9/19/2016

Whyismachinelearningnotmorewidelyusedformedicaldiagnosis?Quora

MedicalDiagnoses

MachineLearning

MedicineandHealthcare

Whyismachinelearningnotmorewidelyusedfor
medicaldiagnosis?
Inmyunderstanding,diagnosisisarelativelystraightforwardmachinelearningproblem.
Technologyexistsforcodingbothsymptomsandconditions,andtherearelargedatasetsof
trainingdataavailable.Theliteratureonthetopicisprettythoroughandsomeadvanced
algorithmshavealreadybee...(more)
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OmarMetwally,M.D.,HealthTechnologist
WrittenMay30,2013

IusedtoscratchmyheadaskingthesamequestionuntilIhadanenlightening
conversationwithaclosefriendofminewhoworksforalargehealthcareconsulting
company.Heledmetotherealizationthataphysician'sagendaismuchdifferentthana
machinelearningpractitioner'sagenda,whichismuchdifferentthanalawmaker's
agenda,whichismuchdifferentthanahospitaladministrator'sagenda.Inthespiritof
fulldisclosure,Iamamedicaldoctorwithamachinelearningbackground,andIuseML
onadailybasistohelpotherhealthcareprofessionalssolveproblems.
Tolayouttheproblemmoreconcretely,let'sdividethehealthcarelandscapeinto3broad
categories:
1)Largeinstitutions,suchasuniversitiesandprivatehospitals
2)Solophysiciansinprivatepractice,orsmallgroupsofphysicians,whoaretryingto
resistthetrendtowardconsolidation.
3.Healthcareprofessionals,suchasnurses,physicaltherapists,andadministrators,who
arejustascriticaltoasuccessfulpracticeasphysiciansare
Healthcareprofessionalshaveseveralgoals:
1)Wewanttohelpourpatientslivehealthierlives.
2.Wewanttodoourworkmoreefficiently.
Healthcareprofessionalsoftenworkinhighvolumeenvironmentsandmustbeperfect,
evenundertimepressure.Electronicmedicalrecordsareconstantlybeingchangedand
upgraded,andphysiciansspend/wastetoomuchtimebeingtrainedonamovingtarget.
Physiciansinlargergroupsfaceperpetualpressuretoseemorepatientsinlesstime,while
documentingalloftheirencounterstotheT.
3.Costreduction.
Thisisimportantwhetherwe'retalkingaboutsolopracticesorlargeacademicinstitutions.
Thisisalsoimportantonasocietallevel,asitpertainstolackofpreventativecareand
resourceutilization.

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Machinelearningpromisestohelpphysiciansmakenearperfectdiagnoses,choosethe
bestmedicationsfortheirpatients,predictreadmissions,identifypatientsathighriskfor
pooroutcomes,andingeneralimprovepatients'healthwhileminimizingcosts.Thisis
happeningatarapidpacedespitethemanyhurdles,whichcanbeovercomeby
practitionersandconsultantswhoknowthelegal,technical,andmedicalobstaclesandthe
bestsolutionstothoseobstacles.
Intheearlyinfancyofhealthcareinformatics,beforeitwasevencalledhealthcare
informatics,machinelearningalgorithmssuchasneuralnetworksandsupportvector
machineswereshowedoffinpublicationsthatpredictedthelikelihoodofmalignancyor
mortalityfromadisease.OnerecentpublicationthatillustratesthisisArtificialneural
networksandprostatecancer...[NatRevUrol.2013] fromagroupattheCharite
HospitalinBerlin.Thisisagreatpaper,andtheChariteHospitalhasatraditionofstrong
interdisciplinaryworkbetweenphysiciansandcomputerscientistsIappreciatedthis
quicklywhileIwasrotatingthere.However,mostphysicianshaveneverevenheardof

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Whyismachinelearningnotmorewidelyusedformedicaldiagnosis?Quora

machinelearning,andmostMLpractitionersdon'tunderstandtherealitiesofpracticing
medicine.
ManyapplicationsofMLfordiagnosisarejusttoyexampleofwhatmachinelearningcan
do.Therealityisthatphysiciansusuallydon'tneedhelpmakingdiagnosesbecausethey
candevelopakeenGestaltappreciationofapatientjustbylookingather/him.Eventhe
mostsophisticatedMLalgorithmcan'tlookatasickchildinhermother'sarmsanddecide
whethersheneedstobeemergentlyintubatedorwhethershecanbedischargedwith
conservativetherapy.Physicianssynthesizehugeamountsofinformationwithin
milliseconds,oftenjustby"eyeballing"apatient.
However,asanMLpractitioner,IamveryexcitedabouttheemergingroleofMLin
healthcare,andIamabelieverinitscapacitytotransformhealthcareforthebetter.
Machinelearningcandoscutworkforhealthcareprofessionals,leavingthemwithmore
timetodothemostimportantpartoftheirwork:communicatewithpatients.PerhapsML
isnotbeingusedmorefordiagnosisbecauseit'smoresuitedtopredictreadmissions,triage
patients,autopopulateordersets,andalltheothertasksthatcanbeautomatedsothat
healthcareprofessionalscanputtheirtimetobetteruse.LetMLalgorithmsdowhatthey
dobest,andlethumansdowhattheydobest.
OnefinalpointI'dliketomakepertainstolawsgoverninghealthcaredata,andthe
availabilityofhealthcaredataingeneral.HIPAAisanecessarylawbecausehealthcare
dataissensitiveandshouldbeprotected.TheflipsidetothisisthatMLpractitionershave
lessflexibilitytoplaywithdataandmoveitaround.Eventhelargesthealthcareconsulting
companywiththefanciestsoftwarearoundislimitedbytheavailabilityofquality,
consistentdata,evenamongthelargestinstitutions.Theharvestingandsafekeepingof
healthcaredataisanimportantnicheinthehealthcareinformaticsecosystem.Oncethis
dataismadeavailabletohealthcareprofessionalsinsecure,HIPAAcompliantdatabases,
thenthey'llappreciatethemanifoldapplicationsofmachinelearning,beyondmere
diagnosis.
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KaichengLiang,biomedicalengineer
UpdatedFeb1,2012UpvotedbyJessicaSu,CSPhDstudentatStanfordandLiliJiang,Data
ScientistatQuora

Thisisatopicclosetomyheartasabiomedicalengineer,andI'vereadtheanswershere
carefullyandenjoyedallofthem,especiallyJaeWonJoh'sverypersuasivecasestudy.
PreviouslywhileanundergraduateatDuke,Iworkedforabouttwoyearsdevelopinga
prototypedevicethatperformsbreastbiopsybasedonrealtime3Dultrasoundguidance,
andrequiresnohumanguidanceorintervention.Duringthecourseofconceptualization,
discussionswithsurgeonsandradiologists,buildinganddesign,andrebuttalsto
(sometimeshostile!)journalpeerreviews,I'veconsideredsomeoftheseissuesatgreat
length,andIwouldliketosharesomeofmythoughts.
Thegeneralconsensusfromtheanswerssofaristhatwearealongwayfromseeing
machinelearningoranykindofartificialintelligencetechniquefinditswayintomedical
diagnosis,andthattheclinicalneedforsuchathing(ifaneedevenexists)isofrelatively
lowpriority.IndeedthecomplexityofJaeWon'sclinicalexamplewouldinstantlyturnoff
someengineersasan(asyet)impossibleproblem.
ButIwouldarguethatAItechniqueshaveadefiniteclinicalvalueinrelativelysimpler
problems,particularlythosebasedonimaging,whichhasbecomeatremendously
successfuldiagnosistoolinrecentyears.Imagingathighquality(CT,MRI),highspeed
(ultrasound)andboth(OCT)hasbeggedthequestionofhowwemayuseimage
processingandlearningtechniques,honedtoincrediblesophisticationinthelastcentury
andubiquitousinbothindustrialandconsumertechnology,inaclinicalscenario.Iam
proposingthatsuchtechnologynotreplaceadoctor'sexperienceandexpertise,buttake
careofrelativelystraightforwardyettimeconsumingdiagnosistasks,thusfreeingupthe
doctorformoreclinicallydemandingprocedures.IntheThirdWorld,suchtechnology
couldgoastepfurtherinassistinghealthcareprofessionals,especiallywhendoctorsare
oftenscarceandoverworked.
AIappliedtothediagnosisofbreastcancerisanincrediblyactivefieldinmedicalimaging
andengineeringresearch.Thebreastbeingexternalislogisticallyconvenientforimaging

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andcanprovideimagesofstunningclarity.Currentprotocolforbreastcancerdiagnosis
involvesamammogram(Xray)andthenanultrasoundduringthelattertheradiologist
mighttakeaneedlecorebiopsy.Biopsycanbeatrickyprocedureevenforanexperienced
practitioner,andsideeffectssuchasbleedingandinfectionarenontrivial.Thedifficulty
isindiscerningthelesiononultrasound(whichhaslowresolution),andthenspatially
locatingandtargetingthelesionintheultrasound'sviewingplaneusingthebiopsyneedle
(whichbecomesintuitiveonlyaftersignificantpractice).
These(human)difficultiesarealmosttailormadefora(superhuman)machineto
overcome.BreastcancerindicationsforbiopsyonXrayandultrasoundareunambiguous
anddefinitivefor90%ofcases,andwouldbeastraightforwardrecognitionproblemfor
machinelearning,whichhasthebenefitofmillionsofhighqualitybreastimagesacquired
inthepastthatcanbeusedastrainingsets.
Icannameatleastonecompanythathassuccessfullyimplementedcomputeraided
diagnosisinpartnershipwithanultrasoundimagingfirmtheirFDAapprovedsoftware
canaccuratelyclassifyanddiagnosebreastlesions.GroupsatDuke,JohnsHopkinsand
UCSDareworkingindependentlyonrobotictechniquesthatwouldeasilyandrepeatably
reachtheselesionsthataresodifficultforafatiguedorlessexperiencedclinician,withthe
helpofcomputeranalysis.Suchtechniqueswouldalsobeagreatassettogroupssuchas
DoctorsWithoutBordersinthedevelopingworld,wherespeed,repeatabilityandaccuracy
inthesimplestoftissuesamplingtaskscouldhaveanincredibleimpactonlarge
communitieswithlimitedaccesstothemostbasicofhealthcare.
Whileweshouldbefullyawareofthedifficultyofaccuratemedicaldiagnosisandbe
carefulnottotrivializetheworkofthemedicalpractitionerasameredecisiontree,we
shouldneverstoplookingforareaswheretechnologycouldhelpthepatient(andthe
doctor!).Ironicallysomeofthesepossibilitiesaretheproblemsthatseemthemost'trivial'
becausethereisnothingwecandoaboutthemduetoourhumanlimitations.Butitis
preciselytheselowlevelproblemsthatwillbeeasyfodderfortechnology.Sowhilewe
appreciatethatthepracticeofmedicinerequiresthehighestlevelsofhumanability,itis
importantthatwedonotcloseourmindtothepossibilitiesoftechnologicalaidsthatcould
freedoctorsupforthereallyhardstuff.
Butthenbacktothequestioniftechnologyworkssowellasthedoctor'sassistant,why
aren'tweseeingmoreofit?Ithinkwealreadyare(atleastwe'realreadypayingforit!),
andIbelieveitisonlyamatteroftimebeforemachinelearningcomesintowidespread
clinicaluse.Butthemainproblemisalmostcertainlysocietalacceptancenobodywantsa
computercheckingthemoutanddecidingtheyhavecancer(justlookwhathappenedinA
SpaceOdyssey),andtheFDAisthusextremelycarefulaboutmedicaldevices,especially
thosethatareinvasive,andforgoodreason.
Asecondaryproblemisthatonlyasmallpercentageofcliniciansareinterestedin(and
haveanytimeatallfor)collaborationswithengineerstodevelopviablemedical
technology.AshasbeenpreviouslydiscussedonQuora,somedoctorsarenotalways
comfortableandfamiliarwithcomputersandengineering,andwouldoftenprefertheir
triedandtestedbutadmittedlyoldschoolmethodsthatseemmorereliable.Thereisalso
theimpressionthatengineersoversimplifyclinicalproblems,andproducesolutionsthat
arenearlyasimpossibleastheproblemsthemselves.
Whatisneededhereissimplymoredialogbetweenengineersandclinicianssotheycan
betterunderstandeachother'sworkandconcerns.IntheUS,wheremedicalstudentsdo
verysubstantialbiomedicalresearch,suchacultureiscommonandcelebrated,butin
manypartsoftheworldwheremedicalschoollacksanR&Dcomponent,doctorshave
consequentlyverylittleinterestoutsideoftheirpatients.
Quoraisfastbecomingnotonlyatechnologycentriccommunitybutalsoaveritable
resourceofmedicalopinionthisisagreatplaceformedicalengineeringcollaborationsto
conceptualizeandtakeshape.Ihopethebrilliantcomputerscientistsinourcommunity
arenotdemoralizedbythemassivenessoftheclinicalproblem,butinsteadfocuson
discoveringnicheswheretechnologycouldbeavaluableasset.Ibelieveitisoftenthe
simplestandmosttrivialclinicalquestionsthatseemthemosthopelesslyinsolvableindeed
theyare'trivial'becausewehavealreadygivenupandgrowntoacceptthem.Butwhatis
impossibletoaclinicianisalmostalwayssomethingthatanengineerhasananswerto.
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Whyismachinelearningnotmorewidelyusedformedicaldiagnosis?Quora
JaeWonJoh,sleepymedicaldork
WrittenFeb18,2011UpvotedbyNickGenes,AssociateProfessorofEmergencyMedicineat
theMountSinaiHospitalinNewYorkCityandJessicaSu,CSPhDstudentatStanford

Anactualclinicalexamplewillbemorepowerfulthananyspiel/explanation.Thisiswhat
happenedwhenapatientcameinwiththesinglecomplaintofabdominalpain.
===STEP1:DIFFERENTIALDIAGNOSIS===
Possibleetiologiesbrokendownbytype(tobehonest,I'msuretherearemanypossibilities
I'mforgetting):
Infectious(*=multiplecauses):
disseminatedTB
worm/otherparasite*
gastroenteritis*
ulcers*
abscess*

Malignancy(*=multipletypes):
pancreaticcancer*
coloncancer*
stomachcancer*
kidneycancer*
sarcoma*
cholangiocarcinoma
lymphoma*
MALToma*
hepatocellularcarcinoma
metastasisfromaprimarytumorelsewhereinthebody*

Physiologic(*=multiplecauses):
constipation*
hepaticdamage*
splenicdamage*
diverticulitis/diverticulosis
Crohn'sdisease
intussception
appendicitis
inflammatoryboweldisease
irritablebowelsyndrome
kidneystone*

===STEP2:HISTORY===
WhatquestionsdidIaskthepatient?Allofthefollowing:
Howoldareyou?
Whatisyourethnicheritage?

Canyoudescribetheonsetofyourpain?
Wherespecificallyisthepain?

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Whyismachinelearningnotmorewidelyusedformedicaldiagnosis?Quora
Howlongdoesitlast?
Isitsharp?Dull?Throbbing?Constant?Intermittent?
Arethereanyassociatedsymptoms?
Doesthepainradiateanywhere?
Onascaleof110,howbadisit?
Doesanythingmakeitbetter/worse?

Doyouhaveanyothermedicalproblems?
Whatmajorillnesseshaveyouhadinthepast?
Haveyoueverbeenhospitalized?Ifso,forwhat,when,andhowlong?
Whatmedicationshaveyoubeenon?Whatmedicationsareyouonnow?

Whatisyourcurrentlivingarrangement?
Doyouhaveajob?Ifso,whatisyourprofession?
Canyoudescribesomeofyourdailyactivities?
AskQuestion
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Areyouexperiencingstressorsinyourfinances,personalrelationships,orother
aspectsofyourlife?
Whatisyourdietlike?...
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YaroslavBulatov,SoftwareEngineeratGoogle
WrittenFeb18,2011

ProbabilisticexpertsystembasedonPromedasisbeingusedatUltrechtMedicalHospital.
Youcanseehowitworksbycreatingafakepatientandrunningsometestsunder
"PromedasLive"http://www.promedas.nl/
Asfarasgoingfurtherthanassistingwithdiagnosisbasedonseriesoftestoutcomes,there
areunresolvedchallengesanMLsystemthatreplacesadoctorneedsgoodnatural
languageprocessingtobeabletoreadlatestmedicaljournals,aninferenceenginetoturn
thatinformationintodecisionrules,visualrecognitiontomakejudgementsbasedon
patientsappearance,etc.
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LeonardKish,IhaveaMaster'sinBiomedicalScienceandhaveworkedinhealth
carefor7...

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WrittenJun22,2011

Greatarticlewithgreatlinks:
"MostengineersandcomputersscientistswithwhomIvespokenconceptualizemedicine
asprimarilyarational,evidencebased,problemsolvingenterprisefocusedonwell
definedconditions,ratherthanadisciplinethatinmyexperienceowesmoretoscientism
thanscience,isfarmoreambiguousthanmostengineerstendtorecognize,andis
foundedonrelationships,connectedness,trustedadvice,reassurance,andfrequentlythe
offloadingofsignificantresponsibilitiesfrompatienttodoctor."
fromhttp://blogs.forbes.com/davidsha...
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ManakShah,ABiomedicalEngineerwholovestolearn:P
WrittenFeb21

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ThereisonemoreissuewhichexistsinapplicationofMachineLearningindiagnosisof
diseases.ItisthePatientdata.CurrentlyinmyMasterThesis,IamusingMachine
Learninganditsalgorithms.Mybiggestdilemmaiswillmyalgorithmworkonanother
dataset?Eachandeverypatienthavedifferentmedicalhistoryanddifferentmedical
problems.Let'ssay,ItrainedmyalgorithmonpatientshavingHighBloodPressurethenI
cannotguranteeifitisgoingtobefullyefficientforpatientswithLowBloodPressure.
Therearelotsofvariationsindiseasesandalsotheiravailabledatasets.Thereisalways
goingtobeabiasandyoucannotrisksomeone'slifeduetoerrorinyouralgorithm.
RecentlyIwasworkingonamathematicalmodelofanactivitythattakesplaceinLungs.I
proposedamodeltomyProfessorandheaskedmeasinglequestion,"Evenifyoufitthe
data,willyoubeabletoexplainitPhysiologically?".Ihopeyougottheideaofthe
complexityofthePhysiologicalModelling.
InBiomedicalEngineering,thereisasubjectcalledPhysiologicalModellingandithasa
famoustextbookPhysiologicalControlSystems ,byMichaelC.K,Khoo .Inthe
introductionchapteronlywearegiventhelimitationsofthephysiologicalmodels,oneof
themisthatwecanmodeltheinterdependenyofthephysiologicalactivitieshappeningin
thehumanbody.Mostoftheorgansarerelatedtoeachother,soyouneedtotakecareof
alltheorgansandprocessesrelatedtothepartofthebodyyouwanttostudy.
Frommypointofview,MLcanbeusedforidentifyingpatternsinImagingandrelated
stuffbutitisgoingtobedifficulttouseitfordiagnosisfully,becausetherewillbeabias
alwaysandyoucannotblameacomputerforthefailure.
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