9/19/2016 Whyismachinelearningnotmorewidelyusedformedicaldiagnosis?

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medicaldiagnosis? bestanswersonQuora.
Inmyunderstanding,diagnosisisarelativelystraightforwardmachinelearningproblem.
Technologyexistsforcodingbothsymptomsandconditions,andtherearelargedatasetsof UpdateYourInterests

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.
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2.Wewanttodoourworkmoreefficiently.
Healthcareprofessionalsoftenworkinhighvolumeenvironmentsandmustbeperfect,
evenundertimepressure.Electronicmedicalrecordsareconstantlybeingchangedand QuestionStats
upgraded,andphysiciansspend/wastetoomuchtimebeingtrainedonamovingtarget.
Physiciansinlargergroupsfaceperpetualpressuretoseemorepatientsinlesstime,while 496Followers

documentingalloftheirencounterstotheT. 87,683Views

LastAskedSat
3.Costreduction.
Edits
Thisisimportantwhetherwe'retalkingaboutsolopracticesorlargeacademicinstitutions.
Thisisalsoimportantonasocietallevel,asitpertainstolackofpreventativecareand
resourceutilization.

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

https://www.quora.com/Whyismachinelearningnotmorewidelyusedformedicaldiagnosis 1/6
9/19/2016 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

https://www.quora.com/Whyismachinelearningnotmorewidelyusedformedicaldiagnosis 2/6
9/19/2016 Whyismachinelearningnotmorewidelyusedformedicaldiagnosis?Quora
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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9/19/2016 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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9/19/2016 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?
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Areyouexperiencingstressorsinyourfinances,personalrelationships,orother
aspectsofyourlife?
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Whatisyourdietlike?...

(more) Whatmachinelearningalgorithmscouldbeusedfor
decisionmakingandfindingappropriatemedical
Upvote 278 Downvote Comments 7+
diagnosesinashorttime?

Ismachinelearningoftenusedincorrectly?
YaroslavBulatov,SoftwareEngineeratGoogle
WrittenFeb18,2011 MedicalResearch:Arethereanygroupsusing
machinelearningtosearchforacancercure,orto
ProbabilisticexpertsystembasedonPromedasisbeingusedatUltrechtMedicalHospital.
developimprovedcancertreatments?
Youcanseehowitworksbycreatingafakepatientandrunningsometestsunder
"PromedasLive"http://www.promedas.nl/ Therehasbeenalotoftalkaboutuseofmachine
learningonweb.Whichprogramminglanguageis
Asfarasgoingfurtherthanassistingwithdiagnosisbasedonseriesoftestoutcomes,there widelyusedforML?

areunresolvedchallengesanMLsystemthatreplacesadoctorneedsgoodnatural CanmachinelearningbeusedforADD/ADHD
languageprocessingtobeabletoreadlatestmedicaljournals,aninferenceenginetoturn diagnosis?
thatinformationintodecisionrules,visualrecognitiontomakejudgementsbasedon
patientsappearance,etc. Whyislogisticfunctionwidelyusedinmachine
learning?
6.9kViewsViewUpvotes
Iscognitivepsychologyusefulformachinelearning?
Upvote 14 Downvote Comment
DoesGmail'snewtabbedinboxusemachinelearning,
oristhealgorithmmorecrude?
LeonardKish,IhaveaMaster'sinBiomedicalScienceandhaveworkedinhealth
carefor7...
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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Upvote 21 Downvote Comment

ManakShah,ABiomedicalEngineerwholovestolearn:P
WrittenFeb21

https://www.quora.com/Whyismachinelearningnotmorewidelyusedformedicaldiagnosis 5/6
9/19/2016 Whyismachinelearningnotmorewidelyusedformedicaldiagnosis?Quora
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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