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AI is permeating American culture, but radiologists hesitant to place patients' health in an algorithm's hands

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AI is permeating American culture, but radiologists hesitant to place patients' health in an algorithm's hands

How good would an algorithm have to be to take over your job?

It’s a new question for many workers amid the rise of ChatGPT and other AI programs that can hold conversations, write stories and even generate songs and images within seconds.

For doctors who review scans to spot cancer and other diseases, however, AI has loomed for about a decade as more algorithms promise to improve accuracy, speed up work and, in some cases, take over entire parts of the job. Predictions have ranged from doomsday scenarios in which AI fully replaces radiologists, to sunny futures in which it frees them to focus on the most rewarding aspects of their work.

AI TECH AIMS TO DETECT BREAST CANCER BY MIMICKING RADIOLOGISTS’ EYE MOVEMENTS: ‘A CRITICAL FRIEND’

That tension reflects how AI is rolling out across health care. Beyond the technology itself, much depends upon the willingness of doctors to put their trust — and their patients’ health — in the hands of increasingly sophisticated algorithms that few understand.

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Even within the field, opinions differ on how much radiologists should be embracing the technology.

“Some of the AI techniques are so good, frankly, I think we should be doing them now,” said Dr. Ronald Summers, a radiologist and AI researcher at the National Institutes of Health. “Why are we letting that information just sit on the table?”

Dr. Laurie Margolies demonstrates the Koios DS Smart Ultrasound software, Wednesday, May 8, 2024, at Mount Sinai hospital in New York. The breast imaging AI is used to get a second opinion on mammography ultrasounds. “I will tell patients, ‘I looked at it, and the computer looked at it, and we both agree,’” Margolies said. “Hearing me say that we both agree, I think that gives the patient an even greater level of confidence.” (AP Photo/Mary Altaffer)

Summers’ lab has developed computer-aided imaging programs that detect colon cancer, osteoporosis, diabetes and other conditions. None of those have been widely adopted, which he attributes to the “culture of medicine,” among other factors.

Radiologists have used computers to enhance images and flag suspicious areas since the 1990s. But the latest AI programs can go much further, interpreting the scans, offering a diagnosis and even drafting written reports about their findings. The algorithms are often trained on millions of X-rays and other images collected from hospitals and clinics.

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Across medicine, the FDA has OK’d more than 700 AI algorithms to aid physicians. More than 75% of them are in radiology, yet just 2% of radiology practices use such technology, according to one recent estimate.

For all the promises from industry, radiologists see a number of reasons to be skeptical of AI programs: limited testing in real-world settings, lack of transparency about how they work and questions about the demographics of the patients used to train them.

ARTIFICIAL INTELLIGENCE NOT ALWAYS HELPFUL FOR REDUCING DOCTOR BURNOUT, STUDIES SUGGEST

“If we don’t know on what cases the AI was tested, or whether those cases are similar to the kinds of patients we see in our practice, there’s just a question in everyone’s mind as to whether these are going to work for us,” said Dr. Curtis Langlotz, a radiologist who runs an AI research center at Stanford University.

To date, all the programs cleared by the FDA require a human to be in the loop.

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In early 2020, the FDA held a two-day workshop to discuss algorithms that could operate without human oversight. Shortly afterwards, radiology professionals warned regulators in a letter that they “strongly believe it is premature for the FDA to consider approval or clearance” of such systems.

But European regulators in 2022 approved the first fully automatic software that reviews and writes reports for chest X-rays that look healthy and normal. The company behind the app, Oxipit, is submitting its U.S. application to the FDA.

The need for such technology in Europe is urgent, with some hospitals facing monthslong backlogs of scans due to a shortage of radiologists.

In the U.S., that kind of automated screening is likely years away. Not because the technology isn’t ready, according to AI executives, but because radiologists aren’t yet comfortable turning over even routine tasks to algorithms.

“We try to tell them they’re overtreating people and they’re wasting a ton of time and resources,” said Chad McClennan, CEO of Koios Medical, which sells an AI tool for ultrasounds of the thyroid, the vast majority of which are not cancerous. “We tell them, ‘Let the machine look at it, you sign the report and be done with it.’”

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Radiologists tend to overestimate their own accuracy, McClennan says. Research by his company found physicians viewing the same breast scans disagreed with each other more than 30% of the time on whether to do a biopsy. The same radiologists even disagreed with their own initial assessments 20% of the time, when viewing the same images a month later.

About 20% of breast cancers are missed during routine mammograms, according to the National Cancer Institute.

And then there’s the potential for cost savings. On average, U.S. radiologists earn over $350,000 annually, according to the Department of Labor.

In the near term, experts say AI will work like autopilot systems on planes — performing important navigation functions, but always under the supervision of a human pilot.

That approach offers reassurances to both radiologists and patients, says Dr. Laurie Margolies, of Mount Sinai hospital system in New York. The system uses Koios breast imaging AI to get a second opinion on mammography ultrasounds.

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“I will tell patients, ‘I looked at it, and the computer looked at it, and we both agree,’” Margolies said. “Hearing me say that we both agree, I think that gives the patient an even greater level of confidence.”

The first large, rigorous trials testing AI-assisted radiologists against those working alone give hints at the potential improvements.

Initial results from a Swedish study of 80,000 women showed a single radiologist working with AI detected 20% more cancers among mammograms than two radiologists working without the technology.

In Europe, mammograms are reviewed by two radiologists to improve accuracy. But Sweden, like other countries, faces a workforce shortage, with only about 70 breast radiologists in a country of 10 million people.

Using AI instead of a second reviewer decreased the human workload by 44%, according to the study.

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Still, the study’s lead author says it’s essential that a radiologist make the final diagnosis in all cases.

If an automated algorithm misses a cancer, “that’s going to be very negative for trust in the caregiver,” said Dr. Kristina Lang of Lund University.

The question of who would be held liable in such cases is among the thorny legal issues that have yet to be resolved.

One result is that radiologists are likely to continue double-checking all AI determinations, lest they be held responsible for an error. That’s likely to wipe out many of the predicted benefits, including reduced workload and burnout.

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Only an extremely accurate, reliable algorithm would allow radiologists to truly step away from the process, says Dr. Saurabh Jha of the University of Pennsylvania.

Until such systems emerge, Jha likens AI-assisted radiology to someone who offers to help you drive by looking over your shoulder and constantly pointing out everything on the road.

“That’s not helpful,” Jha says. “If you want to help me drive then you take over the driving so that I can sit back and relax.”

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A jury hands Bungie a landmark victory in a Destiny 2 cheating lawsuit

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A jury hands Bungie a landmark victory in a Destiny 2 cheating lawsuit

Yesterday’s jury decision awarded Bungie (PDF) a tidy sum of $63,210. Bungie counsel James Barker said in a statement emailed to The Verge that the company is “committed to our players and will continue to protect them against cheats, including taking this and future cases all the way to trial.”

In 2021, Bungie sued AimJunkies and four defendants (here’s a PDF of the complaint), alleging, among other things, that they hacked Destiny 2 to copy the code used to make cheats. Some of Bungie’s complaints — like that AimJunkies violated a DMCA provision forbidding circumvention of copyright protection tech — went to arbitration and saw Bungie winning $4 million. AimJunkies appealed after the judge confirmed that award. That appeal is still in process, as Polygon wrote this week.

Phoenix Digital founder David Schaefer will move to dismiss the jury’s verdict and appeal it if necessary, according to Totilo. However that shakes out, the verdict is significant, given that cheating lawsuits tend to conclude in other ways, like settlements. (For example, a judge shut down a Grand Theft Auto cheat distributor in 2018 following a Take-Two Interactive lawsuit, or when Bungie settled another cheating lawsuit in 2022 for $13.5 million.)

The win may only mean pocket change for Bungie, and it won’t likely put an end to online cheating, but it does put a jury on record about the legality of creating such cheats. That makes this more significant than the pocket-change-for-Bungie $63,000 award lets on.

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Don’t fall for this email scam that almost cost an elderly woman $25K

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Don’t fall for this email scam that almost cost an elderly woman $25K

Unfortunately, phishing scams seem to be the new normal. 

Most recently, an elderly woman in the tri-state area almost got scammed for $25,000. 

According to Patch.com, what began as an average phishing scam turned even more sinister when the scammer turned up at this elderly victim’s house to retrieve money physically.

GET SECURITY ALERTS, EXPERT TIPS — SIGN UP FOR KURT’S NEWSLETTER – THE CYBERGUY REPORT HERE

Kurt “CyberGuy” Knutsson has a warning about an email scam. (Kurt “CyberGuy” Knutsson)

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Geek Squad scammer caught in elaborate phishing scheme

While this Geek Squad scam isn’t new, this scammer took it to new lows and got caught in the process. In this particular scam, scammers send their victims phishing emails pretending to send them a large invoice for their Geek Squad subscription. The email recipients usually panic at the large charge and call the customer service telephone number listed in the scam email and invoice. 

The scammer then pretends to be the customer service representative helping to cancel or refund the charge. They’ll usually use that moment as an opportunity to confirm bank account information with the victim to steal their money later. Even if you simply click on their links or download the invoice from the email, there is a potential risk that viruses or malware have been downloaded onto your device. 

woman on phone

A woman on her cellphone and laptop. (Kurt “CyberGuy” Knutsson)

MORE: THE ‘UNSUBSCRIBE’ EMAIL SCAM IS TARGETING AMERICANS

Elderly victim foils scammer’s elaborate plot

The elderly victim gave her bank account number and remote access to her computer. The scam, however, doesn’t just stop there. The scammer went a step further and proceeded to convince this elderly woman that they had accidentally refunded a fake $25,000 into her bank account by mistake and that he needed her to withdraw $20,000 in cash initially for him to pick up with arrangements to pick up the remaining $5,000 the following day. This is when the elderly woman called her local authorities. Thankfully, the authorities set up surveillance and apprehended the scammer when he came to collect the $20,000. 

Perhaps the elderly victim lucked out that this scammer had an extra level of greed: combining multiple scams into one. 

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stressed woman on phone

A woman stressed out while on a phone call. (Kurt “CyberGuy” Knutsson)

MORE: 7 EFFECTIVE WAYS TO MAKE YOUR LIFE MORE SECURE AND PRIVATE ONLINE

How do you prevent this scam from happening to you?

Know your subscriptions: The better you know what active subscriptions you currently pay for, the less likely you are to realize such emails are fake. 

Organize your invoices: If you’re still receiving emails or physical invoices, keep track of when they usually arrive. Invoices, for better or worse, come regularly and on a consistent schedule. If something shows up in an unusual form (an email instead of a letter in the mail per usual) or at a particular time, you are more likely to stop yourself from falling for this type of scam.

Go to the official website for contact information. If the scammers happen to pick a company that you do subscribe to, it can be even easier to fall for this type of scam. But before clicking any links, downloading any invoices or calling the number listed, you can google the company’s official website and use the contact information there. If the company did indeed send you a bill, they should be able to help you with the refund or confirm whether you were sent legitimate communications.

Watch for language and tone of voice: Most legitimate companies go out of their way to specially train their employees to provide their customers with excellent service. They are trained not to lose their temper, so if you happen to be on a call with a scammer, they often don’t use professional language or have a professional demeanor. If you push back on providing certain information, a real customer service agent wouldn’t make any threats or demands. Providing Social Security numbers or bank account information is usually frowned upon for security reasons by legitimate companies. Legitimate companies typically have other ways to validate your identity and account information. You can always hang up the phone if you get overwhelmed on a call! After all, an honest company doesn’t disappear after one disconnection. 

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Setup payments electronically: If you have your subscriptions paid electronically on a regular basis, you’ll know that you shouldn’t be receiving an additional invoice for a subscription service. Additionally, if you are paying with a credit card, you can try to use a specific card for all your subscriptions so you know where and when to expect the charges. You’ll also know that certain bank information shouldn’t be relevant to paying an invoice if you get one of these phishing emails. For instance, why is the scammer asking for bank account information when you charge your subscriptions on a credit card, etc.?

ASK OUR TECH EXPERT ANY QUESTION, AND GET KURT’S FREE CYBERGUY REPORT NEWSLETTER HERE

scam illustration

Kurt “CyberGuy” Knutsson shares his caution about an email scam. (Kurt “CyberGuy” Knutsson)

SCAMMERS ARE USING FAKE NEWS, MALICIOUS LINKS TO TARGET YOU IN AN EMOTIONAL FACEBOOK PHISHING TRAP

What to do next if you’ve been scammed?

These scammers could have obtained your email address through various methods, from email harvesting to purchasing it from the dark web; below are some active steps you can take to protect yourself if you feel you have been scammed:

1. Change passwords: For any accounts that might have been accessed or mentioned to or by the scammer, you should log in from a secure, virus- and malware-free device and change your password immediately. It is best to create unique and complex passwords, including letters, symbols and numbers, for each separate online account. If you need help generating and storing complex passwords, consider using a password manager.

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2. Keep an eye on all your accounts and credit consistently: Contact the financial institution and explain the situation for all accounts impacted by the potential scammer. They can help you freeze or lock your account, so these scammers have little or no access to your money. Contact the three main credit bureaus to freeze your credit. This will prevent anyone, including hackers, from wreaking havoc on your credit. Make sure to report any errors on your credit reports with the credit agencies. Remember that you are allowed a free annual credit report. If there are too many accounts for you to keep track of regularly, a credit monitoring service can help by constantly monitoring and alerting you of any account changes or problems.

3. Setup alerts for financial accounts: Most financial institutions offer financial alerts or restrictions for all transactions for checking accounts and cards. Do use them so you can be notified of any fraudulent transactions immediately. The faster you can report these charges to your financial institution, the more likely you can stop the scammers in their tracks.

4. Enable two-factor authentication for any account impacted by the phishing scam: This would include your financial accounts and email address. If you have this additional layer of security on, the hacker or scammer would have to send a code to another device or account to gain access, even with your password. 

5. Get Identity Theft Protection: While getting an identity theft service seems overkill, many identity theft protection services can help you when your accounts get compromised. They continually monitor the dark web and your financial accounts to see if any crucial personal information like your email addresses or bank account information is compromised or up for sale on the dark web. Getting those alerts immediately allows you to act faster and take the above-mentioned steps. If you have already given out your information to a potential scammer, you should follow these steps to ensure that your identity hasn’t been stolen. See my tips and best picks on how to protect yourself from identity theft.

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6. Use strong antivirus software: If you have antivirus software installed on the device where the scam email was received and any links clicked or attachments downloaded, run a scan on that device to identify suspicious software, delete it, and restart your device. Get my picks for the best 2024 antivirus protection winners for your Windows, Mac, Android & iOS devices.

7. Call the local authorities: While you hope never to encounter a scammer like the elderly woman who was victimized, if you feel unsafe and uncertain about how scammers will use your information, definitely reach out to local authorities. 

DON’T CLICK THAT LINK! HOW TO SPOT AND PREVENT PHISHING ATTACKS IN YOUR INBOX

Kurt’s key takeaways

While there is little you can do about your digital information swimming around the internet, there are active steps you can take to protect yourself from these types of phishing scams. In the worst-case scenario, there are also ways to prevent further compromise if you fall victim.

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Have you been a victim of a phishing scam? How did you find out it was a scam? Let us know by writing us at Cyberguy.com/Contact

For more of my tech tips and security alerts, subscribe to my free CyberGuy Report Newsletter by heading to Cyberguy.com/Newsletter

Ask Kurt a question or let us know what stories you’d like us to cover.

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Copyright 2024 CyberGuy.com. All rights reserved.

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I hated Animal Well until I beat the game

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I hated Animal Well until I beat the game

About midway through Animal Well, I felt I had been lied to. I read all the glowing reviews of the game and heard the breathless praise heaped upon it on social media. But my expectations did not match my reality… until I beat the game. Now, I’m well on my way to 100 percent completion for a game I was seriously considering abandoning.

Spoilers for Animal Well are below.

Though I loved Animal Well’s novel take on traditional movement abilities — the tools it provides possess multiple clever uses — platforming itself often felt demoralizing. Initially, Animal Well’s platforming felt like it had difficulty spikes that were both too great and too frequent. I could often see where I had to go and how to get there (and I often looked up video guides to confirm I was doing it right with the right tools) but actually executing was more laborious than fun and engaging.

Though I loved Animal Well’s novel take on traditional movement abilities, platforming itself often felt demoralizing

I’ve always felt that the difficulty of a task in a platformer should be commensurate with its importance: the hardest moments should be reserved for secrets and optional goals, while everything involved in completing the game should be more attainable. That way, I am still in control of my experience and, critically, still having an experience. If reaching a secret is harder than I’d like, then I can opt out to continue on to beat the game one completion percentage point lower. But if simply getting from point A to point B is too dang hard, opting out means opting out of the game entirely. Animal Well’s platforming convinced me I’d run into an obstacle so frustratingly difficult that I’d quit and never come back.

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On a lark, I decided to see what would happen if I pressed a big red skull button in a room full of crows, and yup, they pecked me to death.
Image: Big Mode / Shared Memory

Thankfully, that didn’t happen. Somehow, I persisted long enough to collect all four animal flames to complete the game’s first “ending,” figuring I’d stop there. But then, right before the final encounter, I found a room littered with skulls containing an upgrade to the bubble wand item. Remember this, it’ll be important in a moment.

The bubble wand creates little bubble platforms you can jump on, but you can only blow one at a time. The upgraded bubble wand allows you to blow multiple bubbles that, with the right technique, let you bypass a lot of the game’s obstacles.

Remember the skulls? I figured out that all the skulls in that room, piled high enough for me to reach the wand, represented the number of times I died. With that realization came the shock that even though I wasn’t initially vibing with the game, it was always vibing with me. The bubble wand upgrade is unreachable unless you’ve accumulated enough skulls to build a platform up to it. The only way I got what finally made this game click for me was because of all the frustration it put me through in the first place.

When I figured that out, I started laughing maniacally, tears in my eyes, thinking, “Oh, you cheeky bastards!” I immediately went right back to the start of the game to go egg hunting, something I already decided I wasn’t going to do. But I was locked in now. I understood. I’m stuck in the (animal) well now, and I’m never coming out.

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