> 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.
I 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.
Agreed, I'm not sure where the OP from TFA is working but around here, radiologists have all been bought out and rolled into Radiology As A Service organizations. They work from home or at an office, never at a clinic, and have zero interactions with the patient. They perform diagnosis on whatever modality is presented and electronically file their work into their EMR. I work with a couple such orgs on remote access and am familiar with others, it might just be a selection bias on my side but TFA does not reflect my first-hand experience in this area.
Interesting - living near a large city, all of the radiologists I know work for hospitals, spending more of their day in the hospital reading room versus home, including performing procedures, even as diagnostic radiologists.
I think it may be selection bias.
> They work from home or at an office, never at a clinic, and have zero interactions with the patient.
Generalizing this to all radiologists is just as wrong as the original article saying that radiologists don't spend the majority of their time reading images. Yes, some diagnostic radiologists can purely read and interpret images and file their results electronically (often remotely through PACS systems). But the vast majority of radiology clinics where I live have a radiologist on-site, and as one example, results for suspicious mammograms where I live in Texas are always given by a radiologist.
And as the other comment said, many radiologists who spend the majority of their time reading images also perform a number of procedures (e.g. stereotactic biopsies).
Holy shit why did I waste my time in tech.
I could have just gone to med school and never deal with layoffs, RTO, etc.
My wife is an ER doctor. I asked her and she said she talks to the radiologists all the time.
I also recently had surgery and the surgeon talked to the radiologist to discuss my MRI before operating.
I'd clarify if her "all the time" means a couple of times a week. For 99.9% of cases an ER doctor would just read what the radiologist wrote in the document.
It's sort of like saying "sometimes a cab driver talks to passengers and suggests a nice restaurant nearby, so you can't automate it away with a self-driving cab."
Not an ER physician, but as a paramedic that spent a lot of time in the ER, it depends. Code 3 trauma/medical calls would generally have portable XR brought to the ER room, waiting for our arrival with the patient. In those cases, the XR is taken in the room, not in the DI (diagnostic imaging) wing, and generally the interaction flow will be "XR sent by wifi to radiologist elsewhere, who will then call the ER room and review the imaging live, or very quickly thereafter (i.e. minutes)", because of the emergent need, versus waiting for report dictation/transcription.
She said that all the time means more than 1 out of 100 reads but less than 5. It also takes longer for them to discuss a read than it does for them to do the read.
She also said that she frequently talks to the them before ordering scans to consult on what imaging she’s going to order.
> It's sort of like saying "sometimes a cab driver talks to passengers and suggests a nice restaurant nearby, so you can't automate it away with a self-driving cab."
It’s more like if 3/100 kids who took a robot taxi died, suffered injury, had to undergo unnecessary invasive testing, or were unnecessarily admitted to the hospital.
What the article suggests is backed up by research, at least in hospital settings: https://www.jacr.org/article/S1546-1440(13)00220-2/abstract
Are these the ones making 500K? Sounds like more of an assistance job than an MD.
Radiologists 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?
Makes 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".
For this job a decade of studies would be a bit wasteful though.
Right, which is why I asked.
>consume a series of medical images while dictating their findings, and then go home.
In the same fashion as construction worker just shows up, "performs a series of construction tasks", then go home. We just need to make a machine that performs "construction tasks" and we can build cities, railways and road networks for nothing but the cost of the materials!
Perhaps this minor degree of oversimplification is why the demise of radiologists have been so frequently predicted?
Saw radiologists at a recent visit in a hospital.
Do you have some kind of source? This seems unlikely.
If 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.
If 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.
Nope.
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.
Let’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.
Pretty much everything has false positives and false negatives. Everything can be reduced to this.
Human radiologists have them. They can miss things: false negative. They can misdiagnose things: false positive.
Interviews have them. A person can do well, be hired and turn out to be bad employee: false positive. A person who would have been a good employee can do badly due to situational factors and not get hired: false negative.
The justice system has them. An innocent person can be judged guilty: false positive. A guilty person can be judged innocent: false negative.
All policy decisions are about balancing out the false negatives against the false positives.
Medical practice is generally obsessed with stamping out false negatives: sucks to be you if you're the doctor who straight up missed something. False positives are avoided as much as possible by defensive wording that avoids outright affirming things. You never say the patient has the disease, you merely suggest that this finding could mean that the patient has the disease.
Hiring is expensive and firing even more so depending on jurisdiction, so corporations want to minimize false positives as much as humanly possible. If they ever hire anyone, they want to be sure it's absolutely the right person for them. They don't really care that they might miss out on good people.
There are all sorts of political groups trying to tip the balance of justice in favor of false negatives or false positivies. Some would rather see guilty go free than watch a single innocent be punished by mistake. Others don't care about innocents at all. I could cite some but it'd no doubt lead to controversy.
In 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".
Doesnt this become the developer? Or perhaps a specialist insurer who develops expertise and experience to indemnify them?
Oh 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.
They 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.
>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.
Train 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.
I 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.
As 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?
No, that is the norm. Radiologists speak with their colleagues the most, and patients rarely
It 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.