Is imaging increasing health or profit?

Brain imaging is a huge business. The benefits of this research field are vast, the costs are high and most important of all: everybody wants in.

Wasteful behavior of X-rays

Ionizing radiation hazard... proceed reading with caution!
Ionizing radiation hazard… proceed reading with caution!

This (dutch) article (May 2013) sums up the problem: we’re getting scanned too much. The main problem is the high number of CT scans. Because of this Belgium ranks very high in ionizing radiation (2 millisievert/capita), which isn’t a very healthy situation.

Worse still a lot of these examinations weren’t necessary in the first place. 25 % of these examinations were done in questionable circumstances. Instead they should have been replaced by MRI scans or scrapped altogether.

The Belgian Health Care Knowledge Centre already reported this problem in a paper released in 2009. It warned policy makers that regulation and financing of CT and NMR can’t be allowed to lead to an increase in CT scans for other than medical reasons.

Quote: Belgian Health Care Knowledge Centre

De reglementering en financiering van NMR en CT mogen niet van die aard zijn dat het uitvoeren van CT wordt gestimuleerd in plaats van NMR voor andere dan medische redenen, zoals op dit moment soms het geval lijkt.

MRI shortage

The main problem is that there is a shortage in MRI scanners, according to Martijn Grietens (head of radiology Ziekenhuis Oost-Limburg). This isn’t helped by the significant cost to buy one. An MRI scanner is three times as expensive as a CT scanner: 1,2 million Euro. This leads to long waiting lists ranging from 22 weeks up to 5 months.

A second problem is that the number of MRI units in Belgium is restricted by the government. A hospital has to meet the accreditation criteria In order to obtain approval, after which it gets funds to operate the MRI unit. The MRI scanner and its usage are then reimbursed by the National Institute for Health and Disability Insurance (NIHDI) (source) . Without these funds the cost for buying and running a MRI scanner is too high for a hospital to carry.

Every patient needs a total body scan

Online health shopping
Online health shopping in the Netherlands (source: prescan)

But it doesn’t stop there. Patients have become more and more demanding. We no longer wait for the doctor to tell us that we need to have a scan done, we ask/demand it. This has opened up a whole new market.

A number of companies have started selling health care. They don’t act on medical judgement, but let the “customer” decide which checkups and scans they need. Now everyone, who’s willing to pay the price, can get a his whole body examined on simply request.

40 % reduction? lowest price guarantee?! The hypochondriac in me is urging me to sign up!
40 % reduction? lowest price guarantee?! The hypochondriac in me is urging me to sign up!

One of the companies that specializes in selling health care is prescan. On their website they use all the same marketing tricks that you can also find in the best teleshopping programs. They even handy bundles for those amongst us who just can’t decide.

The checkup can include MRI scans of various body parts, lab work, external and internal examination, ECG, … Even a hotel, food and transportation can be included depending on which package you choose.

For me this is taking it a bit too far. Health care is an area that, in my opinion, shouldn’t be commercialized. On a related note, people should also understand that searching the internet doesn’t compare to a real medical training and years of expertise.

And yet the long waiting lines in hospitals could well be causing a lot of patients turning towards these kind of organisations.

Is imaging increasing health or profit? I think the answer lies somewhere in between.

What defines you?

Who or what are you really?

What defines you as a person? Can we really perceive reality for what it really is or do we only sense its rough outlines? These questions are beautifully embedded in the following comic:

XKCD comic - Trapped
911? My brain is hatching an escape plan, please stop it!

This comic raises some interesting questions. The first question makes us reflect on who we really  are and what defines us. Our brain is trapped in a continuously changing “cage”. In essence, one could say we’re nothing more than a bunch of cooperating cells. However most of these cells get damaged, die and are regenerated.

Shocked? Probably not, yet losing a limb or even a finger is a very traumatic experience. A lesson can be learned here: our brain doesn’t seem to cope well with mass-murdering, but tolerates occasional fatalities. But more importantly, this shows that we think of ourselves as more than just a bunch of neurons and the ideas trapped inside of them.

Indeed, our brain needs the rest of our body to move about, get sensory input, nutrients and oxygen. That’s were the third panel comes in. The girl suggest that the brain shouldn’t feel trapped, but use the surrounding tissue to move about and make sense of the world its living in.

The last panel is of course a nod to Plato’s “Allegory of the Cave”. The main protagonist rightfully remarks that its senses only show an imprint of reality, one that is far less complex than the true underlying processes. We only sense the “shadows” of reality.

Plato would certainly approve. I bet he would have loved the opportunity to see what’s going on inside our brain.

Brain imaging will make health products smarter

Brain neuronsTechnology is changing the way we monitor our health. We track our bodies performance during sports, have smartphone apps to monitor our sleep patterns and measure our body fat percentage using body fat scales.

The brain is uncharted territory… or is it?

We’ve been able to accurately track our heart rate, using a consumer product, since 1977. In that year, Polar introduced the first heart rate monitor that had an accuracy comparable to an EKG (electrocardiography).

The human brain is obviously much harder to monitor. We have various techniques to record brain-activity, each of them offering distinct advantages and disadvantages. The real challenge however is interpreting the data.

Although we only understand a fraction of the functioning of our brain, some companies are already trying to develop consumer-grade products to let you take a look inside at a democratic price. The Emotiv headset and the crowd-funded Melon headband both offer a complete solution that lets you measure brain activity using EEG (electroencephalography).

This is certainly an area where fNIRS could shine. Its low cost, size and power usage could lead to small and unobstructive headsets. A multimodal product combining fNIRS with EEG, could even further improve the accuracy of the already existing products. And we’ll be one step closer to measuring our performance wherever we are or whatever we’re doing..

What will happen next?

I’ll be honest, predicting the future isn’t easy (or wise, for that matter). My best guess is that we’ll certainly see brain data being used to ease our everyday life or make it more efficient in the near future. If fNIRS will be the prevailing technology or not remains to be seen.