Recapping RSNA(i)18

Key Takeaways

  • Fear of AI has given way to exuberant optimism/anticipation/impatience.
  • Many vendors are trying to pivot their legacy products as next-generation AI platforms/marketplaces.
  • Confidence in AI performance will only come with independent validation.
  • Cloud has faded to the background.
  • Not everything about AI is good news, adversarial attacks could bring about a new era in cyber-security concerns for providers.

Over the course of the last 18 months artificial intelligence (AI) has matured to the point where there are several viable vendor options for nearly every use case.

AI dominated every aspect of the annual gathering of the Radiological Society of North America (RSNA18) in Chicago. Self-described ‘machine learning’ vendors with a presence on the conference floor more than doubled from 49 in 2017 to over 100 in 2018, 25 of which were first-time presenters.

I moderated a panel hosted by Life Image on practical uses cases of imaging AI and was blown away by the conversation that ensued, particularly what I learned about how the veteran radiologists feel about being “replaced.” During the question period, a senior radiologist approached the microphone to address a comment made by a more junior radiologist on the panel which he interpreted to be too pessimistic about the potential for AI. To paraphrase the elder, “Listen here sonny, you are too young to fully appreciate what you don’t know, and you don’t know how many mistakes you are truly making on a day to day basis. 1-2 percent error rate due to fatigue alone. WE NEED AI to save us from ourselves.”

Not all old school radiologists are so optimistic: “When you’re going up the ride, you get excited,” noted University of Chicago radiologist Paul Chang said during his workshop on AI. “But then right at the top, before you are about to go down, you have that moment of clarity—‘What am I getting myself into?’—and that’s where we are now. We are upon that crest of magical hype and we are about to get the trench of disillusionment… It is worth the rollercoaster of hype. But I’m here to tell you that it’s going to take longer than you think.”

The cloud fades to the background

Last year, the major cloud vendors each had a significant footprint at RSNA, but this year the two largest, Amazon and Microsoft, were nowhere to be found. Only Google Cloud had a significant, if smaller than last year’s, presence. Donny Cheung, one of the Google Cloud team leaders, was on the panel I moderated and his message to the imaging community could be boiled down to two words: storage and compute. No dashboards or toolkits or tensorflowing, just storage and compute, a smart and refreshing strategy amidst the obvious feature creep many other vendors suffer from.

Over the course of the last 18 months artificial intelligence has matured to the point where there are several viable vendor options for nearly every use case.

What’s Facebook doing here??

While it was surprising that Amazon had no noticeable presence, it was even more surprising to find Facebook making news on the conference floor. Facebook AI Research (FAIR) has partnered with the Center for Advanced Imaging Innovation and Research (CAI2R) in the Department of Radiology at NYU School of Medicine and NYU Langone Health to release the fastMRI, an open source dataset for training and testing machine learning algorithms to reconstruct MRI images.

This offering is roughly equivalent to similar X-Ray and CT datasets released by NIH. Given that algorithms ALWAYS significantly outperform on all metrics against the data used to train them versus new data, the industry needs independent validation of AI claims so it is unlikely that Facebook moves the needle with this offering.

Platforms abound

PACS vendors want to get in on the AI action by positioning their existing products as AI marketplaces or platforms (Philips HealthSuite Insights, PureWeb, LifeImage, GE Edison, FujiFilm REiLI, Nuance AI Marketplace, Blackford Analysis). Nuance has shown there is a viable market for these platforms, counting 40 startups and health systems among user groups for its marketplace. There is no shortage of startups taking this approach (MDW,, Medimsight, Lify, Fovia). Imaging hardware vendors refused to be left out too, with many partnering with AI vendors to embed their algorithms on the “edge.”

AI is global

International AI startups, particularly from Israel, China, and South Korea, stood out from the crowd in terms of their approach to product design, but only the companies from Israel have been able to break into the US market so far. One Korean company voiced frustration with the FDA, saying it couldn’t understand what was wrong with their application. I wonder if it underestimates the importance of using data from US patients to validate their algorithms?

Some cautionary tales were told…

Not everything we learned about AI at RSNA was positive. A paper presented at the conference showed that neural networks could be used to insert malignant features into mammograms giving a false positives, and then reverse the alterations without detection. Even scarier, it took about 680 images to train the algorithm that executed the adversarial attack. Cyberattacks have been increasing in healthcare over the last couple years, but mostly just for taking data hostage and demanding ransom to get it unencrypted. This type of attack would represent a frightening new paradigm in cyber-vulnerability, and it is certainly not difficult to imagine ways this could be exploited to make money. It could be used for a different sort of ransom, with every image appearing to show cancer until a ransom is paid and the adversarial attack is reversed. Another conceivable way this type of attack could be exploited would be falsifying data for clinical trials.

Stay up to the minute.

Did You Know?

Merging Outsourced Services with Software

Merge Healthcare, a company that was once a darling in the Business 2.0 community has fallen from its lofty perch and is now struggling to stay viable in the rapidly changing medical imaging market.

Despite current financial woes, the company will demonstrate at next week’s big industry confab, RSNA, a new solution combining software, Merge TeleRead, with offshore radiology consulting services, Consult PreRead. While it appears that each can be purchased separately, there are no strict dependencies between the two, Merge sees customers getting the greatest value from using both concurrently: TeleRead for workflow and communication, Consult PreRead to do initial imaging analysis and reporting.

While this may appear at first glance to be a nice combination, I’m not too convinced that this will provide much uplift to Merge’s anemic sales. First, the TeleRead solution appears to be a simple workflow solution that just about every RIS/PACs vendor worth their salt already has in their product suite.  Secondly, the Consult PreRead leverages a trend that has been occurring for some time in the radiology sector – tapping into cheaper, offshore resources to supplement internal ones. Did a quick search of exhibitors at RSNA’07 and there are literally dozens of providers of such services exhibiting at RSNA. Don’t see why Merge would be any different than these other outsourcing service providers and seriously doubt Merge will be cost competitive with them.

Probably the best part of this long-winded press release were the quotes from their consulting physician:

I have been in radiology for over twenty years, and I believe that this is an industry-changing capability,” said Steven Mendelsohn, MD, a U.S. based radiologist who has been a clinical advisor in the Merge Teleradiology clinical beta tests. “I am impressed with the workflow and technology, and the medical acumen, technical accuracy and communication skills of the offshore radiologists. I am confident that this is the impetus for a new way of doing business and improving clinical efficacy in radiology.

Is it all that surprising that a consulting physician would speak positively about a vendor’s product?  Seriously, after what we saw with the orthopedic surgeons and their consulting contracts, there’s some big money to be made here and doubt if any “consulting physician” would ever speak poorly of a company that they are advising – that’s just plain “biting the hand that feeds you.” But in all fairness to the physician, he probably didn’t even fabricate the quote but was provided one by the PR department for him to sign-off on.