Incidental Pain and Suffering

From Matthew Davenport’s upcoming article in AJR, “Incidental Findings and Low-Value Care“:

It is increasingly recognized that incidental findings are incompletely understood, expensive, and surprisingly harmful. Rather than a benefit of imaging, they are usually a harm. They are not sought, the odds of them being important is low, and they create tremendous uncertainty and low-value care.

A good primer on an often unintuitive and yet incredibly important problem in medical diagnostics (both for radiologists and clinicians).

The ABR Finesses its Bylaws

A few years ago I published my deep dive into the bylaws of the American Board of Radiology. Bylaws are boring, dry documents that most people don’t care about and even fewer read. But they do shed light on the culture of an organization and its priorities. The ABR’s were comically nefarious. For example, their old conflict of interest policy (emphasis mine):

It is the policy of this Corporation that the legal duty of loyalty owed to this Corporation by a Governor serving on the Board of Governors of this Corporation requires the Governor to act in the best interests of this Corporation, even if discharging that duty requires the Governor to support actions that might be contrary to the views, interests, policies, or actions of another organization of which the Governor is a member, or to the discipline of which the Governor is a member. Consistent with a Governor’s duty of loyalty, a person serving as a Governor of this Corporation does not serve or act as the “representative” of any other organization, and his or her “constituency” as a Governor of this Corporation is solely this Corporation and is not any other organization or its members.

The ABR approved an update to their bylaws on November 2, 2022 (available here), and they’ve finessed that bit by removing the bolded language above. It now reads:

It is the policy of this Corporation that the legal duty of loyalty owed to this Corporation by an individual while serving in the capacity as a member of the Board of Governors or Board of Trustees requires the individual to act in the best interests of this Corporation. Consistent with the duty of loyalty, a person serving as a member of the Board of Governors or Board of Trustees does not serve or act as the “representative” of any other organization, and said member’s “constituency” as a member of the Board of Governors or Board of Trustees of this Corporation is solely this Corporation and is not any other organization or its members.

So they’ve removed that choice verbiage requiring selling out radiology itself in the interest of the ABR: “even if discharging that duty requires the Governor to support actions that might be contrary to the views, interests, policies, or actions of another organization of which the Governor is a member, or to the discipline of which the Governor is a member.”

Good for them.

On a related note, in case you’re wondering, the composition of the “executive compensation committee” is unchanged:

Executive Compensation Committee. The Executive Compensation Committee will carry out the Board of Governors’ responsibilities for designing, managing and annually reviewing Executive compensation and the Executive compensation policy. This committee will consist of the President, President Elect, and at least one (1) additional member from the Board of Governors appointed by the President. The President will chair the committee.

As I mused in my previous post:

I love that the committee that handles executive compensation is chaired by the president and then attended by the president-elect and “at least one additional” presidential appointee. Good thing that a conflict of interest for the ABR is just when a Governor cares about something outside of the ABR.

Asking AI about AI in Medicine

I had a brief chat with the OpenAI ChatGPT about noise, radiology, and AI in medicine:

Human: Summarize the book Noise by Daniel Kahneman
AI: Noise by Daniel Kahneman is a book that examines how our minds work in a noisy, uncertain world. It dives into the cognitive biases and heuristics we use to make decisions with limited information, and explains how they can lead us astray. The book covers topics such as perception, intuition, and decision-making, and explores how noise and confusion can shape our lives and our thinking.

Human: How does the book argue that noise impacts radiology?
AI: In Noise, Daniel Kahneman argues that noise can have a major impact on radiology. He explains that radiologists are often subject to cognitive biases like confirmation bias and anchoring bias, which can lead them to make decisions that are not in the best interest of their patients. Additionally, he shows how noise can affect diagnostic accuracy and decision-making, making it harder for radiologists to provide accurate treatments and diagnoses.

Human: How could radiology address those limitations?
AI: Radiologists can address the limitations of noise in radiology by taking steps to reduce cognitive biases and increase accuracy. These steps include utilizing evidence-based decision-making, double-checking results for accuracy, and employing advanced imaging technologies such as computer-aided detection systems. Additionally, radiologists should strive to keep up with advances in medical technology and imaging techniques so that they can identify any noise or errors in their images.

Human: What are the current limitations in utilizing AI in radiology?
AI: Currently, one of the biggest limitations in utilizing AI in radiology is the potential for errors and false positives. While AI systems have the potential to be more accurate than human radiologists, there is still a risk that the AI system will miss diagnoses or misinterpret images. Additionally, AI systems can be costly to implement, and require significant computing power, which may not be feasible in many medical settings.

Human: What would be the easiest type of medicine to outsource to AI?
AI: The easiest type of medicine to outsource to AI would be administrative tasks such as scheduling appointments and completing insurance forms. AI can quickly and accurately complete these types of tasks, saving time and resources for medical professionals.

Even the machines think there’s some low-hanging fruit out there.

ABR soliciting nominations for its Board of Governors

The bylaws of the American Board of Radiology are interesting. I’ve written about them here, and you should read that post. Go ahead, I’ll wait.

Relevent to an email blast the ABR sent out this week is section 4.3:

Section 4.3. Election of Governors. Nominees shall be solicited from the Board of Trustees and Board of Governors, and may be solicited from any appropriate professional organization. Professional organizations shall provide such nominations in writing. An affirmative vote of at least three-fourths (3/4ths) of the entire Board of Governors shall be necessary for the election of any nominee to the Board of Governors.

The Board of Governors is the main decision-making body of the ABR. Historically, as you might surmise, it’s been a pretty insular group. The people already in charge nominate their friends and colleagues, most of whom have already put in the time and effort to earn a place in this upper echelon through years of service to the organization.

As I wrote in that post:

If you didn’t know, there are currently 8 Governors, and they basically run the show. Lincoln’s famous “team of rivals” approach this is not. The current people in power shall nominate their replacements and other organizations may, but the key for any hopeful member is making sure that you fit in with the cool kids, essentially guaranteeing that no one with substantially differing views would ever make it to the upper echelon.

On November 7, the ABR sent an email out to all diplomates (people who are board-certified):

The American Board of Radiology (ABR) is seeking interested candidates to serve on its Board of Governors. The Board of Governors discharges the fiduciary duties of the Board through its oversight of the business and affairs of the ABR.

The ABR recognizes the benefits inherent in a diverse community and seeks individuals with varied experiences, perspectives, and backgrounds. Interested candidates must be board certified by the ABR and willing to participate in Continuing Certification (MOC). Those from nonacademic practice environments are especially encouraged to apply.

And the nomination process for those interested candidates?

Nomination Process: Interested candidates should send a curriculum vitae and a letter of interest before November 15, 2022, to Brent Wagner, MD, ABR Executive Director (bwagner@theabr.org).

How about that.

Now presumably the actually election process is still the same (as is the impressive Conflict of Interest policy), but I believe this is the first time the ABR has publicly asked for all-comers. Now that doesn’t mean they’ll actually take any of those candidates seriously or that such candidates would ever comprise more than a single spot on the board, but—nonetheless—I would encourage anyone interested to apply.