Artificial intelligence may have already been used to diagnose you

A doctor looks at an X-ray on a screen helped by artificial
intelligence. (Photo by Damien Meyer/AFP via Getty Images)

Kentucky Health News

As Congress and federal regulators begin to take steps to monitor and control the use of artificial intelligence, "The technology has already been put to use in unseen and unregulated ways in health care," Ben Leonard and Chelsea Cirruzzo report for Politico Pulse, drawing on a Politico story by Daniel Payne and Ruth Reader on how A.I. is affecting Americans. Here are some ways:

Medical imaging: A.I. is is commonly used in radiology, to help "decipher medical images like X-rays — and some systems work on par with humans, according to recent studies," Politico reports. "The algorithms also measure and improve radiologists' performance."

Cancer: The progression of a cancer can be hard to evaluate, and A.I. can help, especially with prostate cancer, in which "tumors grow in multiple locations and extend in ways that might not get picked up on imaging," Politico reports.

Recordkeeping: "A.I. systems help doctors make better sense of their notes. Many health-tech companies target 'low-risk, high-reward projects' that can summarize information and act more like a secretary than a co-pilot.

Billing and coverage: "Firms are toying with technology that can change how bills are generated and processed. . . . A.I. can scrutinize bills more quickly than humans, leading to potential labor and time savings." Advocates say it will make claims move faster, "but skeptics worry AI could reduce transparency and accountability in decision-making" by health-care providers and insurers."

The Food and Drug Administration "has taken an experimental approach to regulating A.I. in medical devices, mostly issuing strategic plans and policy guidance," Politico reports. "The biggest challenge is that A.I. evolves over time, and companies don’t want to re-apply for FDA clearance to market their technology." The Department for Health and Human Services finalized a rule in December that would require more transparency about A.I. in clinical settings.

Louisville doctor has possible cure for rare brain disease of Iranian woman, who gets visa after CJ story

UPDATE, Aug. 13: "U.S. officials in Armenia granted Marzieh Taheri, 61, the exemption on Monday, just hours after her son sent them links to the Courier Journal's initial article about her plight and subsequent coverage by other media," the CJ reports.

A Louisville doctor has found what may be the first treatment to repair a rare, debilitating brain condition that can eventually lead to death, and has said he would treat a 61-year-old woman from rural Iran who needs it, but she's from a country that's on the U.S. travel restriction list and her visa application is jumping through hoops, Caitlin McGlade reports for the Louisville Courier Journal.

Marzieh Taheri and son Mehran Jafari
 (Photo provided to Courier Journal)

Marzieh Teheri suffers from a condition called radiation necrosis, which developed after she received treatment for a tumor on her ear about three years ago. McGlade reports that the tumor is gone, but because of a condition that affects 10 percent of patients who get radiation therapy on their heads, brain tissue has died, which has "distorted her brain." Until recently, there has been no hope of a cure.

But that changed after Dr. Shervin Dashti, a neurosurgeon at Norton Healthcare, recently found what may be the first treatment to repair the brain indefinitely without any side effects, McGlade reports.

Dashti told McGlade that it's like half of Taheri's brain is "on fire." He has offered to treat her at the Norton Neuroscience Institute, but won't be able to until the U.S. government approves her visa.

The Trump administration set travel restrictions on people from Iran, North Korea, Venezuela, Libya, Syria, Somalia and Yemen that were upheld in June by the U.S. Supreme Court. The administration says the restrictions are needed to be able to properly vet people from these countries trying to enter the U.S.

McGlade reports that on a case-by-case basis, "People traveling to the U.S. from these countries may get waivers if they can show that denying the visa application would cause them 'undue hardship,' that they are not a threat to the United States, and that their visit would be in the U.S. national interest, according to a September 2017 White House proclamation."

The State Department "asked Taheri to list every country she traveled to in the past 15 years, detailing where she stayed, specific locations visited, how she paid for it and length of visit.The office also asked for previous passport numbers; names and birth dates of all immediate relatives; a list of her addresses for the past 15 years; all phone numbers, email addresses, social media accounts, including messaging apps; and her job history. Her daughters compiled and sent a mountain of documents."

Taheri told McGlade that she is optimistic she'll get a waiver, since the proclamation cites urgent medical care as grounds for eligibility. However, McGlade reports that critics call the restrictions discriminatory because most of the countries on the list are Muslim-majority, and Trump said he wanted to ban Muslims during his campaign.

Dissenting Supreme Court Justice Stephen Breyer has also questioned the waiver program's legitimacy, "citing the small number of waivers granted, lack of transparency and a sworn affidavit from a former consular officer who called the process "window dressing,"" McGlade reports.

A lawsuit has also been filed this year by dozens of people impacted by the ban asserting that the "government is denying or stalling virtually all waiver grants and hasn't given consular officials discretion to grant them," McGlade writes.

McGlade writes that the agencies have yet to file formal responses, but a State Department website disputes that claim. It notes that 1,246 visa applicants have been cleared for waivers as of July 31, 2018.

McGlade reports that the State Department won't say how many of the current visa applicants are from the affected countries, but a June letter to Sen. Chris Van Hollen, D-Maryland, said they had approved waivers for just 2 percent of applicants from Muslim-majority countries in the ban.

"Out of 27,129 applicants who could possibly get a waiver, only 579 had been cleared as of April 30," she reports.

Taheri applied for her visa in June. Dashti told McGlade that everyday Taheri gets weaker, and that she is "circling the drain."

"It is agony to place my faith in a process that I know might be fraudulent, but I have no choice," wrote her son, Mehran Jafari, who now lives in Georgia. "My mother’s life could be saved by 30 minutes of surgery, and I must do everything in my power to get her to Louisville."

He added, "I don't know how my 60-year-old mom who was in the United States three years ago can pose a national security threat. If someone like my mom can pose a threat . . . how safe do Americans feel now? If a 60-year-old kind-of disabled woman can jeopardize your safety . . . this is just not America."

Health cabinet says it will seek heavy penalties for dumping in Estill and Greenup of radioactive brine from oil and gas drilling

State health officials say they will "seek significant civil penalties" against companies "responsible for the illicit dumping" of radioactive waste in Estill and Greenup counties.

The Cabinet for Health and Family Services, which has authority over radioactive waste, “intends to impose the harshest civil penalties available under the law against all those responsible for the illegal dumping of waste in the Commonwealth,” Secretary Vickie Yates Brown Glisson said in a press release. “We will not tolerate any actions that threaten the health and well-being of our citizens.” She said there are no immediate threats to public health.

One company named in the release is Advanced TENORM Services of West Liberty, which disposed of radioactive brine from oil and gas drilling at the Blue Ridge Landfill in Estill County. (TENORM stands for "technologically enhanced, naturally occurring radioactive material.") The other is Fairmont Brine, which sent similar but less potent waste to the Green Valley Landfill in Greenup County.

Tests at Blue Ridge "showed no evidence that the TENORM dumping led to radiation or radioactive contamination above federal and state safety limits," the release said. It said the cabinet is "working with the Energy and Environment Cabinet and Blue Ridge’s attorney and management to remediate and/or manage the landfill property and ensure that the property remains safe for workers and the general public, regarding both in-state and out-of-state (illegal) TENORM waste," and is "working with outside entities to perform dose assessments on the workers at the landfill. The preliminary results indicate that the workers are not at risk for any negative outcomes."

Democratic Attorney General Andy Beshear decided not to seek criminal penalties against either dumper, citing "insufficient evidence." Beshear said he asked the health cabinet for authorization to seek civil penalties, but the cabinet declined, saying it would handle that.

Under Beshear's father, then-Gov. Steve Beshear, and for a shorter time under Republican Gov. Matt Bevin, the Energy and Environment Cabinet took "seven months to alert Kentucky landfill operators to be on the lookout for illegal shipments of radioactive drilling waste and that they should not accept any it," Jim Bruggers reported in April for The Courier-Journal. "The health cabinet waited another three weeks – until March 4, two days after The Courier-Journal first reported the dumping – to order the company alleged to have quietly brought the waste into Kentucky to stop, and for landfills to stop accepting it."

Low-dose CT scans find lung cancer before X-rays, save lives

Low-dose computed tomography, commonly known as CT scans, are reducing lung-cancer deaths by finding the cancer early before it spreads to other parts of the body, UK HealthCare reports. Used as a screening tool, the American College of Radiology says CT is "the only test ever shown to reduce mortality in high-risk smokers."

This is good news for Kentucky, which leads the nation in both lung cancer and deaths from it.  It also leads, by some estimates, in smoking, the leading cause of cancer.  An estimated 25 to 28 percent of Kentuckians are smokers, compared to 18 to 19 percent nationally.

Low-dose CT screening for lung cancer is recommended for high-risk patients, defined in a Mayo Clinic article as someone 55 to 79 who's smoked the equivalent of a pack of cigarettes every day for 30 years, or those 50 and older who have smoked a pack a day or more of cigarettes for 20 years or longer and have one additional risk factor for lung cancer.

Chest X-rays, the other screening technique, typically are not done until a person has symptoms because studies have shown that they are not effective in detecting lung cancer early. However, researchers have found that heavy smokers screened with low-dose CT scans can pick up much smaller tumors than chest X-rays and have a "20 percent lower risk of dying from lung cancer than those screened with chest X-rays," UK HealthCare reports.

A recent study found that nearly one in five lung tumors detected on CT scans are probably so slow-growing that they would never cause problems, reports Lindsey Tanner of The Associated Press. These tumors are not false positives, but cancerous tumors without symptoms, which are unlikely to become deadly, according to the research. However, National Lung Cancer Screening Trial results conclude that the benefits from low-dose CT scans significantly outweigh the "comparatively modest rate of over-diagnosis," according to the American College of Radiology. "Overdiagnosis is an expected part of any screening program and does not alter the benefits you get from the screening,"

Dr. Paul Ellenbogen, chair of the American College of Radiology Board of Chancellors, said in the release, "Physicians should certainly discuss the risk and benefits of CT lung-cancer screening with patients – including that of overdiagnosis. However, for high-risk patients, the group in which CT lung cancer screening is proposed, the lifesaving benefit outweighs the risks."

Experimental concentrated breast cancer radiation therapy offers new options for women who live far away from treatment facilities

A study at the University of Louisville James Graham Brown Cancer Center designed to make  radiation treatment more accessible to women who face obstacles such as distance, transportation problems and time constraints is proving promising. The idea is to cut daily trips to the cancer center to once a week, says Dr. Anthony Dragon, a radiation oncologist at U of L. It also has the added benefit of cutting treatment costs by better than half.

Laura Ungar of The Courier-Journal in Louisville reports that Dragun led a previous study that found that "about a third of Kentucky women with early-stage breast cancer didn’t get recommended radiation treatments after lumpectomy surgery. Among those least likely to get radiation were rural Kentuckians, the elderly, African Americans and women in the Appalachian region of the state. Women who did not get recommended radiation were 60 percent more likely to die during the time they were studied."

Dragun told Ungar that the folks at U of L were not satisfied with just gathering those numbers, they wanted solutions to the problem. Dragun said the new experimental regimen is yielding good results, with women who get weekly radiation reporting similar levels of side effects as those getting radiation every day. Ungar notes that some outside experts say the approach does seems promising, but one critic was concerned about breast appearance results after the once-a-week treatments.

According the National Cancer Institute, more than 3,070 new cases of breast cancer were diagnosed in Kentucky in 2009 and was responsible for 614 deaths.  (Read more) 

Several Kentucky hospitals overdo CT scans, despite cost, risk

Despite the risk of exposing patients to more radiation and the fact that radiologists say it is very rarely necessary, Medicare outpatients are regularly receiving two CT scans on the same day at 12 Kentucky hospitals, according to analanysis of Medicare data by The New York Times, which produced a handy interactive map, a segment of which is copied here. To use the actual map, click on the map below.

Though only 5.4 percent of hospitals nationwide scan a patient's chest twice on the same day, nine Kentucky hospitals are double-scanning at least 15 percent of the time and three are doing it more than 30 percent of the time, accoding to data for 2008. Figures for 2009, which are expected to be similar, are due out next month from the federal Center for Medicare and Medicaid Services.

Clark Regional Medical Center in Winchester has the highest rate, double scanning 43 percent of the time. Monroe County Medical Center in Tompkinsville double scans 34 percent of the time, followed by Pineville Community Hospital at 32 percent.

Other Kentucky hospitals that are double scanning at least 15 percent of the time include: Clinton County Hospital, Albany, 30 percent; Paul B. Hall Regional Medical Center, Paintsville, 25 percent; Harlan Appalachian Regional Healthcare Hospital, 24 percent; Norton Hospitals, Louisville, 23 percent; Westlake Regional Hospital, Columbia, 23 percent; Spring View Hospital, Lebanon, 20 percent; Methodist Hospital Union County, Morganfield, 19 percent; T.J. Samson Community Hospital, Glasgow, 18 percent; and The Medical Center at Bowling Green, 18 percent.

There are two types of CT scans, one that uses iodine contrast to monitor blood flow and one that does not. In rare circumstances, performing both scans — each with a separate charge — could help spot a tumor, said Dr. Michael J. Pentecost, a radiologist and Medicare consultant. While doctors may opt to double scan to get the most information on their patient possible, experts say being so thorough is rarely necessary, particularly given the added cost to the system and the exposure to radiation for the patient.

As Kentucky's numbers indicate, double scanning happens more often at small, community hospitals, where treatment can involve transferring patients to larger facilities. Nationwide, 200 hospitals administered double scans more than 30 percent of the time.

The Medicare agency released the data last year to hospitals "to show how they performed relative to each other and to encourage more efficient, safer practices," Walt Bogdanich and Jo Craven McGinty of the Times report. "The Medicare agency believes hospitals can and should do more to change physician behavior ... The federal agency plans to use other, similar measurements to rein in what it considers to be unjustified — and potentially dangerous — medical procedures." (Read more)