In my opinion [0] a much more interesting track to pursue than super high-T scans that only work on mice (dead mice at that) is low field MRI scanning. MRI is amazing, but incredibly bulky and slow. In Canada you have to live for 6 months with a knee injury before surgery just because of the wait to access an MRI. Companies like Hyperfine (not affiliated) and Deepspin (just learned of them) make low power portable machines (I believe NFL teams were early costumers).
A single MRI image is not super helpful, still more art than science, the real benefit comes from having periodic scans against a baseline. Boutique health clinics offer yearly scans to high net-worth individuals, rolling this out to a larger population could have a huge impact.
[0] educated opinion, I also collaborated on a PNAS MRI paper
> A single MRI image is not super helpful, still more art than science, the real benefit comes from having periodic scans against a baseline.
An MR when someone has a problem is pretty helpful.
Screening MR is not really a good thing except in a very narrow range of conditions - you just generate unnecessary procedures, more imaging and stress.
In regard to low field MR, the likes of Siemens Deep Resolve and their low field magnet (0.55T) have taken this a long way, and really improves image quality. It looks useful for imaging around implants and metal.
If you have a major issue, say a tumor, MRI is great, but for smaller things I agree with you that a single image is not great for a quantitative assessment. What does have a lot of value is when you have a baseline image and you perform yearly scans that are compared against each other (similar to how carotid ultrasounds are used for cholesterol assessment)
> In asia you can walk into a clinic and see a doctor in 30m
... If you're rich relative to the general population, then you can go to an expensive private clinic and be seen quickly, yes.
I doubt that's the case for public hospitals and in any case, I've been inside public hospitals in Indonesia, Cambodia, and Vietnam (all for other people's needs, nothing major thankfully). Trust me, you do not want to get treated in one of those and as a westerner you'll never even see them unless you friend gets bitten by a monkey in the Cambodian jungle (for example) and there's no private clinics nearby. I always assumed the casual attitude towards hygiene that Asian people have wouldn't extend to hospitals. I was wrong. There were literally blood stains on the wall in the corridor. The toilet was a hole in the ground with a bucket of water and a scoop to wash your hands and ass with. There was no soap. This wasn't a small hospital, it was the main hospital for a city of about 200k people.
Back when I lived in Japan, my employer-sponsored yearly health screening had an optional head MRI exam. I could book it a few days before, and would take 15 minutes with a single technician.
This is a really weird claim to me. It can’t be about the MRI itself, it must be about the surrounding politics or legal environment.
How can it ever be bad to have more objective data? Having a test result to ignore is still strictly better than not testing at all. You still have the option to ignore or discount the test results if you want to. If you’re forced to do otherwise that’s entirely a human problem, not a technological one.
If MRIs lead to unnecessary biopsies, then don’t do the biopsy. What exactly does the data show? If doing a test leads to an unnecessary biopsy, how can it be the test’s fault? Tests aren’t moral agents. The MRI machine can’t make any healthcare decisions for anyone.
That’s a problem with the interpretation, and how results are presented to patients. The MRI scanner is working as intended but the humans are getting the probabilities wrong, as usual.
Specificity is not always high. Yes, it’s an interpretation issue, but it’s a know problem. A better radiologist might help, but the issue is that many things look the same or very very similar on MRI.
Evidence based medicine is the way to go.
It’s not terribly expensive. Most scans cost under $100 at the top facility in the wealthy part of Delhi. The cost would be 20-30% lower at centers in cheaper parts of the city.
Delhi’s nominal per capita income is north of $6k. Even if you’re plain average, a $60-80 one time scan is within reach.
Edit: replied to completely wrong comment. Below was supposed to go to one comment above.
Government rate is $120 per imaging session, with standard 1/3 deductible. Minimum wage in Tokyo at this moment is $1336, so more like 3-5% after additional diagnosis and fees.
Just the scanner install, service contract and chilling is 6 figures, and the staffing is a significant sum. Maybe the throughout is very high (scan quality low)?
You wont pay many bills with 10 MRs a day even if your staff are cheap. They must be doing 50ish. And I have questions about the quality of the protocol and the resolution of the scans.
> I always assumed the casual attitude towards hygiene that Asian people have
You're totally right to call me on that generalization. I meant the parts of Asia I've personally spent time in: India, Sri Lanka, Nepal, Bangladesh, Myanmar, Cambodia, Indonesia, Vietnam, Laos, Philippines, and to a lesser extent Malaysia and Thailand.
Other Asian countries like Taiwan, Japan, Korea, and Singapore don't deserve this shade thrown at them and I apologize.
I suspect the issue is less of a general attitude and more of a combo of poor resources and poverty. Tons of hospitals in India are spanking clean - though these are often the private ones.
No, it's a cultural thing. For sure it came from poverty. But it persists in places where that's no longer an excuse. For example my neighborhood in Vietnam has kerbside trash/recycling collection four days a week. Even if you couldn't pay you could easily put your bags with someone else's. Hell I'd pay for the entire street gladly. And yet several of my neighbors still pile up their trash and burn it. I've ended up shouting at them a few times - unfortunately being polite does nothing in this culture, while getting angry, as a foreigner, is extremely effective no matter how much I dislike doing it.
I know people would say "adapt to the place you're in". But I draw the line in a few places. Burning trash and mistreatment of dogs are what push me past that line and turn me into a shouting maniac.
> Tons of hospitals in India are spanking clean
Private hospitals. Lots of commercial places are kept spanking clean. It's weird though, it rarely extends to the neighborhood. I'll never stop finding it weird to see a stylish hotel with manicured grounds next door to a literal dumping ground that they don't seem bothered by.
Yeah. And so much staff… I am from Germany where I have the fancy private health insurance and I spent 5 days in a hospital in Bangalore. I think on my fancy-pants hospital wards were 10 nurses on staff per shift for roughly 20 patients, plus support personnel. The quality was very good. I think it comes down to the availability of a skilled workforce for relatively cheap salaries, while in Germany the salaries are higher, staff is incredibly less in headcounts.
Asia is a big region and using "Asian" to describe people from different areas seems overgeneralizating to me at least (though it's the language customs that do that)
Well, as a "European", I feel your frustration. But in this context I think it's fair to assume that people are talking about the parts of Asia where westerners are likely to go for cheap healthcare. Which basically means SEA + India.
You don’t need to be rich, and it doesn’t matter if it’s public or private. Having lived in 6 countries in Asia over 20 years it’s never been expensive, difficult, dirty, or anything like you describe.
Well the exception being Singapore. That was expensive but covered by insurance so it still cost $0.
Edit: another thing. What is with the west more or less forcing natural birth and kicking you out of the hospital the next day? I would hate to give birth in a western country. Thankfully my kids were born in Asia. Hospital took care of baby and mum for 6 days then we left the hospital. Cost was 2 weeks salary.
This is the result of single payer or nationalised systems where private healthcare is not allowed.
So in systems like the UK, you can walk into a clinic for an MRI, you just have to pay privately for that access, usually covered if you have additional medical insurance. If you want the procedure though nationalised healthcare (NHS), there is a wait.
Health insurance is relatively cheap in the UK compared to the US. A lot of frontline care is done via the NHS contracts with the GPs and the A&E service at the NHS hospitals.
This is also how it works in US, you just go to imaging place and they do it immediately. You just have to pay for it. In countries with state controlled healthcare, service is rationed.
> In countries with state controlled healthcare, service is rationed.
Americans really love eating up this meme.
I can get scans any time in Japan and I never wait. If doctors think it’s an emergency, they’ll do whatever scan is necessary then and there. If not, they’ll pull out a calendar and ask me to pick any day that’s convenient for me.
Meanwhile my friends in the US are waiting months for basic shit. My dad visited me in Japan in December and had to visit a dentist for emergency care and was offered to do surgery on the spot. He decided to delay it until he returned to the US. The earliest available appointment in his area is next month.
It’s insanity seeing Americans parrot this stuff. It’s North Korea-level propaganda. Hell, it’s worse. North Koreans have no access to the outside world so you can’t blame them. Americans just actively turn away anything in favor of “well a guy who knows a guy said he saw a guy on tv who heard about a guy who once heard a story about a guy from a guy in another country said those people wait a long time for health care!”
But the strangest thing is countless Americans, including myself, will pop into any thread to talk about how they have endless bad experiences with health care in the US (I’ve been forced to wait forever and then still charged out the ass because my health insurance was randomly rejected), while most bad experiences with other countries is seventh hand info. Americans complaining about health care in countries they’ve never been to far outnumbers people with first hand info—usually the ones with firsthand info are saying “it’s pretty good out there”
As someone who lives in Sweden I can assure you that the 'meme' is 100% true here. There is no way you are getting an MRI unless it's literally life and death, without either waiting 4-6 month or having private health insurance.
As someone who lives in Norway (permanent resident) I'm quite surprised that Sweden is so bad. A couple of years ago I visited my GP complaining of a small hard swelling on my foot. he said it's probably just a ganglion and that he could fix it if it didn't improve by itself but that he would like an MRI scan first to check exactly what it looked like. It was obviously not even slightly urgent but I still got the scan with a month. In Norway such scans are normally performed at a specialist company (Unilabs in this case) even though it is all paid for by the health national service (except for about 150 NOK egenandel, that's about 15 USD copay)
I'm in the US and have had multiple MRI scans happen either the same day as an appointment or the next. Compared to that, even a month seems pretty long.
It wasn't urgent, I wasn't in pain, there was no rush. If it is sufficiently urgent it's possible to get an MRI within minutes of arriving at a major hospital.
Consider that Americans tax payers pay about $5k/year on average for Medicare and Medicaid that most of them don't (yet) qualify for before they even starting to pay those private insurances. People in most other countries can pay a lot privately before getting close to what the average American tax payer pays for healthcare.
The point is that it's an option that is available. Most people in Europe just has a base level health coverage that means most of us don't feel it's justified to take up additional cover.
Yea, don't get me wrong. At the end of the day there is no way I would want to trade the Swedish system for the US system, no matter how flawed I find the Swedish system.
Consider that your experience is not everyone’s experience in America. My American wife was able to get emergency dental care within two hours at a dentist who she’d never seen before.
My Canadian uncle had to wait months for cancer specialists.
Life expectancy in US has more to do with very bad lifestyles of Americans, mostly obesity and drug abuse, than with quality of healthcare, which in fact is superior. We are great at keeping alive very unhealthy people. As a food for thought, consider that Japanese-Americans have higher life expectancy than Japanese in Japan.
> Life expectancy in US has more to do with very bad lifestyles of Americans, mostly obesity and drug abuse, than with quality of healthcare
Obesity, diet and drug abuse are healthcare problems. Dying is a healthcare problem, and that’s why I suggest using average lifespan as a crude measure of population health. Population health is something a unified healthcare system should be tackling, with obesity and addiction help and care.
US healthcare might be superior for some, but population health is poor relative to the cost paid. The expense is spectacular when compared to other countries.
My point is that the reason the American population health is bad not deficiencies in what people typically understand as healthcare system (that is, hospitals, clinics and doctors). If prices tomorrow went down by 90%, and healthcare availability skyrocketed, we’d still have population that’s unhealthily obese and addicted to drugs. At the same time, countries that are much poorer, and have much worse access to healthcare, often have much superior population-level health.
Totally depends. Mostly on where you are in Germany, and to a degree whether you're willing to call a few different doctors. An acquaintance with a shoulder injury got an appointment with an orthopedic specialist within a week, who recommended an MRI. The second hospital she called just happened to have a free MRI slot the next morning.
Personally, I never had to have an MRI, but when I needed to see a specialist for acute back pain, I got an appointment (and a fix) within 24h. I have never in my life waited months for an appointment with any specialist.
This is all on public health insurance (and without any additional charge, ie. the MRI was "free"). Relatives tell me it's much more difficult in other places in Germany; I sometimes wonder if they should just get an appointment here, Germany isn't that big.
I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care.
I'm not a policy expert so I won't pretend to understand all the problems involved or the potential solutions.
But as a patient I have a disability that makes it so the state covers 100% of my health expanses. I've been needing to see a physiotherapist for 3 years but can't find a single one that does home visits. Because of the dwindling number of physiotherapists even those that receive patients in their office sometimes have to see 5 patients at a time. So I have great coverage for terrible or no care at all.
I was so desperate I called every physio in my region and told them I'd pay them any amount to come see me, but they can't take my money because the price of their service is regulated and they'd lose their license.
Same thing for public hospitals, I came in Friday with three broken bones they wanted me out by Saturday, they didn't have a single available bed in their orthopedic unit and they needed the E.R bed back as soon as possible. All that because we decided to regulate the maximum number of doctors so now everyone has to go get care at the hospital instead of at home care by their local doctor.
We do have some pretty stellar private hospitals though but it doesn't help because you don't choose where you get sent to when you call an ambulance.
>a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care
We sort of have this in Croatia, public care and a lot of private options. It's not that great because :
- There is a tension with public system where doctors from public care move to private system, you hear about doctors working at a private clinics while they are on shift in public hospital, or referring you to their private clinic if you want to get treatment in reasonable amount of time
- Private clinics usually don't cover everything, they focus on the profitable stuff. Like we had two smaller earthquakes (~5) around the time my wife was pregnant and both times they were evacuating pregnant women out in the street because the public hospital buildings are >100 years old. Private option was expensive and in case of complications they would still need to ambulance you to a general hospital
- Medical tourism eats up private capacity - this is kind of a mixed thing because medical tourism also keeps the field growing/investing much more than domestic demand alone would
There's another consideration too: the wealthy people stop caring about funding the public tier because they can afford not to care about it, lobby for policies to cut public funding to lower taxes. Two tier systems typically degrade the public tier over time.
Depends. There is rarely a private ER, and as you say, private care will often focus on the higher margin items so the lower margin stuff might be left to the public option.
Some countries forbid two tier systems entirely for this reason, like here in Canada.
> I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care.
I think that's quite common? There are both public and private clinics in Norway, but public health care only covers the public ones.
My wife and I visited a private clinic in Denmark to get NIPT test even though it was covered in Norway, because the process was longer in the public system (not too bad, but wasn't too expensive to just pay to have it done fast and we wanted to take a trip to Denmark anyway).
I know there's kind of a mix in Taiwan too.
The argument against having policies that encourages private clinics is that wealthy individuals with a lot of political influence might try to push for funding cuts for public clinics if they don't depend on them. And the best doctors might prefer to work for private clinics if the pay is better. All-in-all I think a mix is best though.
> I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care.
That is the case in most countries with universal healthcare.
Very few countries restrict your ability to pay extra for "top up" insurances and services.
E.g. in the UK about 10% have private insurance. These tend to be cheap because they basically expect you to use NHS for emergencies, and to try to go to your NHS doctor first, but ask for private referrals if there are waits on the NHS, or for "extras" like regular comprehensive checkups.
The NHS itself is also allowed to offer some extras. E.g. many NHS trusts runs private clinics to maximize utilisation.
We have an expensive tier here in the UK. Not many people use it. When they do it takes doctors and nurses away from treating more urgent needs in the NHS system.
It's absolutely insane. I had a knee MRI in SF 5 ears ago, and the out of pocket cost, with insurance, was $900. Insurance paid around $2000. And the wait was 3 weeks. I found a private imaging place that could do it for $750 next day. Called the insurance company and told them that we could both save some money on this, and got "that's not how it works." Bureaucracy is societal cancer.
You can wait months for a specialist in the US. Especially a neurologist (as in an MS forum). And then, you have to get one in network OR pay more - and your insurance might not cover it.
You have business rationed health care, and some folks are going without. Some folks are now thinking about different programs for poor folks... but we know those don't cover everyone with need.
On the other hand, I now live in Norway. The health care system, in general, works. I'm never going to be bankrupt due to medical expenses and I know other people aren't using riskier and harder to use insulin because it is all they can afford. I can get to the doctor in a timely manner and if there is a wait (for non-critical things), there is an actual safety net that means I can take the time off work while I wait for the MRI to open up. Even when there is a wait, it isn't nearly as bad as it would be in the US.
yep getting a neurologist here in the states is a nightmare. Both of my neurologists typically book 3-4 months out. When I first began needing neurological care my primary Dr. told me he had a patient who had a stroke and needed to wait a month to see a neuro.
pro tip for others: if you you really can't wait for care, just keep calling your doctor's office every day asking about recently cancelled appointments. I usually get in fairly quickly this way though it's pain
In Italy you can wait (lenght depends on the seriousness of your problem) and pay nothing, or you go to the very same public hospital, pay and do it right away.
Oh, it costs 200-400eu. About 1/10th and what its asked for here in CA. Healthcare in US is a little bit scammy....
At most a few countries worldwide has anything resembling "state controlled healthcare" (in fact, I cant name any - Norway used to a couple of decadds ago, but bow have plenty of private providers)
Almost all countries with universal healthcare have widespread private services.
Many have their universal services provisioned entirely or in part from private providers.
When I had a gastroscopy a while back it was done in a private hospital but arranged by the NHS and paid by the NHS.
If I want a private MRI there are dozens of providers in London.
We believe in healthcare for all, so we endeavour to allocate limited resources carefully. And this is one of many things that contributes to a society where I feel safe sending my kids to school without Kevlar.
The problem is decades of underfunding of health services. Neoliberals in charge like having reasons for increasing privatisation of healthcare, so they underfund, reduce quality, increase wait times, and attempt to get the public on board with more privatisation.
> The healthcare system in the west is just plain stupid.
What the hell is "the west" in this context? Do you have experience with every health care system in Europe? Why is "NZ" considered "the west"?
> In asia you can walk into a clinic and see a doctor in 30m.
You can in many places in Europe too.
The flip side of the asian systems can be incredibly overworked and stressed health care workers. I know the service in Taiwan is fantastic (though a bit stressful, was way busier than in Norway), but I also know a nurse working there saying the working conditions are quite awful. They also encourage doing way more testing than necessary. That makes it so testing is pipelined and efficient. You get economies of scale. But doing this is generally considered a very bad idea, because you can get false/misleading diagnosis and undergo unnecessary treatments with potentially bad side effects. Along with all the wasted time and resources that could have been spent working on actually sick people. Which in asian countries can mean that poor people don't get the resources they need to get treatment.
> The Western world, also known as the West, primarily refers to various nations and states in the regions of Australasia,[a] Europe,[b] and the Americas.
> but I also know a nurse working there saying the working conditions are quite awful.
I can imagine during covid the conditions were awful. But on a day to day basis the hospitals are pretty quiet.
The hospitals don’t do more tests. It’s more people taking advantage of their health card. For example our daughter was in hospital for ~7 days. It cost $65 USD.
People get health check ups often cos it costs almost nothing. Visiting a clinic costs $5~ and people often want antibiotics when they have a cold even when advised it won’t help as it’s a virus not bacterial.
I walked into an ER in Tucson, Arizona last winter, and was out within an hour with a CT scan and clear diagnosis. Took me another 2 days to get the raw data. It was awesome.
My coworker fell in Costa Rica, hurt her knee and came back and had an MRI the same week. I saw my doctor in mid-March and she ordered an MRI on my neck, it's scheduled for next week. Do some people wait 6 months... yes, those that can wait 6 months are asked to wait 6 months. Those that need it quickly, get it quickly. It's the triage method.
I also had the option to book a private MRI and get it next day. It would have been $650CAD or $483USD. I happen to be in LA when my issue came up and I looked at private MRI. It was way more expensive than the Canadian alternative (however, it could have been LA/Hollywood pricing).
No it's not. I tweaked my knee pretty badly to the point where i would wake up at night from deep sleep due to pain (and I generally have a higher pain tolerance) and the best the doctor could do was prescribe ultra sound cause getting an MRI scan would take 6-7 months.
Even then the earliest appointment I could get for a knee specialist to look at my knee is 6 months.
It really depends on where you're. If you're in the city of Toronto, good luck getting an MRI appointment.
> those that can wait 6 months are asked to wait 6 months
You do know that you're body doesn't decide to wait 6 months for an MRI and stop developing scar tissue right?
Priority 4 patients (the lowest priority) waited on average 73 days. Highest priority scanned on average of 3 days. Are the numbers great? No, only 42% of people are scanned within the recommended timelines (priority 4 - 28 days, priority 3 - 10 days and priority 2 - 2 days). But it hyperbole to say it's a 6 month wait when the data doesn't show that. Do some people wait 6 months... yes, but those are likely priority 4 people where a qualified medical provider has determined the scan is not a priority.
Cool, tell that to my knee that is still waiting for an MRI and I can't event get appointment for a specialist to look at my knee at my walk in clinic.
I would like to see the source for your data since clearly in my case, the doctor flat said there's no point getting an MRI because the wait time are too long.
Well yes of course, why or how would you include those people?
I'm just here defending the publicly funded Canadian health care system. When people go online and make false claims, it devalues the system we have. Is it perfect? Definitely not. But is it better than fully private systems where your healthcare depends on a job and one injury or hospital stay could bankrupt you? Definitely, but only if people care to defend it.
You're here defending while brushing apart valid points that people bring apart without any logic. Is Canadian healthcare system good if you're dying? Yes, it's god send, they'll do everything to save. But if you happen to not be dying, good luck with this system.
> Well yes of course, why or how would you include those people?
That's the entire point, you can't take those numbers at face value because how many people who need MRI aren't prescribed one to begin with.
>you can't take those numbers at face value because how many people who need MRI aren't prescribed one to begin with.
Citation needed (that isn't your n=1 story). If someone's problem was bad enough, they'd book an MRI regardless of how far out it was. If someone says "nah, don't even bother" perhaps their problem isn't that bad.
> My coworker fell in Costa Rica, hurt her knee and came back and had an MRI the same week. I saw my doctor in mid-March and she ordered an MRI on my neck, it's scheduled for next week.
You started your entire argument on this point, i.e. (n=2) lol
Sure I'll give you that. However I then followed with population level data from two of the large Canadian provinces representing nearly 20 million people.
In India, you can book an appointment for MRI scans at private clinics the very same day or at worst within 1-2 days. Costs about USD 100 or lesser.
There is also this startup - https://qure.ai (Not my employer, I know someone who works there) which has already automated the report generation part for several classes of X Ray / CT / Ultrasound scans. This takes away the requirement of having a trained Radiologist to go through the scan and then create a report, which certainly helps in scaling the availability of such scans - you just need the machine and trained staff to operate it, and are not dependent upon having a doctor with a postgrad in radiology to write the reports.
MRI scans in our budget MRI lab (yes that’s correct) a km away is 2500 Rs or like 60 USD and less than an hour wait time. How MRIs got commoditized in india through competition should be studied hard.
I just checked and MRI scans in Ireland are about 300eur, while the average monthly wage is about 3300eur.
I know average monthly wage isn't the most robust of measures, but still, looks to me like MRIs are pretty expensive in India relative to people's ability to pay for them.
Healthcare in India is rather amazing. When my wife was pregnant, we could get a sonography scan at a top private hospital for $30-40 without any insurance. The scan was done by an experienced doctor, not a technician.
Off topic: "high net-worth" is word "rich" not politically correct anymore or what is the thinking behind using three words instead of one? This reminded me of "George Carlin on soft language"
There are plenty of "old money" rich that are no longer "high net-worth" individually but their family name and other resources available to them more than make up for it.
There's also "fat bank account and loads of debt" which nets out to not very much, but would count as "rich" if the bank account was all you cared about. And, in terms of liquid resources, it may well be.
In Uruguay I got (multiple times) a 3T MRI for $300 in under 24h (https://cudim.org/). Or 1.5T for free, no more than a week after the doctor asks. Anyone in the world can go there and pay for that and get it.
It's insane to belive I have a 3T MRI 2 blocks away from my home.
Now while staying in the US I just pray I don't need have health issue.
But when I was waiting for the MRI I asked the three other people waiting there with me, out of curiosity about this exactly.
Two told me they had public health insurance, one had been given the appointment one day prior, the other three. So at least for Berlin there seems to be no difference.
But I can confirm that for seeing specialists, it does make a difference. My partner has public health insurance. I would say if I have to wait one week to get an appointment, she has to wait two. But it's never months, like you read from people that live in certain other countries.
On a sidenote, my appointment for the MRI was at 8:15pm. It seems the radiology places here all run the machines long into the night to max out workload. I had a CT a few day later at a different clinic at 9pm!
>in Berlin I can get a knee MRI appointment within two days
Are you sure about this? Luckily I have not been in need of an MRI for a few years, but I remember having to wait a bit despite having private insurance.
Hamburg here, same. Got 2 MRIS in the last 5 years and both could have been the next business day if it would have fit my schedule. and all that as a "kassenpatient"
Yes that does sound quite interesting and valuable v line of research but don’t you think one-off high-res MRI scans might advance humanities understanding of the brain in a meaningful way more so than low-field MRIs for all? I think this is more about the long game (scientific development) than how an average person right now could benefit from the new advance perhaps.
My family has had same-day MRIs in the USA. I’ve never heard of anyone waiting, ever, outside maybe a few days or longer if they’re trying to line up their own schedule with availability.
In Mexico you can buy a (private) head
MRI scan with contrast for around $300 USD. It's really cheap. So theoretically you could do one every couple of months.
Not an either-or situation at all. There is no one “more interesting track”. Always tradeoffs as I am sure you know.
The key advances in this paper are four-fold:
1: Much higher spatial resolution and contrast that is essential to define boundaries of brain regions
2. Much faster scan time using multiple angle acquisitions
3. Accurate segmentation of brain regions of interest even for highly diverse genomes of mice.
4. Accurate alignment and multimodal merging of MRI with 3D lightsheet microscopy from the same animal with fluorescent labelling of multiple CNS cell types.
fMRI in mice is limited in its resolution. To generate time series data we use large sets of isogenic (identical twin) mice. See figure 5 in the paper for a comparison of young and old mice that are identical twins—one a young adult and one quite old adult.
Canada triages MRI access to high-urgency cases. My partner got an immediate MRI and 3 follow-ups within a month when she presented at an ER with stroke symptoms.
> Boutique health clinics offer yearly scans to high net-worth individuals, rolling this out to a larger population could have a huge impact.
And are the outcomes of these high net-worth individuals any better than the overall population, in ways that cannot as easily be explained by other factors? I'm not really sold on the idea, and a lot of scientists and doctors aren't either.
> In Canada you have to live for 6 months with a knee injury before surgery just because of the wait to access an MRI.
Really? I had a lower back MRI appointment at the hospital inside a month or so about 2 years ago, in the middle of the pandemic. Is it the surgery wait itself that takes that long, or did waiting times generally become that worse in that 2 years?
All appointments are triaged. Some people get them 2 minutes after seeing a doctor, some people wait 6 months. It all depends on need. Source - work in a hospital, have an MRI scheduled next week.
Sure it would be nice that everyone gets an MRI when they need it, but they are expensive pieces of equipment, requiring a very specialized room and staff.
Another possible factor is specialist availability. As I assume is the case in all public healthcare systems (and in some way or another, e.g. through price differences, in private healthcare), some specialties have a glut of physicians while others have a real scarcity. I've personally experienced having to wait many times longer for a neurologist than a gastroenterologist, even though the issues my GP referred me to those specialists for were about equally serious, simply because there are so many more gastroenterologists available (relative to the demand) compared to neurologists (be it because too few neurologists were trained 5-40 years ago, because neurological issues have gotten more common, because GPs refer patients to neurologists more often than they used to, because neurologists may be more likely to go into private practice than gastroenterologists...).
With medical imagery, you don't just need to get to get the MRI, CT or whatever done, there often needs to be a specialist available who can decide how (or if) to treat you based on the results (the exceptions being very routine stuff that a GP can often handle the treatment of, e.g. common bone fractures; or screenings where a negative result is expected in 95%+ of cases, such as if you present with a headache and your GP wants to make sure you don't have brain cancer).
In the public healthcare system we have where I live, if my GP thinks I have a problem that's serious/non-obvious enough that an MRI would be useful (and it's not a highly routine issue as previously mentioned), the waiting time for that MRI will depend almost completely on when a specialist in the relevant field (or subfield) of medicine is available – otherwise, the MRI won't be up-to-date, etc. The MRI scans themselves tend to be done by private labs that are subcontracted by the public healthcare service anyway, and (as you'll learn if you ever book a private appointment with one such lab) these labs have lots of capacity. MRIs in themselves are cheap enough (it would surprise me if the public healthcare service paid these labs more than $500 per MRI on average, a pittance compared to the cost of a physician*) that there is no point for the public health service to queue up MRI appointments for months if they manage to book you an appointment with one of their own specialists.
The details vary between countries, of course, but if a public healthcare system in a rich country has so few MRI machines (and doesn't subcontract out outpatient MRIs to private labs) and/or are so penny-pinching that they find a speedy $500-$1000 MRI to be too expensive, then I would say those problems seem to be relatively easy to fix without changing anything fundamental about how the country's healthcare works.
*) Although this may not be the case if the physicians in your country earn less than, say, $30,000 USD on average – the cost of technical equipment matters less the richer a country is.
damn that’s fucked up. at my medical facility when my doc ordered an MRI i literally just walked over to radiology and got it done on the spot for like a $40 copay.
I didn't expect this one would be one of those "IN MICE" things...
In a decades-long technical tour de force led by Duke’s Center for In Vivo Microscopy with colleagues at the University of Tennessee Health Science Center, University of Pennsylvania, University of Pittsburgh and Indiana University, researchers took up the gauntlet and improved the resolution of MRI leading to the sharpest images ever captured of a mouse brain.
It's not just "in mice", it's "in dead mice" AFAICT, as they must open the mouse to use LSM. Mice tend to not work after you open them. It also is difficult to get high resolution images of samples disturbed by sources of noise such as blood flow. I had an uninformed perspective that for a given field strength the resolution is limited by how long the subject can stay still. This is obviously a lot longer for one that isn't alive and is screwed to the platform.
Of course, lots of important research will benefit from improved scanning resolution on dead subjects -- one might get mislead by the headline, especially if one isn't a research scientist mostly concerned with scanning things you've poisoned or genetically programmed to die in interesting ways.
Yes, several hours per image. This resolution is still an achievement. But in vivo images (alive) are much more useful as they enable longitudinal studies, but obviously far more challenging to get anything close to good resolution in a mouse. More like 150 micron in alive, sedated mouse brains, even from 9.4T.
Not true so much in mice. Because we use isogenic cohorts we get pseudo-longitudinal data per genome. Ten of you, ten of me scanned every 10 years. And we can do all 20 scans in mice within 1 month of machine time. We just finished scanning 110 mice—half young and half much older—all with balance for genomes and sex.
Currently, some people are (IMO deliberately) misreading your research as having immediate live human applications and spreading this news as such, with misleading graphics of human brain scans accompanying their news reports.
So sad that people focus on a mistaken belief that stuff like this could be used to diagnose disease in a patient when tools like this may someday help researchers eliminate some kinds of diseases entirely.
Co-author here: No this is actually becoming a less expense acquisition protocol at the cost per voxel per unit of scan time. Of course not intended for clinical application but rather to understand the basic biology and genetics of Alzheimer’s, Huntington’s And Parkinson’s diseases, addiction, and aging.
Does anyone think we understand AD and how best to intervene? This technology is already proving useful. Stay tuned—-this is the tech paper but the application papers are in the wirks.
Strange that a lot of the comments here basically say "who needs this?"
But I remember when TVs were 640x480-ish and 1920x1080 was amazing. And 4k.
Maybe this won't be for knees in live patients. Maybe it won't be for MRIs in the far-flung corners of the world.
But what if it was for researchers to find elusive parts of the brain? What if the high quantity of data led to better algorithms for current MRIs to make them faster (which probably means cheaper).
I think of pure science and how it doesn't immediately teach us something, but later it answers (or provokes) questions and moves the needle.
Just saying.
That doesn't mean I don't groan at some advances - like any advance that "adds value" to some product by collecting more data without your consent. :)
Yes, unfortunate PR title that we the co-authors do not control. This generates some adverse gut response—-even for us. Headline writing is tricky in terms of the balance between reality and README.
This is a very clickbaity title. Over 6 years ago I worked as a student on reconstruction of 50 micron human brain (part, occipital lobe) MRI images, also captured in 9.4T.
Obviously a 10x higher resolution is still impressive, but it’s a mouse brain, and it’s certainly nowhere close to 64M times the resolution of comparable prior work…
Co-author here. Recommend reading the paper itself. The resolution comparison is to clinical MRI, not previous state of the art. Improvement compared to previous state of the art is substantial in terms of both resolution AND throughput. This work is a genuine game-changer for our neurogenetics team. We can generate 100s of very high resolution MRI dataset and get great global estimates of volumes and connectivity. We are using these methods in combination with “humanized” Alzheimer’s disease mice.
Side question: are there any interesting brand new medical imaging modalities being worked on these days or is all work focused on improving existing ones?
Yes, lots of innovative new algorithms to process the diffusion tensor metrics and images. That is how we got down to nominal resolution of 5 microns for the tractography. The effective resolution is closer to 10 microns.
I have a heart stent that is only rated to 3T, so I'm kind of sad that I can't make use of the newer MRI technologies (granted, this particular MRI imaging doesn't seem to be a thing for humans yet).
I'm wondering if, at some point, I'll be able to have it replaced with a newer material that isn't ferromagnetic (or wouldn't be affected like mine is)
Your stent is only rated to 3T because that's about the absolute maximum field strength used by human clinical MRI systems, with the vast majority being half to a quarter that.
As you noted, this imaging was done at much higher field strengths, ~10T. That sort of field strength is practical at the scale of a system sized for a mouse. For a human, it's likely to never be practical for a whole slew of reasons related to the energy needed, forces on the machine, the increase field size and strength affecting room construction, safety thresholds, etc.
1.5T and 3T are very common, and 4-7T are definitely used in a number of hospitals. UMN has a 10.5T magnet they've shoved humans into. Their stent is rated to 3T for a variety of reasons including:
1. That's all they've tested (as you alluded to).
2. It might actually fail at higher fields.
3. Stents act as antennas and can focus RF into unwanted places like cooking the middle of the brain, and it's a lot more likely that the stent is rated for exactly 3T than up to 3T since the relevant frequencies are proportional to field strength, and the associated wavelengths can coincide more or less with the length of the stent (kind of like how the Tacoma Narrows bridge could have experienced a lot more wind, but that particular set of factors was problematic). It _might_ be certified for 0-3T, but that takes additional research to actually do.
4. Any number of other reasons. High fields have a variety of counter-intuitive properties.
For what it's worth, most of the concern seems to be migration (movement of the stent) and temperature increase, and there's also a passive optical artifact introduced by the stent in the image itself. The manufacturer docs are here: https://www.cardiovascular.abbott/int/en/hcp/products/percut...
Nonclinical testing has shown that the XIENCE Sierra™ Stent, in single and in overlapped configurations up to 71 mm in length, are MR conditional. A patient with this device can be scanned in an MR system under the following conditions:\*
Static magnetic field of 1.5 or 3 Tesla Maximum spatial gradient field of 3000 Gauss/cm or less
Maximum MR system reported whole-body-averaged specific absorption rate (SAR) of 2.0 W/kg (normal operating mode)
Under the scan conditions defined above, XIENCE Sierra™ Stents are expected to produce a maximum temperature rise of of less than 4.5°C after 15 minutes of continuous scanning.
The XIENCE Sierra™ Stent should not migrate in this MRI environment. MRI at 1.5 or 3 Tesla may be performed immediately post-implantation.
In non-clinical testing, the image artifact caused by the device extends approximately 6 mm from the XIENCE Sierra™ Stent when imaged with a gradient echo or spin echo pulse sequence and a 3T MRI system. It may be necessary to optimize the MRI parameters to account for the presence of XIENCE Sierra™ Stents.
Cardiac stents are fine in MR and most others are too. As the document you have provided says, it won’t move. One did once but it seems it wasn’t related to the MR. You can scan them to immediately after insertion - I used to.
Massive amounts of overlapping stents should get people thinking a bit though.
The force from a beating heart is more than the MR exerts and the cooling provided by flowing blood are factors.
The funny thing is, most scanners aren’t what it says on the label. Scan water, get the centre frequency and work back to get the field. The most recent one I tested was 2.89T.
We have a complete map of C. elegans, a small worm with 302(ish) neurons. We have a complete wiring diagram of the adult worm’s neurons as well as a “fate map” showing how those connections form during development.
Nevertheless, it’s fairly hard to simulate. Neuromodulators cause all sorts of “spooky action at (synaptic) distance” that the wiring diagram can’t explain, for example.
to pile on, most impressive "complete mapping" so far is without a doubt the hemibrain connectome which took months and cost ~$50M, for a not quite good enough resolution image of a microscopic brain that was quite dead.
The only interesting question in here so far and also the only one that got a downvote from someone. 4 microns is about the size of the cell body of the smallest neurons so this technique could potentially give you the position of every neuron in the brain but isn't going to pick up the dendrites and synapses. You'd need resolution closer to 10 nanometers for that. 1 micrometer (micron) = 1000 nanometers
I was curious about the machine itself. There is a description and picture on their lab page[1]:
“The vertical bore 9.4T Agilent MRI has been specially constructed for the microscopic imaging of fixed specimens. A bespoke gradient system, one of only two such systems in the world, provides encoding gradients up to 2500 mT/m, more than 50 times that of a clinical MRI. The system has been tightly integrated to a high performance cluster computer to enable compressed sensing”
Cool, but as described, this wouldn't work on humans. The light sheet microscopy technique that the suped-up MRI data is paired with to create these images requires tissue to be "cleared" (or made transparent) with solvents, which obviously you can't do with a living human brain. To be honest, I don't quite understand how light sheet microscopy works with living _mouse_ brains.
It doesn’t. The brain must be cleared which generally involves removing lipids so the tissue has a homogeneous index of refraction throughout. Given lipids are an extremely important component of the brain (for instance myelin is a lipid rich material that surrounds axons) even if one were able to clear the brain without excising it from the skull, the clearing process essentially destroys the brain by preventing it from function properly.
Correct. But that is where the lightsheet adds sufficient resolution. MRI for the “mesopic” scale, lightsheet for for microscopic scale to 0.2 microns, and selective elecron microscopy down as low as tissue quality will allow.
Two and three photon microscopy works on living brains down to depth of approximately 1.5 mm. A company even sells head mounted miniature microscopes for mice. Try to refrain from commenting on topics outside your expertise.
We do this. It’s rather old hat now and the Philips offerings are destroyed by the likes of Siemens Deep Resolve.
It applies deep learning to the raw data (more signal!) and to the final image (more resolution). It’s compatible with the likes of SMS, Grappa and various other acceleration techniques.
It occurs to me that a scan that only works on dead brains isn’t nearly as much of a problem if it scan in enough detail to extract an algorithmic continuation of the mind involved.
5 microns might not be there yet, but it’s quite a leap in that direction.
Ability to use a giant peace of copper (coil) plus time of medical personnel plus some supa cool leet haxor medical software plus extremely expensive legal medical terrorism-preventing licensing - seems like a recipe of an expensive treatment which will never become significantly cheaper.
A bit misleading (or underwhelming). It’s like citing a supercomputer and saying “math computation just got 64M times faster”.
Sure. But at scale? No. Maybe the likes of Bill Gates can access this tech for treatment today. For the likes of us, I am guessing another 10-15 years?
A single MRI image is not super helpful, still more art than science, the real benefit comes from having periodic scans against a baseline. Boutique health clinics offer yearly scans to high net-worth individuals, rolling this out to a larger population could have a huge impact.
[0] educated opinion, I also collaborated on a PNAS MRI paper