Comment by p0pularopinion
7 days ago
The problem is that just because you‘re detecting something, it does not mean it is worth watching. Bodies are not standardized and most people habe something off. But you can‘t really reschedule everybody constantly, as that would entirely break the concept.
"Worth watching" implies that watching is expensive. It's really not. A full-body MRI scan is about $1k, and it can be even cheaper.
So if you have abnormal findings in 10% of patients that merit follow-up scans, you can trivially do a series of 3-4 scans without affecting the overall cost too much.
Doctors simply need to get out of the headspace where MRIs are extremely scarce tools of last resort and treat them like we treat blood tests.
I totally agree. US healthcare is broken and costs aren't tied to the reality of how expensive something actually is. I have very high hopes that modern medicine is in for a massive disruptive change where things like full body MRI, along with analysis, could be done very cheap and with no admin overhead. In that model 'we see something we aren't sure of. It is probably nothing but to be sure we want to do follow-ups' is far less of a problem.
A lot of this however is how it is discussed with the patient. Discussions about the likelihood of there being a real issue when something is seen need to be clear and informative without being alarming. 'We did a routine scan and these often show transient artifacts that turn out to be nothing, but in an abundance of caution we want to do a followup' is totally different than 'we saw something we are concerned about and need to do a followup'. How things are messaged really matters.
> MRIs are extremely scarce tools of last resort and treat them like we treat blood tests.
How would this work?
I can do a blood test and send it to the lab to be processed in ~5 minutes from the moment I meet the patient. Consumable costs are about $2.
I can also do an MR scan. It took a fair bit of training and the scanner and scan room cost about US$2 million. Service contracts on the scanner, scan room, chillers and required staffing utterly dwarf the cost of the scanner over its lifetime.
The scan takes 20-75 minutes. Then the images get sent for reporting. Unlike a blood test, reporting isn’t automated. Even if it was, how could availability of MR ever be similar to a blood test?
> I can do a blood test and send it to the lab to be processed in ~5 minutes from the moment I meet the patient. Consumable costs are about $2.
This depends on a blood test. Bacteria cultures or PCR tests still take more time.
A mid-range scanner costs $500k, the room itself indeed might cost more. Just as real estate. Scanners are just not scarce anymore, there are even sites that sell used ones: https://prizmedimaging.com/collections/mri-equipment (I now want one in my backyard...)
You can lease a new top-level device at around $30k per month: https://www.meridianleasing.com/equipment/medical/mri-machin...
So you're looking at maybe $1k a day that you need to pay towards the device cost. The consumables (helium) are pretty negligible.
A full-body scan is about 1 hour. But for a follow-up you will need to focus only on a few areas, reducing that to maybe 20 minutes. So one device can feasibly do 10 primary scans a day and 20-30 follow-ups. So the cost of the device itself becomes on the order of $100 per imaging session.
This is literally in the "blood test" expenses range.
> Unlike a blood test, reporting isn’t automated.
Radiology readings is one thing where AI is already making inroads. And radiologists can be located anywhere, it's a perfectly remotable job.
> Even if it was, how could availability of MR ever be similar to a blood test?
Yeah, indeed. How can we imagine that people will have computers on their _desks_ when even a small IBM takes half a building?
Mass production happened. And this time it has taken the industry completely by surprise.
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I think you're missing the point. The psychological cost of a conditional-positive result is nonzero, and can be very significant (I speak from a little bit of experience here). But far more importantly: the physiological cost of invasive followups when you eventually trip the threshold of "time to go explore with a scalpel" is very high, and the missing evidence this story is about is whether you can get to that threshold with an MRI.
Treating MRIs the way we treat blood tests would almost certainly result in huge numbers of needless invasive procedures.
> Treating MRIs the way we treat blood tests would almost certainly result in huge numbers of needless invasive procedures.
Again, _all_ you need to do is to make a follow-up scan in 1-3 months to see if there are any changes. It's a preventative tool, so unless you have other indications, it's almost always safe to wait for a bit.
And yes, it requires educating patients that sometimes just waiting and doing a follow-up scan is right. And yes, I also have a personal experience with that (I had an "idiopathic lymphadenopathy", aka "we don't know WTF is going on").
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This is pretty much what the experts say:
https://www.ranzcr.com/college/document-library/2024-positio...