Dr A.I. will see you now — The age of Artificial Intelligence in Healthcare

Google DeepMind’s breakthrough might help save the sight of millions around the world.

Rutger Hauer playing Roy Batty in Blade Runner (1982). The Lead Replicant describing his life as both rain and tears flow down his face. Credit: Warner Bros

“I’ve seen things you wouldn’t believe…”

Had he spent more time scrutinising millions of Optical Coherence Tomography (OCT) scans rather than attack ships on fire off the shoulder of Orion, perhaps Dr Roy Batty might have been the most eminent Medical Retina specialist of Ridley Scott’s fictional 2019.

Philip K. Dick’s dystopian vision was penned in 1968 and later adapted into a neo-noir masterpiece by Scott in 1982. The synthetic beings of his tale, outwardly identical to adult humans, have been created in order to replace humans in performing menial or undesirable jobs. Their only deficiencies seemingly being a lack of emotional range and a four-year life span. The themes of humanity and identity continue to resonate despite the decades which have passed since the short story was written.

We are still a long way from androids replacing any profession, let alone doctors or nurses. Nevertheless, a potentially monumental triumph in the application of AI technology in medicine has just materialised, the fruits of which might benefit millions worldwide.

Two London-based teams have collaborated to develop AI technology which can analyse OCT retinal scans and detect a number of eye conditions, then triage those patients who are in need of urgent care. Google’s DeepMind team, spearheaded by Jeffrey De Fauw, have applied a neural network learning system which matches highly experienced doctors and reduces sight loss by minimising the time between detection and treatment. This delay in referral for treatment still causes many people to go blind.

The potential AI-enhanced process to detect eye disease. Credit: DeepMind Health/Moorfields Eye Hospital

Pearse Keane, lead clinician for the project at Moorfields Eye Hospital, describes DeepMind’s algorithm:

“As good, or maybe even a little bit better, than world-leading consultant ophthalmologists at Moorfields in saying what is wrong in these OCT scans”

Artificial Brains — From Chess to Go

Google’s DeepMind, founded in 2010 in the UK and later acquired by Google, seeks to build powerful general-purpose learning algorithms and uncover the mystery of intelligence. Thus-far, its greatest tangible successes had been in defeating humans in games.

Perhaps its landmark gaming victory came in 2016 when DeepMind’s AlphaGo beat high-ranked Go player Lee Sedol 4–1 in a five-game match by using a supervised learning protocol, watching and analysing large numbers of games between humans. Despite the resounding triumph of machine over man in the ancient strategy board game, DeepMind has to thank its ancestor, IBM’s Deep Blue, for the first of such victories.

Garry Kasparov playing chess against IBM’s Deep Blue in 1997. Credit: Peter Morgan/Reuters

In 1996, world chess champion Garry Kasparov beat Deep Blue 4–2. One year later, Deep Blue came back for revenge and beet Kasparov 3½–2½. The message was clear, artificial intelligence was catching up the human intelligence. Yet Deep Blue’s algorithm depended on “brute computational force”, evaluating millions of positions. That works fine for chess, in which there are 20 possible opening moves. Go, a game originating in China almost 2500 years ago, has 361 possible opening moves on its 19×19 grid. It is so large that no AI can currently explore every possibility using Deep Blue’s “brute force” method.

LeeSeDol losing to DeepMind at Go. Credit: Korea Baduk/Reuters

DeepMind’s AlphaGo, on the other hand, works on a combination of different elements which are meant to mimic human decision-making. The algorithm was developed by DeepMind co-founder Demis Hassabis and consists of a number of phases which include supervised learning (being trained by analysing games between human experts), reinforcement learning (playing itself millions of times and maximising expected winning outcomes), “intuition” rollout policy (predicting how a human would play), Value network learning (quantifying the chances of success) and an algorithm which brings all these together called a “Monte Carlo tree search”.

The Age of Scans

A practitioner performing an OCT scan. Credit: Moorfields Eye Hospital

It’s all very good to beat humans at chess or Go, but what about diagnosing diseases? To find a real-world application for the human-like decision making used by DeepMind’s AlphaGo, the team at the company’s Health division looked at Optical Coherence Tomography (OCT) scans. This is a form of three-dimensional eye imaging which slices the retina into different layers, first introduced over two decades ago. OCT machines have come a long way since their inception and have become increasingly complex in how data is generated and presented. Nevertheless, they are used routinely by eye doctors to diagnose diseases such as age-related macular degeneration, diabetic retinopathy and glaucoma.

The publication of the work from DeepMind and Moorfields Eye Hospital in Nature this week states categorically that the algorithm performed as well as two leading retina specialists in analysing OCT scans and grading the urgency of a referral for management, with an error rate of only 5.5%. This was despite the algorithm not having access to some extra information, such as patient records, that the doctors had. The algorithm was used on two different types of OCT machines, and was also able to give confidence ratings based on aspects of the scans which it considered suggestive for diagnosis. Importantly, not a single urgent case was missed from the 14,884 scans used in the study.

Real-world application

This is just the first stage of research, although Dr Keane is confident that a final product is not too far away. DeepMind and Moorfields now need to run clinical trials of their OCT system so that doctors have the chance to test it. Mustafa Suleyman, DeepMind co-founder hopes that:

“when this is ready for deployment, which will be several years away, it will end up impacting 300,000 patients per year”

The team hopes that regulators approve a final product based on the immediate tangible benefits of a reduction in time and manpower needed to manually inspect scans, make diagnoses and refer for treatment.

Practical Benefits in the Developing World

PeekVision is a smartphone suite and includes an adapter called Peek Retina which allows the retina to be viewed with a smartphone. Credit: PeekVision.org

AI-powered screening can have an enormous impact in hard-to-reach areas. The ubiquity of smartphones around the world makes adding a portable camera and creating an image acquisition system simple and inexpensive. Already, companies such as UK-based Peek Vision have introduced camera adapters which allow high-quality images to be obtained easily and then analysed remotely.

Companies such as California-based Compact Imaging are currently working to make small form-factor multiple reference OCT (MR-OCT) available for smartphones and wearable technologies. The combination of these compact devices and AI-powered screening software could bridge geographical and economic chasms for many of the 285 million people worldwide living with some form of sight loss.

Sight loss around the world. Credit: DeepMind Health/Moorfields Eye Hospital

Artificial Intelligence elsewhere in health

These developments can act as a blueprint for the development of artificial intelligence elsewhere. DeepMind is currently doing research with University College London to assess whether AI can tell the difference between cancer and healthy tissue in CT and MRI scans. It is also working with Imperial College London to assess whether AI can interpret mammograms and improve accuracy in breast cancer screening.

In all these cases, the most practical benefit of using AI to screen for disease is one of resources — doctors’ time would be freed to spend more time with individual patients, and more time working on and providing treatments.

Pitfalls in AI’s Future

“I did everything, everything you ever asked! I created the perfect system” Clu in Tron Legacy (2010). Credit: Disney

Back to the realms of fiction, where accounts of AI are often littered with depictions of ever-evolving intelligences which strive to be perfect, such as Marvel’s Ultron or Tron’s Clu. These AIs struggle to balance a “human” rationalisation of ethics with the necessity to achieve their goal, with Earth-threatening consequences.

Though we are far from apocalypse scenarios, DeepMind itself has already been embroiled in controversy when it emerged that 1.6 million patient data records had not been adequately safeguarded when shared between London’s Royal Free Hospital and DeepMind. Data sharing agreements between the two had to be rewritten and DeepMind has also created an “Ethics & Society” group to maintain the ethical standards of AI, and ensure that social good is prioritised during the fast-moving evolution of these technologies.

Clearly, there may be obstacles ahead that no one can predict. DeepMind’s co-founder Mustafa Suleyman highlights the extent of the challenge:

“It won’t be easy: the technology sector often falls into reductionist ways of thinking, replacing complex value judgments with a focus on simple metrics that can be tracked and optimised over time….

Getting these things right is not purely a matter of having good intentions. We need to do the hard, practical and messy work of finding out what ethical AI really means.”

A future with everything to play for

Nevertheless, Suleyman describes a future which, with the right guidance, could be aided immensely by artificial intelligence when aligned with human values:

“If we manage to get AI to work for people and the planet, then the effects could be transformational. Right now, there’s everything to play for.”

A future, potentially, riding on AI. Credit: Luca D’Urbino
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Seven of the UK’s healing hospital gardens — in pictures

https://www.theguardian.com/healthcare-network/gallery/2017/sep/12/seven-uks-healing-hospital-gardens-pictures

Article from The Guardian 12th September 2017:

Horatio’s Garden at Salisbury district hospital, Salisbury

Horatio’s Garden is a charity which creates gardens of sanctuary in centres for spinal injury. The gardens are named after Horatio Chapple who came up with the idea with his father while volunteering in Salisbury. Various events for patients with spinal injuries are held in the garden, such as painting classes with artist-in-residence Miranda Creswell.

 

The Chapel Garden, Norfolk and Norwich University Hospital

This chapel garden features a central wish tree and a number of water features, such as a vertical fountain and a rill, which give the impression of water moving continually throughout the garden. The calming flow of water and the illusion of space have transformed this small and previously unused area of the hospital.

 
The Morgan Stanley garden, Great Ormond Street hospital, London

This woodland-themed garden, designed by Chris Beardshaw, was transplanted from the RHS Chelsea Flower Show (where it won a Gold medal) to a disused roof space, surrounded by tall hospital buildings that look onto it. The garden provides a quiet and peaceful space for children and families, the centrepiece of which is a sculpture of a child.

 
Ninewells community garden, Dundee

Patients, staff and the local community can volunteer at this garden. The vegetable and sensory gardens, orchard, wildlife habitat and play areas offer multiple options for people to de-stress, recuperate and exercise

 
Horatio’s Garden, Queen Elizabeth national spinal injuries unit, Glasgow

The second Horatio’s Garden on this list has six distinct spaces, all of which serve to stimulate different senses. There is also a greenhouse which is surrounded by areas used for horticultural therapy activities.

 
Chase Farm hospital rehabilitation gardens, London

Chase Farm hospital has renovated two areas into specialist therapeutic gardens for patients. One of the gardens supports dementia patients, while the other supports stroke and rehabilitation patients. Based on a Japanese design, the gardens are compact but tranquil sanctuary within the hospital, and are also open to staff and visitors

 
Bournemouth hospital garden, Bournemouth

A desolate tarmac courtyard in the hospital was revamped and made into a three-part garden. There is a therapeutic garden outside the chemotherapy suite, a sensory garden linking the courtyard to a lakeside garden, and a large area to walk around and exercise in.

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Holodance: Dancing with Dragons in Virtual Reality!

Rhythm-based VR fitness games are ubiquitous, but each one seems to have its own niche feature. Holodance has dragons.

No seriously, it’s also very good. The rhythm mechanic rivals other VR rhythm fitness games: Audioshield, Beats Fever and Soundboxing.
Calories/hour: 348
Distance travelled: 2145m
Average HR: 97 (range 80-134)

Find all the Virtual Reality reviews here: https://www.youtube.com/playlist?list=PLkYBGegM5dQmeqL5SlZ19NOXFUlT9qBgM

Steam Curator site – essential HTC Vive games and applications:
http://store.steampowered.com/curator/2724129

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Sairento: VR Ninja Skills with bullet-time.

This is a very ambitious game, with certain elements that can only be described as pure joy (the slow-motion/bullet-time). Mechanics for both sword and gun components are richly satisfying, and it compares well to Raw Data from Survios.

Nevertheless, it is a resources hog, and my graphics card perhaps wasn’t powerful enough to play it for sustained periods without stalling.

Calories/hour: 248
Distance travelled: 985
Average HR: 92 (range 71-108)

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[MUST READ] Coca-Cola’s secret influence on medical and science journalists

Please read this article from the British Medical Journal: http://www.bmj.com/content/357/bmj.j1638

 

This is a very important argument, and it is essential for healthcare professionals, journalists and politicians alike to make a concerted and aggressive effort to kick these sugar-peddling companies out of the sphere of academic influence.

The more overt “More Doctors smoke…” advertisements of yesteryear are thankfully a thing of the past, but the covert influence of sugar-saturated food companies is no less a threat to our health. Aaron and Siegel (1) report that from 2011 to 2015, the Coca-Cola Company and PepsiCo were found to sponsor 95 national health organizations, many medical and public health institutions amongst them. They also lobbied against 29 public health bills intended to reduce soda consumption or improve nutrition.

The British Nutrition Foundation, for example, lists amongst “Sustaining Members” Coca-Cola, PepsiCo, Kellogg, Nestle, Tate & Lyle and has “Corporate Members” British Sugar plc, Mars UK, KP Snacks, McDonalds, United Biscuits, Weetabix, Ocean Spray and many more. Although it is open to companies and corporations from a variety of backgrounds including healthcare and fitness, the actual members who have provided support read as a Who’s Who of Sugar Salesmen (2), making their promise of a “a focus on objective nutrition science interpretation and delivery” open to scrutiny. The American Society for Nutrition is no different, with an almost-identical list of names cropping up (3) for this group, which publishes the Journal of Nutrition.

Indeed, the editorial boards of top nutrition journals are littered by corporate affiliations with sweetie companies – The American Journal of Clinical Nutrition, for example, lists the likes of Mars, Coca-Cola, PepsiCo, Nestle, McDonald’s  and Ferrero amongst companies who have a relationship with members of their board (4). The ambassador’s reception may also be overflowing with hazelnut-and-wafer spherical treats at many other nutrition journals, who often  home of the Journal of Nutrition Education and Behavior, who have eight “corporate patron friends” and four “corporate sustaining friends.  (5)

It would be interesting to note how these journals consider submissions which report a detriment to health from these companies’ products, but when some of the largest nutrition journals display such a conflict of interest it must become clear to all that the Honey Pot relationship between “Big Food” and academia is poisonous and needs to be dealt with.

References:

(1) Sponsorship of National Health Organizations by Two Major Soda Companies. Aaron, Daniel G. et al. American Journal of Preventive Medicine , Volume 52 , Issue 1 , 20 – 30

(2) “Member Organisations – British Nutrition Foundation”. Nutrition.org.uk. N.p., 2017. Web. 10 Apr. 2017.

(3) “American Society For Nutrition – Our Sustaining Partners”. Nutrition.org. N.p., 2017. Web. 10 Apr. 2017.

(4) AJCN Editor Conflict of Interest Statement. (2017). Ajcn.nutrition.org. http://ajcn.nutrition.org/site/misc/EditorCOI.xhtml Web, 10 April. 2017.

(5) Nestle, Marion. Food Politics. 1st ed. Berkeley, Calif.: University of California Press, 2013. P112. Print.

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