclaimer: this is not medical advice.
-The severity of aortic stenosis determines whether any intervention is indicated. Only a cardiologist or cardiac surgeon can reliably make this determination.
-The aortic stenosis procedure with the strongest evidence base is transcatheter aortic valve replacement, or TAVR. See the PARTNER 3 trial, https://www.nejm.org/doi/full/10.1056/NEJMoa1814052
-Bear in mind that only a cardiologist or cardiac surgeon can apply the available evidence to a patient and make a recommendation. In some cases of severe aortic stenosis, despite the PARTNER trials, an open surgical valve repair is still a better option. Only a cardiac surgeon can decide this after reviewing all of a patient's information.
-The evidence base for other interventions is weak. These options should probably not be considered outside of the context of a clinical trial. You can look for clinical trials here: https://clinicaltrials.gov/ct2/home
-Echoing other commenters, you should know that any procedure on the aortic valve has a risk of stroke. This would include any procedure that removes calcifications and possibly releases them into the blood. Only an interventional cardiologist or cardiac surgeon is qualified to discuss these risks in detail.
In addition to what other commenters have said, I'd guess that some purpleair sensors are placed in garages or other places with a local concern for air quality. That may explain some of the local variation you see on purpleair.
Kapton is an outstanding substrate material for flexible printed circuits. It has one of the lower dielectric loss tangents available, and this becomes important in RF and microwave applications. However, PTFE is better.
This dish was in the movie Goldeneye and apparently a lot of other films as well. https://en.wikipedia.org/wiki/Arecibo_Observatory
Not to downplay lung scarring from covid, but the "life expectancy less than five years" in this article refers to idiopathic pulmonary fibrosis which is a completely different disease. We don't yet have the data to say what long term outcomes are after severe cases of covid.
A rough summary: narratives are a form of lossy compression that enable us to make sense of events so that we can plan actions and coordinate with others. In the past, influential and powerful individuals would compress events into a Narrative (basically an authoritative version of history) which although it might have been "false" in some objective sense, and probably oppressed certain groups of people, nevertheless enabled social consensus. But today, much more of what happens is recorded (on video, on social media, etc) into what the author calls the Database. This makes it easy for anyone to point out the flaws in the Narrative. As a result, there is conflict over which of many narrative options should become the authoritative Narrative. This can play out in various ways like censorship (deleting/blocking entries from the Database), rejecting certain items from the Database as being not true, and even faking entries in the Database.