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

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

#61

Post by Stefan-H »

pjungwir wrote: post #53
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.

With babies we know the shape. It is not as if we are likely to get a 2d slice of just an arm to estimate the age. With tumors we do not have an idea of the shape, and therefore could accidentally take a slice of the narrowest portion the first time, then the largest portion the second and assume it grew.

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

#62

Post by neurotech1 »

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.

"Trust but verify": There are standards for tumor measurement. However, for something with major life-altering consequences, having the same radiologist compare scans is important to avoid observational variability.

A neurologist I know, she always checks the actual scans as opposed to relying on the report narrative alone. Her background is in computer science, before her MD.

The issue with new analysis tools is that most doctors won't stake their reputation by exclusion. If a doctor says the tumor isn't growing, and it is, they are liable. If a neurosurgeon removes a benign tumor, then its business as usual.

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

#63

Post by smacktoward »

DMac87 wrote: post #54
KyleBrandt wrote: post #43

Earlier quoted context omitted.

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.…

The problem is that it's not just "needless interventions" that can backfire. Even in situations where an intervention could unquestionably help, there's still plenty of ways for it to go wrong. The most obvious is human error -- a well-intentioned intervention that's disastrously mis-executed -- but that's just the beginning of the list, not the end.

What you have to remember is that for the vast majority of human history, medical interventions of all kinds were at least as likely to hurt the patient as they were to help them, because of our crude understanding of how the body works and how disease is communicated.

A textbook example is Oliver Wendell Holmes Sr.'s classic 1843 study of puerperal fever (http://en.wikipedia.org/wiki/Oliver_Wendell_Holmes,_Sr.#Medi...). It showed how doctors who were doing a completely routine intervention -- general examinations of the health of newborn babies -- were actually picking up that infection from babies who had it and then spreading it to others who did not, because they didn't sterilize their instruments and change their clothing between examinations.

This seems obvious to us today, but at the time it was quite shocking, because in thousands of years of medicine doctors had never sterilized their instruments or clothing when moving from one patient to another. It never occurred to them, because none of the prevailing theories of how diseases spread called for it. So untold numbers of newborns sickened and died because of well-meaning, completely uncontroversial interventions by their doctors.

Today doctors obviously do understand the role of germs in spreading disease better, and they have much improved medical technologies and practices available to them, which has helped reduce the risks of those types of interventions. But millennia of these types of unpleasant discoveries has given medicine as a profession a healthy regard for the possibility that what they think they know even today could be incomplete or flat-out wrong.

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

#65

Post by Flott »

agumonkey wrote: post #45
Flott wrote: post #2

Wow. Amazing story. Moral of the story : If you can, ask for a second opinion!

Beware, my mother, dissatisfied with the first answer[1] asked for a second one, the next doctor told her exactly what she wanted to hear[2] but underestimated the risks. Massive internal bleeding during the operation => emergency decision => remove the whole organ. Like precogs, we may need a 3rd opinion as arbiter. [1] situation is very complex, probably need to remove part of an organ [2] the he could fix the issu…

Thanks for the reply. You're making a very valid point!

First : Sorry to ear what happened to your mother.

Doctors telling what we want to ear is also a problem! Mostly, I believe, because when something like a brain tumor is threatening your life, you might not want (and know) what is best for yourself. Doctors can be influenced by their patients.

As you stated, the second opinion can be wrong and it is very hard for the patient to know who to believe. I wish everybody could have a little help from a friend with some photoshop & 3d printing skills!

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

#67

Post by snowwrestler »

pjungwir wrote: post #53
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.

The real problem here is the concept of "overdue" tied to interventions. Babies are like wizards: they are never late. They arrive promptly when they intend to. And there is actually not much evidence that arriving within a week or two on either side of the "due date" has any correlation with health problems for the mother or baby.

So, a well-educated OB can be a bit casual about the exact age of the fetus because it doesn't really matter all that much.

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

#68

Post by Nagyman »

jkokenge wrote: post #40
nhstanley wrote: post #35

Earlier quoted context omitted.

> 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…

It seems that health care professionals don't have a nuanced problem solving attitude. They make a diagnosis, see how this diagnosis fits into a preconceived treatment bin, then just solve from that position without understanding what's different, what's unique to each case. And, in their defense, they probably just don't have the time for that extra work. That's where I see technology as most useful....how to automa…

I agree with you and also believe this extends to the majority of professions. Even within software development, there are a significant number of people that will only solve the immediate problem in front of them in a stepwise manner, rather than using lateral thinking to evaluate if the problem should be solved in the way that's most familiar to them, or to look at it from a different perspective and solve another problem entirely (e.g. the root cause).

To be fair, the majority of problems are probably addressable without thinking differently. So people get into habit/routine and that's their "job"; thinking otherwise is not a day-to-day operation. To your point, automating the redundant/repetitive problems should allow for creative problem solving where machines don't yet excel.

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

#70

Post by tsax »

jkokenge wrote: post #40
nhstanley wrote: post #35

Earlier quoted context omitted.

> 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…

It seems that health care professionals don't have a nuanced problem solving attitude. They make a diagnosis, see how this diagnosis fits into a preconceived treatment bin, then just solve from that position without understanding what's different, what's unique to each case. And, in their defense, they probably just don't have the time for that extra work. That's where I see technology as most useful....how to automa…

I come from a long line of docs, though I'm a software dev. Let me tell you that the vast majority of patients can easily be sorted into these pre-formed category bins. Rare conditions are rare by definition. Most of medicine is dreary repetition.
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