iBrisk

Houston hospital uses AI to create new breast cancer risk calculator

A new tool being used at Houston Methodist taps into artificial intelligence breast cancer diagnosis. Photo courtesy of Houston Methodist

In the medical field, billions of dollars are wasted each year — about $935 billion, but who's counting? According to a paper published by the JAMA Network, an estimated $75.7 billion to $101.2 billion is wasted through overtreatment. Of the many procedures that can lead to wasted resources, breast cancer biopsies are a major source of overtreatment. Houston Methodist Hospital is using artificial intelligence to create a more efficient and accurate Breast Cancer Risk Calculator, called iBrisk.

Breast cancer is something that plagues the lives of many women, and some men. According to the National Breast Cancer Foundation, one in eight women will be diagnosed with breast cancer in their lifetime.

Women are advised to start having annual mammograms to screen for breast cancer starting at age 40 to try to catch cancer in its earliest stages. With mammograms becoming a standard procedure, the process inevitably leads to more biopsies.

While more biopsies sound like the obvious course of action, Houston Methodist Hospital shares that out of 10,000 women biopsied, less than two will be positive while using the national standard. The result of a negative biopsy? Wasted time, resources, and money, as well as undue worry for the patient.

"It's not just wasteful. . .when you do an unnecessary procedure, you're potentially harming the patient," says Stephen Wong, Ph.D. After a negative biopsy, Dr. Wong explains that patients often begin to show emotional responses like high anxiety and low self-esteem. They often speculate the biopsies are wrong, and that they've had a missed cancer diagnosis by their medical provider.

Dr. Wong estimates that more than 700,000 patients have unnecessary biopsies in the breast cancer category alone.

Spearheading the iBrisk tool, Dr. Wong has found a way to utilize a smarter model than the current system for detecting breast cancer risk.

Hospitals across the country currently use the Breast Imaging Reporting and Database System score (BI-RADS), a system created by the American College of Radiology to determine breast cancer risk and biopsy decision-making.

To expand on BI-RADS data, Dr. Wong used multiple patient data points and AI technology to create the improved system. The iBRISK integrates natural language processing, medical image analysis, and deep learning on multi-modal BI-RADS patient data to make one of three recommendations: biopsy not recommended, consider biopsy, or biopsy recommended.

"While using AI, we try to simulate how the physician thinks," explains Dr. Wong. "The physician looks at different data: imaging, patient clinical data, demographic, history and other social factors. You don't rely on one particular thing."

To create iBrisk, Dr. Wong used 12 to 13 years of BI-RAD data at Houston Methodist Hospital to train the AI using deep learning.

He estimates that more than 80 percent of technical information is in the free text format, meaning unstructured data, in the United States.

"We applied an AI technique called natural language processing, which is using the computer to read the text automatically for us," explains Dr. Wong.

This data extraction tool was also used with imaging of mammogram ultrasounds by applying image analysis computer vision.

iBrisk also deploys deep learning, a machine learning tactic where artificial neural networks, inspired by the human brain, learn from large amounts of data. They determined approximately 100 parameters to analyze, including age, sex, socio-economic data, medical history, and insurance plans. After putting the data points into a deep learning method, the AI reduced the data points to the 20 risk indicators.

Houston Methodist Hospital used an estimated 11,000 cases for training, and then used 2,200 of its own data to test iBrisk. They have even been able to create unbiased independent validation by working with other hospitals like MD Anderson, testing their patients using iBrisk and confirming the results.

The potential of iBrisk to cut costs and contribute to less overtreatment has garnered support with other hospitals around the country. The breast cancer risk calculator is a collaboration with Dr. Jenny Chang of HMCC and breast oncologists at MD Anderson, UT San Antonio, and University of Utah Cancer Center.

While implicit racial bias has become a more prominent issue in the United States, Houston Methodist's iBrisk grants a neutral, unbiased lens. AI isn't immune to racial bias; in fact, computer scientist and founder of the Algorithmic Justice League, Joy Buolamwini, uncovered the large gender and racial biases of AI systems sold by IBM, Amazon and Microsoft in a 2019 article for Time.

With AI's history of racial bias in mind, Dr. Wong set out to create an impartial, fair system. "Our AI data is not sensitive to race. . .it's unbiased," he explains.

Houston Methodist Hospital plans to expand the iBrisk model to other forms of cancer in the future, including its next venture into thyroid and incidental lung nodule screenings.

The AI allows patients to save the stress of getting a biopsy.

"We are very careful to put any drugs or any procedure into clinical workflow until we are very sure you really have to pick this [outcome]," explains Dr. Wong. Using advanced risk detectors like iBrisk allows medical practitioners to make more thorough, informed decisions for patients looking into biopsies.

The categories are broken into low, moderate and high-risk groups. The low-risk groups have seen a 99.8 percent accuracy in results, missing only two cases out of a sample of 1,228. Patients that have fallen into the high-risk groups (leading patients to get a biopsy) have seen an 85.9 percent accuracy, compared to radiology, which is 25 percent accurate according to Dr. Wong.

Dr. Wong notes that patients that fall in the moderate section of the risk assessment can then have a dialogue with their physician to determine if they want to move forward with the biopsy. In the moderate category, there is a 93.4 percent accuracy.

If implemented, iBrisk would be able to reduce 75 percent of unnecessary biopsies, estimates Dr. Wong.

Currently, Houston Methodist Hospital is using AI technology outside of oncology, with the recent release of a tool that can diagnose strokes using a smartphone, announced in Science Daily. The tool, which can diagnose abnormalities in a patient's speech and facial muscular movements, was made in collaboration with Dr. Jay Volpi of Eddy Scullock Stroke Center at Houston Methodist Hospital.

"We are answering bigger questions," explains Dr. Wong, who looks forward to continuing to expand AI capabilities and risk calculators at Houston Methodist Hospital.

In the future, Dr. Wong looks forward to doing a multicenter trial to bring this technology outside of Texas.

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Building Houston

 
 

Houston-based Soliton can use its audio pulse technology to erase scars, cellulite, and tattoos. Photo via soliton.com

Soliton, a Houston-based technology company, is using audio pulses to make waves in the med-aesthetic industry.

The company, which is licensed from the University of Texas on behalf of MD Anderson, announced that it had received FDA approval earlier this month for its novel and proprietary technology that can reduce the appearance of cellulite.

MIT engineer and doctor Christopher Capelli first developed the basis of the tool while he led the Office of Technology Based Ventures at M.D. Anderson.

Capelli uncovered that he could remove tattoos more effectively by treating the skin with up to 100 waves per second (about five to 10 times greater than other devices on the market), giving birth to the company's proprietary Rapid Acoustic Pulse (RAP) platform.

In 2012 he formed Soliton with co-founder and entrepreneur Walter Klemp, who also founded Houston-based Moleculin, and later brought on Brad Hauser as CEO. By 2019, the company had received FDA approval for using the technology for tattoo removal.

"The original indication was tattoo removal, which is what Chris envisioned," Hauser says. "The sound wave can increase in speed whenever it hits a stiffer or denser material. And tattoo ink is denser, stiffer than the surrounding dermis. That allows a shearing effect of the sound wave to disrupt that tattoo ink and help clear tattoos."

According to Hauser, the team then turned to a second application for the technology in the short-term improvement in the appearance of cellulite. With the use of the technology, patients can undergo a relatively pain-free, 40- to 60-minute non-invasive session with no recovery time.

Brad Hauser is the CEO of Soliton. Photo courtesy of Soliton

"It works similarly in the fibrous septa, which are the tethered bands that create the dimples and cellulite and the uneven skin. Those are stiffer than the surrounding fat cells in the subcutaneous tissue," Hauser says. "That allows the technology to disrupt those fibrous septa and loosen and release the dimples."

In 2021 the company plans to commercialize their product and get it into the hands of dermatologists, plastic surgeons, and other medical professionals for 25 key accounts—potentially including ones Houston—with a plan for a national rollout in 2022.

And they don't plan to stop there.

The company has already announced a partnership for a proof-of-concept study with the U.S. Navy in which Soliton will aim to use its technology to reduce the visibility of fibrotic scars, and more importantly work to increase mobility or playability of scars.

"Often the scar ends up causing restrictions in motion and discomfort with pressure of even clothing and certainly with sleeping," Hauser says. "We believe based on the reduction in volume and the increase in playability that we saw in our original proof-of-concept study that we will be able to bring benefits to these military patients."

Work on the study is slated to begin in the first half of this year.

In the meantime, the company is making headway with treatment of liver fibrosis, announcing just this week that it's pre-clinical study in animals demonstrated positive results and a reduction in effects by 42 percent seven days after the completion of carbon tetrachloride (CCL4) induction. The RAP technology was also named the best new technology by the Aesthetic Industry Association earlier this month.

"It's really targeting collagen fiber and fibroblasts on a cellular level" Hauser says. "Which we think has numerous potential uses in the future."

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