New Job in Surgical Data Science: please RT/share!
We're hiring a PhD computer vision / machine learning staff scientist in my NIH-funded lab
@ChildrensNatl
Unique access to clinicians, clinical data, research infrastructure.
Send CV cover letter to email in the image below.
Today in the doctor’s lounge a physician pulled out a printer from their backpack and started printing their patient notes because “connecting to hospital printers is impossible”
and I think that says everything you need to know about healthcare IT.
Carry on, king.
@SlickTweetsSC
I don't usually but uhh...
On the worst day of your life as a parent, when your vulnerable baby is fighting for their life ...
That "barely a doctor pediatrician" will sustain every organ system in your baby's body for as long as it takes, skillfully navigating through dozens
Two new surgical RCT's just released by
@nejm
@AANSNeuro
If you're caring for patients with stroke or traumatic brain injury, these trials might change your practice or help you understand what we surgeons do and why ...
Here comes an evidence based surgery megathread ...
Secrets of Pediatric Neurosurgery Fellowship (weekly series)
1. One good picture is priceless.
In fellowship I spent hours explaining brain and spine MRI and CT to families using a 🖥 screen. Parents were often more 🫤 confused.
Then I learned the power of going analog … 1/
Since coaches don't exist in the OR, surgeons receive less feedback than a 4th-grade basketball player.
Can an AI system help surgeons improve?
In a three paper series just published 🔥 in
@Nature_NPJ
, we trained an AI to measure urologic surgery performance.
How did it do?
Secrets of Neurosurgery Fellowship Weekly🧵
In 2018, I had the privilege of reading the operative records of Harvey Cushing
An umatched surgical legend
From his records I learned
his most important lesson
and how to translate from the 1920s to the 2020s ... 1/
(RT if useful)
it’s time for residency rank lists again. I’ll share my advice based on a successful two subspecialty surgery couples match (DM me if you want to know more) and 10 years of advising and interviewing in a competitive field
Now using AI 😉
Rank lists: a systematic approach🧵
There’s two really great things about neurosurgery clinic.
1. A child who wants to go into medicine to help other people the way their brain surgery team helped them.
2. Seeing a previously paraplegic kid walk after spinal cord tumor resection.
Today our team was 2 for 2.
@FrogLevelWood
@DocDifferently
The only thing that’s surprising is that anyone is still surprised by this. Maybe we do need to share this info with the public more broadly.
USC Neurosurgery Residency 2013-2020. Watching those doors close for the last time evokes gratitude, pride and sadness at leaving our
@LACUSCMedCenter
home.
I owe a great debt to the staff who support us at the tip of the spear.
Having given our full measure, we now stand down.
After several hard months, I submitted my first NIH (K23) grant today. I’ve had a ringside seat for others. Now it’s my turn to take a shot at it. 🙏
And tomorrow we get to do one of my favorite operations in
#neurosurgery
🧠👃🔬🥇to help a nice kid who has a serious problem!
Thought provoking RCT about a common neurosurgical condition where a first surgery is often ineffective. The trial made a single simple change at surgery that costs $0 and might cut re-operations in half !!
Interested? Here's a quick 🦃🧵 ...
We started a new annual meeting:
To bring together the best in surgery, AI/ML, venture and med tech.
Featuring leading scientists from
@MSFTResearch
@Apple
@GoogleHealth
& more
October 12-15 in Palo Alto
Limited room blocks available- sign up today !
@ryanclearyMD
This is a hard thing and it is good to share the burden with others. Many departments have ways of sharing that burden- ED gen surg etc. NS typically does not.
So we are here for you. This is a great post and a model for the community. Thank you. Always with you.
Surgery is one of the most dangerous and inspiring events that human beings willingly face.
You might think that surgical training would be guided by rich performance data- just like elite athletes, pilots, and soldiers.
But it hasn't been. Until today.
We deployed a
It takes a village to start an intraoperative MRI program 🏆🏆
I am proud of our team
@GWnsgy
@GWHospital
‘s first intraoperative MRI. Having the capability to get beautiful intraop 3T images improves our ability to cure functional pituitary tumors!
Weekly thread 🧵:
It’s the end of another academic year, and medical students everywhere are graduating.
If I could speak to my younger self, I would give a very different address.
It’s not easy to write.
It wouldn’t have been easy for me to hear.
Here goes… 1/
Surgical video is digital gold.
We mine video data to make surgeons better.
Here, we measure a surgeon’s skill by tool movements, not diplomas or Healthgrades.
Like an artist’s brushstrokes, their movements prove their mastery of this challenging complication. 1/
#OnlineFirst
: Use of surgical video–based automated performance metrics to predict blood loss and success of simulated vascular injury control in neurosurgery: a pilot study
A surgeon’s first time managing a life threatening complication shouldn’t be in a real patient: simulators can teach high stakes maneuvers rarely seen in training or practice.
Video from these scenarios forms the backbone of our team’s work
@gkugener
@dhirajpangal
@DoctorZada
!
#VisualAbstract
Improved surgeon performance following cadaveric simulation of internal carotid artery injury during endoscopic endonasal surgery: training outcomes of a nationwide prospective educational intervention
@JerusalemDemsas
@ATabarrok
Here’s just one recent example of where 100x resources could have been lifesaving, rather than writing up 40% of families
Our entire system needs help.
Incredible!!
100+ neurosurgeons, computer scientists, technologists, and leaders across multiple fields.
Charting a new course for implementation of novel technologies across surgical fields.
What a weekend and …
The best is yet to come!
Are you a surgeon, physician or medical student interested in machine learning and AI?
Are you an
#ML
/
#AI
scientist trying to apply innovations to healthcare?
Check out "ctrl-alt-operate", our unfiltered thoughts on innovations in healthcare x AI
I’m a pediatric neurosurgeon. I transplant tissue often. Not brain transplants…
Donated bone is a crucial substrate for bone fusion in pediatric spine surgery.
To the organ donors who sustained my patients this year:
(Especially you, 🌻🌻🌻)
We are forever in your debt.
During millions of video-based surgeries, all of the information that surgeons need to improve our performance and revolutionize our field is on the screen.
If only we would use it.
Here's how we are building the way forward.
@TheJNS
@dhirajpangal
@jdimick1
@UMichSurgery
tell people you care about them.
Don’t assume that subordinates will read your mind, or correctly interpret your nice don purchase, or that they will remember the 10 times you were nice and forget the one time you snapped.
This is also a rule born of regret.
Pediatric neurosurgery is a tough job and its nice to savour the wins. Today in clinic our postops brought our team a homemade apple pie, and a T-shirt for my son.
Grateful for our staff and team.
Secrets of Neurosurgery Fellowship (weekly 🧵)
Difficult conversations with families are as impactful, and as tricky, as curing brain tumors
I’ve had to break bad news in the most stressful situations, with successes and failures
Here’s what I didn’t learn in med school … 1/
A quick
#Match21
#tweetorial
🧵for
#medtwitter
, (8 years of my
#Neurosurgery
experience, YMMV). Pls (at) or (dm) me with q’s.
Tl;dr summary:
Rank your needs first.
Overvalue certainty.
Learn from history.
Predict your future.
Disruption is a value.
Give back.
1/7
Grateful for many things but particularly to the team
@NeurosurgeryUSC
@DoctorZada
for all of the years that went into this one little paper. Complication management is a tough area to work in - maybe that’s exactly what’s needed. Hopefully the first of many ...
Addendum:
Since fellowship, I’ve come to learn that the real secret is removing the screen 🖥 between you and other humans. As many times per day as possible.
Mutual information sharing, facing each other, grappling with a common reality.
That’s medicine.
That’s magic.
A critical but rarely taught skill, required for success in surgery is…
Asking for advice
Advice could come from partners, colleagues, or sharing certain decisions with parents.
It demonstrates strength and wisdom, not weakness.
Never worry alone …
It’s a huge privilege to be invited to
@PennNSG
@Penn
as a visiting professor to discuss our work in surgical data science and AI!
I’m excited to explore future collaborations and share what we have learned.
@ChildrensNatl
@SurgicalDSC
Grateful for the recognition
@NIH
of our entire team’s work to make
#Neurosurgery
safer by studying surgical video with AI/ML.
It takes a village to earn a K-award
Mentors
@ChildrensNatl
@GWSMHS
@NeurosurgeryUSC
Supportive colleagues & leadership
Family and friends
Onwards!
Match Monday. On this day last year two excellent candidates didn’t match into neurosurgery.
Today, they both matched.
I am proud of them.
Whatever your NRMP letter says today, congratulations on advancing along your journey.
Cheers to your next step 🥂
#MedStudentTwitter
and
#Neurosurgery
Got questions about:
Nsgy Residency
Couples match
USC (My program)
Pediatric nsgy
Ask away!
“The universe is conspiring behind your back to make you a success. This will be much easier to do if you embrace this pronoia.”
@kevin2kelly
@JerusalemDemsas
@ATabarrok
And yet … the really rough ones that we neurosurgeons treat … could benefit from far more attention and loving care. Let’s 100x the attention on the 1% of these who truly need societal help. Wild.
My pleasure to share our thoughts on how to use AI to:
-make surgery safer
-train surgeons more effectively
-explore previously overlooked research questions in surgical techniques
We're hiring a computer vision / machine learning staff scientist in my NIH-funded lab
@ChildrensNatl
!
Unprecedented access to clinicians and clinical data, research infrastructure, collaboration with
@GWSMHS
Please rt/share
Email in img
#MLjobs
#AIjobs
#datasciencejobs
Moving in to Houston, less than 20% masks in apt bldg near med center (even HCW going to and from work far from 100%), hotel bar full (not socially distanced), foot and vehicle traffic less than normal though. Movers refused to wear masks “covid already hit”.
Worried for TX.
Still can’t believe we got early access to
@OpenAI
Sora to craft the intro for Craig Mundie
@MSFTResearch
, the Cushing Orator
@AANSNeuro
Sneak peak of Sora below …
Here's the link to the full paper. It was impressive and a worthy addition to the conversation about surgical randomized controlled trials.
All the usual caveats apply YMMV, track outcomes, needs better understanding of mechanism.
Kudos to the authors!
Lesson to myself this week:
When people come into your life, treat them as though they‘ll be with you forever.
Even your Uber driver
I recently gave a grand rounds talk at a program I had never visited.
I was honored and blushed a bit at their speaker intro for me because …
Congrats to
@hani_marcus
and the organizing team at Hamlyn Symposium on a fantastic Neurosurgery workshop.
It was a pleasure to share our experience
@SurgicalDSC
and
@ChildrensNatl
solving for the lack of available data - a roadblock to advancing surgical robotics and AI
Two years ago: an idea
Last year: a promise
Now: a reality
Grateful for
@ChildrensNatl
writeup of our
#Neurosurgery
#DataScience
team. With world experts, ample clinical datasets and a developing
#MLOps
pipeline, we're building every day.
Come join us!
Here’s the magic 🪄
Leave the images with the patient. 🖼 Include your annotations, highlights or explanations. They treasure ‘em.
Your 🖼 are a transparent tangible gift. By sharing with your patient, you deepen your bond 🤝 and create trust.
Repeat as needed.
4/4
Grateful to perform our first exoscope AVM resection. Still a long learning curve (how do we fit all the toys in the hybrid OR!) but my neck is much happier.
Much more engagement from the whole team, even the anesthesiologist got excited.
Are you at
@NASBSorg
Skull Base this weekend?
Do you love studying surgical video?
Did you ever wonder how AI is going to change our understanding of surgery?
Come learn more about a video platform and AI research collective you can join.
Honored to give grand rounds
@UCINeurosurgery
. Combined insights from violinists in Berlin, baby sleep monitors, carotid injuries and deep learning to improve training for the surgeons of tomorrow (gratitude to
@doctorzada
,
@hlweiner
& many more). Here's what I learned... 1/
After a scientific meeting I feel exhausted, exhilarated, and a bit unsure what to do next.
A mentor taught me to write a post-meeting debrief with technical lessons learned, contacts/followup, self-assessment & research ideas.
Try it - you'll learn more at the next meeting!
Are Med school or residency interviews coming up?
I've got some unusual mental models to help you ace your interviews by:
-getting inside the head of your interviewer
-sending your message
-managing "imposterhood"
-turning a long day into playful fun
Here's a🧵...
@DissanaikeMD
@ketaminh
the whole thing is beyond belief but for one second can I ask is there such a thing as a “potential intoxicant” or are there just “intoxicants” and “non intoxicants” and if we don’t have the tox tests then why are we speculating about “potential” unless... 🤦♂️🤦♂️🤦♂️
What makes the greatest surgeons tick?
Amazing humility and knowledge within this group.
Wisdom of these great surgeons shared at NASBS 2023. Thanks to Dr. Theodosopolous for sharing.
@docfingerguns
@nataliemwall
More like they reply back by asking you how you would build a clock... and then chastising you for not knowing the answer to the question you were asking ... 🤦♂️
The hardest part about leaving residency is parting with best friends. Dr. Ian Buchanan is one of the smartest (USC record for highest board scores) and all around best people I have known. His infectious enthusiasm for spine deformity has led us on some crazy adventures ...
We’re hiring a research assistant
@ChildrensNatl
!
Are you a hardworking BA/BS grad who wants to make brain surgery safer for kids?
Got CS / data science experience ?
Join our NIH funded machine learning research & neurosurgical innovation team at:
Pediatric neurosurgery week on call math:
+1 shunt in
-1 craniopharyngioma out
+ 4 c1-2 screws in
-3 Subdural empyemas out
+43 notes to sign
+10 research mris done
-a few dinners at work
+36 more hours of 🤩 to make my 🐣🪡🎥 slides
Still learning the 🏄♂️ ⚖️ amidst 🌊 of life
Actual surgeon here.
Nope.
Here's how actual Harvard-trained surgeons choose the right surgeon for their loved ones ...
Steal this secret and use it for yourself!
(sorry for dunking on
@SahilBloom
who is often excellent)
The Surgeon Paradox is a concept I can’t stop thinking about.
If you’re choosing between two surgeons of equal merit, you should choose the one who DOESN’T look the part, because they’ve had to overcome more to get to where they are.
“Looking the part” is sometimes the worst
One of our patients became pulseless today and our medical student was unsure how to help. Our excellent nurse manager pushed her into the CPR line and our student was doing chest compressions when we regained a pulse. I was proud to watch her learn, grow and help save a life.
It’s official. PGY7 Chief year begins tomorrow
@LACUSCMedCenter
. Bittersweet to leave great friends and colleagues
@BWHNeurosurgery
, but it’s good to be home.
#AANS2022
Shared our early experience with
@Hyperfine
low field strength MRI in the
#neurosurgery
clinic. Scans in clinic are family centered, feasible and give evaluable results of the ventricles- more to come on from this exciting tool
@ChildrensNatl
Computer vision - teaching machines to make sense of images and video - is one of the final frontiers of AI.
@MetaAI
released a new open source vision model that might change everything ... or might be a dud.
Does it work on medical visual data? What should physicians do?
Memory is fleeting, recording is forever.
If you don’t store your lessons/thoughts/learning in an accessible format, no matter how vivid the case or how many you’ve seen, you will forget it.
Power up: complete.
Spoiler alert: some myalgias may occur after dose 2 even though I felt fine just arm soreness after dose 1.
Grateful and privileged to go first to protect my family. Mom’s up next in a few weeks.
#shotofhope
Amazing excitement among neurosurgical leadership and community in response to
@SebastienBubeck
‘s talk on AGI in medicine at
#digitalnsgy
!
We will be defined by our interactions with systems that reason over web scale knowledge in response to multimodal input (and output).
As a new attending neurosurgeon I think about how to get better All. The. Time.
We (surgeons, proceduralists)
MUST
learn from other fields
And never be satisfied
Ana Vidovic teaches us about deliberate practice (which is NOT possible in the OR).
There were more than 7 shootings in Houston yesterday.
@abc13houston
I remember every child I’ve cared for.
Again, last night we had to answer that call.
If you want to call us “heroes”, then listen to us:
#GunViolence
is a
#PublicHealth
problem.
#thisisourlane
Grateful for the opportunities to train with
#Orthopedics
,
#Craniofacial
and other
#PedSurg
folk (especially those not trained in the US). It’s a pleasure to share techniques and learn new tricks (old to others). Surgeons should break out of our silos and learn together...
Congratulations to
@AjhungMD
and co for a fantastic session at Society for Robotic Surgery.
It’s an honor to be invited to places I don’t belong - my learning rate was insane.
Fantastic keynote from
@TGrantcharovMD
@surgicalsafety
And great lectures from all the faculty
Wow. Not a lot of places could handle a mass casualty event, run 4 OR for almost 24 hours, including several great trauma saves, and do it all without regard for our patients’ ability to pay, nationality or background. Very grateful to our team and staff.
Well there’s one less epidural hematoma in the world. Thanks to all the folks who help us deliver these outcomes- it takes a team to get a child into the OR and many of our colleagues never get to see the whole picture. Grateful to do some good tonight.
Congratulations and a warm welcome to all
#MedTwitter
entering
#MatchDay2021
particularly those aiming at
#Neurosurgery
.
However the week finishes, I hope that you make your match worthy of being your choice.
That’s a secret I’m still learning. Now it’s yours. Congrats!🍾 🥂🤩
Lots of excitement next week for
#MatchDay
....
For some people- you may not get your first choice, or (like me) you may not match at all. The thread below is a reminder, “it’s now where you start, but where you finish...”
Chin up no matter the outcome. You’re in good company...
Instead of the usual
#MedEd
#MedTwitter
Saturday thread, please accept the following message.
We support human rights.
Humans have the right to bodily autonomy.
Health care decisions should be made by patients in consultation with medical professionals.
Is it weird that JNS Focus is my favorite journal these days? Quick turn around, thematic issues ensure you submit relevant work, open access, and I enjoy reading the whole thing.
And you stay connected to a tradition: Dr. Weiss, Dr. Jane Sr. & other greats.
🙏🙏🙏
Can a neurosurgeon use AI to learn abdominal surgery in one weekend?
Last week, we demoed the Surgical Data Science Collective (SDSC) platform at the North American Skull Base Society annual meeting, giving surgeons a sneak peek at what's coming next in Surgical AI.
This
Wow. The first day of
#digitalnsgy
2023 is in the books.
I’m amazed at the energy and combined enthusiasm for computer vision applications in surgery - and we learned great insights from all of our speakers in sports, defense, self driving cars and industrial applications.
On
As this chapter in our journey closes, I’ll cherish time spent with another one of my closest friends Dr. Vance Fredrickson. The most dependable and relentless person I have known, and a man of few words. Never shies away from doing the right thing - not even when ... 1/
End of the 5th to last week in residency, this week had it all. On call for 6/8 days (calmate acgme it was supervisory), had the highest highs and lowest lows (and that was just on rounds!). Cases ran from the “simplest” trach to the “tricky” parasellar meningioma ... 1/
AI will be embedded throughout the
@AANSNeuro
#AANS2024
annual meeting.
We are excited to unveil new technologies and bring new innovations to our community.
Check it out today!
Craig Mundie’s Cushing Oration culminates in an unprecedented two-day
#AI
Immersion program, ending in an interactive town hall. Join discussions on one of the most consequential issues of our time at
#AANS2024
.
#WhatMatters2Me
#ArtificialIntelligence
Happy Father’s Day to all the dads out there
As a fellow dad bod inhabitant
Today, give yourself the gift of moving your body and other heavy things
Repeat at least a few times a week
Here’s to healthy fathers days in years to come
This is beautiful, and an important note for all
@youngneuros
when we consider intubation and intraoperative positioning of the neck during cranial and spine surgery. Beware neck extension!
#neurosurgery
#anaesthesia
#spine
Very grateful to
@MeghanChayka
for sharing her expertise with
@HockeyAnalytics
and lessons learned for surgeons developing surgical computer vision systems.
Her company provides advanced analytics for hockey and uses computer vision to identify critical moments in sports- using
Papers That Changed My Practice:
BASICS trial. n=1600 RCT, first-time shunts, compared to plain catheter, antibiotic impregnated reduced infection from 6% to 2%.
I switched.
next up:
@DrBenRodgers
thank you:
@kiswanson
@paxyjuvekar
Neurosurgeons don’t get to hear from the broader robotics companies very often. Today we brought leadership from
@IntuitiveSurg
to teach us about their best practices within robotic surgery performance assessment.
Very excited to see what we can develop together in neurosurgery.
⏰⏰⏰ High Impact paper
RESCUEICP 24 month results
@JAMANeuro
Prior paper showed DHC > medical tx for severe
#TBI
with refractory ICP > 25mmHg.
Now: from 12-24 months, 30% of DHC improved ≥1 GOSE point vs 15% non surgical.
Aggressive surgery in severe
#TBI
is the way.