Dr. Brian Dolan
Development and Impact of Medical Technologies on Clinical Skill and Decision Making
a) Computer Aided Diagnosis in Mammography
In 2002 Dolan started research on a project investigating the uses of Computer Aided Diagnosis technology in medical imaging, examining a case study of mammography. The research examines the co-evolution of computer technology (scanning devices, high resolution film processors, fast and affordable processors, and artificial intelligence (‘neural networks’)) and protocols for national screening programs and the interpretation of mammograms. Of particular interest were the ethical and potentially legal implications of relying on machines to make first-level decisions about regions of interest in scans and its image processing techniques for prompting users to pay attention to certain areas. The computer-human interface with rendering images clearly visible and aiding interpretation has raised challenging questions for physicians and radiologists regarding the division of labor, work flow, trust in “black boxed” technologies, and the definition of expert knowledge. It also raises interesting questions about techniques for training in certain skills and the demands of health and social policy for major screening recommendations. (See an online publication resulting from this research.)
This project is being facilitated with the assistance of Allison Tillack, MD/PhD candidate, UCSF.
b) The Development of MRI at UCSF: early clinical applications of a revolutionary technology
Since 2004, Dr. Dolan has been working in collaboration with Dr. Larry Crooks (UCSF/UC Berkeley engineer and early MRI developer) and Dr. Nancy Rockafellar (UCSF Oral History Project, retired) to write a history of the development of the one of the first clinically useful MRI machines. This provides a detailed look at early collaboration between engineers, physicists, radiologists and other physicians to determine how the principles of nuclear magnetic resonance could be used in an imaging modality and the first results which yielded diagnostically significant information about human diseases.
An educational video essay that re-presents a number of the first images produced with the MRI from the Radiologic Imaging Lab at UCSF is under production. The video narrative also includes unique perspectives on an early university-corporate research and development endeavor and the origins of “bio-entrepreneurship” in the Bay Area.
Madeleine Hanks, Anthropology student at UCB, is a researcher on this project.
Bio-Ontology and the Organization of Knowledge for Evidence Based Medicine
The rapid generation of biomedical and clinical research data has created a need for methods of analyzing endless online information by both scientists and computers. Ontologies—formal representations of the concepts and relationships existing between entities within a domain of knowledge—have provided researchers with the means to describe biomedical entities for scientific modeling and health care professionals with logical information retrieval for decision support.
The use of ontologies in medical informatics has great implications for the implementation of evidence-based medicine and the future of healthcare. Clinical online ontologies could provide clinicians with fast and more comprehensive data—ideally based upon results from clinical assessments and research across the country—upon which they can base their decisions. As computer-based clinical decision support systems gain momentum, the establishment of a universal medical language and standards for qualifying evidence raises a number of questions in the medical community.
At the center of this evolving field are computer scientists, physicians, informaticians, and philosophers working together to create appropriate and useful medical technology. How they go about this may have strong implications for the establishment of medical knowledge and the dependency of medical practice on computer technology in the future. We are studying this interdisciplinary relationship by working with and analyzing the work of expert communities who design systems and using a case-based approach to understand the transformation of semantic web technology into the reality of physician decision-making in the clinic.
This project is being assisted by Mya Sendowski, an undergraduate student at UCLA.
The Medical Humanities as Crisis Management
The Medical Humanities (MH) is a growing academic field within university medical centers in America and the UK. The challenge is to identify what role the discipline plays as an educational or analytical approach to understanding both biological and non-biological issues relevant to the health professions. Anything that touches on “the human condition”, or “the humanizing process”, “the humanist philosophy” or what is “means” to be human becomes relevant. It has been claimed that the raison d’être of MH is to remind us that modern medicine can and should look beyond its technological fixation to reconnect with the human understanding of disease. But there are just as many ways to embrace the “art” of medicine and its service to humanity as there are ways of breaking the health field into discrete parts that are each concerned with their own pathology of illness.
As it stands, too often the discussion turns on the apparent juxtaposition of “medical” and “humanities”, which becomes symbolic of the cliché of the “two cultures” that allegedly talk past each other. What I propose here is that we put into abeyance the apparent problem of the division between the arts and sciences, and instead think about the common goals of problem solving and the complementary techniques of humanities-driven and science-driven paradigms of research. I believe this gets to questions about theory and practice that can reveal more similarity between “medical” work and “humanities” work than is often claimed. This also allows us to address the ways that the Medical Humanities reflect a critical attitude about medical work, as well as the ways that it complements original research in the health sciences. One conclusion from this research suggests that MH is not representative of a conflict between the cultures of art and science but of the notions of liberal inquiry and practical instruction. Ironically, MH would, I think, die a Darwinian death in the competitive environment of medical education if it was not for the possibility that MH is now working to address a crisis in “the humanities” rather than medicine.
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