A.I. Shows Promise as a Physician Assistant - The New York Times

Art Papier apapier at VISUALDX.COM
Thu Feb 14 10:52:25 UTC 2019


Mike, we also are in the camp that AI will be Augmented Intelligence. here’s an article in Forbes from yesterday about AI diagnosis and our perspective. Best
https://www.forbes.com/sites/charlestowersclark/2019/02/13/ai-diagnosis-tool-bridges-the-gap-between-doctors-and-patients/#3a66761b5dea

Art Papier MD
CEO
VisualDx

Sent from my iPhone

On Feb 12, 2019, at 3:07 PM, Gerrit Jager <gerrit.jager at planet.nl<mailto:gerrit.jager at planet.nl>> wrote:

Hi Mike,

It was a last year podcast: https://www.itnonline.com/content/podcast-imaging-smack-down-siim-ai-won%E2%80%99t-soon-replace-radiologists-eliot-siegel

‘It’s ridiculous to think that in the coming two decades, artificial intelligence will replace radiologists, says AI expert Eliot Siegel, M.D. <http://www.medschool.umaryland.edu/profiles/Siegel-Eliot/<http://www.medschool.umaryland.edu/profiles/Siegel-Eliot/>>  Even if AI got good at reading medical images, “radiologists do much more than that,” he says in a podcast interview with Contributing Editor Greg Freiherr. Listen to the podcast. <https://soundcloud.com/user-787893434/podcast-imaging-smack-down-at-siim-ai-wont-soon-replace-radiologists-with-eliot-siegel>  You can also view Freiherr's video with Siegel, VIDEO INTERVIEW: Imaging Smack Down at SIIM: AI Won't Soon Replace Radiologists, Says Expert <https://www.itnonline.com/videos/video-interview-imaging-smack-down-siim-ai-wont-soon-replace-radiologists-says-expert> , here <https://www.itnonline.com/videos/video-interview-imaging-smack-down-siim-ai-wont-soon-replace-radiologists-says-expert> .

In the accompanying video interview, Siegel, a radiology professor at the University of Maryland School of Medicine <http://www.medschool.umaryland.edu/<http://www.medschool.umaryland.edu/>>  and chief of Imaging Services at the VA Maryland Health Care System, will highlight these and other reasons why it’s ridiculous to think computers will replace radiologists. ‘


Gerrit


Op 12-02-19 16:39, Bruno, Michael <mbruno at PENNSTATEHEALTH.PSU.EDU> schreef:

Dr. Eliot Siegel, a professor emeritus (I think) of Radiology from the U of Maryland, published a paper not too long ago (which I can’t find to reference at the moment) that AI is being asked a very different question than physicians are.  AI is only asked to emulate physician decision making, whereas physicians are asked to care for patients.  This difference has profound implications regarding the expectations we should place on such systems.

Mike



From: Jason Maude [mailto:jason.maude at ISABELHEALTHCARE.COM]
Sent: Tuesday, February 12, 2019 10:06 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] A.I. Shows Promise as a Physician Assistant - The New York Times


I think it depends on what the system sets out to do. If it intends to come up with the definitive diagnosis or a specific recommendation then that is more of an issue. If the system is just designed to come up with a short list for the clinician to consider and its made easy for the clinician to read up on the suggestions then that shouldn’t be an issue.

As we also know from the extensive work on biases, the human mind is far more of a black box than any of these systems!

Regards
Jason

Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890
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From: Edward Hoffer <ehoffer at GMAIL.COM>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Edward Hoffer <ehoffer at GMAIL.COM>
Date: Tuesday, 12 February 2019 at 14:45
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] A.I. Shows Promise as a Physician Assistant - The New York Times



Fascinating study.  The biggest problem with neural networks is their opacity - inability to explain in a comprehensible way why/how they reach their conclusions - which makes many reluctant to accept their conclusions.  The biggest problem with a "big data" approach is that one may be finding correlations rather than cause and effect, and correlation does not prove causation.  Only when these systems can explain their reasoning will they be widely accepted.

Ed

Edward P Hoffer MD

Co-creator, DXplain


On Mon, Feb 11, 2019 at 11:17 PM HM Epstein <hmepstein at gmail.com> wrote:


I still believe that AI is there to help, not take over. But still an interesting article.
https://www.nytimes.com/2019/02/11/health/artificial-intelligence-medical-diagnosis.html <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.nytimes.com_2019_02_11_health_artificial-2Dintelligence-2Dmedical-2Ddiagnosis.html&d=DwMGaQ&c=_FmMnDvUH5queZcSmOuBzHZMbp7E7EwtGwv5cxxnTj0&r=XZJky8Jx0OuETXcWpBMhx9j_wSYpSZPDVXdInJ5O9gQ&m=J61V89oG0ArMKQ_hwBqxs52q7tSX0lSOHGNDblnv4Uw&s=LoJWgdO6Ch9enk6YuJKrj2Gmf2d_fKQkFNPkDwq6QWs&e=>



Best,

Helene





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A.I. Shows Promise as a Physician Assistant
Feb. 11, 2019

Doctors competed against A.I. computers to recognize illnesses on magnetic resonance images of a human brain during a competition in Beijing last year. The human doctors lost.



Each year, millions of Americans walk out of a doctor’s office with a misdiagnosis <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.sciencedaily.com_releases_2014_04_140416190948.htm&d=DwMGaQ&c=_FmMnDvUH5queZcSmOuBzHZMbp7E7EwtGwv5cxxnTj0&r=XZJky8Jx0OuETXcWpBMhx9j_wSYpSZPDVXdInJ5O9gQ&m=J61V89oG0ArMKQ_hwBqxs52q7tSX0lSOHGNDblnv4Uw&s=8gRsEWrHg920sqgHTJYIBPL2MDPgM5QFs1tTG4O8crw&e=> . Physicians try to be systematic when identifying illness and disease, but bias creeps in. Alternatives are overlooked.
Now a group of researchers in the United States and China has tested a potential remedy for all-too-human frailties: artificial intelligence.
In a paper published on Monday in Nature Medicine, the scientists reported that they had built a system that automatically diagnoses common childhood conditions <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.nature.com_articles_s41591-2D018-2D0335-2D9&d=DwMGaQ&c=_FmMnDvUH5queZcSmOuBzHZMbp7E7EwtGwv5cxxnTj0&r=XZJky8Jx0OuETXcWpBMhx9j_wSYpSZPDVXdInJ5O9gQ&m=J61V89oG0ArMKQ_hwBqxs52q7tSX0lSOHGNDblnv4Uw&s=4siUOBu6PAlvUe3D9zW6Ha_mdpDMwafqZm6U9XTL45s&e=>  — from influenza to meningitis — after processing the patient’s symptoms, history, lab results and other clinical data.
The system was highly accurate, the researchers said, and one day may assist doctors in diagnosing complex or rare conditions.

Drawing on the records of nearly 600,000 Chinese patients who had visited a pediatric hospital over an 18-month period, the vast collection of data used to train this new system highlights an advantage for China in the worldwide race toward artificial intelligence.
Because its population is so large — and because its privacy norms put fewer restrictions on the sharing of digital data — it may be easier for Chinese companies and researchers to build and train the “deep learning” systems that are rapidly changing the trajectory of health care.
On Monday, President Trump signed an executive order <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.nytimes.com_2019_02_11_business_ai-2Dartificial-2Dintelligence-2Dtrump.html-3Fmodule-3Dinline&d=DwMGaQ&c=_FmMnDvUH5queZcSmOuBzHZMbp7E7EwtGwv5cxxnTj0&r=XZJky8Jx0OuETXcWpBMhx9j_wSYpSZPDVXdInJ5O9gQ&m=J61V89oG0ArMKQ_hwBqxs52q7tSX0lSOHGNDblnv4Uw&s=KDZkTPj1w7yyDJsips6pl7uAV34ufWBUmvnCqOa6IxY&e=>  meant to spur the development of A.I. across government, academia and industry in the United States. As part of this “American A.I. Initiative,” the administration will encourage federal agencies and universities to share data that can drive the development of automated systems.
Pooling health care data is a particularly difficult endeavor. Whereas researchers went to a single Chinese hospital for all the data they needed to develop their artificial-intelligence system, gathering such data from American facilities is rarely so straightforward.
“You have go to multiple places,” said Dr. George Shih, associate professor of clinical radiology at Weill Cornell Medical Center and co-founder of MD.ai, a company that helps researchers label data for A.I. services. “The equipment is never the same. You have to make sure the data is anonymized. Even if you get permission, it is a massive amount of work.”

After reshaping internet services, consumer devices and driverless cars in the early part of the decade, deep learning is moving rapidly into myriad areas of health care. Many organizations, including Google <https://urldefense.proofpoint.com/v2/url?u=https-3A__ai.googleblog.com_2018_05_deep-2Dlearning-2Dfor-2Delectronic-2Dhealth.html&d=DwMGaQ&c=_FmMnDvUH5queZcSmOuBzHZMbp7E7EwtGwv5cxxnTj0&r=XZJky8Jx0OuETXcWpBMhx9j_wSYpSZPDVXdInJ5O9gQ&m=J61V89oG0ArMKQ_hwBqxs52q7tSX0lSOHGNDblnv4Uw&s=OBBmv_3JcvqbNU4vhcQt_jj2mk6UuJm1F-pk_kUY0Uk&e=> , are developing and testing systems that analyze electronic health records in an effort to flag medical conditions such as osteoporosis, diabetes, hypertension and heart failure.
Similar technologies are being built to automatically detect signs of illness and disease in X-rays, M.R.I.s and eye scans.
The new system relies on a neural network <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.nytimes.com_2018_03_06_technology_google-2Dartificial-2Dintelligence.html-3Fmodule-3Dinline&d=DwMGaQ&c=_FmMnDvUH5queZcSmOuBzHZMbp7E7EwtGwv5cxxnTj0&r=XZJky8Jx0OuETXcWpBMhx9j_wSYpSZPDVXdInJ5O9gQ&m=J61V89oG0ArMKQ_hwBqxs52q7tSX0lSOHGNDblnv4Uw&s=Ez3xkko_CIPtGAxda5M-xO145799p5lPziMzRCZoG4U&e=> , a breed of artificial intelligence that is accelerating the development of everything from health care to driverless cars <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.nytimes.com_2018_01_04_technology_self-2Ddriving-2Dcars-2Daurora.html-3Fmodule-3Dinline&d=DwMGaQ&c=_FmMnDvUH5queZcSmOuBzHZMbp7E7EwtGwv5cxxnTj0&r=XZJky8Jx0OuETXcWpBMhx9j_wSYpSZPDVXdInJ5O9gQ&m=J61V89oG0ArMKQ_hwBqxs52q7tSX0lSOHGNDblnv4Uw&s=UKoj-1cXT1Vzaz2ctMGV6DGKcw16BxMBeGzyaGihjPM&e=>  to military applications <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.nytimes.com_2018_02_20_technology_artificial-2Dintelligence-2Drisks.html-3Fmodule-3Dinline&d=DwMGaQ&c=_FmMnDvUH5queZcSmOuBzHZMbp7E7EwtGwv5cxxnTj0&r=XZJky8Jx0OuETXcWpBMhx9j_wSYpSZPDVXdInJ5O9gQ&m=J61V89oG0ArMKQ_hwBqxs52q7tSX0lSOHGNDblnv4Uw&s=yfU1GxL4qz9dhJH8t4Lqnxe7amgibdm6ZUQAPc-CnAs&e=> . A neural network can learn tasks largely on its own by analyzing vast amounts of data.
Using the technology, Dr. Kang Zhang, chief of ophthalmic genetics at the University of California, San Diego, has built systems that can analyze eye scans for hemorrhages, lesions and other signs of diabetic blindness. Ideally, such systems would serve as a first line of defense, screening patients and pinpointing those who need further attention.
Now Dr. Zhang and his colleagues have created a system that can diagnose an even wider range of conditions by recognizing patterns in text, not just in medical images. This may augment what doctors can do on their own, he said.
“In some situations, physicians cannot consider all the possibilities,” he said. “This system can spot-check and make sure the physician didn’t miss anything.”
The experimental system analyzed the electronic medical records of nearly 600,000 patients at the Guangzhou Women and Children’s Medical Center in southern China, learning to associate common medical conditions with specific patient information gathered by doctors, nurses and other technicians.

First, a group of trained physicians annotated the hospital records, adding labels that identified information related to certain medical conditions. The system then analyzed the labeled data.
Then the neural network was given new information, including a patient’s symptoms as determined during a physical examination. Soon it was able to make connections on its own between written records and observed symptoms.
When tested on unlabeled data, the software could rival the performance of experienced physicians. It was more than 90 percent accurate at diagnosing asthma; the accuracy of physicians in the study ranged from 80 to 94 percent.
In diagnosing gastrointestinal disease, the system was 87 percent accurate, compared with the physicians’ accuracy of 82 to 90 percent.
Able to recognize patterns in data that humans could never identify on their own, neural networks can be enormously powerful in the right situation. But even experts have difficulty understanding why such networks make particular decisions and how they teach themselves.
As a result, extensive testing is needed to reassure both doctors and patients that these systems are reliable.
Experts said extensive clinical trials are now needed for Dr. Zhang’s system, given the difficulty of interpreting decisions made by neural networks.

“Medicine is a slow-moving field,” said Ben Shickel, a researcher at the University of Florida who specializes in the use of deep learning for health care. “No one is just going to deploy one of these techniques without rigorous testing that shows exactly what is going on.”
It could be years before deep-learning systems are deployed in emergency rooms and clinics. But some are closer to real-world use: Google is now running clinical trials of its eye-scan system at two hospitals in southern India.
Deep-learning diagnostic tools are more likely to flourish in countries outside the United States, Dr. Zhang said. Automated screening systems may be particularly useful in places where doctors are scarce, including in India and China.
The system built by Dr. Zhang and his colleagues benefited from the large scale of the data set gathered from the hospital in Guangzhou. Similar data sets from American hospitals are typically smaller, both because the average hospital is smaller and because regulations make it difficult to pool data from multiple facilities.
Dr. Zhang said he and his colleagues were careful to protect patients’ privacy in the new study. But he acknowledged that researchers in China may have an advantage when it comes to collecting and analyzing this kind of data.
“The sheer size of the population — the sheer size of the data — is a big difference,” he said.



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