Dorothy: [00:00:00] In this episode, our own leading interpreting physician, Dr. Raz, who is our ace radiologist, our, our lead interpreter, and also an incredible podcast, is talking with Freddy Cruz, who is our producer, and who also has his own podcast, Cruz Through HTX. What you need to know about Freddy is he was in the radio business for some 25 years. He was quite a personality, had a huge following, and then left it all to become a podcast producer.
Today, he’s talking with Dr. Raz. And I have to tell you, these two people get going on, for lack of another word, the nerdiness of this work in technical fields and Dr. Raz shares with him some pretty interesting things that have to do with detecting breast [00:01:00] cancer, using technology, and combining it with that very human touch.
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Freddy: Dr. Raz, when I think of doctors, I think of very busy people that are always working 20 hour days, 175 hour work weeks. What do you do in your spare time?
Dr. Raz: Great question. [00:02:00] Since I got my kids, everything goes after the kids. All right. But, um, just hobbies, etc. Just the common stuff. Like, I like to read, like to run. And I just started doing piano lessons. I always wanted to. So I’m learning that.
Freddy: What was the first song you learned?
Dr. Raz: Uh, right now I’m practicing, well the first song, they started very simple, like Jingle Bells.
Freddy: Oh, Jingle Bells, okay.
Dr. Raz: Yeah, you’re right. Actually, that was the first one. But, um, right now I’m playing Minuet in G by Bach, so that’s, that’s fun. Um, but just always my dream to, learn one instrument. I just feel like everybody should know one musical instrument before they die. It’s kind of sad without.
Freddy: Yeah. No, you’re you’re absolutely right. So where did that where did that come from? Did you play the recorder in elementary school and—
Dr. Raz: I did nothing nothing. No, I mean, um, you know, it’s an interesting story I’m an immigrant so I I didn’t come to america till junior year of high school.
Freddy: Okay.
Dr. Raz: So, you know come from humble backgrounds back then. Didn’t have the [00:03:00] facility for any sort of like musical instrument back home. So just never picked it up, but seen plenty of music, always been into classical music, just wanted some instrument. Like guitar, piano. Piano just seemed more accessible, easier to learn. So I started with that and yeah, I like to travel. I’m taking kids to Europe this next week.
Freddy: Nice.
Dr. Raz: So just that. So that’s, that’s really what it is.
Freddy: Going back to piano, do you have a dream song that you would one day like to learn? Is it by The Weeknd, is it by Lana Del Rey, is it by Selena Gomez, Rolling Stones?
Dr. Raz: Rolling Stones would be great. Um, any old, like, um, rock, rock, you know, you can play, let’s say, a couple of Beatles songs.
Freddy: Okay.
Dr. Raz: Um, Bohemian Rhapsody on piano is extremely difficult to play. You know, the Freddy doing their—
Freddy: You’re probably all over the—
Dr. Raz: Oh yeah, he is. But it was a beautiful piano intro, if you remember Bohemian Rhapsody.
Freddy: Yeah.
Dr. Raz: So that would be a great goal to get to, probably in a couple of years, hopefully.
Freddy: Yeah. Huh. So let’s talk about what [00:04:00] got you into medicine.
Dr. Raz: So, great question. Always, um, you know, my dad was a dentist. And always had this band. I was actually an engineering major up in Michigan.
Um, and then, you know, I’ve volunteered a lot and I still do. And that was the other thing I forgot to mention. I volunteer, try to volunteer my spare, spare time. So I always had that band and, you know, seen enough patients and seen enough, You know, misery in the world, if you will, um, that always wanted to do it. And then when I was doing engineering, I was, I did what we call biomedical engineering. So it was this fusion of, you know, engineering mixed with medicine.
Freddy: It sounds hard.
Dr. Raz: It’s difficult.
Freddy: Sounds like I probably would have dropped out of school after three weeks.
Dr. Raz: It’s, it’s tough. You know, engineering schools, they’re difficult. It was Michigan too, right? You, if you go to UT and Michigan or Texas, you Cal or Berkeley, MIT, these are tough engineering schools. But you know when we [00:05:00] invented, there’s this patient with hip abnormality.
Freddy: Okay.
Dr. Raz: And our senior project was, well then how do you fix it? So we had to come up with a model so these orthopedic surgeons can fix the hip.
So they can practice, you can’t really practice on a live patient, right?
Freddy: Why not?
Dr. Raz: Well, you can. The results won’t be that as great. Um, so how do you train the residents? So we came up with a nice model with where you can see like in 3D where your needle is going and you have to pin the hip to the proper socket. So, so I met with the patient and after, you know, residents trained on it, they started becoming really good. It was like a year on project.
Freddy: Yeah.
Dr. Raz: And I visited these patients really got drawn to, you know, that we could really make a difference and really got me into medicine. I chose to pursue medicine afterwards.
Freddy: And so, you built the hip, and then what led you to wanting to pursue radiology?
Dr. Raz: That’s correct. So, Radiology, one of the, probably the only field, the other field would be what we call radiation [00:06:00] oncology.
Freddy: Okay.
Dr. Raz: That has a lot of gizmos. There’s a lot of technological advancements.
Freddy: I imagine there are a lot of gizmos in what you do, so even more, more so.
Dr. Raz: That’s right.
Freddy: Wow.
Dr. Raz: So, it’s, it’s just the, um, the perfect combination of doing medicine and, using technology to get to whatever objective you’re trying to get to.
Freddy: Okay.
Dr. Raz: Um, so got drawn to that and that’s what really led me to radiology. So you see all these newest things, you know, even the AI thing, it’s all in radiology. In fact, we were the first ones with that had AI before AI became hip.
Freddy: Before Chad GPT.
Dr. Raz: That’s right.
Freddy: Before you kids.
Dr. Raz: Because what is Chad GPT? It’s, you know, it’s coming up with, Basically, they train them on multitudes of text, and now it’s just conversational, human level, right?
Freddy: Yeah, yeah.
Dr. Raz: So, why? Because they fed him trillions and trillions of books from the Gutenberg Library into the Library of Congress and everything in between on the web.
And then the computer is self recognizing, [00:07:00] self understanding, and just does normal conversation. But, before Chad GPT came along, radiologists, if you notice, we dictate.
Freddy: Mm hmm.
Dr. Raz: It’s something called PowerScribe. The PowerScribe recognizes our voice and it’s dictating what we say.
Freddy: Get out. Ok.
Dr. Raz: Right. So that’s how we dictate. That’s how we dictate reports, right? Let’s say, Freddy, I do your chest x ray. I say, well, Freddy has a normal chest x ray. Or I would say something like, there is no pneumonia or plural fusion. I just say it in the mic and then it gets dictated, right? Or in your phone.
Freddy: Yeah.
Dr. Raz: How did that come about? It was because these models are so sophisticated they can convert your voice into just text.
Freddy: Uh huh.
Dr. Raz: That’s an AI. I mean, these are all applications of AI. So radiology already had it 20 years before. The field that I’m in, uh, breast imaging, we already had CAD. It was approved in 1998.
Freddy: What is CAD? What does that stand for?
Dr. Raz: So it’s, uh, computer assisted diagnostics.
Freddy: Gotcha.
Dr. Raz: And then it’s basically, It figures out if there’s an abnormal lesion in the mammogram. So it’s in the, under the class of what we [00:08:00] call classification problem. So think of it like now, if you, you know, listeners should probably figure it out where they open their Gmail or they have Google photos. Google is very smart. It sometimes segments the family members and say, this person’s in the photo or not.
Freddy: Right.
Dr. Raz: Or if you have ring or anything like these camera based thing in front of your house, Hmm. It recognizes the facing, Oh, Hey, mom’s visiting or my cousin, my brother is image segmentation. It figures out your face and then assigns a name, you know, same thing.
It figures out that there’s something abnormal in mammogram and then says, it draws a line around it, segments it and says, okay, that may be abnormal. This was back in 1998. So this is one of the first AI applications, if you will, image segmentation. So all of this is radiology. And since I was an engineer, I got interested. So I chose to pursue it.
Freddy: You know, what’s wild to me is that we think of 1999 as the stone ages, but, [00:09:00] or at least if you were to ask somebody in their 20s, right, they can’t imagine what life must have been like when they were, you know, when they were a baby or not even born yet or in the womb. Um, but the first computers. As I understand, the first, the very first computer was in the 1960s, which took up the room, the, the space of a room, which was like the most mind blowing thing ever. Um, and now we’ve got these little teeny tiny gadgets.
Dr. Raz: Yeah, your, your phone has more power than Apollo 13 did.
Freddy: Than Ronald Reagan did to win the Cold War and save the world, right?
Dr. Raz: Yeah, those computers, yes. And they’ve come a long way. I mean, it’s all due to chips, and the chip is called, uh, I forgot the law it’s called, not Murphy’s Law, that’s something else, but where the chip size keeps decreasing, and then the computer power keeps increasing. The smaller the chips got, the more Processing power we got, and now they’re so small, they’re in the palm of your hand.
Freddy: Yeah.
Dr. Raz: It does all these fabulous computations for you from, you [00:10:00] know, the imaging, image stuff that I said.
Freddy: Yeah.
Dr. Raz: From photographs to complex, like, calculations to Siri recognizing your voice and doing whatever. It’s just in one, in the palm of your hand. This was impossible. Because of integrated chips, this is possible.
Which is, also leads me to say, all this new AI stuff, chat GPT stuff, also chip based. It’s a GPU. It’s called, you know, it’s an accelerated GPU from NVIDIA or AMD.
Freddy: I’m sorry, say that five times fast.
Dr. Raz: So, but NVIDIA and AMD, these are these big chip makers. And then these specialized chips is what these big companies are training their models on. So, chat GPT is from OpenAI. Or you have Meta that’s doing all these virtual, you know, the virtual AR, VR.
Freddy: Yeah.
Dr. Raz: Um, they’re training all these data sets on these chips and that’s what’s possible. So really we are in, in, in, in, in a fourth revolution, if you will, you know, we started with Stone Age fire, this [00:11:00] steam revolution, industrial revolution.
Freddy: Yep.
Dr. Raz: Then came the internet revolution, and now we’re in this new paradigm of AI revolution, which is just training lots and lots of data to have a computer, figure out general intelligence. We’re not there yet, but you see these green shoots of it, like Tesla driving itself. That’s getting close to a general intelligence, which is the, angle of flying cars. Flying cars. Flying self flying cars. So it’s, it’s, it’s getting pretty scary.
Freddy: Scary.
Dr. Raz: It’s scary.
Freddy: Um, when we first met, and you are, uh, lead radiologist for The Rose, which is a podcast partner of my company Speke Podcasting. And so you do the radiology work here.
Dr. Raz: Yes.
Freddy: And, uh, when, when we first met, uh, you were, you would, um, You had articulated that you are, uh, hopeful, [00:12:00] um, um, optimistic about, uh, medicine as it pertains to women, uh, having more knowledge at their, at their fingertips.
Dr. Raz: Yes.
Freddy: Uh, do you have that same optimistic outlook? At all about this technology that’s, uh, that’s coming about seeing is how you have been working with a I for longer than than I have as a creative.
Dr. Raz: Yes, I think as you know, any new innovation that we have, we come up with solutions and then problems. And, you know, there’s a lot of people worried that, okay, AI is going to replace jobs, and I think it’s going to create new jobs, but that’s creative, destructive processes, what really, what drives the world, drives American innovation, if you will, the GDP, the productivity in the economy.
Um, so harken back to, let’s say, internet revolution. You remember 1999 we were talking about, personalized computers started coming out. And I don’t know if you remember, we [00:13:00] used to have the 56k modem that’s like, and then connect to the internet.
Freddy: AOL, these kids.
Dr. Raz: That’s right.
Freddy: They don’t know the struggle.
Dr. Raz: And the internet was like this, like, this fantastical place we used to go. People used to just do normal things and, you know, chat, all that. But, Just that alone has increased our productivity tenfold, but it came up with questions about privacy, of online bullying, you know, all this stuff, pornography, all that stuff.
Same thing with the AI. We’re going to have challenges in privacy, intelligence, what it means to, you know, people spoofing, scams, all these things are going to come about. But, if one thing we need to bet on is human resiliency and intelligence and I believe that, yes, with proper guidance and laws, I think we can control this technology to our benefit as we’ve always done in human, you know, in our life cycle as humans.
Freddy: You seem so cool and, um, [00:14:00] calm about all of this stuff. And there’s this study that I had, uh, come across about radiology.
Dr. Raz: Yes.
Freddy: And how it’s, uh, AI is 20 percent more accurate? Did I, did I read that right?
Dr. Raz: Yes, so it’s, there have been multiple studies that have been done. And it’s not just in breast imaging, women’s imaging, throughout radiology.
Freddy: Yeah.
Dr. Raz: The thing with radiology in AI is, It feeds itself on data. The more data, the more accurate it becomes. However, when you put out a report, there is, I would say probably like 99 percent is science, or well, let’s say 95 percent science, 5 percent is art. In, in medicine. And that part in AI can never come to, you know, that sort of general intelligence where, we do see something, let’s say on a CT scan, but we communicate with the physician saying, it’s there but it’s [00:15:00] not as important.
Does that make sense?
Freddy: Makes sense, yeah.
Dr. Raz: AI will not be able to say that. It will actually mention that lesion and then will sensationalize it and the physician’s confused. So the human touch still exists in radiology. And that is very difficult for AI to replicate.
Freddy: It doesn’t have a soul.
Dr. Raz: Yeah. Yes, you can say that. And they’re also, you know, as I said, the legal thing, let’s say AI says something and you’re wrong and the AI is wrong. Well, who are you going to do lawsuit against? A physician or it’s going to be an AI, right? So, yeah, that’s right. So it’s, There are challenges, and I, I think the field of radiology, it’s an integration of, and we’ve been doing it, right?
We had CAD, we have these power scribe, and now we, segmentation and image recognition. That, a perfect fusion is what I see a path forward versus pure replacement, let’s say, of a radiologist. And it’s difficult to envision, but yeah, it’s possible [00:16:00] maybe 50 years down the road, we’re so sophisticated that we don’t need many radiologists, but we will see, probably need some oversight.
You know, that’s where radiologists will come in. And, you know, need just— bears repetition. Radiologist isn’t the only one that just reads stuff. We also do procedures. Difficult for me to visualize, unless you get to general AI, generalized intelligence and AI doing surgery, if you will.
Freddy: If you could, I guess if you could put on a hat, and I know we’re playing, at this point we’re playing armchair quarterback, but I’m willing to indulge you, I mean what, what would you, what would you see as being the first sort of operation or, or major procedure, uh, in which there, a doctor would get replaced?
Is it heart surgery, a broken arm, or?
Dr. Raz: Probably more simpler procedures, um. Like, just being able to do simple biopsy, I think it’s, it’s, can it, is it doable? I think so. I think [00:17:00] intel, general intelligence, well, I shouldn’t say general intelligence, but I think, I think it’s doable for a computer or mechanized system to get there within the next 10 years. I think we’re going to start seeing that.
Freddy: Mm hmm.
Dr. Raz: Um. Yeah.
Freddy: Are doctors like, uh, people in my former world of traditional broadcasting where they’re on private Facebook groups complaining about artificial intelligence? I can’t believe it. All I want to do is do x rays.
Dr. Raz: Yeah, I mean. I mean, as I said, you know, new technology, new fears, right?
Freddy: Yeah.
Dr. Raz: And, but in the end, what’s going to end up happening, in my opinion, is new opportunities for a physician to engage with the patient or workflow. And that’s really where I think AI can make an immediate impact. For example, let’s say, let’s pick a general physician. They do, you know, they do an examination on the patient, then they have to write giant notes.
I think summarizing the notes in a [00:18:00] very legible form is something that, language models, chat GPD can do because if you’re trying to read those notes, they’re illegible. They’re really long, right? They take forever to finish or paper, right? Even there’s some physician. There’s still not on electronic medical record. Summarizing that are converting that into a very nice summarized form, that would be great usage of AI and I think that’s what we’re gonna get. So I think that’s where AI can make an immediate impact and I don’t think physicians should be scared. I think it’s something to embrace and utilize in your practice. I can assure you, patients do not want to talk to a computer. They are like some giant model that trying to treat them, right? They want the human touch. You cannot replace that.
Freddy: No, absolutely. I think especially when it comes to your personal health and double especially, uh, if, if, if I may, um, when we’re talking about the world that you are in, where you’re screening women for breast cancer.
Dr. Raz: That’s right.
Freddy: You know, this is something that’s very personal to them.
Dr. Raz: Right. And, you know, I, I try to see as many patients as I can face to face and then [00:19:00] talk all, all this about benefits of screening, but they appreciate that. They appreciate that. They, they read that, you know, a lot of women don’t even read the report.
They just see me assuring them, okay, everything’s fine, come back in a year. That’s that for them. It comes into the mail, probably goes in the trash can, uh, but yeah, I mean that, so that face to face is something that’s always been the one thing with physicians, right, since age old, and I think they can replace that.
Freddy: What is an example of a story, whether it’s here at The Rose or elsewhere, a story that’s, that’s kept you motivated, that you think about when, I don’t know, maybe you, you’ve had a A rough day, maybe, I don’t know, you’re such a happy guy every time I see you, do you wake up on the wrong side of the bed? But I mean, when, when things are maybe a little less, uh, less than optimal. Something keeps you going.
Dr. Raz: I mean, it’s, it’s a couple of cases I remember from intern year. One was a really young woman. She was in super young. I’m talking about 19/20 and she came from a small town in Texas. [00:20:00] And this is a sad story because when I was an intern, used to rotate in different specialties when we interned. You do many things. And she had what we call, you know, GBM, which is a tumor of the brain and it’s incurable. And it was like a year long thing for her where she had headaches and, but in a small town that, you know, parents, nobody really cared and nobody really heard her, if you will. And then eventually, you know, her headaches became so severe that, you know, she came into Houston, did an MRI, found this incurable thing.
And I saw her, took care of her. But basically, by the time I finished intern year, she wasn’t there, right? She passed away. I saw her earlier in intern year. I went to her funeral as well. That really showed me that, you know, no matter what, How bad the day is. There are people like that. I mean, her, she couldn’t live through her, beyond her youth.
I’m sure she had some [00:21:00] dreams. What, she was a star athlete, actually. So all of that was taken away from her. And then access to care. That’s where I really became interested. That’s where a lot of mammography comes in, where we have all these mobile vans going out there. Imagine if, you know, she had the access to MRI or CT in her town.
It’s possible, maybe, The physician over there would have just done it right away, but it didn’t, they delayed it, she didn’t, you know, nobody really guided her till it became advanced. So, cases like that, another one was, I actually did something where I became interested in procedures, was I was in, I was in radiology. I was a second year, it was overnight, you know, overnight we’re doing trauma cases, up at Ben Taub, especially. Lots of trauma and this patient doing CT all of a sudden was gasping for air. The Technologist called me saying hey, it’s something’s abnormal and I looked at the CT real quick and his lung had collapsed. So, I don’t know if you watched the movie Three Kings which like George Clooney and like Mark [00:22:00] Wahlberg?
Freddy: Never seen that one.
Dr. Raz: Well, basically when lung collapses, you have to decompress it. You have to put a needle in and take the air out so that lungs can re-expand.
Freddy: Gotcha.
Dr. Raz: So I was interned. I’d never done it, but I had seen it and read about it. The benefit of radiology is I I was she the patient’s already in CT scans. We put him back into CT and I use CT to guide my needle and overnight I call my my attending but he was coming from home and There’s not enough time, you have to get going.
So the ER physician came in and I was the one who did it right by the bedside. Immediate decompression, the patient felt fine. So all of these things are to say that, quick impact you can make in Patient’s life and then yes, there are stories out there when even if your worst day if you’re alive and breathing you’re happy, you should just take it.
So that really plays into like why I do what I do. Why is try to stay happy if you will and even my worst day, I’m not like that girl. She [00:23:00] couldn’t move beyond 20 and It’s sad and I think about it often but plenty of cases like that daily. So if you have your health you walk around you have good family, you have it all.
Freddy: I love that. Dr. Raz, everybody, uh, please get your mammograms, get them early. Recommended age, 40?
Dr. Raz: 40.
Freddy: Okay, so real quick, if there is family history, do you get it before 40, or?
Dr. Raz: Right, so general guideline is, let’s say if: mom, we care about first degree relative, So mom or sister, let’s say, had breast cancer, especially premenopausal. Average American woman age for menopause is 50. So let’s say mom had it at 40. Then you have to screen at 30. And more, so 10 years before they had breast cancer, premenopause. So sister had it at 45, you start at 35. So yeah, guidelines do change. And you become what we call a high risk patient because your first degree relative had [00:24:00] breast cancer.
So that’s number one. And if anybody in the family, like, especially first degree relative had breast cancer, you may want to speak with a physician and stratify yourself if you’re high risk or not. Nowadays, Freddy, we have amazing genetic testing. So all it takes is doing blood tests and it checks for all your abnormal genes.
It’s possible you have one. It changes the calculus. You may want to screen aggressively some decisions need to be made.
Freddy: Okay, one last question. Um for people who have cancer in the family, let’s say it’s a dad who— who had prostate cancer when he was young eventually leukemia; took him out in his 90s And then there’s a sister with a different form of cancer— How concerned should a daughter or even a granddaughter be uh about any of those?
Dr. Raz: Sure, there is some concern. It’s difficult to give you a number, [00:25:00] but if there are, I would say general rule of thumb, let’s say if you had two or three people in your family with breast cancer close to you, mom, sister, or grandmother, and then one of her daughters or whatever— sons. I think nowadays genetic testing is so accessible that you may want to go speak with the genetic counselor.
Freddy: It’s worth exploring.
Dr. Raz: Absolutely. And when you go speak with the genetic counselor, they ask all sorts of questions. And they have very sophisticated models. Yeah, it comes in two.
Freddy: Yeah.
Dr. Raz: And these models will then spit out risk, like what’s your risk versus, let’s say, an average American person. And if you’re a higher risk, it will trigger the blood test.
Freddy: Gotcha.
Dr. Raz: So I, and a lot of this isn’t very expensive, like going, seeing a genetic counselor, not very expensive, seeing a physician, just like that. And then beyond that, if it triggers, when it triggers, if it’s not, then that’s fine. You, you know. You went and you got your, you got everything, bases covered. Um, but if it triggers a [00:26:00] blood test, then they check for everything under the sun.
Freddy: Mm. Like beyond cancer.
Dr. Raz: That’s right. So, they check for lots of abnormalities. And again, that’s not a very expensive test. And you will know.
Freddy: To me it seems like even if it was moderately expensive, it’d be worth it.
Dr. Raz: Yes, especially with history and family. Again, it’s difficult to give you a general answer, but in breast imaging you can tell that, okay, there is some strong family history. Mom’s sister had it. Same thing with colon cancer. Some of these colon cancers are genetic and run in families. So, you wouldn’t know if your family members have had cancer. Especially earlier the age, the higher the risk that there is some genetic abnormality. So yeah, I do encourage people to take care of, take control of their health and go see a genetic counselor.
Freddy: Bottom line is get screened. And if there’s family history, Get screened early, and, uh, women, get your mammograms, your screenings here at The Rose. [00:27:00] Three insured women will help one uninsured woman, or even a man, get a critical screening. Men have, when they get it, it’s rare, but when they do get it, it’s 40 percent more fatal. So yeah, please come to The Rose. Check out Dr. Raz on previous episodes with Dorothy Gibbons, co founder and CEO of The Rose and their podcast, Let’s Talk About Your Breasts, uh, spreading all kinds of knowledge. And of course, thank you all so much for making the state of Texas just a better place.
Dr. Raz: Thank you.
Post-Credits: Thank you for joining us today on Let’s Talk About Your Breasts. This podcast is produced by Speke Podcasting and brought to you by The Rose. Visit TheRose.Org to learn more about our organization. Subscribe to our podcast, share episodes with friends and join the conversation on social media using #Let’sTalkAboutYourBreasts. We welcome your feedback and suggestions. Consider supporting The Rose. Your gift can make the difference to a person in need. And [00:28:00] remember self care is not selfish. It’s essential.
