I used Claude Code to get a second opinion on my MRI

The finer detail (which you may already know) is more complicated.

MR does ‘2D’ scans which are a slice, then a gap of non-imaged tissue (typically 10% the slice thickness) then a slice. Each slice is an image with a number of pixels, say 320. Each pixel in the slice is small, eg 0.5mm but very thick due to the slice being thick, which is required for MRI signal. The pixels are 3mm in the shoulder scan done here.

‘3D’ scans don’t have a gap between slices, and are often isotopic, meaning the same resolution in all directions. The voxel (a pixel with depth) would be something like 1mm x 1mm x 1mm.

3D scans are slow, prone to movement artifact and never as pretty in plane as a good 2D. You can reformat them to look ok in any plane.

LLMs are the best PDF-to-markdown converters, in my experience. I have a CLI that converts PDF to PNG, then run a background agent to "read" each PNG and write it down as markdown; it works flawlessly even for complex math formulas, it can "translate" complex charts, graphs, and tables into words.

It's slow and arguably expensive compared to traditional OCR, but very effective and precise.

> They performed shockwave therapy on my shoulder even though a recent clinical practice guideline says clinicians should not use or recommend shockwave therapy for rotator-cuff tendinopathy without calcification; I was told during ultrasound that there was no calcification.

Ultrasound isn't a great way to assess for calcification. It'll find large calcification but easily miss small ones. Plain radiograph would be more helpful, but the MRI may have revealed it as well. Either way, shockwave therapy isn't harmful in the absence of calcification--it's just not helpful.

Edit: when a radiology report says something isn't present, there's always an implicit caveat that the finding isn't present within the context of the modality and images obtained. So an ultrasound report can state there are no calcifications while a plain radiograph can report the presence of calcifications without being inconsistent. Obviously very confusing to patients and people unfamiliar with medical jargon, but clarifying this in reports would make them sound even more qualified, "hedgey", and annoying to read than they already are.

Edit: I should mention that ultrasound is basically unusable for evaluating bones. Sound waves can't penetrate bone, and so you end up just seeing a huge black void. That's a huge orthopedics use case that ultrasound just can't benefit. However, ultrasound is fantastic for evaluating muscles, ligaments, tendons, and other superficial soft tissues.

Since MRIs are more expensive, private doctor's might order them instead of an ultrasounds.

(I'm a doctor)

Given the skill involved, it's probably a liability concern they don't want the exposure over there.

Spoiler: because it hurts like hell.

Both inductive and abductive reasoning would say that just because something hurts that doesn't mean that everything that hurts is that thing.

Any comment that doesn't start with this or similar qulaification should be taken with a grain of salt (yes, including this one).

Medical imaging is one of those things everyone thinks is simple because they don't know what they don't know. I'm a cardiac sonographer, and I have to assume radiologists hear at least as many eye-rolling takes on AI coming for their job as I do.

Full sarcasm, is there one that’s that’s more immune?

I know my anatomy and etc and have done a short stint in ultrasound. I have no idea what you are doing or looking at and can identify pretty much nothing.

Echo techs are going to be around a lot longer than MR techs.

This is being overly nice, I think. Anyone who doesn't understand this is an idiot imo. You would have to assume that every type of diagnosis instrument has infinite clarity and is always correct to be confused in this case.

Reminds me of the Babbage quote where somebody asked him, if I put the wrong question into this computing device, will it still give me the right answer? His response, paraphrased "I can not fathom the logic of the minds which would come up with such a question".

Would have also been a fair point if Babbage had channeled his inner techbro and insisted it would directly replace human calculators; simple machines like Babbage's will chug along blindly on obviously erroneous data, but humans for all their sloppiness can often backtrack on errors.

Well, he did diagnose the situation correctly. He couldn't comprehend the confusion of ideas that provoked the question.

I'm also not entirely sure it's an odd question to ask. To this day, users are surprised when their software produces garbage output instead of failing. Perhaps the members of parliament were expecting some form of input validation or sanity checking out output.

I suspect their sarcasm might have escaped Babbage who seems to have been on what we now call "the spectrum."

Isn’t there a saying about there being no stupid questions, only stupid answers or something?

I disagree. A priori it's not obvious to a layperson whether or not a statement that uses unconditional phrasing is intended to be authoritative or conditional on something unspecified, like the resolution of the measuring device. This goes for any sufficiently technical field.

If you got the brakes checked on your car, and the mechanic did <something> and told you there are no issues with them, and you then took your car to a different mechanic who did <something else> and told you there is a problem, you would not be an idiot for thinking that these conclusions contradict one another.

I don’t think that’s true. Avoiding this mistake requires knowing that an ultrasound may not detect calcification. For a patient reading their own report, I don’t think that’s intuitive. I would expect most people to read “no calcifications” and assume that their joint has no calcifications.

If a report states that X was not found, it does not mean X did not exist, it means it was not found.

What may be lost on the layperson is the nuance and understanding of how thorough or not a particular scan is and how much weight to give the findings and thus the odds that the report is correct.

Yah you can argue that the tool is not ideal for that diagnostic, yadda yadda. I get it, and in the end I agree with the subtle difference you highlight, because it is something that makes sense to a certain kind of people. You know how many medics would read the report exactly like the author did? Too many.

How do I know? Im not in a wheelchair after being constantly misdiagnosed by using the wrong imagiology technique by (mostly) chance, and a good help from friends, including a surgeon. This seems to be a case where AI would be a valuable doctor tool for differential diagnosis; instead we have know-it-alls that can't bother to verify, and AI that often gets details wrong. That is the problem.

That might be true, but it is definitely not the world we live in.

And I think we can easily have examples where we can reasonably trust this, and a spectrum of such.

E.g. there is a math solution and the report says "there is no errors in this solution", you would imagine that to be quite reliable, no?

Even then, the context that "ultrasound isn't a great way to assess for calcification" is important when reading either statement. Laypeople don't necessarily have that context.

I’m fairly sure that there are no lions in my house. Lions are quite large and I’m capable of detecting lion sized objects with my eyes.

To demonstrate that something is not present you first define the object, then come up with a test that will reliably detect the object. If the test comes back negative then the object is not there.

In a strict philosophical sense I cannot prove that there are no lions in my house, the external world might not exist! A hypothesis that no one has thought of might be correct and that hypothesis could show that there are invisible lions in my house!

However I intend to act with the certainty that there are no lions in my house. Because I have no evidence of lions in my house.

Absence of evidence is evidence of absence.

My internal model is/was “if the scan wasn’t set up / can’t detect the thing, why would the statement be present at all?”.

That implicit assumption is really subtle.

There's a difference between 99.9% clarity and 50% clarity. Even if neither exactly equals 100%, it's understandable that a layperson would expect different language between them

Even if this is true, so what?

Idiots get sick at least as often as others, and the medical system needs to work as well as it can for that population too.

> seriously underdeveloped

What's the difference?

[1] https://www.nature.com/articles/s41591-026-04501-8

Someone on reddit claiming to be a radiologist claimed that.

I wonder where the savings will go when those jobs are gone.

The radiologist I know does not, but they are paid very well (and these numbers are always dumb when you're not sure if they're living in Manhattan vs literally anywhere in Kentucky)

Like most medicine, a large % of the job could be done by any decently talented person willing to follow instructions and shadow for a few months.

Like most medicine, the remaining % is what you're paying for, because it is literally life and death and you can't do things like "pull the logs" or "lets turn it off and take it apart" or "huh i need to put this down and come back later". Even in radiology, because "well lets just do it again to be sure" is often not a viable option.

While there is a problem in how we have inflated the cost of education for medical fields, the insane health insurance issues (US obviously, but it does have some effect globally when the expert radiologist you hire from the US to help with research costs that much), and probably some better ways to approach splitting the work for the entire field, like most professions dealing in life or death, medicine likely will always be paid well.

You would think that the AI would point out that calcium is best demonstrated on Radiographs/CT imaging vs Ultrasound or something to that effect.

Between the toes and the below the knee amputation, there were no less than 15 different doctors and PAs / related personnel who COULD NOT COME TO A CONSENSUS. They would just tell my mother and I (PoA) the details; they refused to come up with a singular plan of action moving forward, leaving it up to us to make 'an informed decision,' something that's IMPOSSIBLE when you have to take up to 15 different opinions into consideration.

What exactly are we supposed to do as patients/family members when medical personnel cannot give reasonable paths forward and instead just throw a bunch of shit over the fence at you and tell you, "you decide what to do from here," regardless of how many VERY DIRECT conversations I had w/the 'care team' on doing better to provide a limited array of options and reasons/likelihood of 'positive outcomes'.

I'm used to dealing with a wide variety of stakeholders/SMEs in decision-making; it's my job to apply my extensive industry experience to present our clients with their options, ranked and reasoned. Doctors, in my experience and most recently with my father, clearly do NOT do that (I assume due to liability; but, no real idea, honestly). So; when dealing with LIFE CHANGING circumstances, what are we supposed to do except rely on what might be able to offer more analysis and option narrowing w/AI?

I certainly don't want to make the job of medical staff more difficult by putting out crazy theories I found on the interwebbernets through my own research, etc; but, when we're having to deal with uncertainty and insanity, what else can we do?

All of the above was intertwined with brief stints with doctors that would just berate her for being a painkiller junkie, even though she hated the stuff and just wanted to find/fix the problem.

Kind of a rant, really. I'm not sure how to tie it back into AI. I do wish we had AI at the time so that we could at least cross-check, but I also understand that doctors are already sick of patients self-diagnosing on the web and that AI probably just makes that worse. At the same time, if our medical system could catch up a bit (more doctors? less corruption/paperwork? not sure what it needs) then maybe people would be less inclined to take matters into their own hands.

AI is absolutely a god send for patients navigating the medical system.

I know the US system is horrible and I sympathize with doctors doing their best within it. But we must admit, they are also responsible for the countless stories just like yours, and have contributed to the public's deteriorating trust of medical institutions. It's not just the insurance companies and conglomerate CEOs.

P. S. Opiates work, very well. If you tale one and it doesn't work, you might also be allergic. Hydro didnt really work, then itching and puking started after 2 days of untouched pain(essentially, a reduction of 2 points). Codeine nausea.

I wasn't aware of the possibility.

I empathize with you as my grandmother is also being what feels like gaslit by several doctors being told her symptoms are dementia and not from the chronic UTI’s she suffers from, but when the UTI’s clear all of a sudden no symptoms. Our medical system is very frustrating, between doctors who don’t have the time needed for complicated cases, or the threat of every patient suing them causing them to be overly cautious.

I think as long as you’re aware of the pitfalls of AI, as you seem to be, it’s a solid tool for helping to understand medical situations with the right amount of double checking.

I don’t think our system will improve until 1) We increase the amount of doctors in our country and tell Congress to quit limiting the amount we can train yearly, and 2) the system of liability for doctors is changed to be more like New Zealand’s where their liability insurance is nationalized and they’re not at constant threat of losing everything to a lawsuit over a patient who wouldn’t take their meds and got worse (the cases are generally much more complex than that, but the idea is it’s not always the doctors fault as media would have us believe).

The problem is these are just statistical models at the end of the day, so you need to know something to be able to identify the errors. You can’t let them really be autonomous and you also can’t really have people turn into glorified approvers. If the machine is correct 89% of the time, you cannot make people responsible for that 11%. It’ll just cause automation fatigue.

tl;dr: the actual use cases of these LLM (or generative AI in general) is rather limited, so it is offensive how much hay has been given to them eating the entire capitalist system. They are not fit for purpose.

The human experts are literally just a trained biological neural network. In this domain they are not capable of anything a computer can't already do.

Humans can identify. A computer vision model can return a statistical value. Both can make errors, but these errors are orthogonal to how we work and what is being asked of them. I think a CV model can absolutely provide value as augmentation. Identifying possible misses or a different diagnosis worth considering, but that is not what is being asked of them here. The pitch by Altman and Amodei is not to say, “This tool that might cost $1,000/month can help increase the accuracy of your diagnoses by 10%,” instead it’s, “This tool can allow you to keep 10% of your workers to monitor it and you can fire the rest. Also, the workers carry all the liability.”

> The human experts are literally just a trained biological neural network. In this domain they are not capable of anything a computer can't already do.

People need to stop making this baseless claim. Human beings are not stochastic computing devices, we are not neural networks. We don’t fully understand human cognition and intelligence. I have the highest confidence we will figure it out one day, though.

Yes, neural networks were based on a superficial view of the human brain, that’s it. For instance, it is biological impossible for the human brain to do backpropagation, which is kind of important for a modern neural net.

This really rubs me the wrong way because it's objectively false, but people keep bring it up because I think people want it to be true rather than accepting generative AI for what it is: a tool with a bunch of caveats.

Also disagreement among human radiologists has been documented for decades, so the clean expert baseline you're defending doesn't actually exist outside this argument.

When the identifiers pass human-detection-rate percentages, it will most likely be cheaper to hire a fall-guy for the liability with a much smaller salary, I think this will be a big market in fact.

I also didn't say anything about whatever Altman or any specific company is doing.

The simple fact is that we send humans to school for years to learn to read and classify these things. It's something computers will be able to do strictly better.

I don’t think there’s any evidence that’s true.

If we would allow AIs to be trained on the petabytes of medical data hidden in hospital systems, they would most likely be much better at diagnosing illnesses and conditions than the average doctor.

(Justifiable) Privacy around medical records so far prevents this.

You think you're cheering for humans, but in fact you are gatekeeping healthcare.

It would be like the sum of all medical professors in existence.