Thursday, August 31, 2006

Logmein al Carbonite

Periodically, a product comes to market that improves my life considerably. Today, I'll mention two such wonders.

LogMeIn, found at, lets me and Mark the PACS Guru take care of a lot of computers in a lot of places. There are various services offered including LogMeIn IT Reach, which is the one we use the most. This advanced program gives me remote control access to the target machine, the ability to perform management functions (turn services on and off, for example, remote reboot, and even direct file transfer). There is a free version that just gives one remote control, pretty nice for the price. This system is secure with 256-bit encoding, and the best part is that it will automatically negotiate firewalls, with no need to fool around with port-forwarding and the like. LogMeIn also offers a "Rescue" product that doesn't require any software installation on the receiving end. There is even a new service called Hamachi which is "a zero-configuration virtual private networking (VPN) application. In other words Hamachi is a program that allows you to arrange multiple computers into their own secure network just as if they were connected by a physical network cable." LogMeIn just might put the networking guys out of business! Well, not yet. My little illustration is prompted by the Chinese-dish sound of the non-caps version, chow mein, get it?

Carbonite (, like its namesake, is a protective shell of sorts. I had been looking for a way to back-up my computer onto some nebulous place on the internet, and Carbonite provides this. It works like a charm. Basically, one just installs the small app and it backs up whatever portion of your disk you specify, up to and including the whole thing if you wish. The price is pretty reasonable, depending on how long you contract for the service. Check it out!

Tuesday, August 29, 2006

Dalai PACS

I don't like to repeat gossip, but there is a rumor floating around that I am going to start my own PACS company.

It's true.

Film at 11.

Sunday, August 20, 2006

How Many Monitors?

How many monitors is enough? How many are too many? Is there a "just right" number, Goldilocks?

Probably, the answer differs for every radiologist, and every group. The 21 members of my group would give you a several answers. At home, most use just one commercial-grade Dell monitor for on-call prelims. (I, being different, have two, and a couple of my partners have just ordered out some used Barcos so they can do full interpretations at home.) At the hospitals, the majority of our stations have the 2+1 configuration: two high-res monitors and one 17" or 19" color monitor for worklist or 3D display. We still have several stations that consist of four high-res Barco monitors only. Now here is where opinions differ. Personally, I am satisfied with the 2+1 setup. I figure I can only concentrate on a small area of one monitor at any one time, so why have so much screen-real-estate that I can't look at immediately? Those who prefer the four-bangers (a legacy title I bring to this post from the old days of four-function calculators) counter that it is much easier to compare complex multisequence MRI's if you have more space to put the images. I guess that makes sense. The second reason, and the one that I find more compelling, is that when comparing CR's, it is helpful to view more prior exams at once, to better see trends in the patient's condition. That one makes more sense to me. This can still be done with a two-banger, but you have to cycle the priors on the second monitor.

I mentioned in a prior post that Agfa Impax 6.0 probably doesn't play well with an all high-res monitor set-up, so we will probably be adding a fifth, color monitor, to the four-bangers. We may need bigger desks, or maybe some sort of bracket suspension aparatus. Remember back when PACS was new, and some companies were showing the huge banks of 8 CRT's? Those were the days....

Image courtesy of

Another interesting discussion involves what should go where. Where should the new study go? Where should the priors go? On the far left monitor, on the far right monitor? This can and should be strictly up to the individual user, and with hanging protocols and presentation states, that should not be hard to, well, arrange. I've been hearing some talk about moving one particular series around, and that one has me concerned. Let's say you are looking at a complex multisequence MRI, and you wish to compare the current axial T1-weighted post-contrast sequence with its counterpart from last month's examination. The theory is that you should be able to move just that one prior sequence into a viewport or window that otherwise holds nothing but the current study. Personally, I have a feeling that could be dangerous. What if I get distracted, and somehow, in my reverie, forget that this sequence in the middle of the screen is actually from the old (here, the wrong) study? Disaster awaits. I know those planning to do this sort of thing are intending to put some fancy border around the foreign sequence, but will it be enough to penetrate my thick skull? Perhaps if the border had a flashing marquee that said "Danger Will Robinson, Danger, Danger!!" Personally, I want the ability to disable this function, although I guess I might come to like it someday.

You can sometimes teach an old doc some new tricks....

Wednesday, August 09, 2006

Anti-Semitic Radiology Residents???

I take the pulse of the world of Radiology via The Residents' Digital Forum is always lively, with discussions of topics ranging from politics to how to go about switching residency programs.

The political threads can get rather intense, with conservative posters (often called Neocons, Right-Wingers, Bushies) going head-to-head with liberal posters (Leftists, Socialists, Bush-haters, Commies). You get the idea!

Israel, Islam, Iraq, and the Mideast situation in general creates a flash-point for discussion. The usual polarization is present within these threads, but I have noticed a very ominous trend: there are now several blatantly anti-Semitic posts. Here is a thread about the current war between Israel and the Hezbollah in Lebanon. I won't even try to discuss the issues of the war itself here; that's beside the point I am trying to make. The AuntMinnie thread contains a considerable majority of anti-Israel sentiment: Israel is bloodthirsty, Israelis are the real terrorists, America is stupid for supporting Israel. Fine. But then come the racist rants: The media and Congress are Jew-run, Jew this, Jew that. It makes my blood freeze. You see, this forum is on a RADIOLOGY web-site, and is geared toward residents (although old farts like me drop in periodically.) These comments are ostensibly from intelligent young physicians! What has happened? I wish I knew. But I can only speculate. There is a lot of frustration out there, and a tremendous amount of anger, mainly on the part of the liberal posters anyway, about our involvement in Iraq, and about President Bush. I don't know if this is manifesting into anti-Semitic sentiments de novo, or just unmasking such feelings that were already there. Either way, the fact that supposedly smart people are rehashing material from the Protocols of the Elders of Zion (an anti-Semitic tome from years ago) makes me worry. A lot. What will happen to this country, and to Israel, for that matter, when this angry young generation comes of age and acquires real political power?

Those who hate destroy themselves just as much as the objects of their hatred. You might not be able to prove that scientifically, but it is so nonetheless. I hope these kids learn that before too much longer.

Wednesday, August 02, 2006

Edge Detection Rule(r)s!!

I haven’t posted much in the way of pure PACS lately, in my quest to be a politician and policy maker (or breaker as the case may be). My good ideas seem to be coming less and less frequently; must be old age, or stress, or some combination thereof.

Finally, my rusty steel trap of a mind has come up with something new. Well, it really isn't new, but it is a simplified and useful twist on an old concept.

Edge-detection is a well-known mathematical procedure, useful in the detection of abnormalities on mammograms, and nodules on CT's. There are a number of Artificial Intelligence (AI) programs out there that sniff out badness on these exams and do all sorts of measurements allowing for followup.

My idea is much simpler, and applicable to the everyday PACS world. In fact, it occured to me whilst measuring innumerable lung nodules on a cancer patient. It is a true pain to draw in short and long axes, especially when the nodule is in the subcentimeter range (and even more so when your non-averaGE PACS won't let you show more than one pair of measurements on the screen.) So, let's create an edge-detection-based ruler! As in the rather primitive mock-up above, the user draws a circle or ellipse around the nodule in question, and tightens up its radius to a reasonable level. The computer then takes over, detecting the edge of the nodule, finding long and short axes, and even giving average density, total area, etc. Yes, this could be expanded into 3D, seeking the nodule in the slices above and below, but that adds so much complexity, it probably isn't worth it. All I want is my measurements done for me without tedious submillimeter movements of the mouse. The Dalai Edge Detection Ruler would do the trick.

OK, which PACS company is going to make this happen? I'll take 50% royalties, thank you. Uh, how about 30%? 20%? Oh well, just put this in action and I'll be happy!