Hacker News Reader

Comment by switchbak | Hacker News Reader

"MRIs are actually widely available in most cities at reasonable cost" - I live in one of those first-world countries, and our citizens regularly wait many months if not over a year to get a single MRI scan. Yes, it's not just an issue of the MRI but the entire medical system, but the point still stands. Were there machines that were one or more orders of magnitude cheaper and simpler to run - I think we would see a marked increase in availability.

I agree on your ground-truth desire, and I would hope they've done a lot of that to validate what we see here.

View on HN

Your country has decided to ration MRIs.

Here in Australia, it is a one to two day wait for a MRI. Costs 240 AUD, (160 USD ) for a 1.5 Tesla MRI and AUD 400 for a 3 Tesla MRI just up the road.

And if I mark the request Urgent, I can send a patient 5 minutes up the road and have it done within the hour.

Are you in the UK ? I know that the UK health system has effectively collapsed, due to that country's poverty and chaos.

Even in Sudan the waiting time is less than in your country:

"Due to the ongoing conflict in Sudan, healthcare infrastructure and diagnostic imaging services have faced severe disruptions, with wait times for an MRI now extending from several weeks to months"

As an Australian I've had specialists say improved resolution is leading to over diagnosis and over presentation risks. An argument in the margins and one which loses its force as we learn to interpret finer grained imaging better, do you see this as a valid critique? (The case I last heard of was a future blockage/calcification risk in the carotid which the specialist said was way way too young to act on and would not have been noted before imaging improved)

> do you see this as a valid critique?

It's a valid point to raise, and a point critical of "boutique" medicine practices specialising in insecurities of the rich.

In a nutshell our flesh is rarely homogenous, more often tarnished by odd blemishes and gnarly growths that often amount to naught.

Experienced work a day doctors appreciate seeing odd lumps earlier but refrain from taking any action until some threshold is crossed "for fear of doing greater harm" - the knives that cut things out, the concoctions that burn things away often come with side effects.

Contrasting that, the Lamborghini doctors actively self promoting their genius on 60 Minutes and other Australian paid journaltising media - they're up for any excuse to charge for an "essential procedure" (pinky promise no failures).

Improved resolution is sometimes irrelevant, but the advent of high Telsa scans has improved multiple sclerosis diagnosis and has led to revision of the MacDonald criteria. Particularly the addition of of the central vein sign as an imaging marker and the addition of the paramagnetic rim lesion https://radiopaedia.org/articles/mcdonald-diagnostic-criteri...

As for incidentally found abnormalities, acting on every abnormality is AI level dumb. One has to use Bayesian reasoning and consider risk, context and the likelihood of the lesion being real.

This is in Canada. Our healthcare problems are both well known and well documented, but also strongly resistant to being solved. I do wish we had a system as efficient as what you describe. I’ve personally been on the receiving end of this nonsense. And it is actively costing lives every year. That’s just the tip of the iceberg of course.

No joke, it’s actually a lot easier to schedule an assisted suicide than it is to receive proper treatment in a large number of cases.

I completely agree that's an issue, although more of an economic / public health policy issue than a technical one. There are low field MRI systems, such as the one made by Hyperfine that are, like you say, an order of magnitude cheaper and simpler to run. We should have these everywhere, IMO

https://www.hyperfinemri.com/

MRIs are fundamentally expensive. Yes we can bring the price down a bit, and we can set more money aside for them, but they’ll always be limited by their price.

Even if this technique is much worse (I can certainly believe it is) the price might allow uses that would never be practical with MRI even with the best financial support. For example, ultrasound might be viable for use in GPs or small medical facilities which could never dream of justifying an MRI machine.

Yes totally, and ultrasound already does wonders in that regard. It's a good strategy to focus on the specific use cases that match the strengths of the tech. I think MRI will be useful in validating and mapping out those cases.

Why would they remain fundamentally expensive? It is a fixed machine (so eventually you recoup the investment) and running consumes nothing other than electricity and a paper gown. MRIs cost under $200 in Japan.

> $200

This makes more sense than the comment elsewhere here that says $50.

My guess: It would be a basic scan with minimal sequences and low quality at that price.

Is $200 close to what it costs the hospital, or after subsidies?

$200 is the cost for the hospital, they "resell" it for $750-1500 mostly paid by insurance

With insurance in the US they’re $750 each… As in elbow and wrist on the same arm count separately…

The methods described in the main article refer specifically to neurovascular imaging. In order to have a higher resolution, they’re making use of microbubbles (which need to be prepared and injected just prior to imaging).

There is no world where vascular imaging with a methodology like this is better than what I can do today in a GP clinic with a handheld GE or butterfly (or similar) US probe for anything that matters:

- for dvts and thrombus I can already image them

- if it’s in the brain the last thing that is useful for you to do is fuck around in a small clinic when you should be getting to a major tertiary centre as soon as possible

They are claiming to want to detect CTE which normally is only diagnosable in an autopsy, I thought. Can current MRI do that? Right now we get former NFL players offing themselves with gunshots to the chest, intentionally leaving the brain intact for postmortem scanning, so posterity can figure out what was wrong with them. It's painful to think about.

My impression isn’t that they are trying to improve CTE imaging (did it say that in the article?!) but somehow approach the resolution of being able to run the blood flow data through a black box so they can demonstrate what the occipital cortex is processing. I mean, that’s literally the first part of the article?

Can MRI/CT demonstrate CTE.

Well, like a lot of things which as alzheimers, that is still a pathological diagnosis for the most part, to the best of my knowledge (not post mortem scanning but out some brain tissue on a slide), but this belies the general fact that getting the tissue diagnosis is really not that important to anyone except a pedant, because yes MRI will show changes in grey/white matter differentiation and size compared to age and sex weighted cohort; and CT will show similar; and in fact it is the history and examination that practically matter to both the patients and their family.

So while it’s nice to have a totally 100% bulletproof ‘diagnosis’ for labelling purposes, practically on history and exam it’s not going to change how they are managed or what they and their family do say to day; given that both CTE and basically any of the dementias don’t have any treatment associated with them, and the current neuro imaging we have can deliver much higher resolution than what this is promising anyway (I mean even CT angio, and it’s not using ‘advanced imaging processes’ to create data out of noise)

Many months to a year for an MRI? Wow, in the USA, we can get MRI's the same day or at worst case, week. It's been that way for a decade or more.

> Wow, in the USA, we can get MRI's the same day or at worst case, week.

You can. And the cost is higher than almost anywhere on earth.

You can get them quickly in most places with a publically funded healthcare system, it’s just that a priority patient is very very sick and you never want to be that person.

Scarcity demands some means of rationing out the product. Setting higher prices is one means of doing this, so only those with some means of paying can get it. Another approach is via wait times, where only those who can wait and afford the time penalty can get it. There are other variations, but there's no such thing as a free lunch.

The scarcity comes from waiting to get preapproval from your physician and health insurance. If you are willing to pay out of pocket, there are many private MRI clinics that will scan you to your heart's content, as quickly as you want, as long as the payment clears.

Granted, anything you find in that reading won't be accepted by your physician or insurance company, so it's more of a checkup for you and you alone. And most scans will find something anomalous. We're all asymmetrical and lumpy. so take that as you will.

> anything you find in that reading won't be accepted by your physician or insurance company,

Surely that it isn't the norm? Where do you live that the (I assume government run) health system dismisses evidence when its collection wasn't sanctioned by official channels?

They are mistaken. I am a practicing radiologist in the US. We regularly work-up findings from private pay whole body screening MRIs and the workups are covered by insurance.

The scarcity comes from there only being a finite number of the devices.

But I was really speaking more broadly, about healthcare in general. There are only so many doctors, so many MRIs, so many heart surgeons, so many this or that. Giving everyone a bunch of extra money so they could pay the current prices doesn't do anything to address the scarcity, so everyone flush with those subsidies will just bid up the prices - which is exactly what happened.

Reply on news.ycombinator.com