
One whole-body MRI could replace multiple cancer scans - howard941
http://www.pharmatimes.com/news/one_whole-body_mri_could_replace_multiple_cancer_scans_1287814
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nknealk
Many doctors hate full body scans. Every individual has a handful of anomalies
which are almost always benign. They show up on full body scans and chasing
them down comes with cost and patient risk.

I have a hard time with reporting like this that doesn't quantify cost of
biopsy on false-positives as well as cost of complications from examining
false-positives.

Source: worked in clinical research for 2 years.

~~~
whatshisface
Why can't a doctor see an anomaly and decide not to chase it down based on the
same reasoning that they use to not scan for it? Is there some pointless legal
trap related to malpractice where the only allowable "don't operate" decision
happens when the doctor decides what to test for?

~~~
a11r
Most tests are probabilistic and you have to think about the conditional
probability given other indicators. Consider a urine culture for detecting
UTIs. If you just get urine samples from a general population, some fraction
will show positive (bacteria in the culture) falsely. It would be pointless to
perform this test on the general population and to treat people that show
positive . But if you perform this test conditioned on the fact that the
patient is presenting other symptoms (burning sensation, fever etc.) then the
same test very useful and the conditional false probability is low enough that
it can be used to decide on treatment.

The same idea applies to most tests in medicine. That is why tests are mostly
done conditionally.

~~~
jedberg
But why can't they go the other way? Oh, you had bacteria in your urine, do
you feel a burning or have a fever? You'd have to find a way to ask that
doesn't incite a false response, but it still seems like it would be useful.

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sampleinajar
> The average cost of a WB-MRI scan for NSCLC patients was £317

Wow! $3000+ here in the US. Ever get the feeling you've been cheated?

~~~
hammock
State of the art MRI machine costs $3 million up front. Would take 20 scans a
week, every week, for 10 years to break even on that investment at $300 per
scan. Not counting physician & staff time or cost of capital.

~~~
Someone1234
Only 20 scans a week?

A scan takes 30-60 minutes. So even if they only work 8 hour days and assume
an hour for lunch/flex that's 35 scans per 5 day week. If they use it on
weekends at all or run it for more than eight hours, that's just gravy.

I'm not sure where you got the 20 scans a week number.

~~~
ChrisLomont
Because scans are not booked wall to wall every hour of every day. Needs more
likely follow a poisson distribution with ample waits in between uses.

To try and pack it that densely, with the large variation in how people show
up at the hospital, would cause bottlenecks and loss of service.

20 a week is a more common number for most places.

Here's actual data [1] measured on site. The usage is indeed around 50%, so
the 20 is a much better answer.

[1] [https://www.researchgate.net/figure/MRI-scanner-
utilization-...](https://www.researchgate.net/figure/MRI-scanner-utilization-
rate-over-the-3-week-data-collection-period-MRI-scanner-type-
and_fig1_51852320)

~~~
DuskStar
40% utilization means that it was in use for 67 hours per week. I don't think
an MRI takes three hours.

(In the case of the study listed, the utilization figures might be out of ~35
hours, which would make things different - but they also exclude scans
scheduled in advance)

~~~
ChrisLomont
The link states "As a result, in our study the maximum hours per week on each
scanner was limited to 35 h for the Vision (no hours on Tuesdays), 39 h for
the Harmony, 32 h for the Sonata (no hours on Wednesdays) and 38 h for the
Avanto."

Why guess 67 when you can look at the answer?

~~~
DuskStar
Because from my reading that's not the number of hours they used the machines,
but the number of hours in which the machines were available to be used. And
since they also state that their utilization figures only include emergency
cases (and exclude scheduled scans) I don't consider it a particularly
relevant source in the first place.

~~~
ChrisLomont
>I don't consider it a particularly relevant source in the first place.

Care to provide a relevant source?

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jedberg
I've had this idea floating in my head for a while. Provide free annual full
body MRIs to people, including being read by a radiologist, which they can
take to anyone they want (doctor, lawyer, whatever). In exchange, they agree
to send the org a copy of all their past and future medical records. The
records are anonymized and tied to the MRIs.

The MRIs and medical data is then pumped through machine learning algorithms
to attempt to identify early signs of disease. The data of course would be
most useful to future people, because we won't know someone has something
until a doctor diagnoses it, but if the AI model can look at the MRI from five
years ago on everyone with disease X and find a common early warning sign,
then we could apply it to future cases where it might be possible someone has
X and catch X much earlier.

Basically, I want to create a charity that gives free full body MRIs in
exchange for a bunch of medical data for training an AI.

~~~
DanBC
> annual full body MRIs to people

So, these are not medically indicated scans which means you're going to be
causing huge amounts of over-diagnosis and thus over-treatment, which cause
harm.

Hypothetical Bob has his first scan, and it returns a few shadows on his lung.
The doctors ask if he's ever had chicken pox and he doesn't think so but he's
not sure. So, these shadows are probably just scaring from chicken pox. But
maybe they're cancer. The only sure way to tell is for a biopsy. Every medical
intervention carries risk, and because you've increased the numbers of
interventions you've increased the numbers of people falling victim to that
risk.

Bob got a scare; he got an unnecessary medical intervention; he was subjected
to risk: what did Bob gain from this?

The only thing this extra data tells us is "chicken pox sometimes scars the
lungs and they sometimes show up on MRI", which is something we already know.

You do have a good point about the difficulty in getting hold of data to train
AI. Sadly, because of recent missteps in England that's going to continue to
be difficult unless the company can show rigorous protections.

~~~
jedberg
> So, these are not medically indicated scans which means you're going to be
> causing huge amounts of over-diagnosis and thus over-treatment, which cause
> harm.

What if we did something like set up a system where Bob's doctor can put in
other symptoms, and only if one shows up that would indicate a lung MRI would
the doctor be told, "Oh hey, we already did that, here's the MRI, and there
was some shadow on the lung"?

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rozza
My wife has had full body scans every 3 months for the past 3 years. She
currently has multiple active sites of bone mets, from the spine to shoulders
and hips. A single scan is much more convenient and keeps the oncologist up to
date with the state of her cancer.

In our experience sometimes a new cancer site isn't diagnosed quickly,
especially if it's asymptomatic and slow growing. Having past scans and
reviewing them overtime has found multiple tumors so far.

Seems the radiographers err on the side of caution when feeding back to the
Oncologist. Her last cancer in her neck (c2) had been tracked over 3 scans
(because it was small and slow growing), before it was reported back to us and
subsequently treated with cyberknife.

~~~
lighttower
What's the primary Cancer type? I'm assuming multiple myeloma?

~~~
rozza
Breast Cancer HER2+ Currently being treated with Trastuzumab and Pertuzumab
every 3 weeks. Seems to be doing its job keeping down the cancer growth rate.
She also used to have Zoledronic acid at the same time but that caused
osteonecrosis of the jaw, so has been stopped.

Strangely, we're relatively happy with the bone mets. The two times the cancer
hit soft tissue it grew alarmingly quickly. First in the breast, then when it
came back and broke out the L2 vertebrae and wrapped the nerve. At least in
the bone it grows slowly. When it eventually starts to break out, the next
treatment is Trastuzumab emtansine, which is a chemo drug, so will have many
more side effects to manage.

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mbell
I'm curious what affects this will have on false diagnosis and well...patient
sanity. It seems like the majority of people have some sort of benign growth:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008738/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008738/)

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jlpom
MRI are generaly considered safe but my personnal experience contradict this.
I passed a 3T brain MRI (with gadolinium injection for angiography) ~80 days
ago and my life has been seriously painful since then. I have experienced
hypertension (often >170 of systole, seem unrelated but never had high tension
of my life and like the rest of theses issues it appeared exactly after the
MRI), sleep issues, head difficulties to think and head "rigidity",
sexual/erectile disfunction (other side-effets started to dim a bit since
then, but not this one), continuous heat on of my face up to 3 weeks after the
exam. I am not trying to spread FUD but this has unfortunately been my
experience. I'm a fragile kind of person, though I didn't expected it would be
(so) unsettling. YMMV but you may reconsider passing one if you don't have
confidence it would help you diagnosis or find issues (stenosis, neoplasm...).

~~~
ohithereyou
Make sure you report this to both your GP and to the company that makes the
machine. All major MRI machine makers watch for adverse reactions like hawks,
and if there's any way that your experience is an adverse reaction to either
the contrast or the scan they are going to want the details to prevent it from
happening to somebody else.

~~~
jlpom
Thanks for the advice, I will send an email to GE.

~~~
ohithereyou
GE's hotline for suspected adverse reactions is 1-800-654-0118

You can also report to the FDA at 1-800-FDA-1088

(Both of these were the third hit searching for 'report ge mri adverse
reactions' on Google.)

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choppaface
Friend of mine recently got diagnosed with cancer. Has over a dozen golf-ball
sized tumors in his brain, bones, lungs, liver, etc. After 6 months of nagging
pain and pneumonia they finally did a small MRI and saw something odd. Then
they did a full-body MRI and it was very very obvious.

Taking an image can help catch things? No shit Sherlock! I don't care if
doctors can't agree imaging diagnoses sometimes. Time to get better at doing
that. Computers can help. Yes there's a helium shortage, but since when does
healthcare get short-changed?

Aside: there's at least one company looking to make whole-body imaging more
available: [https://q.bio/](https://q.bio/) The founder is a little crazy, but
a good kind of crazy.

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DanBC
Here's the NIHR blog: [https://www.nihr.ac.uk/blogs/does-how-we-detect-the-
spread-o...](https://www.nihr.ac.uk/blogs/does-how-we-detect-the-spread-of-
cancer-need-to-change/11492)

And here's the paper:
[https://www.journalslibrary.nihr.ac.uk/programmes/hta/106801...](https://www.journalslibrary.nihr.ac.uk/programmes/hta/106801/#/)

These are worth reading, they're in more detail than the submitted site. I
recommend NIHR because they're usually short and very readable.

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eutropia
With sufficient software and computational horsepower, a single whole-body MRI
could replace most diagnostic imaging systems, I'd wager. Computer models
regularly outperform radiologists in diagnosing several conditions involving
structural abnormalities.

~~~
nradov
CT scans still have higher resolution than MRI for certain vascular and
cardiac imaging studies. The down side is radiation exposure.

~~~
mattkrause
The new digital CTs are crazy.

We have one that goes down to 90 µm resolution for the whole head.

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anujbatra
> preferred by patients and involving less exposure to radiation

I thought MRIs didn't have any radiation exposure as opposed to X-Rays and CT
scans; unsure about this benefit of less exposure to radiation from 1 whole-
body MRI vs multiple MRIs (should be the same IMO)

~~~
chris_va
Not the greatest article. From another one: "Standard NHS pathways often
involve different imaging techniques - such as CT, PET-CT or focused MRI scans
- which vary in accuracy in different organs."

... so they do targeted scans (with radiation risk) as their normal practice.
That kind of makes sense, since the resolution of those scans is much better
than WB-MRI.

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amelius
What is the state of cancer detection through blood samples?

~~~
jszymborski
There are some cancers where blood biomarkers give us more information than
others, but save for leukemia, I'm unaware of any that are sufficient for
diagnosis.

While still widely, the effectiveness of some blood biomarkers like PSA
(prostate cancer) can be controversial.

So, while I could be wrong since this isn't my area of expertise, there's a
long way to go for most cancers when it comes to blood testing.

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HyperTalk2
How can I get a full body exploratory MRI done? Is this even possible? I've
tried bribing with tens of thousands of dollars and I still get denied.

~~~
mattkrause
If you're likely to benefit from one (e.g., you had cancer), your doctor
should be able to make that happen. Otherwise, it's unlikely to do much for
your health.

If you're just curious to see what your own brain (liver, etc) looks like, you
might want to volunteer for a study at a local university and ask them if you
can get a copy of your own scan. I know one lab that will even show you how to
3D print your brain, if you want.

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jasonhansel
Someone should start a 23andMe but for whole body MRIs (To be clear: I'm
kidding, this is a joke and a terrible idea.)

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joshu
i actually did this a month ago. found no cancer but some surprises that i
have had to react to... you have to be very careful because they can pick up
irrelevant stuff, but i think this will be a huge field in the future.

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wolfi1
There is no mentioning of exposure during MRIs. Is there none? I would have
thought, CTs as well as MRIs are a problem because of exposure.

~~~
mparlane
Because CT scans and MRI scans are very different technologies....

CT = xray

MRI = Magnetic resonance imaging

There is no exposure in an MRI to radiation. The only danger would be having
bits of metal on you or inside you.

~~~
ohithereyou
Specifically ferromagnetic metal. Surgical implants are largely okay, but
there are some neurostimulators that can be a problem.

