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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

#111

Post by JacobJans »

tsax wrote: post #70
jkokenge wrote: post #40

Earlier quoted context omitted.

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.

It's exactly this attitude that turns me off of a lot of doctors. It dehumanizes the experience of being a patient. First you are put in a bin, then the doctor basically runs you through a check list.

It's really unfortunate that nearly 100% of the bins are disease or a disorder. A typical interaction with a doctor involves finding out which disease bin you should be in, and then putting you in there. Once you're there, they're not concerned with making you healthier, or looking at the variety of options that could improve your life. They're just concerned with doing the standard operating procedure for dealing with the disease. Instead of being a person, the patient becomes a checklist.

Many doctors don't even see you. They see the bin you're in, and the many potential bins you could potentially be in.

What if half the bins were about great physical health? And what if the doctors worked just as hard to get you into one of those, as they do "treating" the diseases you might have?

Ugghhh. It makes me sad thinking about how far we are from that world.

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

#112

Post by agumonkey »

Flott wrote: post #65
agumonkey wrote: post #45

Earlier quoted context omitted.

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 fo…

Luckily, if I may say so, it wasn't that crippling, the damages were more emotional. Waking up to this kind of news unprepared (and they completely dismissed their lack of judgement, ha the sacred doctor) is a pretty big blow.

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

#114

Post by Shinkei »

tomohawk wrote: post #106
Shinkei wrote: post #88

Wow... I really hope I didn't get to this thread too late that this just gets buried. This is a classic example of hyperbolic reporting to try and show physicians as some kind of incompetent lot whereas this 'guy working in his basement with passion and talent' figured out how to hack the entire field of Medicine. The fact is, nearly all Meningiomas are treated this way because they are overwhelmingly benign and the…

This guy did exactly what he should have done. He harnessed his experience and passion to ensure the continued health of a loved one. The first thing to keep in mind is that you own your body. If you're not comfortable with a prognosis or course of treatment, then don't settle. No doctor is going to care about how things turn out for you more than you. You're the one who's going to have to live with the outcome. Don'…

Patients should be informed and the process should be open and honest. And also, any physician who would balk at a 2nd opinion is not confident in his or her own course of action.

That said, it's very easy to get caught up in a situation that is over your head:

http://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect

I can tell you that it took 3 years of medical school (not to mention my heavy science undergrad) to begin to critically appraise basic scientific literature. Medical textbooks are excellent but you have to understand the jargon.

As far as how to choose the 'right' physician, I think I will write a more extensive post about this because it's something that even I struggle with... believe me, physicians and their families know (and are victims of!) the problems in Medicine all too often. But basically, it is hard. I would say, if you have a common illness... almost anyone can help you. If you have an uncommon to rare illness, you should go to a large academic hospital and read about each of the physicians in the relevant department, then make an appointment with that person. Surgery is something else entirely... if you go to a large, academic center, you will only be seen by surgeons that specialize in that procedure. There will be a breast surgeon, a 'gut' surgeon, etc. If you go to a small regional hospital, they will likely only have general surgeons who do common cases and hopefully will refer you to a larger center.

I really agree with almost all of what you said and especially the spirit of it. Just remember that it's all a numbers game and even if your physician is knowledgeable, your surgeon is skilled, etc. there will always be chance events that occur... not medical errors, just random outcomes. There is sadly never a guarantee of health.

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

#115

Post by caycep »

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.

Most research labs can do something a little fancier but basically similar, using mutual information reduction algorithms to mathematically align images. The software is also open source (see ANTS from UPenn or FSL from Oxford).

Sadly, none of this is easily available in FDA approved packages from typical MRI/CT imaging vendors like GE or Siemens. Often need to pay extra for such features. You could theoretically walk to the surgery suites and borrow a stereotactic imaging station (basically an embedded Linux PC) and do it there, but radiologists typically aren't trained to do that.

FSL and ANTS aren't approved by FDA for clinical use so can't be officially documented in a patient's chart...

Most radiology training is based on visual recognition of abnormalities in anatomy - the "eyeball approach" has its value, which is why intelligence agencies employ human spotters and people are working on neuromorphic chips. But there isn't really a lot of quantitative/comp sci expertise among typical medical students (maybe more now, who knows?)

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

#116

Post by [deleted] »

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…

[deleted]

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

#117

Post by [deleted] »

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…

[deleted]

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

#118

Post by entropydude »

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…

I'm a doctor and former software programmer, so let me offer a counterpoint:

I would disagree with your statement that medical people have a fatalistic passive attitude. In this case the decision is between 1) watching and waiting to see if the tumor grows and 2) acting immediately to take it out. The tumor in question is a meningioma, a relatively common tumor of the skull (meninges, to be precise) whose natural behavior is unpredictable (some are essentially benign, others are highly malignant). Sometimes high-risk features can be identified on MRI imaging (brain invasion, areas of tissue necrosis, rapid growth) and these will always be treated with intervention. I work at UCSF, one of the top neurosurgery programs in the world, and I can guarantee you the radiologists don't make the mistake on sizing tumors mentioned here (well maybe they do, but it is out of carelessness rather than a problem with there software. it is not hard to find anatomic landmarks to ensure you are measuring at the same level). I would argue that a small meningioma without worrisome features should definitely not be operated on because the risks of surgery are not negligible! These surgeries are no joke, they are extraordinarily complex and they are mucking around next to structures which can cause significant morbidity, neurologic deficits, and even death sometimes if they nick the wrong artery.

It is well accepted practice and backed by evidence (see the WHO:tumors of the CNS publication) that the best way to decrease overall morbidity is by watching and waiting with these types of meningiomas. This is because MOST meningiomas are low-risk/benign (they are often found incidentally during autopsies for other reasons) and the risk of adverse surgical outcomes would be high if you subjected each of these people to invasive procedures when the incidence of high grade meningiomas is low. It is a population based strategy and unfortunately on an individual level you can't predict the outcome, but that is unfortunately a problem with this data. Fortunately lots of new technologies are emerging that can tease out individual differences (the so-called personalized medicine technologies)

That being said the new techniques to map out anatomy to aid surgeons is very cool! And to be fair, it sounds like the patient in this article did not get great care and that some of the doctors were not following the standard of care (1 year between imaging is definitely too long).

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

#119

Post by saurik »

DanBC wrote: post #89
AceJohnny2 wrote: post #87

Earlier quoted context omitted.

This ought to be highlighted, before people start an echo chamber of "doctor's don't know what they're doing!" that ultimately undermines everyone (guess what argument the anti-vaxxers use). A string of anecdotes of "I double-checked and it turned out the doctor was wrong" remains less than a trickle compared to the flood of patients doctors have to deal with, and a tiny fraction of the hypochondriacs they must deal…

There are some useful questions patients can ask. "What happens if we do nothing? If we do watchful waiting?" "What happens if I don't take these meds?" "How likely is that bad event? Tell me in terms of numbers per 10,000 people rather than percentages".

Why is "numbers per 10,000 people" meaningfully different than taking the percentage and multiplying it by 100?

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

#120

Post by DanBC »

saurik wrote: post #119
DanBC wrote: post #89

Earlier quoted context omitted.

There are some useful questions patients can ask. "What happens if we do nothing? If we do watchful waiting?" "What happens if I don't take these meds?" "How likely is that bad event? Tell me in terms of numbers per 10,000 people rather than percentages".

Why is "numbers per 10,000 people" meaningfully different than taking the percentage and multiplying it by 100?

Doctors and patients do not know what you mean when you say "your risk has gone up 50%". When you say "in a group of ten thousand people we would expect 4 to experience this thing. But in a group of 10,000 people who eat peas we expect about 6 people to experience this thing".

Gerd Gigerenzer has a book explainin it better than I do.

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