Man saves wife’s sight by 3D printing her brain tumor • Hacker News Board

Re: Man saves wife’s sight by 3D printing her brain tumor

#51

Post by gmarx » Wed, Jan 14, 2015, 5:48 PM UTC

VikingCoder wrote: post #42

jpmattia wrote: post #15

> Balzer used Photoshop to layer the new DICOM files on top of the old images, and realized that the tumor hadn’t grown at all — the radiologist had just measured from a different point on the image. Think about the some of the implications of that statement for a while. It really is no wonder that the softer sciences have a reproducibility problem.

There are multiple problems. The biggest problem in my mind is that outcomes are not tracked well. That means that there's no medical feedback loop to measure the long-term effectiveness of... anything. And no good way to do retrospective studies to prove new measurement techniques. And also the laws for patient protection makes it incredibly difficult to get even anonymized data for researchers to use. The next bigg…

Medicine has a data problem. It is multifaceted and far more difficult to fix than it should be. I've worked on these problems for years and it is immensely frustrating. Incentives just aren't set properly to solve them. For example with outcomes tracking, even if you had a good software system for it, you won't get reimbursed for it.

Re: Man saves wife’s sight by 3D printing her brain tumor

#52

Post by ska » Wed, Jan 14, 2015, 5:52 PM UTC

jarvic wrote: post #16

jepper wrote: post #4

Interesting article, glad the operation was successful. The most interesting part of the article is not the advance in technology (nothing new, we've been using 3d prints as models for complicated fractures / bone tumours or even custom prostheses for years (academic centre)) but the low use rate of this technology by most hospitals. The trick with overlaying follow-up scans is called image fusion and is easy and can…

>The trick with overlaying follow-up scans is called image fusion and is easy and can be done by one-click applications Just wanted to point out that image fusion is far from easy. The brain is easier than most areas of the body because the skull provides a good basis for performing a registration, but even then the brain has some small room to shift and you can't get a perfect alignment with only rigid transformatio…

Even without physiological changes, multi-modal fusion is a made more difficult by non-rigid spatial transforms inherent to some of the modes (e.g. CT quite accurate spatially, but MR is certainly not, and can vary with pulse sequence also)

Re: Man saves wife’s sight by 3D printing her brain tumor

#53

Post by pjungwir » Wed, Jan 14, 2015, 5:52 PM UTC

mcmancini wrote: post #19

I coauthored a paper a few years ago on the intra-observer variability of measurements of brain tumors when using the bidimensional product. An increase of 25% in the BP is taken as an indicator of brain tumor progression. We found that the intra-observer variability is so high, you can get that 25% increase purely by chance. The first recommendation of the medical team, to wait and see, is understandable.

Having been to three ultrasounds for my children, I'm amazed how casually they use a 2D length to estimate the baby's age, and therefore delivery date, and therefore when it is overdue and calls for a cesarean, etc. Your results seem like they confirm my suspicions that this can't possibly be very accurate.

Re: Man saves wife’s sight by 3D printing her brain tumor

#54

Post by DMac87 » Wed, Jan 14, 2015, 5:54 PM UTC

KyleBrandt wrote: post #43

tjradcliffe wrote: post #39

Earlier quoted context omitted.

It's somewhat less depressing than that, from a personal point of view, at least. Most interventions carry with them pretty significant risk. Therefore the choice is not between "do nothing and see what happens, or do something with zero risk and see if it helps", but rather "do nothing and see what happens, or do something really high risk and see if it does more harm than good." Iatrogenic disease (harm caused by i…

You have a source for those measures?

Even if true, I don't know what to make of such a statement - needless interventions for ALL diseases/causes may kill a lot more than any ONE single, narrowly defined disease/cause - that says more about the classification/definition system than interventions... it's only if interventions on any ONE disease kill a significant proportion vs the disease itself that that intervention / interventions are truly dangerous...

Re: Man saves wife’s sight by 3D printing her brain tumor

#55

Post by smacktoward » Wed, Jan 14, 2015, 5:57 PM UTC

nhstanley wrote: post #35

jpmattia wrote: post #15

> Balzer used Photoshop to layer the new DICOM files on top of the old images, and realized that the tumor hadn’t grown at all — the radiologist had just measured from a different point on the image. Think about the some of the implications of that statement for a while. It really is no wonder that the softer sciences have a reproducibility problem.

> It really is no wonder that the softer sciences have a reproducibility problem. Even Further, I think it's also indicative of medicine being full of people that have a fatalistic, passive attitude towards their patients and medical care. Medicine and health is really hard, and so many health professionals essentially believe that the only thing they can do is wait until something horrible happens before doing anyth…

A more charitable explanation would mention how the prime directive of their profession is "first, do no harm": (http://en.wikipedia.org/wiki/Primum_non_nocere)

Re: Man saves wife’s sight by 3D printing her brain tumor

#56

Post by Someone » Wed, Jan 14, 2015, 6:06 PM UTC

KyleBrandt wrote: post #43

tjradcliffe wrote: post #39

Earlier quoted context omitted.

It's somewhat less depressing than that, from a personal point of view, at least. Most interventions carry with them pretty significant risk. Therefore the choice is not between "do nothing and see what happens, or do something with zero risk and see if it helps", but rather "do nothing and see what happens, or do something really high risk and see if it does more harm than good." Iatrogenic disease (harm caused by i…

You have a source for those measures?

http://www.avaresearch.com/ava-main-website/files/2010040106... puts it on #3, after heart disease and cancer. So, it may be an exaggeration, but not a huge one and certainly not an inexcusable one. It is fairly common to remember that something is way more common (or way rarer) than one would think, and then overestimate the number when trying to produce it later.

http://en.m.wikipedia.org/wiki/Iatrogenesis#Incidence_and_im... has more links, which I didn't read.

Re: Man saves wife’s sight by 3D printing her brain tumor

#57

Post by bugsbunnyak » Wed, Jan 14, 2015, 6:12 PM UTC

VikingCoder wrote: post #42

jpmattia wrote: post #15

> Balzer used Photoshop to layer the new DICOM files on top of the old images, and realized that the tumor hadn’t grown at all — the radiologist had just measured from a different point on the image. Think about the some of the implications of that statement for a while. It really is no wonder that the softer sciences have a reproducibility problem.

There are multiple problems. The biggest problem in my mind is that outcomes are not tracked well. That means that there's no medical feedback loop to measure the long-term effectiveness of... anything. And no good way to do retrospective studies to prove new measurement techniques. And also the laws for patient protection makes it incredibly difficult to get even anonymized data for researchers to use. The next bigg…

This. 1000 times this. It's not even about automated diagnosis. The software used by most radiologists is more than two decades behind the state of the art, lacking even basic image registration and segmentation capabilities. (source: I've worked with radiologists who review brain images at several tier-one, top-10 hospitals).

If you are lucky, some eager, tech-savvy resident will use 3D Slicer or OsiriX on their personal laptop to coregister and segment images, and do longitudinal volumetric comparison. But those basic tools are not available on the platforms used to read most images.

Major vendors are trying to catch up, but from what I've seen, demand (and thus willingness to invest) is surprisingly limited.

Re: Man saves wife’s sight by 3D printing her brain tumor

#58

Post by artmageddon » Wed, Jan 14, 2015, 6:16 PM UTC

emcrazyone wrote: post #9

carbocation wrote: post #7

Earlier quoted context omitted.

Historically I have fallen into the "don't do unnecessary tests" camp, but I would be willing to consider an alternative viewpoint. Perhaps what is needed is continuous monitoring of biochemical data from volunteers longitudinally to help us understand if any of that data is actionable in a way that reduces suffering or prolongs life. I think the right sensors have not yet been invented for this purpose, but they are…

You're not alone. I agree with you and a very wealthy friend of mine who owns his own company bought an MRI machine for his employees and had it installed in the building he owns.

Wait, does he actually run a medical firm that is licensed to use the MRI machine, or did he just buy one outright? I was told that people couldn't just buy one, you had to represent some kind of medical entity to be able to purchase one.

Re: Man saves wife’s sight by 3D printing her brain tumor

#59

Post by kaybe » Wed, Jan 14, 2015, 6:23 PM UTC

malvim wrote: post #17

wpietri wrote: post #11

Earlier quoted context omitted.

I share your concerns with the US medical system. It is a bunch of busy, reasonably bright people caught up in an insane circus. It on average produces adequate care, but you shouldn't expect much more. Having an active and informed advocate can make an enormous difference. On the other hand, I agree that more data isn't necessarily better. There are plenty of examples. E.g.: http://www.bloomberg.com/news/2012-05-21/…

Brazilian here (and surprised to see they used Brazilian research software in a top HN story!). Couple years ago, my wife had a mass on her throat that turned out to be thyroid-related but (thankfully) benign. I had the EXACT same feeling as you, and feel we're copying the US in only the wrong aspects. "A bunch of busy, reasonably bright people caught up in an insane circus" sums it up better than I could. I'll digre…

You probably don't want sensitive medical information in unsafe messaging systems.

Re: Man saves wife’s sight by 3D printing her brain tumor

#60

Post by kaybe » Wed, Jan 14, 2015, 6:25 PM UTC

artmageddon wrote: post #58

emcrazyone wrote: post #9

Earlier quoted context omitted.

You're not alone. I agree with you and a very wealthy friend of mine who owns his own company bought an MRI machine for his employees and had it installed in the building he owns.

Wait, does he actually run a medical firm that is licensed to use the MRI machine, or did he just buy one outright? I was told that people couldn't just buy one, you had to represent some kind of medical entity to be able to purchase one.

Did they give a reason?

I can't think of really bad stuff to do with it (except very locally to my own building, and it's not like those are very mobile), and except maybe impersonate a medical entity and rip people off.