RSNA 2020: New Horizons Lecture: Insights for Radiology from the Hidden Brain

It’s not a mysterious neural pathway or a peculiar neurological structure. It can’t been seen on a scan or diagnosed in a patient. Yet it shows up in radiology departments all over the world every day.

The “hidden brain” is Shankar Vedantam’s term for a broad range of brain functions, emotional responses and cognitive processes that occur outside of our conscious awareness, yet have an outsized impact on how we all behave.

“The best analogy is what you see when you go to a play. When we sit in a theater, there's action happening on the stage in front of us. And we all know intuitively that the action on the stage is supported by a lot of what’s happening backstage that allow what happens on the stage to unfold,” said Vedantam. “Our minds function in the same way. There are aspects of our minds that are conscious, that are visible, that we're aware of, that we can see all the time and believe there's, there's a whole universe of our brains that's required to support what’s in the conscious mind.”

Vedantam is a social science correspondent and the host of the Hidden Brain podcast, one of the most popular podcasts in the world downloaded by millions of listeners each week. The focus of his reporting is on human behavior and the social sciences, and how research in those fields can get listeners to think about the world in unusual and interesting ways.

He’s also author of The Hidden Brain: How Our Unconscious Minds Elect Presidents, Control Markets. Wage Wars and Save Our Lives, which describes how unconscious biases influence people. In March 2021, his new book, Useful Delusions: The Powerful Paradox of the Self-Deceiving Brain will be published by W.W. Norton.

RSNA President James Borgstede, MD, and Ann Leylek Brown, MD, a radiologist in Cincinnati, Ohio, moderated a conversation with Vedantam about change, AI and diversity during the all-virtual RSNA 2020.

Unconscious biases can hinder equal representation

Vedantam explained the hidden brain has a powerful role in shaping decisions, especially when it comes to the wellbeing of others. These unconscious biases can help us understand the disparities in radiology, where women and minorities are underrepresented compared to other fields and medicine. He says unconscious biases can unintentionally prevent women and minorities from joining the radiological field.

“If you come into a field where you don't see anyone who looks like you, talks like you or has the same background as you, it can be a little lonely. And it can inadvertently the signal that people like you do not belong in this field,” he said.

To combat this trend, Vedantam says mentorship programs across the industry are key to expanding the ranks of women and minorities in the field. “When we look across the the board, we often find that role models and mentors are really important, not just in getting people to join the field, but in staying within a field,” he said.

Equal representation isn’t just important for clinicians and colleagues. It can also have an impact on patients and their outcomes. He notes that some studies indicate that in some cases, patient outcomes are also impacted by having clinicians who represent their patient populations.

>“The fact that you have different outcomes when patients feel a degree of comfort or familiarity with a physician of their own background tells you something about the importance of this. It’s not just a question of equity for the practitioners of the field. This has bearing on the outcomes on patient health and community well being.”

AI: Friend of foe?

The hidden brain is particularly relevant today, as radiology begins to implement Artificial Intelligence (AI) into technology and workflows. But is AI a friend or a foe when it comes to fighting unconscious bias?

“It’s both. When AI first came along, the hope was that machines would function in a ‘clean’ way that wouldn’t be contaminated by human biases and human associations. But we’ve seen in a number of domains that’s not the case. And that shouldn’t be surprising, partly because AI functions by learning from a huge amount of information. And the information that AI is learning from is information that we feed into AI systems.”

That’s why pragmatic solutions that go beyond implicit bias training, such as mentorship programs, are important to radiology today, “Mentorship and developing people over time is one of the practical things that we can do. These are, in some ways, the most powerful things that we have against our unconscious bias,” Vedantam said.

Ultimately, working around our hidden brain to create a diverse workforce based on mentorship and sponsorship has wide-ranging impacts on the entire field.

“I think diversifying the field so it looks and feels more representative of the community in which it’s working is not just the right thing to do, but it’s the more effective thing to do in terms of the outcomes that we offer.”

View the discussion at https://rsna2020.rsna.org/live-stream/15351568/New-Horizons-Lecture-Insights-for-Radiology-from-the-Hidden-Brain