In the beginning.....

This was the post on AuntMinnie.com that started a war with ScImage and an Internet presence:


In a word, HELP! Our department was one of the first in the US to go filmless, umpteen years ago, using AGFA. Today, we are one of the last two departments in the WORLD still using AFGA 3.5. Our hospital didn't like the idea of a $2 million upgrade to AGFA 4.5. In the last 60 days, we have brought a 16-slice CT on-line at our main site, with 2 more to come. We also began reading 16-slice CT studies from an outside clinic. Needless to say, AGFA 3.5 chokes on these scans. It cannot handle the vast number of images in a timely manner. In addition, comparing a new scan to an old study with different slice thickness is an exercise in agony, as AGFA will not track the z-axis. We have been using a demonstation system from a small West Coast company to read the studies from the new scanners. (E-mail me if you really want to know which company....) In truth, we are beta-testing the system. There are numerous bugs, though to their credit the company will fix them within a day or two of their report. The system uses a lot of Java programming, and probably a lot of simple HTML as well for a web-based approach. The patient selection page is very cumbersome to use, but they have written a shell program to buffer this, and it is an improvement. The standard reading module is acceptable, with the usual buttons, and the obligatory right-click menu. The real selling point of this little system is its 3D module. We use the MPR portion of this component to read our 16-slice CT's. The program has adjustable slice/slab thickness for the MPR's, and the images appear to be MIPs...I'm not sure if they are really MIPped or if this is a perception from the slice thickness. One can "swim" through the MPRS as fast as you can move the mouse; the recon appears to be VERY rapid on a 3 GHz P4. The MPR module is still buggy, and is not integrated with the viewer. I can find a lung nodule fairly easily with the MPR, but then I have to wade through the source images to find the slice number to report for followup. The MPR module also has a backwards approach to triangulation; clicking on the lesion does NOT localize it on the other planes, but simply enables the plane you have clicked to scroll. I am one of the radiologists who has to use whatever equipment we buy for the next Gawd-knows-how-many years. I have some computer training (BSEE), and I see lots of bugs, shortcuts, and other danger signs in the small company's product. Not to air dirty laundry, but I find myself at odds with my colleagues about this. They love the (flawed) MPR, and they perceive the system to be cheaper than the big name stuff. They are impressed by the fact that the software gets rewritten for us all the time. (To me, this is like buying a Mercedes with a new, untested engine. Sure, the dealer will tweak it and redesign it and replace it when it misbehaves, but is this a way to function day in and day out?) So, my Forum friends.... 1. Is there a reliable system out there that combines all the necessary PACS elements with an integrated 3D/MPR program, AND z-axis matching to allow comparing old and new CT's? Might it possbly be reasonably priced? 2. How hesitant (or adamant) should I be about the small company product? Has anyone had good luck with this scenario? What happens if Mr. Small gets bought out by GE? Many Thanks!!!