When I told my doctor I had an opportunity to get a full body MRI for work, he told me not to do it.
He cited the general medical community’s opinion that, for most adults, the benefits of full body scans won’t outweigh the risks of chasing down a (likely benign) finding with invasive follow-up procedures. Because while there’s a slim chance the scan will lead to an early diagnosis of a serious health condition or cancer, the likelihood it’ll find something a little off in your body is all but guaranteed.
If they were a good idea, he said, doctors would be recommending them to all of their patients who could afford to get one. (Prices for a full-body scan, which look for tumors and other abnormalities in all the major bodily systems, range from $1,350 to $2,500.)
Like any reporter who does things for the plot, I ignored the advice of the professional and got the scan anyway. Because right now, people who can afford it are going in for full-body MRIs at places like Prenuvo, where I went in New York right before Prenuvo officially opened its eighth branch in the US this spring.
Ezra, another private company offering full-body scans, announced last month that its newest scan called the “full body flash” is now available, which uses artificial intelligence cleared by the US Food and Drug Administration to clean up MRI images. Dr. Daniel Sodickson, head radiologist with Ezra and chief of innovation in radiology at the NYU Grossman School of Medicine, said that Ezra’s AI is used to clean up images similar to how you’d “wipe clean the shower door.”
“Wipe away the fog,” Sodickson said of how the technology assists radiologists. “Basically, remove any obscuring haze so we can see crisply and clearly.”
With or without AI, full-body scans for otherwise healthy adults challenge guidance from traditional medical groups, which rely on bodies of research and careful “risk versus benefits” calculations before they send out recommendations to the masses. Prenuvo and Ezra say they can catch early-stage cancer and other health conditions that often lurk for years before being caught in a doctor’s office. But at a population level, the less common heroic story of something sinister being discovered, like pancreatic cancer, doesn’t make up for the laundry list of follow-up tests and potential side effects that full-body scans may lead to. At least, that’s how the current thinking by medical organizations goes.
“There is no documented evidence that total body screening is cost-efficient or effective in prolonging life,” the American College of Radiology, a medical society that makes recommendations for physicians using imaging tests, said in a statement. Though it will continue to monitor new science, the college does not currently support the use of full-body screenings for patients without “clinical symptoms, risk factors or a family history suggesting underlying disease or serious injury.”
On the other hand, the companies running full body scans, with plans to increase the use of AI in order to maximize results, have the potential to serve a revolutionary shift in medical technology, especially for the four in 10 people who will develop cancer in their lifetime. If these scans can reach the whole population — not just the select few who can afford one — and come with a standardized way for doctors to interpret results, full-body MRIs may have the potential to transform primary care and make late-stage diagnoses a preventable tragedy.
The Prenuvo scan
Prenuvo is a full-body MRI scan — it stands for magnetic resonance imaging — which uses magnetic fields and radio waves to look at every bodily system and virtually all of your organs from head to toe. MRIs have traditionally been considered the “gold standard” for looking at soft tissue, the brain and spinal cord and diagnosing health conditions like aneurysms, strokes, spinal cord disorders, brain injuries and more. Compared to CT scans and X-rays, which use very small doses of ionizing radiation to capture images inside the body, MRIs don’t use any radiation and therefore don’t present the (very small) risk of repeated radiation exposure in a medical setting.
Prenuvo advertises the ability of its whole-body MRI to detect over 500 different medical conditions, ranging from benign to serious or chronic conditions throughout all the major bodily systems, including the digestive, reproductive, musculoskeletal and nervous systems. The company’s co-founder, radiologist Dr. Raj Attariwala, said in an email that Prenuvo’s scan uses multi-parametric imaging, a specific type of MRI that combines a more traditional technique with diffusion, which measures water movement at a cellular level. This “essentially eliminates” the need for a contrast or dye, which may be ordered for some MRI or CT scans to see function, he explained.
When asked about the role AI plays in the scan, Prenuvo said it “routinely” uses FDA-cleared AI techniques to investigate brain volume and fat in the liver. Prenuvo declined to comment on where the company stood on future clearances for AI in its full-body scan.
Prenuvo’s full-body scan was my first-ever MRI. The New York office is clean, pretty and has a comfortability level and snack selection that many high-end wellness clinics or offices sport in an appeal to patients willing to pay big bucks for preventive care and peace of mind.
Before going into the office, I filled out a pre-scan questionnaire with questions about things that would exempt you from a regular MRI, including whether you have a pacemaker or other metal implant that would interfere with the magnetic field of the scan.
For the scan, you undress out of street clothes and slip into scrubs and slipper shoes. Then a technician fixes you with a helmet (for the brain-scanning part) and headphones that also serve as ear protection, allowing you to listen to music or watch Netflix projected above your head. (I chose season one of Grace and Frankie.) Then the MRI machine slides you into its center like jelly into a donut and starts loudly thudding away, taking thousands of photos that will lay against each other and gives you a full picture of your body. The whole thing takes roughly an hour.
Andrew Lacy, Prenuvo’s other co-founder, also founded Tapulous, a startup that brought the world some of its first smartphone apps. Lacy sees full-body scans shaking up the world of primary medicine — specifically Western medicine, which focuses on what he calls “reactive” health care, i.e. treatment instead of prevention — with the same type of momentum smartphones brought to people who may’ve been skeptical about the very idea of owning an iPhone.
“It reminds me so much of that moment back in the early days of the iPhone, where you show people a bunch of apps and they’re like, ‘Holy cow, a phone is for more than just making phone calls,'” Lacy said.
We may view MRIs and body scans in general as something we need when we’re feeling sick. But full-body scan supporters make the case that everyone should get one once in a while before feeling ill. A full-body scan can see very small things that may or may not have an effect now, but will years down the line, Lacy said. Providing that information to people early on gives them the opportunity to make different choices, even if it’s only a small finding that requires minor lifestyle tweaks.
“You can make very small lifestyle adjustments, and that could potentially have a really big impact on your health span,” Lacy said. “So why wouldn’t I want to bring that to the world?”
Why doctors aren’t sold on full-body scans
Dr. David Jordan, the chief medical physicist at University Hospitals Cleveland Medical Center and a representative with the American Association of Physicists in Medicine, says the idea of a full-body scan like Prenuvo isn’t necessarily “good” or “bad.” But he questions what doctors and patients will actually be able to do with whatever information comes out of the scan, because there’s no standard way of interpreting those results.
Preventive full-body scans also don’t align with traditional risk versus benefit assessments. For example, doctors recommend targeted CT scans to detect lung cancer or colon cancer for some people, based on a specific risk assessment that the likelihood of finding an abnormality is high enough to outweigh the cost of future tests and medical procedures. Mammograms for breast cancer screening are another example.
“It’s much less targeted than something like mammography where we’re looking for a very specific problem, and we’re looking at a targeted population of people where we’re more likely to find it,” Jordan said.
Potential risks of a biopsy of an abnormal finding from a scan would include infection or a puncture wound to nearby tissue. Other less obvious risks would be the stress, anxiety and financial pains of follow-up appointments to get to the bottom of an abnormal result. Doing the biopsy and running all the tests may be a no-brainer for patients who went in with symptoms and whose scan turned up a likely tumor, but would a patient with no symptoms get a similar benefit?
“How much risk are you willing to tolerate in exchange for that benefit?” Jordan said. “I’m not completely opposed to the idea that there may be some value to something like this. But we just don’t have the science to know what it means and what to do with it.”
Lacy is aware of the skepticism coming from the medical community and doctors’ reluctance to recommend scans like his to patients. But he says they’re operating off old data and the “black and white pictures” from what past X-rays and other diagnostic tests would pull. Advances in diagnostic imaging and improved technology have changed the context, according to Lacy.
“These exams are not generating the level of biopsies or fallout that previous generations of screenings have done, and a lot of doctors just don’t understand the difference between what we do and what was done in the past,” Lacy said. In fact, getting full-body scans into the medical mainstream may start with a physician recommendation.
“The onus is on us to educate physicians, and we try really hard to do that,” he added.
Sodickson says that he understands the general medical opinion of being against full-body screenings for otherwise healthy adults, because it’s based on the current model of health care and resources.
“This is a long-standing debate and a long-standing opinion, based on current practice — and is entirely appropriate based on current practice,” he said. “We’re trying to change current practice.”
Ezra’s ‘full-body flash:’ how scans are using AI
Ezra is different from Prenuvo in a few ways. Ezra’s full-body scan uses 3T MRI, a higher resolution than Prenuvo’s 1.5. (Prenuvo defends this on its website, saying 3T doesn’t work as well due to physics issues when scanning the whole body and that “bigger is not always better.”)
Most notable, though, may be the fact that Ezra is now using AI technology in every step of the way for its “full-body flash” scan, which is slightly cheaper ($1,350) than its regular, full-body MRI scan ($2,350). It leaves out the spine and lungs, which the full-body MRI covers, but uses AI to enhance the images, which are acquired at faster speeds than what would be typical at a hospital. It also uses a generative AI called the Ezra Reporter AI to help staff radiologists interpret the results. (This AI does need to be cleared by the FDA prior to use because it’s not technically a medical device.) Before the report goes out to patients, who get an AI-generated “1 to 5” score on whether an abnormal finding needs follow-up care, radiologists confirm the results, according to Emi Gal, Ezra’s founder.
The use of artificial intelligence or machine learning isn’t new to medicine, but researchers have been especially excited about how it could improve the world of radiology and diagnostics. An AI could assist the scan in providing clearer results and help the radiologist to better-understand the results. Google, for one example, is experimenting with AI in ultrasound technology, which could make it easier to use and potentially cheaper, if you cut down on radiologist training costs.
Sodickson, who was one of the inventors of parallel imaging in MRI, called Ezra’s new technology in medical imaging “upstream AI.” As opposed to the more traditional approach we think of when it comes to AI, which is taking existing information and then “operating” on it to come up with a conclusion, Sodickson said Ezra is “using AI to change the data that we take in the first place.” The hope is that this then translates into fewer minutes in the machine and a lower cost of the overall process.
The future of full-body scans
Arguably the biggest problem in the MRI room is that scans like Prenuvo’s and Ezra’s are currently limited to people who can afford to get one. They also aren’t supported by health insurance companies, though there’s hope that may change in the future. Prenuvo costs $2,500 up front for a full-body scan, or $1,000 for its cheapest torso-only scan. Ezra’s AI scan costs $1,350, with the more extensive full-body “plus” scan costing $2,350.
When asked about the price barrier, Lacy pointed to the fact that the US spends billions of dollars in cancer medical treatments and that, theoretically, scanning all US adults every few years or so with a preventive scan would result in a comparable cost.
There’s also the fact that traditional, doctor-ordered MRIs, CT scans X-rays and even ultrasounds aren’t necessarily less expensive out-of-pocket, and most people’s insurance will cover a big chunk of it only if the doctor deems it necessary. Ultrasounds, which use sound waves to get pictures inside the body, are often on the cheaper end of diagnostic imaging and may run a patient a few hundred up to a couple thousand out-of-pocket when done through a hospital. MRIs are generally the most expensive scan: out of pocket, they may run you up to $4,000 through a hospital.
But even if someone without health insurance would be able to get a full-body MRI through Prenuvo for the same price as one through a hospital system, we’re still back at square one of interpreting the the results. The fact that the scans are currently limited based on socioeconomic status — which has a huge impact on health outcomes — limits the usefulness of the data coming out of the scans, even if they’re building to someone that will be helpful at a population level, according to Jordan.
“For companies that are in a position to roll this out at a large scale, they’re actually in a position to try to build that evidence base and to do some of that research,” Jordan said.
“One of the challenges is that if patients are coming in and paying for this out of pocket, that’s not a great way to run a large scale research trial because your study population is self-selected for people who are willing and able to pay for it,” he continued.
I was on the fence about doing a full-body scan because of my own fear that the scan would find something life-changing that I would be forced to deal with ahead of “nature’s time” (whatever that means). Before I went to Prenuvo’s office, I promised myself that if something minor turned up, I wouldn’t freak out or go down a rabbit hole asking for additional tests, surfing Reddit for second-hand medical advice or anything else that could be considered financially or mentally compromising.
I ended up being very lucky and, as a 28-year-old woman who feels pretty good most days, the only finding that turned up on my scan was some mild degenerative changes in my spine, which is also sometimes called “tech neck.” This sounds scary but is probably from staring down at my phone and computer too much — it’s an increasingly common finding in younger people who grew up looking down at phones, per Prenuvo. The recommendation from Prenuvo and the subsequent phone call from a nurse practitioner to explain my results, was that it doesn’t require immediate care from my doctor. But I am grateful I know about it so I can fix my posture, and it explains why I’ve been waking up with a stiff neck more often.
But getting a relative all-clear from a full-body scan begs another risk to doing it in the first place: the feeling that you can neglect all the other parts of health care that keep your body running well. One hook of both Ezra’s and Prenuvo’s scans is that they can order the scan that your doctor probably won’t, which has the potential of detecting a life-threatening cancer at an earlier stage. But they shouldn’t be used an an “all-clear” bill of good health, so I’m taking my results with a few grains of salt.
What pristine, clean and AI-powered body scans lack right now in standardization and access, they make up for in boldness. They’re attempting to shift a health care system that, in many ways, is crushing under its own weight.
One of the critiques of Prenuvo’s scan, for example, is that people flocking to preventive scans will take away health care hands, radiologist eyes and time from the people who truly need the scan. But between the majority of Americans already feeling unhappy with their health care system as-is, pandemic-era shortages of what seemed like every important drug on the market, and preventive care becoming more personalized by a growing wave of health tracking devices and telemedicine, routine scans of your body before you get sick may nicely fit the new narrative of what it means to be healthy.
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