by sxg 10 hours ago
I'm a radiologist but can't really weigh in without seeing the full 3D MRI dataset. Regarding this point:
> They performed shockwave therapy on my shoulder even though a recent clinical practice guideline says clinicians should not use or recommend shockwave therapy for rotator-cuff tendinopathy without calcification; I was told during ultrasound that there was no calcification.
Ultrasound isn't a great way to assess for calcification. It'll find large calcification but easily miss small ones. Plain radiograph would be more helpful, but the MRI may have revealed it as well. Either way, shockwave therapy isn't harmful in the absence of calcification--it's just not helpful.
Edit: when a radiology report says something isn't present, there's always an implicit caveat that the finding isn't present within the context of the modality and images obtained. So an ultrasound report can state there are no calcifications while a plain radiograph can report the presence of calcifications without being inconsistent. Obviously very confusing to patients and people unfamiliar with medical jargon, but clarifying this in reports would make them sound even more qualified, "hedgey", and annoying to read than they already are.
> So an ultrasound report can state there are no calcifications while a plain radiograph can report the presence of calcifications without being inconsistent. Obviously very confusing to patients and people unfamiliar with medical jargon
This is being overly nice, I think. Anyone who doesn't understand this is an idiot imo. You would have to assume that every type of diagnosis instrument has infinite clarity and is always correct to be confused in this case.
Reminds me of the Babbage quote where somebody asked him, if I put the wrong question into this computing device, will it still give me the right answer? His response, paraphrased "I can not fathom the logic of the minds which would come up with such a question".
> Anyone who doesn't understand this is an idiot imo
I don’t think that’s true. Avoiding this mistake requires knowing that an ultrasound may not detect calcification. For a patient reading their own report, I don’t think that’s intuitive. I would expect most people to read “no calcifications” and assume that their joint has no calcifications.
It’s 2026 and my computer will happily give me the right answer even when i make typos. I love it.
Most people should have learned at a young age that absence of evidence is not evidence of absence. My 8 year old understands this. After all, you can rarely ever prove something does not exist, only that it is unlikely to exist.
If a report states that X was not found, it does not mean X did not exist, it means it was not found.
What may be lost on the layperson is the nuance and understanding of how thorough or not a particular scan is and how much weight to give the findings and thus the odds that the report is correct.
This is - by far - the most stupid stuff I've read on the internet the past few days. They didnt find cancer either (as well as a plethora of diseases that could be related to the symptoms), and afaik its not in the report.
Yah you can argue that the tool is not ideal for that diagnostic, yadda yadda. I get it, and in the end I agree with the subtle difference you highlight, because it is something that makes sense to a certain kind of people. You know how many medics would read the report exactly like the author did? Too many.
How do I know? Im not in a wheelchair after being constantly misdiagnosed by using the wrong imagiology technique by (mostly) chance, and a good help from friends, including a surgeon. This seems to be a case where AI would be a valuable doctor tool for differential diagnosis; instead we have know-it-alls that can't bother to verify, and AI that often gets details wrong. That is the problem.
It's like when finding out about the sex of your baby via ultrasound before they're born. If you're told it's a boy, you can be pretty certain you're getting a boy. If you're told it's a girl, you shouldn't get too attached to the idea. The ultrasound tech might just have missed the evidence your baby was a boy.
> Most people should have learned at a young age that absence of evidence is not evidence of absence.
That might be true, but it is definitely not the world we live in.
It's a fatal flaw to think counter-intuitive == wrong.
This comment sounds like it's written by someone who doesn't interact with real people very often
> You would have to assume that every type of diagnosis instrument has infinite clarity and is always correct to be confused in this case.
There's a difference between 99.9% clarity and 50% clarity. Even if neither exactly equals 100%, it's understandable that a layperson would expect different language between them
"On two occasions I have been asked [by members of Parliament], 'Pray, Mr. Babbage, if you put into the machine wrong figures, will the right answers come out?' I am not able rightly to apprehend the kind of confusion of ideas that could provoke such a question."
Off topic but I have always felt this seemed like his misunderstanding rather than theirs. It’s an odd question, but it’s a very sensible point to make if Babbage has just told you this will solve the problem of mistakes in calculations - humans being involved at the start means human error still plagues the output.
Looking into his biography, it seems that he was indeed pitching the engine not as a means of efficiency, but as a means of avoiding mistakes in mathematical tables. It would have done Babbage well to insist he couldn't possibly solve all classes of mistakes, but would have solved a great many of them! "Why yes Senator, you are quite intelligent and handsome and make a fair point, allow me to give you the finer picture..."
Would have also been a fair point if Babbage had channeled his inner techbro and insisted it would directly replace human calculators; simple machines like Babbage's will chug along blindly on obviously erroneous data, but humans for all their sloppiness can often backtrack on errors.
To quote the LLM-ism, they were making a sharp point. It doesn't matter how precise the calculations are if you're calculating the wrong thing.
I suspect their sarcasm might have escaped Babbage who seems to have been on what we now call "the spectrum."
> Anyone who doesn't understand this is an idiot imo
I disagree. A priori it's not obvious to a layperson whether or not a statement that uses unconditional phrasing is intended to be authoritative or conditional on something unspecified, like the resolution of the measuring device. This goes for any sufficiently technical field.
If you got the brakes checked on your car, and the mechanic did <something> and told you there are no issues with them, and you then took your car to a different mechanic who did <something else> and told you there is a problem, you would not be an idiot for thinking that these conclusions contradict one another.
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As a rad tech, YOU TELL ‘EM DOC! I do like some uses of AI I’ve seen that help patients advocate for themselves or understand basic things like blood panel numbers, but it’s really bad at glazing people and leading them down medical rabbit holes kind of like the OP.
You would think that the AI would point out that calcium is best demonstrated on Radiographs/CT imaging vs Ultrasound or something to that effect.
Semi-related: my father has complications from a motorcycle accident ~25y ago that crushed arteries in his leg coupled with diabetes (insulin / kept sugar at ~100 and his A1C was kept under 6.7 for ~15y). 6w ago had to have his toes removed due to dry gangrene; they eventually (2.5w ago) had to remove his leg below the knee because of the severe blood flow issues below the knee.
Between the toes and the below the knee amputation, there were no less than 15 different doctors and PAs / related personnel who COULD NOT COME TO A CONSENSUS. They would just tell my mother and I (PoA) the details; they refused to come up with a singular plan of action moving forward, leaving it up to us to make 'an informed decision,' something that's IMPOSSIBLE when you have to take up to 15 different opinions into consideration.
What exactly are we supposed to do as patients/family members when medical personnel cannot give reasonable paths forward and instead just throw a bunch of shit over the fence at you and tell you, "you decide what to do from here," regardless of how many VERY DIRECT conversations I had w/the 'care team' on doing better to provide a limited array of options and reasons/likelihood of 'positive outcomes'.
I'm used to dealing with a wide variety of stakeholders/SMEs in decision-making; it's my job to apply my extensive industry experience to present our clients with their options, ranked and reasoned. Doctors, in my experience and most recently with my father, clearly do NOT do that (I assume due to liability; but, no real idea, honestly). So; when dealing with LIFE CHANGING circumstances, what are we supposed to do except rely on what might be able to offer more analysis and option narrowing w/AI?
I certainly don't want to make the job of medical staff more difficult by putting out crazy theories I found on the interwebbernets through my own research, etc; but, when we're having to deal with uncertainty and insanity, what else can we do?
This lines up with my experience with my mother, though it played out differently. In her case, she would switch doctors every ~5-10 years and each time they'd basically say everything the previous doctor said was wrong. First it was "you have Lupus", second it was "actually it's some other autoimmune disease", then it was "actually whatever you had has been in remission for some time now and you've been taking brain-numming medicine for no reason." Then it was "you have cancer", "it's a rare one", and "oh turns out the brain-numming meds have a correlation with rare cancers". The cancer part was handled well (albeit unsuccessful) though. After such a bad time with rheumatologists, I was shocked by how competent people were when it came to cancer.
All of the above was intertwined with brief stints with doctors that would just berate her for being a painkiller junkie, even though she hated the stuff and just wanted to find/fix the problem.
Kind of a rant, really. I'm not sure how to tie it back into AI. I do wish we had AI at the time so that we could at least cross-check, but I also understand that doctors are already sick of patients self-diagnosing on the web and that AI probably just makes that worse. At the same time, if our medical system could catch up a bit (more doctors? less corruption/paperwork? not sure what it needs) then maybe people would be less inclined to take matters into their own hands.
Probably liability... on the amputations I indicated and contraindicated, it's increasingly difficult to navigate trough patient perceptions while not disclosing so much as to give them rope to hang us. Some decisions are a game of probability that often we don't have clear numbers. In trauma, I have both cases where I recommended an amputation and at last minute decided to see that happened and the patient is walking with their leg today; and cases where I didn't recommend and later had to amputate as the lesion evolved. With cancer it's more straightforward, the cancer is what dictates the surgery... some cancers have poor response to other treatments, so we amputate. Some cancers had invaded the neurovascular bundle, so curative options involve necessarily amputation to get good margins. In cancer there's less doubt in the prognosis, so less chance of legal ramifications.
i'm sorry, but AIs only "know" about stuff that they have been trained on.
If we would allow AIs to be trained on the petabytes of medical data hidden in hospital systems, they would most likely be much better at diagnosing illnesses and conditions than the average doctor.
(Justifiable) Privacy around medical records so far prevents this.
You think you're cheering for humans, but in fact you are gatekeeping healthcare.
I dunno... if we gave an AI all of these medical records as training data, wouldn't it be trained to give the same answers as the doctors already gave, without knowing whether those diagnoses were correct or not?
I feel like the promise of these models is to help people make more informed decisions. Improving the knowledge economy and general understanding.
The problem is these are just statistical models at the end of the day, so you need to know something to be able to identify the errors. You can’t let them really be autonomous and you also can’t really have people turn into glorified approvers. If the machine is correct 89% of the time, you cannot make people responsible for that 11%. It’ll just cause automation fatigue.
tl;dr: the actual use cases of these LLM (or generative AI in general) is rather limited, so it is offensive how much hay has been given to them eating the entire capitalist system. They are not fit for purpose.
Agreed. Not a radiologist, but I do a fair bit of MRI research. Experts vs lay people probably have different success with getting the right diangosis out of a frontier model. Subtle changes in prompts can cause different diagnosis[1]
Huh, I'm reading and looking up these words you guys are saying and it is starting to look exactly like the symptoms I have been having with my own right shoulder! I feel like a giant gaping rabbit hole just opened up next to my desk.
We're discussing calcific tendinitis (https://radiopaedia.org/articles/calcific-tendinitis?lang=us). If you think you have it, you can see a doctor and consider shoulder radiographs to start.
If you think you have it, then you don't. If you have it, you won't think, you'll know.
Spoiler: because it hurts like hell.
Why isn’t diagnostic ultrasound used in orthopedics? They inspect fetus hearts and other organs everyday, why not shoulders? Seems much cheaper and faster.
They do. Ultrasound in orthopedics is a relatively newer field, and there aren't quite as many sonography techs and radiologists experienced in reading these studies, which is likely why you don't see it offered more widely.
Edit: I should mention that ultrasound is basically unusable for evaluating bones. Sound waves can't penetrate bone, and so you end up just seeing a huge black void. That's a huge orthopedics use case that ultrasound just can't benefit. However, ultrasound is fantastic for evaluating muscles, ligaments, tendons, and other superficial soft tissues.
We order ultrasounds all the time for shoulders (for like soft tissue issues; for trauma, you'd start with an xray). For other joints, such as the knee, MRIs are a better choice (unless htere has been substantial trauma, in which case xray initially or further), though more expensive, unless you're excluding a Baker's cyst, in which case an ultrasound is fine.
Since MRIs are more expensive, private doctor's might order them instead of an ultrasounds.
(I'm a doctor)
Where are you? Pi and work comp attorney in medium US midwest metro. I've never seen one in 20y. Not from HCA ERs, medicaid er visits to univ affiliated er, nor prestige practices.
Ultrasound was overlooked by US medicine as a first line imaging tool for a long time because it takes real skill and experience to do it right. But it's making a comeback. We've had Chinese, Indian, Australian, and American doctors visit us for one to two month stints to build up their skills.
Given the skill involved, it's probably a liability concern they don't want the exposure over there.
They're used quite a bit for nerve entrapment—both in diagnosing and treating.
It's a manual, non-standardized process without a standardized output. Image quality depends both on user skills (how deeply they press the sensor on the skin) and the machine they have. Unlike CT/MRI the examination results cannot be easily shared and compared between patients for studies.
> I'm a radiologist
Any comment that doesn't start with this or similar qulaification should be taken with a grain of salt (yes, including this one).
Medical imaging is one of those things everyone thinks is simple because they don't know what they don't know. I'm a cardiac sonographer, and I have to assume radiologists hear at least as many eye-rolling takes on AI coming for their job as I do.
Ahh, AI is coming for your job.
Full sarcasm, is there one that’s that’s more immune?
I don't completely understand what you mean, but I can tell you for my job, having AI tell you how to get the images is (without exaggeration) like putting someone who's never played an instrument on stage and saying "don't worry, the AI will show you how to do it."
I did a lot of cardiac MR and often GA cases. Sometimes after the scan an echo would be done.
I know my anatomy and etc and have done a short stint in ultrasound. I have no idea what you are doing or looking at and can identify pretty much nothing.
Echo techs are going to be around a lot longer than MR techs.
cough Immunology
I mean, probably not. No expert, but everytime I go to an immunology meeting (I'm a paediatrician) they've got a whole stack of new diseases. The field is moving fast, and there has to be a careful amount of shared decision making about when to test, what a positive test means and so on. I reckon they're as safe as any of us.
yeah, you said "one that is more immune"
So Opus might be correct?
Does radiology really make +$700,000.00 a year ?
Someone on reddit claiming to be a radiologist claimed that.
I wonder where the savings will go when those jobs are gone.
> Does radiology really make +$700,000.00 a year ?
The radiologist I know does not, but they are paid very well (and these numbers are always dumb when you're not sure if they're living in Manhattan vs literally anywhere in Kentucky)
Like most medicine, a large % of the job could be done by any decently talented person willing to follow instructions and shadow for a few months.
Like most medicine, the remaining % is what you're paying for, because it is literally life and death and you can't do things like "pull the logs" or "lets turn it off and take it apart" or "huh i need to put this down and come back later". Even in radiology, because "well lets just do it again to be sure" is often not a viable option.
While there is a problem in how we have inflated the cost of education for medical fields, the insane health insurance issues (US obviously, but it does have some effect globally when the expert radiologist you hire from the US to help with research costs that much), and probably some better ways to approach splitting the work for the entire field, like most professions dealing in life or death, medicine likely will always be paid well.
Physicians salaries account for about 8% of healthcare costs in the US.
The savings go straight into patients' worse outcomes.
You know the radiologist you're responding to is a real person? Your last line seems needlessly callous.
To the consumer! Haha just kidding. We all know where they'll go.