> "Functional magnetic resonance imaging has transformed medicine."
This is not even close to true. The clinical impact of fMRI is very constrained. I've met many clinicians who have completely written it off at this point. Others that remain interested but find it mostly impractical and error prone. The only people I've met who seem to have any significant investment in it as a technology are cognitive scientists, and that's a ways from medicine.
> It allows non-invasive mapping of a patient’s brain regions to enable more accurate, precise neurosurgery,1"
Approximately nobody does this. fMRI isn't really even on the radar for most neurosurgeons. It's only recently that even detailed structural information (e.g. DTI) has got some real traction, let alone functional info. Note commercial vendors have had clinical packages on the scanners for (nearly? I forget who shipped DWI stuff first) a couple decades now. No such thing exists for fMRI, at minimum you need to buy a 3rd party processing system and may need a research key on your scanner.
Some researchers are interested in this; that's a long way from transforming anything.
> " as well as validating pharmacological effects of potential drugs on human brains.2"
There is perhaps a bit more promise here, but it's still way into the research only end. In the 15 years since the referenced paper was published, not much of this "promise" has been realized as far as I know (but this is further from my wheelhouse)
People doing related research are interested in it, and a few teaching hospitals etc., but that’s a really small fraction. it’s not really a factor in most clinical practice.
Thus “transformed medicine” is more than a bit of a stretch.
I was just reading about them using fMRI in conjunction with high frequency focused ultrasound to lesion parts of the brain associated with certain mental disorders such as OCD. They seemed to be having decent success with that
Sure, there is research all over the place - but HIFU also hasn’t made a real impact clinically, maybe it will in future.
Most of this stuff gets interest in papers for a few years , turns out to be impractical for whatever reason and dies on the vine. That’s ok, it’s worth trying .
Thank you for sharing your story. Although fMRI has low resolution, it can be very useful for surgical planning in certain clinical scenarios. For example, to determine hemispheric dominance: "Although the estimated percentages are of some debate, language is the purview of the left hemisphere in approximately 95% of right-handed people and 70% of left-handed people ... At MSKCC, language lateralization mapping is most often requested in right-handed patients with left hemispheric lesions, left-handed patients with left or right hemispheric lesions, or right-handed patients with right hemispheric lesions and signs or symptoms of aphasia." [1]
That’s interesting! You are right the resolution (both spatial and temporal) and accurately coregistering (and then with surgery, brain shift) can be among the limiting factors for clinical use. Plus the difficult in getting good signal.
I suspect this has more to do with where they had it done than anything else. There are neurosurgeons who champion it for sure , but not that many. Most places aren’t set up for it at all from what I’ve seen. I'm guessing her procedure wasnt' done awake, was it? This is a very common way to deal with the functional stuff especially near speech or motor.
Oh that's a good point, I should have been more clear (and honestly had forgotten BrainWave, you can option that with their DTI fibre stuff).
These systems are still not on the scanner (unless some of the latest acquisition stations support it? Still not on most of the deployed stuff) so typically another workstation is needed at least, this package does happens to be from the vendor. For anyone reading who finds this confusing, you can license on the machine the ability to do the "pulse sequences" you need, but it only handles the raw data - you typically need another step to process that into images you can use.
Otoh most of the people I know doing this on GE scanners used something else, but that could easily be sampling bias.
As a cognitive scientist with only 1 graduate level fMRI course and no hands-on experience outside of playing around with Neurodebian, I will not be so bold (haha) as to make a claim that there is absolutely nothing to fMRI.
However, I am very skeptical.
I would not be willing to make any strong claims about causality when the alleged neural event and the measurement thereof are 15-30 seconds apart, and the thing being measured (blood flow) is not the event itself (neural activity), and there are so, so many potential sources of error.
Now, structural MRI is super cool.
I have a bunch of friends at my university who work in fMRI brain imaging. I feel bad, but when we talk about their work, I can't help but think they are chasing alchemy. Or maybe a better analogy is that it is almost like they are trying to learn about the world (brain, cognition) based on the shadows at the back of Plato's cave (fMRI BOLD signals).
I sincerely hope they overcome the challenges, but I expect they will be facing the exact or nearly the same challenges 20 years from now.
It's a while since I ran fMRI studies but my favourite analogy was to tell people that it was like trying to measure your electricity usage by watching your water meter.
Even if they’re on a deadend they may discover a thing or two that can be applied somewhere else. But I hear you, your intuition is probably right. But if they left this area unexplored it would still be a loss.
My impression is that Nautilus and Quanta are, among pop science magazines, fairly high brow, but that Nautilus is substantially more likely to use human-interest narratives (e.g., the opening vignette) to keep the reader's attention. Is that right, or do I have the wrong impression?
You'll never get a full brain scan with fMRIs. For real detail, you'll need a planetary-scale XFEL with a human head-sized reticule and be okay with your irl head being vaporized.
Optimized models for simulating your brain accurately don't exist yet either. I highly suspect that we will have to finish the above first.
Longer version. It's still a copy, but is a copy of you still you; are you still you if you've had a copy? (My belief is yes; though at that point timelines diverge and neither 'you' is fungible for the other.)
Tom Mitchell has been using machine learning to interpret fMRI data.[1] The method struck me as one that could potentially work (though I was a bit surprised by the apparent success rate of studies in his lab).
The fundamental problem with fMRI is its poor time resolution. MEG is promising in this respect.[2]
> As for the Eklund, et al. paper, Rosen conceded, “It was an excellent point of statistics. It’s actually a point we understood, but there are no doubt lots of people that didn’t understand.” But he thinks the paper’s implications were overblown. “The impact of that paper was actually pretty modest in terms of the number of results that were invalidated, that were important results. And whether we were significantly misleading people or sending doctors astray or anything like that, was negligible as best as I could tell. But the paper got a lot of press, and suddenly, now fMRI has a black eye.”
“You see, it’s the others that don’t do it right, we do things correctly so _our_ results are accurate and relevant. It’s those other researchers who are not contributing to curing cancer/Alzheimer’s/etc” - this is the argument I have heard time and again from many colleagues when we point some fundamental issue with their whole field. Rest assured they also do the same mistakes but have often built large cognitive fortresses to shield their conscience from the reality that they are also a charlatan at least partially.
The only endgame that you can truly live with given such realisations is to leave the field but many can’t afford to do that, so you have a perpetuation of such fields which shouldn’t exist at the scale that they do.
1. fMRI only measure brain activity indirectly.
2. Nothing stops people from messing with any one parameter, setting, statistical knob out of houndreds.
I don't know if #1 is a problem itself. We measure many things indirectly. As long as the limitations are known and respected, it is still useful.
#2 Is the real issue. What we need is a movement towards saving and publishing the the actual data as close to the hardware as possible. But I'm sure medical hardware is full of quirky, proprietary Windows CE junk that makes this almost impossible.
I don't know what the solution is. If the healthcare industry wanted better software they would have to pay even more than they already do. Cheaper and better software doesn't happen because those companies and developers would rather work elsewhere. Real disruptors will have a hard time convincing the 100 vendors they need to integrate with to change their ways.
It seems that large industries will always be 10-15 years behind 'what they should be'.
What we need is a movement towards saving and publishing the the actual data as close to the hardware as possible. But I'm sure medical hardware is full of quirky, proprietary Windows CE junk that makes this almost impossible.
It's always easy to blame proprietary junk. But in this case, from the couple of things I know about it, I don't think the real problem in publishing actual data is that it's proprietary. Rather that doing something with that data is very hard. To the point that if you don't know how to build an MRI scanner, you probably also don't know how to transform the raw data into a usable and correct image.
This article reads like a longform version of why statistical power/effect size is important but doesn't mention it by name, only alluding to it. I suspect there would be much less of a replication crisis if, instead of just focusing on statistical significance, there was also a focus on effect size, or both.
Readit News
This is not even close to true. The clinical impact of fMRI is very constrained. I've met many clinicians who have completely written it off at this point. Others that remain interested but find it mostly impractical and error prone. The only people I've met who seem to have any significant investment in it as a technology are cognitive scientists, and that's a ways from medicine.
> It allows non-invasive mapping of a patient’s brain regions to enable more accurate, precise neurosurgery,1"
Approximately nobody does this. fMRI isn't really even on the radar for most neurosurgeons. It's only recently that even detailed structural information (e.g. DTI) has got some real traction, let alone functional info. Note commercial vendors have had clinical packages on the scanners for (nearly? I forget who shipped DWI stuff first) a couple decades now. No such thing exists for fMRI, at minimum you need to buy a 3rd party processing system and may need a research key on your scanner.
Some researchers are interested in this; that's a long way from transforming anything.
> " as well as validating pharmacological effects of potential drugs on human brains.2"
There is perhaps a bit more promise here, but it's still way into the research only end. In the 15 years since the referenced paper was published, not much of this "promise" has been realized as far as I know (but this is further from my wheelhouse)
Except at basically any academic neurosurgery center?
https://thejns.org/focus/view/journals/neurosurg-focus/48/2/...
People doing related research are interested in it, and a few teaching hospitals etc., but that’s a really small fraction. it’s not really a factor in most clinical practice.
Thus “transformed medicine” is more than a bit of a stretch.
Most of this stuff gets interest in papers for a few years , turns out to be impractical for whatever reason and dies on the vine. That’s ok, it’s worth trying .
It wasn't a big deal, so I think they apply it routinely in some cases in their practice.
I'm not sure if they got much from it because it was really low res in comparison with standard MRI.
Although she made a full recovery after that surgery.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966674/
I suspect this has more to do with where they had it done than anything else. There are neurosurgeons who champion it for sure , but not that many. Most places aren’t set up for it at all from what I’ve seen. I'm guessing her procedure wasnt' done awake, was it? This is a very common way to deal with the functional stuff especially near speech or motor.
Glad to hear she had a good outcome!
This is not the case, for example see the GE BrainWave software.
https://www.gehealthcare.com/products/advanced-visualization...
These systems are still not on the scanner (unless some of the latest acquisition stations support it? Still not on most of the deployed stuff) so typically another workstation is needed at least, this package does happens to be from the vendor. For anyone reading who finds this confusing, you can license on the machine the ability to do the "pulse sequences" you need, but it only handles the raw data - you typically need another step to process that into images you can use.
Otoh most of the people I know doing this on GE scanners used something else, but that could easily be sampling bias.
However, I am very skeptical.
I would not be willing to make any strong claims about causality when the alleged neural event and the measurement thereof are 15-30 seconds apart, and the thing being measured (blood flow) is not the event itself (neural activity), and there are so, so many potential sources of error.
Now, structural MRI is super cool.
I have a bunch of friends at my university who work in fMRI brain imaging. I feel bad, but when we talk about their work, I can't help but think they are chasing alchemy. Or maybe a better analogy is that it is almost like they are trying to learn about the world (brain, cognition) based on the shadows at the back of Plato's cave (fMRI BOLD signals).
I sincerely hope they overcome the challenges, but I expect they will be facing the exact or nearly the same challenges 20 years from now.
As a fellow cognitive scientist, I am too.
Optimized models for simulating your brain accurately don't exist yet either. I highly suspect that we will have to finish the above first.
Longer version. It's still a copy, but is a copy of you still you; are you still you if you've had a copy? (My belief is yes; though at that point timelines diverge and neither 'you' is fungible for the other.)
The fundamental problem with fMRI is its poor time resolution. MEG is promising in this respect.[2]
[1] https://www.youtube.com/watch?v=zy0-_HNF1us&t=6m8s
[2] https://en.wikipedia.org/wiki/Magnetoencephalography
> As for the Eklund, et al. paper, Rosen conceded, “It was an excellent point of statistics. It’s actually a point we understood, but there are no doubt lots of people that didn’t understand.” But he thinks the paper’s implications were overblown. “The impact of that paper was actually pretty modest in terms of the number of results that were invalidated, that were important results. And whether we were significantly misleading people or sending doctors astray or anything like that, was negligible as best as I could tell. But the paper got a lot of press, and suddenly, now fMRI has a black eye.”
“You see, it’s the others that don’t do it right, we do things correctly so _our_ results are accurate and relevant. It’s those other researchers who are not contributing to curing cancer/Alzheimer’s/etc” - this is the argument I have heard time and again from many colleagues when we point some fundamental issue with their whole field. Rest assured they also do the same mistakes but have often built large cognitive fortresses to shield their conscience from the reality that they are also a charlatan at least partially.
The only endgame that you can truly live with given such realisations is to leave the field but many can’t afford to do that, so you have a perpetuation of such fields which shouldn’t exist at the scale that they do.
1. fMRI only measure brain activity indirectly. 2. Nothing stops people from messing with any one parameter, setting, statistical knob out of houndreds.
I don't know if #1 is a problem itself. We measure many things indirectly. As long as the limitations are known and respected, it is still useful.
#2 Is the real issue. What we need is a movement towards saving and publishing the the actual data as close to the hardware as possible. But I'm sure medical hardware is full of quirky, proprietary Windows CE junk that makes this almost impossible.
I don't know what the solution is. If the healthcare industry wanted better software they would have to pay even more than they already do. Cheaper and better software doesn't happen because those companies and developers would rather work elsewhere. Real disruptors will have a hard time convincing the 100 vendors they need to integrate with to change their ways.
It seems that large industries will always be 10-15 years behind 'what they should be'.
It's always easy to blame proprietary junk. But in this case, from the couple of things I know about it, I don't think the real problem in publishing actual data is that it's proprietary. Rather that doing something with that data is very hard. To the point that if you don't know how to build an MRI scanner, you probably also don't know how to transform the raw data into a usable and correct image.