8 ms·

Speaking as a physician who works with both interventional and diagnostic radiology -- the self promotion and style of the post is offputting to say the least.

Speaking as a physician who works with both interventional and diagnostic radiology -- the self promotion and style of the post is offputting to say the least. In addition, I'd never, ever, not in a million years, consider any interventional or diagnostic strategy from a blog post, most of which is written in a language, any language, I can not readily understand. Not to mention, I'd like to see names, not 1337 h4xx0r handles ("coolwulf" is great if you're 12 and playing WoW as a Worgen Deathknight, it's not cool if you'd like to convince me to add more tools to my workflow), when I consider modalities. As a sidenote: modalities like this one are common in modern radio diagnostics. Harvard, MIT, Cambridge with King's, Paris Cité, and a few more are working on evidence based (and Open Source/Open Algorithm) approaches to AI diagnostics, all of which seem to have their ups and downs in outcomes. All their services are HIPAA compliant and certified as such, run in-house, do not require me to upload vast amounts of radiographic data to a website operated in a country I wouldn't trust with my daily egg consumption stats. We're not talking funsies at the 7/11 here. We're talking diagnostic and therapeutic decisions. Basing those on a black box "pinky promise, it works" approach, is pretty much how people get killed. Not to mention, it's a 1980s view of things, the "if I can see it, I can cure it" approach. Modern oncology means to diagnose based on genetic and sequential markers, develop individualized strategies, long before imaging modalities become important. And if they do, there's plenty of hard- and software out there to make our lives so insanely easy, why send our stuff to a graphics card in China?

eighto 3y ago
It sounds like he's sold this system to several hospitals in the US though? According to the article anyway. Does that not indicate that he might have something useful here? Even if he has a gamer nickname and is based in China.
- yorwba 3y ago
  Also according to the article, those hospitals run the software HIPAA-compliant in-house, whereas the free online service is intended for people who literally couldn't afford anything else.
  - medimikka 3y ago
    The resolution and planes in modalities that are useful for visual diagnostics (which, again, are outdated as hell) are so expensive, I don't think the little AI script drawing over suspected lesions (something a PET can do much better, including staging and grading) is the cost factor here. But, hey, you do you. If you're comfortable subjecting yourself or your loved ones to this, by all means, do it. Without a decent sensitivity and specificity review, without an actual review in general, and without a corporation whose jugular I can cut if they screw up and murder my patient through a misdiagnosis, I'll stay away from someone's home grown shoe box medicine as far as I can. And I know all my serious colleagues will and are as well. It's not like that's the first person this week (or even today) trying to sell us one of those.
    - yorwba 3y ago
      From the article: "Currently, many countries cannot operate Treatment Machines (radiation therapy machines) and CT scanners simultaneously due to insufficient power supply. This might be hard to imagine for countries like China or the USA, but hospitals in these countries do not have hardware with sufficient computing power, nor do they have the funds to purchase AI service software. There's also a lack of understanding about AI technology, and even the performance of computers used by doctors can't be guaranteed." By all means if you can afford it, sign an actual contract with the company developing this product; the free plan wasn't meant for you.
      - medimikka 3y ago
        > "Currently, many countries cannot operate Treatment Machines (radiation therapy machines) and CT scanners simultaneously due to insufficient power supply. Yes, I know. I worked in Ghana. And, know what? Unless you're running a $5m/month Cyberknife or similar, you don't do those dual modality approaches. Most, literally all except five or six research hospitals in the US and EU, treatments still work (very well) with lead marker lines on patients. We image, we look at the image we stage, we localize, we take out a tape measure, we draw. It might sound archaic, but it works extremely well, especially in places like Ghana. I'd seriously love to see "coolwolf"s experience in developing country cancer treatments. I mean, in developing countries we deal 95% with cervix, breast, liver and prostate. Neither are hard to image and localize/stage. In the case of higher stages, exploratory imaging is also done, but those lesions aren't of initially surgical or radioherapeutic concern. Those who are, can be localized by eye only. And that's the ones, that software outlines.
- medimikka 3y ago
  It indicates, that he has sold a solution. It neither indicates that this solution is used[1], nor that those solutions are used for diagnostics. And if Chinese single-individual solutions with gamer nicknames don't worry you, someone who frequents Hacker News and is probably not dumb, I understand many of the issues we have with medicine and medical communication much better. I'm sure you're confident that you, or a loved one, will be correctly diagnosed by this thing. I am not. [1]: these hospitals are conglomerate hospitals who will buy things to try them out. I have dozens of bullshit solutions my bosses bought in storage. Why do you think you're getting raked over the coals for every small issue? Why do you think health care in the US is that expensive)
  - eighto 3y ago
    Thanks for your insights and sharing your expertise. I found it interesting to learn that these hospitals will purchase a solution just to test it out, possibly to then just shelve it. If that's what's happened here it seems quite dishonest of the author to imply that his software is being used there in actual clinical practice.
    - coolwulf 3y ago
      NeuralRad is being used during the clinic practice workflow at the moment. The platform currently is not FDA 510k cleared so we had to establish an IRB with the clinics which are building the platform into their clinical workflow.
      - alwa 3y ago
        You’re handling all the skepticism and hostility here with much more grace than I would be able to. I admire your tenacity and the scope of your effort-your hacker ethos, as it were. I understand why the audience’s instinct is to judge you by the standards they’d judge a clinician or a formal medical device manufacturer, in that history of medical tech is littered with examples of well-meaning engineering efforts unintentionally causing harm. As a counterbalance, though, I’d like to speak to the charitable interpretation: after all, how many times have I as a tech guy relied on practitioners in other fields to tell me what they could use, and whether what I built was helping them? It seems like you’re being judged on your skills as a practicing oncologist or full-scale US-market medical device manufacturer, when maybe a more fair frame might be that of a person who tries to help professionals whose work they admire by building tools they ask for. I feel like just as it’s somebody else’s job to know how to doctor cancer, it will be somebody else’s job to prove that the tech is safe and appropriate to commercialize or popularize (what else is regulation for?). From one person who likes making stuff to another person who makes stuff, though, I appreciate your good intentions, your creativity, and your follow through-and I admire your grace handling criticism here!
- coolwulf 3y ago
  I'm actually based in US. To clarify, we have several research collaborations on-going in US clinics.
hef19898 3y ago
Yeah, that's where the serious business and online culture meet. And I know which one I prefer. That being said, with diagnostics becoming better each and every year, it is less straight forward to know which, if any treatment, to use against which tumor at a given time. Generally, I do very much oreder if projects like this, regardless of the field, do include a healthy number of very experienced people in the actual domain, here that would be oncologists and radiologists specialized in oncology. Otherwise, I always assume it is some potentially dangerous almost-right first principle thinking at play. IMHO there is not a lot that is more dangerous than this.
- medimikka 3y ago
  Not so much business, as real medicine. The reason people get pissed at medicine is that it moves "slow" by their standards. But Jason M Somebody in his garage already built a cryo scalpel, why are you not using it? Well, Thalidomide, the aforementioned cryo scalpel, Paolo Macchiarini, and others have taught us, that that's never a good idea. It's 2024. We're throwing our lot in with serodiagnostics over anatomical localization, a PET scan being the only thing we need these days. If we know it's a lesion and we can FNA it, we will, else there's enough serodiagnostically we can do, to build individualized treatment plans (or determine if there's even a reason to use them). It's pretty fun to see the computer draw little circles around lesions. The Bruker solution (also Open Source and free, by the by) does this admirably well. But it's neither useful in diagnostics nor in therapy, since both don't really hinge on a circle around a lesion.
  - hef19898 3y ago
    But is an AI-generated circle! For sure there is a billion dollar start-up in there somewhere, right? /s I see a lot of parallels between what you just wrote and big data and AI applications in a field I know a thing or two about: Logistics and Supply Chains. Same things happen there, a smart system highlighting a problematic order or time period. Great, but identifying those never was the real problem to begin with. At the same time, all the potential of using better planning tools to enable people or to automate repetitice tasks to free up peoples time get somewhat ignored because those use cases are less sexy than automating, and solving, all those "problems" using AI... But tjis hype cycle will ultimately be replaced with new one, like those before it. And I will yell at some other hype cloud!
coolwulf 3y ago
Thank you for your comment and I would like to clarify a few things: 1) NeuralRad could be running locally inside your own clinic. Currently, Stanford hospital, UTSW, Jefferson and several other clinics in the US are using it in house. In this configuration, the data never transferred outside the clinic. 2) The whole platform is HIPAA-complaint. All Dicom data are anonymized before submitting to NeuralRad server for inference if using the NeuralRad cloud server. 3) NeuralRad server is within US, not in "other" country. Thanks.
- medimikka 3y ago
  > Stanford hospital No. Know how I know this?
  - coolwulf 3y ago
    At Stanford, the platform is used to help Physicians and Medical Physicists to contour Brain Mets. In addition, the platform never approves any dicom RT Structures. Physicians can use the generated RT structure to assist their SRS workflow.
  - iwontberude 3y ago
    I don’t know, I assume you are implying that you are on the hospital or SoM IRB or are privy to their work? I am curious to hear more of your opinions if you can share.
    - coolwulf 3y ago
      [flagged]
  - dang 3y ago
    Would you please make your substantive points less aggressively? I appreciate that you know a great deal about this topic and we all probably have a lot to learn from you. Nonetheless you crossed the line here, and not only here—repeatedly mocking someone for their username, for example, is a cheap shot. You undermine your own arguments when you do things like this, in addition to poisoning the culture that we're trying so hard to prevent from becoming outright toxic. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
jph00 3y ago
You're reacting to the style and medium of the post, and the handle and race of the author. Maybe consider looking at the science too? (FWIW, I've started working on AI for radiology nearly a decade ago, and Chinese researchers have been leaders in the field for most of that time.)
joconne 3y ago
As a medical physicist in radiation oncology who looks at segmentations generated like these I think you are missing the application slightly. The application of these segmentations is not in diagnosis or intervention, they are used mostly by a treatment planning algorithm. The radiation oncologist will outline the tumour and a few organs at risk manually. This segmentation algorithm would then steps in and outlines organs that the doctor would not have traditionally contoured. For a lung lesion the RO may contour the lesion and the heart but might not contour both lungs and the diaphragm. We can then input these segmentations into a treatment planning optimization algorithm that sets the radiation beam angles and collimation to meet constraints that minimize organ dose and maximize tumour dose. So in effect the application of this sort of segmentation is to give more information to an optimizer. Not that it doesn't have its problems! But I think it's important to note that the application is not diagnostic

eighto 3y ago

It sounds like he's sold this system to several hospitals in the US though? According to the article anyway. Does that not indicate that he might have something useful here? Even if he has a gamer nickname and is based in China.

yorwba 3y ago
Also according to the article, those hospitals run the software HIPAA-compliant in-house, whereas the free online service is intended for people who literally couldn't afford anything else.
- medimikka 3y ago
  The resolution and planes in modalities that are useful for visual diagnostics (which, again, are outdated as hell) are so expensive, I don't think the little AI script drawing over suspected lesions (something a PET can do much better, including staging and grading) is the cost factor here. But, hey, you do you. If you're comfortable subjecting yourself or your loved ones to this, by all means, do it. Without a decent sensitivity and specificity review, without an actual review in general, and without a corporation whose jugular I can cut if they screw up and murder my patient through a misdiagnosis, I'll stay away from someone's home grown shoe box medicine as far as I can. And I know all my serious colleagues will and are as well. It's not like that's the first person this week (or even today) trying to sell us one of those.
  - yorwba 3y ago
    From the article: "Currently, many countries cannot operate Treatment Machines (radiation therapy machines) and CT scanners simultaneously due to insufficient power supply. This might be hard to imagine for countries like China or the USA, but hospitals in these countries do not have hardware with sufficient computing power, nor do they have the funds to purchase AI service software. There's also a lack of understanding about AI technology, and even the performance of computers used by doctors can't be guaranteed." By all means if you can afford it, sign an actual contract with the company developing this product; the free plan wasn't meant for you.
    - medimikka 3y ago
      > "Currently, many countries cannot operate Treatment Machines (radiation therapy machines) and CT scanners simultaneously due to insufficient power supply. Yes, I know. I worked in Ghana. And, know what? Unless you're running a $5m/month Cyberknife or similar, you don't do those dual modality approaches. Most, literally all except five or six research hospitals in the US and EU, treatments still work (very well) with lead marker lines on patients. We image, we look at the image we stage, we localize, we take out a tape measure, we draw. It might sound archaic, but it works extremely well, especially in places like Ghana. I'd seriously love to see "coolwolf"s experience in developing country cancer treatments. I mean, in developing countries we deal 95% with cervix, breast, liver and prostate. Neither are hard to image and localize/stage. In the case of higher stages, exploratory imaging is also done, but those lesions aren't of initially surgical or radioherapeutic concern. Those who are, can be localized by eye only. And that's the ones, that software outlines.
medimikka 3y ago
It indicates, that he has sold a solution. It neither indicates that this solution is used[1], nor that those solutions are used for diagnostics. And if Chinese single-individual solutions with gamer nicknames don't worry you, someone who frequents Hacker News and is probably not dumb, I understand many of the issues we have with medicine and medical communication much better. I'm sure you're confident that you, or a loved one, will be correctly diagnosed by this thing. I am not. [1]: these hospitals are conglomerate hospitals who will buy things to try them out. I have dozens of bullshit solutions my bosses bought in storage. Why do you think you're getting raked over the coals for every small issue? Why do you think health care in the US is that expensive)
- eighto 3y ago
  Thanks for your insights and sharing your expertise. I found it interesting to learn that these hospitals will purchase a solution just to test it out, possibly to then just shelve it. If that's what's happened here it seems quite dishonest of the author to imply that his software is being used there in actual clinical practice.
  - coolwulf 3y ago
    NeuralRad is being used during the clinic practice workflow at the moment. The platform currently is not FDA 510k cleared so we had to establish an IRB with the clinics which are building the platform into their clinical workflow.
    - alwa 3y ago
      You’re handling all the skepticism and hostility here with much more grace than I would be able to. I admire your tenacity and the scope of your effort-your hacker ethos, as it were. I understand why the audience’s instinct is to judge you by the standards they’d judge a clinician or a formal medical device manufacturer, in that history of medical tech is littered with examples of well-meaning engineering efforts unintentionally causing harm. As a counterbalance, though, I’d like to speak to the charitable interpretation: after all, how many times have I as a tech guy relied on practitioners in other fields to tell me what they could use, and whether what I built was helping them? It seems like you’re being judged on your skills as a practicing oncologist or full-scale US-market medical device manufacturer, when maybe a more fair frame might be that of a person who tries to help professionals whose work they admire by building tools they ask for. I feel like just as it’s somebody else’s job to know how to doctor cancer, it will be somebody else’s job to prove that the tech is safe and appropriate to commercialize or popularize (what else is regulation for?). From one person who likes making stuff to another person who makes stuff, though, I appreciate your good intentions, your creativity, and your follow through-and I admire your grace handling criticism here!
coolwulf 3y ago
I'm actually based in US. To clarify, we have several research collaborations on-going in US clinics.

hef19898 3y ago

Yeah, that's where the serious business and online culture meet. And I know which one I prefer. That being said, with diagnostics becoming better each and every year, it is less straight forward to know which, if any treatment, to use against which tumor at a given time. Generally, I do very much oreder if projects like this, regardless of the field, do include a healthy number of very experienced people in the actual domain, here that would be oncologists and radiologists specialized in oncology. Otherwise, I always assume it is some potentially dangerous almost-right first principle thinking at play. IMHO there is not a lot that is more dangerous than this.

medimikka 3y ago
Not so much business, as real medicine. The reason people get pissed at medicine is that it moves "slow" by their standards. But Jason M Somebody in his garage already built a cryo scalpel, why are you not using it? Well, Thalidomide, the aforementioned cryo scalpel, Paolo Macchiarini, and others have taught us, that that's never a good idea. It's 2024. We're throwing our lot in with serodiagnostics over anatomical localization, a PET scan being the only thing we need these days. If we know it's a lesion and we can FNA it, we will, else there's enough serodiagnostically we can do, to build individualized treatment plans (or determine if there's even a reason to use them). It's pretty fun to see the computer draw little circles around lesions. The Bruker solution (also Open Source and free, by the by) does this admirably well. But it's neither useful in diagnostics nor in therapy, since both don't really hinge on a circle around a lesion.
- hef19898 3y ago
  But is an AI-generated circle! For sure there is a billion dollar start-up in there somewhere, right? /s I see a lot of parallels between what you just wrote and big data and AI applications in a field I know a thing or two about: Logistics and Supply Chains. Same things happen there, a smart system highlighting a problematic order or time period. Great, but identifying those never was the real problem to begin with. At the same time, all the potential of using better planning tools to enable people or to automate repetitice tasks to free up peoples time get somewhat ignored because those use cases are less sexy than automating, and solving, all those "problems" using AI... But tjis hype cycle will ultimately be replaced with new one, like those before it. And I will yell at some other hype cloud!

coolwulf 3y ago

Thank you for your comment and I would like to clarify a few things: 1) NeuralRad could be running locally inside your own clinic. Currently, Stanford hospital, UTSW, Jefferson and several other clinics in the US are using it in house. In this configuration, the data never transferred outside the clinic. 2) The whole platform is HIPAA-complaint. All Dicom data are anonymized before submitting to NeuralRad server for inference if using the NeuralRad cloud server. 3) NeuralRad server is within US, not in "other" country. Thanks.

medimikka 3y ago
> Stanford hospital No. Know how I know this?
- coolwulf 3y ago
  At Stanford, the platform is used to help Physicians and Medical Physicists to contour Brain Mets. In addition, the platform never approves any dicom RT Structures. Physicians can use the generated RT structure to assist their SRS workflow.
- iwontberude 3y ago
  I don’t know, I assume you are implying that you are on the hospital or SoM IRB or are privy to their work? I am curious to hear more of your opinions if you can share.
  - coolwulf 3y ago
    [flagged]
- dang 3y ago
  Would you please make your substantive points less aggressively? I appreciate that you know a great deal about this topic and we all probably have a lot to learn from you. Nonetheless you crossed the line here, and not only here—repeatedly mocking someone for their username, for example, is a cheap shot. You undermine your own arguments when you do things like this, in addition to poisoning the culture that we're trying so hard to prevent from becoming outright toxic. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

jph00 3y ago

You're reacting to the style and medium of the post, and the handle and race of the author. Maybe consider looking at the science too? (FWIW, I've started working on AI for radiology nearly a decade ago, and Chinese researchers have been leaders in the field for most of that time.)

joconne 3y ago

As a medical physicist in radiation oncology who looks at segmentations generated like these I think you are missing the application slightly. The application of these segmentations is not in diagnosis or intervention, they are used mostly by a treatment planning algorithm. The radiation oncologist will outline the tumour and a few organs at risk manually. This segmentation algorithm would then steps in and outlines organs that the doctor would not have traditionally contoured. For a lung lesion the RO may contour the lesion and the heart but might not contour both lungs and the diaphragm. We can then input these segmentations into a treatment planning optimization algorithm that sets the radiation beam angles and collimation to meet constraints that minimize organ dose and maximize tumour dose. So in effect the application of this sort of segmentation is to give more information to an optimizer. Not that it doesn't have its problems! But I think it's important to note that the application is not diagnostic