OP-ED

Watson will replace me? Not a chance!

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Arthur C. Clark and Stanley Kubrick predicted supercomputers more intelligent than humans.  In 2001: A Space Odyssey, the HAL states, with typical human immodesty, “The 9000 series is the most reliable computer ever made… We are all, by any practical definition of the words, foolproof and incapable of error.” Forty years later, IBM’s Watson pummeled humans in Jeopardy – a distinctly human game.

Watson is a big shot oncology fellow at MD Anderson – he is already impressing nurses and the attendings.  The supercomputer presented patients in the morning rounds, parsed data within seconds, and made few mistakes. The real oncology fellow, the human I mean, flabbergasted by the efficiency of his binary colleague, relayed to the Washington Post, “Even if you work all night, it would be impossible to be able to put this much information together like that.” Watson doesn’t have to worry about duty hour restrictions.

CEO of IBM, Ginni Rometty, claims that Watson 2.0 will interpret medical imaging like a radiologist.  In its third iteration, the supercomputer will “debate and reason.” Why hire radiologists who sap productivity with lunch breaks and sleep?  Watson will never complain about the dearth of vegan food in the cafeteria, never get tired, and – best of all – never whine about Medicare reimbursement cuts.

But forgive me for snoring at night without fear of the Robo-Radiologist. The reasons are simple.

There are tasks which a toddler can do with no easy computational solution, like recognizing moms, dads and aunts.  “Aunt Minnies” are diagnoses that can instantly be identified the same way you might recognize the face of your aunt in a crowd.  These are the easiest diagnoses for a radiologist but are so difficult for a computer that computer scientists have invented heuristics – shortcuts which trade accuracy for speed.   Heuristics are “good enough” algorithms, but may not be good enough for the high stakes in medicine.

Facebook’s facial recognition might pick your face from a group picture most of the time, but it also makes laughable mistakes.   Before Watson replaces radiologists, it must meet a higher bar than Facebook. “Might” is not good enough.

Suppose that Watson can spot Aunt Minnies.  It must communicate which is does using natural language processing. But medical lingo is anything but natural.  A helpful radiology request might read, “75 yo M w/ MM, AAA s/p TEVAR c/b EL on 2/2013 p/w CP r/t back.”  A less helpful one: “Unspecified,” Medical lingo has typographical errors, missing punctuations and ambiguous acronyms.

MM – is that Multiple myeloma?  Mediastinal mass? Malignant mesothelioma? Metastatic melanoma? Or Mr. Mean?

During the 2011 Jeopardy competition, a clue asked for the “anatomic oddity of US gymnast George Eyser.”  Watson answered “what is ‘legs?” The correct response: “what is missing a leg?” Watson misinterpreted the question because it knew “anatomic” but not “oddity.”

Misunderstandings in medicine do not happen from bad grammar and split infinitives. Misunderstandings come from wrong context.  Radiologists do not get partial credit for “pulmonary embolism” when the right diagnosis is “no pulmonary embolism.”

Watson does not need vacations, reimbursement or oxygen.  It may not need to physically exist – Watson already works from the cloud.  But its only way of maximizing utility is through a radiologist, not instead of one. The computer can be a decision support tool, not a doctor.

Dr. Chen is a radiology resident at the University of Pennsylvania, a programmer and an optimistic futurist.

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Categories: OP-ED, Tech, THCB

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Pauhanahowardpchenlawyerdoctor@RogueRadPeter Recent comment authors
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Pauhana
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Pauhana

Frankly, the objections you raise here are a bit silly. First, the issue highlighted in the title: nobody is asking Watson to “replace” you. (At least not yet…). I believe the short-term objective is to offload the “Aunt Minnies” you describe, allowing the human doctor to focus his/her attention on the tough things. If a machine is able to say “I’m 92% sure I’m looking at xyz”, that’s a pretty good level of confidence. Yes, the stakes in medicine are high, but every diagnosis — be they made by a machine or a human — will come with a certain… Read more »

howardpchen
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You make an excellent point. If I correctly interpret your point, humans are better than computers in some things (like contextual processing), and vice versa. In other words, there is an inherent complementary – not competitive – nature of humans and artificial intelligence. Perhaos we agree on more things than are initially apparent. Watson makes contextual mistakes like man with leg named Bob and ambiguous terminology like MM and biweekly, but excels at Bayesian diagnostics not tainted by human cognitive biases. Human radiologists are excellent at contextual interpretation but must manage their all-too-human biases to avoid cognitive errors. AI will… Read more »

lawyerdoctor
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lawyerdoctor

The biggest threat to radiologists is not a robot, it is a doctor. Doctors are trained to read x-rays. Just this am I performed a stat portable chest x-ray on a patient with dyspnea. A quick look at the film 60 secs after it was performed showed a huge right pneumothorax. By the time I had inserted the chest tube, and re-inflated the lung, I received a dictated report from the radiologist, advising me there was a “50% pneumothorax on the right.” The radiologist also wisely “advised a chest tube placement.” Thanks doc, it’s already done. By the time the… Read more »

howardpchen
Member

Agree – for the obvious diagnoses, adding value means rapid interpretation, and the doc at bedside is well suited. The radiologist’s value in those studies then lie not in the diagnosis but in excluding the rest – the left pancoast tumor, the lytic lesion in the right 8th rib, the strangely prominent hilar lymph nodes.

Maybe only on 5% of the films will the radiologist have something to show for their work, making marginal contribution over that of the clinician. But which 5%?

@RogueRad
Member

Can Watson deal with extravasation?

Peter
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Peter

“But its only way of maximizing utility is through a radiologist, not instead of one.”

Also through a radiologist in India for a much better price.

BobbyGvegas
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