I know one top tier diagnostic radiologist and he could tell which piece of equipment an image was taken on (or if something is out of calibration) with a fairly quick glance. Regularly on the phone with techs and technologists to get things fixed or reimaged. He retired recently.
From his telling most of the work has been outsourced to India for the last 10-15 years. He only gets the really challenging stuff.
This is just going to be another case of patients needing to take ownership of their own care. It’s no longer “tell the doc your symptoms and they’ll figure out what’s wrong”, it’s now “tell the doc what you think you have and if they interrupt you and brush it off, go to another doc” until someone agrees with your diagnosis and gets you the referral or test or prescription that you need. For those who know what I’m talking about, I’m sorry. For those who don’t- you’ll learn this lesson someday.
I was at the hospital last week for a pretty bad condition and my IV was badly set. I told the nurse to change it for 4 days, they kept refusing, trying to adjust it.
Eventually I just told the doctor what was happening, and he said "oh, that's why your readings were messed up, I was wondering why I had to change your drug dose every day".
They changed my IV in the next hours, and my conditions improved overnight.
I discussed that with some doctor and nurse friends, and they all told me to never, ever trust a health practitioner you don't know very well. You need to be very proactive in your treatment, because they are exhausted, have many people to treat in a row and are only humans.
If someone’s not going to do their job, why does AI matter at all? Why wouldn’t they just use the same boilerplate text for everyone today?
It's like the lawyer using ChatGPT to file legal briefs... he'd feel bad and be obviously incompetent, if he didn't file anything at all, but didn't feel bad (or feel the need to check anything) once it "looked right".
It doesn't matter what the radiologist rationalizes - they're going to get killed by malpractice lawsuits. Imaging is particularly prone since the radiologists' work product and a second opinion is all the evidence the plaintiff needs if something obvious was missed.
> It's like the lawyer using ChatGPT to file legal briefs... he'd feel bad and be obviously incompetent, if he didn't file anything at all, but didn't feel bad (or feel the need to check anything) once it "looked right".
That lawyer is going to get sanctioned. It's an open question if he loses his license but he's not getting off scott free.
However, since I'm the final set of eyes judging my care I'll be asking to see a doctor who has never been assisted by AI and is in fact not a mind-atrophied cyborg. Who knows when this opinion will morph into harmspreading and wrongthink that gets you escorted to the schizo wing instead. AI might yet be paraded as safe and effective.
In my opinion, an AI system like this (diagnostics) shouldn't even be implemented until it is statistically the case that "won't bother to even review the AI output"-level poor performance on the part of radiologists produces better outcomes than a traditional non-AI system. Then we don't have to worry about what happens when the radiologist isn't good enough to review their work product: the answer is that the medical care is at least better than it would have otherwise been. Deploying a system like that would improve medical outcomes with minimal disruptions.
That said, I think we'll reach that point (statistically provable that an AI system is making better diagnoses than the average radiologist) sooner than most people probably think, maybe a couple of years and then [regulatory approval] years until it's actually used. That doesn't mean radiologists shouldn't exist, though. A radiologist fits into a much larger organisational framework - they file paperwork, they hold responsibility, they are ostensibly available to call and ask about a specific quirk, etc. Even with a 100% perfect AI at the task of "what disease, if any, is indicated by this image?", that still doesn't automate a radiologist's job. A lot of other stuff needs to happen first.
Also, at least in my practice, I would double the number of CTs read in an average day :)
Imagine a Radiologist that already has to read 20 scans per day. With AI helping, and Radiologists just confirming, they will probably be expected to analyze 40 scans per day. Eventually the Radiologist will quickly get into a habit of confirm, confirm, confirm... 500 times in a day. They will stop treating each case as a real reading and instead they look at the AI's output and think, "looks about right" and will become complacent in actually providing valuable feedback. Furthermore, they will be expected to produce more work, meaning they are giving every case less attention than previous. They will begin to just trust the AI to keep up with their schedule.
The better use of AI is to flip it on its head. Let the radiologists continue to work like normal. They will produce reports like they do now, only 20 per day. But the AI will analyze each scan after them, and if it flags the scan as remarkable or disagrees with the radiologist, then it bubbles the scan back to the top for further analysis. This way Radiologists are still expected to provide their expertise as they do currently and we generally rely on their opinion, but we will have an added layer provided by AI to catch anything that might be missed. This overall improves the accuracy of medical imaging instead of compromising it (which the original proposed AI solution certainly would do). Productivity would not be increased in this scenario, but accuracy (and indirectly malpractice instances) would improve.
I for one, would not want to get scanned somewhere that relies on AI to analyze my scan. But i would love a place that used AI as a second pair of eyes to confirm a human's findings.
Your math also doesn’t add up because 90%ish of studies are normal so you can basically sign a template without looking at the pictures and be more or less entirely accurate, before adding AI.
Also what practice only reads 20 abdo CTs a day? Seriously, let me know I could use a more relaxing job.
Lastly, an AI that functions with the competency of a PGY3 resident does not exist at the moment or on the horizon. Especially for cross sectional studies.
Source: am a diagnostic radiologist and AI researcher (on the NLP side).
Almost 90% of the diagnostic studies I read could be pre-drafted by AI. That's where the money is and where AI-in-radiology companies should focus. The money is not in detecting hemorrhage or pulmonary embolism. It's a classic fallacy to think that life-saving means money-saving. Rather, the money in radiology is reads per day.
Here's a user story: A private practice radiologist reads 20 abdomen and pelvis CT scans with contrast per day. In each of these studies, he must write a short description of each organ. For example, "Gall bladder: Unremarkable" or "Gallbladder: Cholecystitis without evidence of cholecystitis" or "Gallbladder: Dependent sludge." There are around 15 such organs (liver, gallbladder, pancreas, spleen, adrenal glands, kidneys, etc.). The AI should auto-populate the radiologist report with an appropriate description of each organ system.
The job of the radiologist is to confirm what the AI says in each section, and to go into further detail as needed. It's essentially just customizing the existing template to each patient. This type of pre-drafting is exactly what radiology residents do and what companies like vRad do.