The Best Month Ever For DoctorDalai.com!

January 2008 isn't quite over yet, but already we've passed the 4,000 visit mark for the month, a new record. OK, I know most popular websites have this much traffic every second or two, but to me, it's impressive. As always, many thanks for reading my kinder and gentler blog. I've been hearing through the grapevine that some of you miss the old down-and-dirty approach. Well, I wish I could oblige you, but I think you know why I had to tone it down a bit. Maybe I'll take it up a notch or two in the future, so keep your dial tuned to this station!

Star Trek XI

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Coming 12/25/08. Darn, I'm on call that day!

The Ultimate Radiology Keyboard?

As reported in PACS World, "a blog for Radiology network administrators", there is a brand new take on keyboards that would work wonderfully for PACS.

From the Art. Lebedev Studio comes the modestly named Optimus Maximus keyboard. It is rather pricey at $462.27 US, but for this you get something rather wonderful:

Each key is a stand-alone display that shows the function currently assigned to it.

Optimus’s customizable layout allows convenient use of any language—Cyrillic, Ancient Greek, Georgian, Arabic, Quenya, hiragana, etc.—as well as of any other character sets: notes, numerals, special symbols, HTML codes, math functions and so on to infinity.

If this doesn't make the idea clear, try the Optimus demo. There are some other versions coming or already here, such as the Optimus mini three:

Optimus mini three is an auxiliary keyboard-informer with OLED technology. The three keys can display static or animated images. Optimus mini three keyboard can be used as a toolbar, a remote control, an indicator or an RSS reader.

Functionality

Optimus mini three keys display information associated or independent of the running program. For example, you can be watching a film on your computer, while the keyboard displays a weather forecast, exchange rates or mail notifications.

Optimus mini three works in sync with the regular keyboard and is so configured that its current layout changes as you press the modifier keys (Ctrl, Shift, Alt, and their combinations).

This is really, really a phenomenal development. The author of PACSworld mentions the following applications to PACS:

For instance on a work list screen there may be some icons displayed on the keyboard indicating things like:

• Move patient
• Delete Patient
• Edit Patient
• etc.

But when the Radiologist is in Viewing mode there may be buttons that display icons for:

• Next slice
• previous slice
• render 3D
• annotation
• exit viewer
• etc.

The implementation of such a keyboard could mean a much shorter training period as the radiologists will have all the relevant buttons displayed to them directly on their keyboards.Now all that radiology needs is a standard set of icons that is universal to all PACS systems and the learning curve between systems will be much shorter!

This is almost like something out of Star Trek, where the LCARS (Library Computer Access and Retreival System) control panels supposedly are state-dependent and change with the current situation:

PACS is the perfect environment for such a display. But until we get to SickBay on the Enterprise, the Optimus may be a pretty good second best.

What A Difference A Year Makes

The MD Buyline reports (http://www.mdbuyline.com/) are rather pricey reviews of medical hardware and software, generally not available to those of us too cheap or too poor to buy them. Fortunately, Dynamic Imaging, rightly proud of its Number One status, has made these reports available for the past few years. Now, of course, DI's product has a different name, but we won't talk about that. Here are some exerpts from the 2008 report, and the 2007 version. I'll leave it to my astute readers to spot the differences. (Hint...look at the First Place and Last Place entries for both years.) Congrats to all my friends at DI!

2007:

Vendor Composite

2008:

Vendor Composite

Agfa's Pryor Retires, Stone Takes Over

As reported within the last few days, Bob Pryor has stepped down from the helm of Agfa HealthCare Americas, part of Agfa- Gevaert of Mortsel, Belgium. Details are pretty sparse, but apparently Mr. Pryor has chosen to retire. I can find no reference to his departure on the Agfa website itself as of tonight, 1/26/08, but I do expect one shortly. Barry Stone, currently COO, will step up to the plate. According to Healthcare Informatics, "Pryor joined Agfa with the Sterling Diagnostic Imaging acquisition in 1999. Pryor leaves behind a 34-year career in the healthcare field."


Well, OK, maybe it's time after all. (This coming from someone with a retirement count-down clock on his blog!)



I had the chance to meet Mr. Pryor at RSNA in 2003, when we were looking for a replacement to our elderly Impax 3.5, and Agfa was near the bottom of our list for various reasons. He told us that "Agfa had dropped the ball, but that they were ready to pick it up and run with it." After our other choices more or less eliminated themselves, we had the chance to find out how true this claim might prove. You've read the saga that followed in my earlier posts.



Good luck to Mr. Stone in his new position, and of course to Mr. Pryor in his new endeavours.

French X-Ray Patients Recalled...Trouble in Oui Oui Land

A scary little piece from Reuters:

LILLE, France (Reuters) - The French health service is recalling thousands of patients who might have been wrongly diagnosed or infected at five substandard radiology clinics, the Health Ministry said in a statement.

Health experts said it was the largest such recall in France, adding the case had revealed severe failings in the health system.

Authorities closed the five clinics in the north of France last December after discovering a string of serious problems. "Inspections showed major malfunctions, notably with regard to record-keeping and personnel qualification, and with respect to the rules of hygiene and equipment safety procedures," the ministry said in a statement.

Authorities will ask most of the 7,000 patients in question to be re-examined, ministry spokeswoman Geraldine Dalban-Moreynas said.
"The vast majority are patients who may have falsely received a clean bill of health after undergoing a mammogram or chest X-ray," she said.
But an undisclosed number of patients also ran the risk of infection following examinations with instruments that were not sterilised. French media said some of the patients might have contracted AIDS or hepatitis as a result of the sloppy care.

Wednesday's case followed a series of scandals last year over malfunctioning radiation machines used to treat brain cancer patients in a number of French hospitals.

France regularly tops international rankings for the effectiveness of its health care system, although some analysts say it is unsustainable given the country's ageing population, and will need more private investment to survive.

(Reporting by Pierre Savary and Brian Rohan; editing by Crispian Balmer)

Oops... This is what can happen with socialized medicine, my friends, and it isn't pretty. Is this a typical situation? Let us hope not, for the sake of the French patients. You really have to love the part about "more private investment" being required. That means the French will have to start charging for health care after all. The best things in life may be free, but they might well cut your life short.

ADDENDUM

I have received a number of comments from French readers, who are not pleased with my characterization of their system. I have to agree that my post above is a little acerbic, but if you read it carefully, I did state that I hoped this was not a typical situation. I will take the word of my readers who live in France that it is not typical at all. Still, how could a situation like this occur under the umbrella of the French system? "B" says that the radiology practices in question were closed immediately, and were "private practices". Well, with the number of reexaminations and so forth, I don't think they were closed "immediately" but rather after the problem festered for quite a while. But I guess it is a good thing that the problem was eventually dealt with at all. I would love to know if a private clinic over there has the same degree of autonomy as such a facility here.

For the record, I do not think the American system is perfect. Far from it. However, there are those here that see socialized medicine as a panacea, and that is not accurate either. Here is yet another tale of a glitch in another socialized system:

Glitch held up X-ray results

Patients' health may have been compromised

Michelle Lang, Calgary Herald,Published: Thursday, January 24, 2008

Patient care may have been compromised after a computer glitch at Calgary hospitals delayed the transmission of as many as 40,000 radiology reports such as mammograms to local doctors' offices last year, health officials said.

The Calgary Health Region revealed Wednesday that problems with software responsible for faxing radiology results began in May 2007 and continued until late July, when the region notified nearly 2,000 physicians about the delayed reports.

The health authority, which is still investigating the incident, said it's possible patients were adversely impacted, although they didn't know of any cases. Physicians said the worst-case scenario would be a delayed diagnosis of a disease such as cancer, where timely treatment might stop the illness from spreading.

"It's one of those technical glitches that occurs in a system and it's really unfortunate because it has the potential to impact patient care," CHR spokesman Mark Kastner said in an interview Wednesday.

Kastner said any patients whose reports may have been delayed would have since received the correct information from their physician, noting doctors' offices have now had the reports for several months.

Opposition parties called the situation a "mess," adding the CHR should have announced the problem last summer.

"There may have been a lot of people delayed in getting treatment for cancer and other life-threatening issues," said Laurie Blakeman, the Alberta Liberals' health critic. "People were probably failed."

The CHR's fax problems come more than two years after another computer glitch at the health body where physicians viewed incorrect lab test results for 2,000 Calgarians during a two-month period. No patients were harmed during that mix-up.

In this latest instance, the fax problem related to radiology reports from imaging tests such as X-rays or CT scans, which are performed to help doctors diagnose a wide range of conditions. CHR officials say a configuration problem with the software responsible for faxing radiology results from its hospitals and clinics to doctors offices likely began last May.

Doctors offices that receive radiology reports by mail or courier were not affected.

In June, the CHR noticed it was receiving an unusual number of calls from physicians saying they didn't receive faxed results from radiology exams.

It wasn't until July 20 that the CHR identified the problem and sent a letter explaining the issue to the 1,750 Calgary doctors who had opted for faxed radiology reports. CHR then re-faxed the reports to physicians.
The region's diagnostic imaging department, however, later became concerned that they may not have sent all the radiology reports to all physicians' offices.

Finally, in September, the CHR faxed out 40,000 radiology reports to Calgary physicians as a precaution, sending results from all radiology exams done during that period, although it isn't clear how many of those didn't make it to doctors' offices.

The health authority said it has fixed the computer problem and is still reviewing its response to the situation.

mlang@theherald.canwest.com

Hot Tips
Do you think these delays have affected you? If so, contact us.
CalgaryHerald.com

Is this the fault of Canada's socialized system? The politicians want to make it sound that way. Nice to know political spin is a universal phenomenon. I do know that if a report doesn't make it out to one of our clinicians around here, there is Hell to pay within 24 hours. Take it for what it's worth, folks.

Daxor BVA-100: Turn Up The (Blood) Volume

No doubt some of you have performed blood volume analysis in the past, or at least had to learn how it was done. Remember the good old days, when we labelled red cells with chromium (Cr-51) and the plasma with I-125 albumin, then we had to do painstaking measurements with well-counters, and lots of hand-calculations? That's probably why the test was so expensive, and why it was rarely ordered.

Enter Daxor and the BVA-100, pictured here:

This takes most of the work (and guesswork) out of the test. Basically, the old method has been streamlined and simplified, but philosphically the method is similar. The basic principle involves dilution. If I have a bucket of water of unknown volume, and I dump a gram of sugar (or a microcurie of I-131) into it, I can then take a 1 cc sample of the water, and determine how much sugar (or I-131) is in that sample, and then work my way back to the original volume. If the sample contains 1 mg of sugar, I know that the volume must be 1 cc water x (1 gram sugar/1mg sugar) = 1000 cc water! Simple algebra, right? In the old days, we used this method to determine both plasma volume with I-125 labelled albumin, and red-cell mass with Cr-51. Graphically, think of it like this:

Daxor's method is a little easier from the user's standpoint:

The BVA-100 is a semi-automated blood volume analyzer. The instrument is used in conjunction with a single-use injection kit consisting of a precisely measured standard and matching injectate (of I-131 labelled human serum albumin). The injectate is packaged in a patented flow chamber designed to ensure 99.8%+ delivery. The kit improves accuracy and eliminates the many time-consuming and difficult steps required for on-site standard preparation.

The BVA-100 utilizes five separate sampling points taken at regular intervals starting approximately 12 minutes after injection. In effect, each sample measurement is a separate, single-point blood volume determination. The BVA-100 computes the transudation time for the tracer and calculates the true zero point blood volume with an accuracy of approximately +/- 2.5%. The BVA-100 provides interim blood volume results while the samples are being measured; preliminary data is available within 30 minutes and may be used to guide decisions in emergency situations.

Daxor's stroke of genius for me is the elimination of the direct labelling of the red cells, as well as plasma. Rather, a portion of the blood sample is reserved for hematocrit determination, and that ratio of red cells to plasma is then applied to the rest of the figures, i.e., the plasma volume. Simplistically, if the hematocrit is 50%, and the plasma volume is 2,000 ml, then the red cell volume has to be 2,000 ml as well. (The volume of white cells is negligible.)

The system goes even further, normalizing the readings to the patient's height and weight (and incidentally providing a reading of how far above or below average the patient might be.)

We all remember using blood volumes to document Polycythemia, an overabundance of red cells. As it turns out, blood volume measurement can be applied to a number of other situation such as:

1. Acute blood loss during surgery or trauma
2. Hypertension
3. Syncope
4. Orthostatic hypotension
5. Congestive heart failure
6. Septic shock and hypovolemia
7. Anemia in cancer patients or HIV positive patients on chemotherapy Renal or kidney failure
8. Preoperative screening for low blood volume
9. Chronic fatigue syndrome

Have a look at this brief slide presentation from Daxor:

We purchased a BVA-100 over a year ago, and I am very pleased with the results. I am very slowly getting the word out to the clinicians as to just how much we can help them with this test, and they are actually starting to believe me! Fortunately, as the system uses I-131, it requires a nuclear license, and cannot be placed in the clinicians' offices. Sorry about that.

Is Agfa Getting SoHard?

You may recall that I reported in November, 2005, with much levity that Mercury Computer Systems purchased a German company known for 3D visualization called Sohard. Today, one of my friends from RadRounds informed me of an interesting development. It seems that right around RSNA time, Agfa signed up with Visage Imaging, a subsidiary of Mercury, to provide the Visage CS Thin Client/Server "for supplying enterprise-wide advanced visualization solutions to customers worldwide." Funny how that never got mentioned at the Agfa booth at RSNA! The press release is dated November 26, 2007, and RSNA ran from November 25th through the 30th. I can't directly connect the family tree of Visage to Sohard, but I suspect there has been some adoption of the latter's technology under the badge of the former. Perhaps "Sohard PACS" wouldn't have been a winner in this country for various reasons. Oh well.



According to the press release,

Agfa HealthCare will integrate the Visage™ CS Thin Client/Server into its IMPAX™ product line in order to provide enterprise-wide advanced visualization capabilities based on 3D thin-client technology. This integrated solution ensures that large image data volumes can reside entirely on the central server, and interactive 3D and 4D viewing and post-processing can be performed from any client computer using an innovative thin-client streaming technology. Because of the tight integration of IMPAX and Visage CS, large 3D and 4D images become instantly accessible at the click of a mouse within the PACS workflow, throughout the entire healthcare enterprise.

Sounds pretty good so far. the Visage website has this to say about the CS product:

Visage CS is blazingly fast and easy-to-use software for 3D-based image interpretation, post-processing, and image distribution. Data from virtually all modalities can be viewed and processed, including CT, MR, PET, PET-CT, SPECT, and SPECT-CT. Visage CS allows virtually “instant” access to all data anytime, anywhere inside or outside the hospital or imaging center walls, on standard PCs and even laptop machines*. Visage CS is designed to manage even the largest data volumes smoothly and efficiently. For example, the initial 3D display of a 2,000 slice series takes less than three seconds, regardless of the PC or workstation where it is viewed**.

Visage CS is a “plug and play” solution. You may use it as a standalone system, integrate it into an existing PACS workflow, or obtain a completely integrated solution consisting of Visage PACS and Visage CS.

* Although the thin client software allows users to review image data on standard PCs and laptops, the equipment used for diagnostic image interpretation must meet the legal requirements of the respective country.
** Example value based on actual performance measurements. Performance may vary depending on the actual load and concurrent traffic on the Visage CS server.

Gotta love the disclaimers. But how well (and easily) does it work? I haven't a clue. Our hospitals do need to get some sort of enterprise/thin client system for cardiac studies, and I need to piggyback PET/CT remote reading on this solution. My grandiose plan is to invite key vendors for a "shootout" to see just how well their thin (and thick) clients work in our production environment. I guess I'll be adding Visage CS to the list. More to come.

I Spy Eye Fi

Once in a while (even less frequently in the world of PACS and medical imaging), one finds a new product that actually works and does what it says it should do. Such is the Eye-Fi wireless memory card.

Basically, this is a 2 Gb SD card that will work with most digital cameras (those that use SD cards for memory, that is.) In addition to the prodigious memory, this card contains a tiny Wi-Fi tranceiver with some limited but still powerful functionality. No, it won't turn your camera into an Internet terminal, but it will let you wirelessly upload photos to your computer and to a service such as Flickr (the one I use) or Picasa, or a number of others. When you return home with your photos in camera, just turn on your camera, and the pics are automatically uploaded. There is a 2 minute set-up procedure for your computer that you have to do once, and then you are good to go.

Uploading goes very quickly on my 802.11g home Wi-Fi network. No, you can't use a public hot-spot to upload, and this is why I call the Eye-Fi's function limited. Still, it is a very powerful little device, literally allowing me to cut the cord between my computer and camera.

The card lists for $99, but can be found for less on eBay.

And it works. Quite well, as a matter of fact!

60,000 Hits!

Image credit: http://www.sourcebooks.com

Yes, it's another milestone for the kinder and gentler blog. Visitor 60K came from Amersfoort, Utrecht, Netherlands. Sadly, they didn't stay long....

General Electric Is Doing Business With Iran?

From Bill O'Reilly of Fox News ("The O'Reilly Factor," January 10, 2008) comes this disturbing report. Please don't shoot the messenger, by the way.

BILL O'REILLY, HOST: Now for the top story tonight, reaction to [charges General Electric is doing business with Iran]. Joining us from New Orleans is Christopher Holton, the vice president of the Center for Security Policy. Here in the studio is Debra Burlingame, co-founder of 9/11 Families for a Safe and Strong America. Ms. Burlingame's brother perished on 9/11. So what say you, madam?

DEBRA BURLINGAME, 9/11 FAMILY MEMBER: Well, I'd say that GE has a problem. And it's a problem that I'm glad you're airing here for the country to know.
They say that they're only fulfilling old contracts. That's lawyer talk for yes, we're still doing business in Iran. They're trying to say that they're not going to take up any new contracts, but lawyers know how to finesse that. The fact of the matter is they are defying U.S. sanctions by going around with a loophole, doing business with their foreign subsidiaries in countries like Syria and Iran.

O'REILLY: I think the American government knows this though. And you know, the State Department has not condemned them, the Bush administration has not condemned them. Other companies do it as well.

BURLINGAME: Well, there are some 35 companies that are doing it. And the SEC Office of Global Security Risk did inquire of GE in 2006, basically saying what are you doing, what's your involvement, what's the extent of your contracts? GE responded, I can summarize it for you by saying none of your business; we're complying with law; and our focus is ensuring shareholder value. That's a euphemism for we're looking after GE's profits. And on the street, that would be called blood money.

O'REILLY: What do you say, Mr. Holton?

CHRISTOPHER HOLTON, CENTER FOR SECURITY POLICY: Well, I can't say it any better than Debra Burlingame just said it. She's exactly right. The fact is companies like General Electric and others are providing corporate life support for our enemies in the war on terrorism when they do business with Iran. It would not have been acceptable in the 1940s to build a hydroelectric plant in Nazi Germany. And it's not acceptable today to be building a hydroelectric plant in Iran. Iran's killing U.S. troops in Iraq and Afghanistan.

O'REILLY: Now there were contracts, of course, canceled in World War II after Pearl Harbor, because the United States companies were doing business with the Third Reich in Germany, with Italy. I don't know whether they were doing business in Japan or not because of the relationship with them. So you can cancel contracts and anybody should know that any time you want to cancel them, just to say you're fulfilling existing contracts.

But the bin Laden business is also very disturbing, because Hockenberry, if you believe what he says is true, and he did write this for the Massachusetts Institute of Technology, which is not — he did it in an academic setting. He basically says, look, even after 9/11, even after Usama bin Laden attacked the United States, General Electric wasn't going to probe his operation vis-a-vis his family. And we know now that one of his brothers was involved in Al Qaeda and on and on. That to me is very, very disturbing.

HOLTON: Well, it's disturbing to me, it absolutely is. And it should be disturbing to all Americans as far as I'm concerned.

O'REILLY: Now Ms. Burlingame, Syria also involved, you know, also on the list of the State Department. They do help terrorists in Syria. GE does a lot of business with them as well. So I don't know, man. It's just looking pretty bad here.

BURLINGAME: Well, what really disturbs me about Syria is that we know that 90 percent of the foreign fighters who have come through the Syrian border, who have showed up in Iraq to detonate suicide bombs, IEDs, killing and maiming our troops, they're coming — they fly into Damascus and come through the western border. Our troops call it the ratline. And GE is helping the ratline by, as Chris said, by giving life support to this country.

O'REILLY: Do you see it that way, Mr. Holton? Do you think GE's actually helping the Syrian government? Or is it just a private thing?

HOLTON: They're doing business. They disclosed this themselves. They're doing business with the Syrian government and the Iranian government. GE says that they're doing business with those governments.

O'REILLY: Now when you see the skirmish that they had this week in the Persian Gulf with the boats, little Iranian boats threatening the big American warships — which I think Iran wanted the warships to fire on the little boats — you know, it just ratchets it up in an area that I think most Americans are going to be uncomfortable with. I'm going to give you the last word, Debra, you know, because this is an emotional issue for you. You lost your brother and thousands of other Americans lost people on 9/11.

BURLINGAME: I'd like the American people to understand that what GE is doing is within the letter of the law, but is most definitely violating the spirit of the law. We are trying desperately to avoid another war. These sanctions are to help give our diplomats and our country something to bargain with at the…

O'REILLY: Yes.

BURLINGAME: ...in diplomatic talks. We're trying to turn these countries into international pariahs. And when you give them goods and services, you're working against us.

O'REILLY: OK. Mr. Immelt is invited on this program if he would like to reply.
Debra, thank you. Mr. Holton, we appreciate it.

And a followup from Foxnews.com dated January 11, 2008:

Is General Electric, the parent company of NBC, doing business with Iran? And did they do business with the bin Laden family after 9/11? That is the subject of this evening's "Talking Points Memo."

Now you may remember former NBC correspondent John Hockenberry. He competed against us on MSNBC for a while and reported stories for "Dateline NBC," winning some awards. In this month's edition of Technology Review, a publication put out by MIT, Mr. Hockenberry makes a very disturbing charge.

"In early 2002, [I] was in Saudi Arabia covering regional reaction to September 11. We spent time on the streets and found considerable sympathy for Usama bin Laden among common citizens. We wanted to speak with members of Usama bin Laden's family about their errant son's mission to bring down the Saudi government and attack the infidel West. We couldn't reach the bin Ladens using ordinary means... but GE had long done business with the bin Ladens.

In a misguided attempt at corporate synergy, I called GE headquarters in Fairfield, Connecticut, from my hotel room in Riyadh. I inquired at the highest level to see whether, in the interest of bringing out all aspects of a very important story for the American people, GE corporate officers might try to persuade the bin Ladens to speak with 'Dateline' while we were in the kingdom.

Within a few hours, I received a call in my hotel room from a senior corporate communications officer who would only read a statement over the phone. It said something to the effect that GE had an important, long-standing and valuable business relationship with the Bin Laden Group and saw no connection between that relationship and what 'Dateline' was trying to do in Saudi Arabia. We spoke with no bin Laden family member on that trip."

Now CEO Jeffrey Immelt was running GE back then, and of course is the highest level of that operation. NBC News trashed Hockenberry in a statement today.

"It is unfortunate that John Hockenberry seems to be so far out of touch with reality. The comments are so utterly absurd, we will have no further comment."

Mr. Hockenberry would not come on "The Factor," but told us on the phone he stands by his story. There are also reports that General Electric continues to do business with Iran. CEO Immelt would not respond to our questions about that, so producer Jesse Watters went to him.

(BEGIN VIDEO CLIP)

JESSE WATTERS, "O'REILLY FACTORY" PRODUCER: Mr. Immelt, Jesse with FOX News. We would like to talk to you about your involvement with Iran. Are you still trading with Iran while Iranians are killing Americans in Iraq? You're not selling them airplane parts that can be used for military equipment?

(END VIDEO CLIP)

Now late today GE did issue a statement finally, saying it no longer does business with Iran, except fulfilling past contracts and humanitarian stuff. But "The Factor" has confirmed that through subsidiaries, GE is working with the Iranian government on hydroelectric, oil and gas, and medical projects.

It should be noted that Iran is currently listed as a state that sponsors terrorism, and U.S. intelligence has confirmed Iranian weapons are being used to kill Americans in Iraq and Afghanistan.

Mr. Immelt is in deep trouble within General Electric. The company's stock price is now 10 percent lower than it was when he took over from Jack Welch on September 7, 2001, four days before 9/11. Reports are there is open disenchantment with Immelt's leadership from some stockholders.

But the key issue here is how American corporations are behaving in the middle of a terror war. General Electric should fully explain both situations: the bin Laden deal and Iran.

And that's "The Memo."

I realize that there is nothing personal here, the dealings with a terrorist nation are only designed to increase the stock price. That's all. Nothing personal. Since this is all being done in their name, at least in theory, I think GE stockholders need to consider selling out. My financial advisor sold mine several months ago, but I wish he hadn't, so I could sell it now.

Unanswerable Questions

Some hypothetical scenarios:

1. My company gives me a Ford to drive. I don't like Fords for various reasons, and I publish this opinion on my blog. I get into an accident, harming someone in the process. The victim sues me. Am I in a worse position because I published the fact that I don't like Fords?

2. My company gives me a Ford to drive. I don't like Fords for various reasons, but due to Ford making it clear that they don't tolerate dissent, I refrain from publishing my opinion of Ford on my blog. I get into an accident, harming someone in the process. The victim sues me. Am I in a worse position because I knew Fords had problems but didn't publish that fact?

3. My company gives me a Ford to drive. I don't like Fords for various reasons, but due to Ford making it clear that they don't tolerate dissent, I refrain from publishing my opinion of Ford on my blog. Joe Schmoe, whom I know in passing, buys a Ford, not knowing of my dislikes. He gets into an accident, harming someone in the process. He subsequently finds out that I knew Fords had problems, but refrained from publicising this fact. Can the victim sue me? Can Joe sue me?

4. My company gives me a Chevy to drive. I like Chevys, and I publish this opinion on my blog. Based on my article, Joe Schmoe buys a Chevy, then gets into an accident, harming someone in the process. Can the victim sue me? Can Joe Schmoe sue me?

Rules Aboard the U.S.S. Dalai

I'm back from the Caribbean, having survived the rough seas off Haiti aboard the Celebrity Millennium. I would have to say that the service on board was quite good, better than we have experienced on Celebrity's sister line, Royal Caribbean. However, some of the clientele seemed, well, naive about the ways of genteel society. Or even polite society. Or even civilization. This includes Americans (whether they spoke English, Spanish, or Yankee) and non-Americans alike. I have observed every instance of the bad behaviour that the rules below would attempt to cure. Celebrity did not seem interested in educating anyone, lest they lose a potential customer for an upcoming cruise. Therefore, I have purchased the overloaded boat above, renamed it the USS Dalai, the first of the Lama Cruise Line ships. The rules for the ship are as follows. Itinaries will be published shortly.

SHIPBOARD RULES FOR THE USS DALAI

1. The overriding sentiment aboard this ship is that your rights end where those of others begin. We realize you paid an excessive amount of money to be on this lovely vessel, but that does not buy you the freedom to do whatever you please. The other two thousand passengers also paid their fee, and you do not have the right to interfere with their vacation experience.
2. This ship operates on the concept of lines and waiting one's turn. Most of us learned this by age 5, but many seem to have forgotten how it works. We have enough provisions to keep all of you well-fed and properly entertained. It does you no good to push ahead of someone else.
3. The ship represents a closed environment, and disease can spread rapidly. We give you the option to receive a full refund BEFORE the cruise begins if you become ill and do not wish to bring your pathogens aboard. As a minimal screening, we will take the temperature of all passengers at the pier before they board the ship with hospital-grade instruments, and there will be a limited physical examination. If you are found to have a febrile illnesses or other communicable disease, you will be offered a full refund if you agree not to board. If you insist on boarding, you will be issued a mask and gloves, and you will be quarantined in your stateroom until you are determined to be non-infectious. Violating quarantine will result in your expulsion from the ship at the next port and you will forfeit your entire fare.
4. Similarly, a minimal level of cleanliness is necessary for the health of our passengers and crew, and it will be enforced. You MUST wash your hands after using the restroom. We find it rather distasteful that anyone would even consider returning to the dinner table with fecal material on their hands, but sadly some of our passengers don't seem troubled by this, forcing us to take draconian measures to ensure a modicum of cleanliness. Handwashing will be periodically monitored. Obviously, we cannot and will not check to see if you wash your hands in your own stateroom, but public restrooms will be subject to spot checks by security. A warning will be issued for the first offense, a citation for the second, and you will be expelled from the ship for a third offense, forfeiting your fare.
5. Deck chairs are for everyone's use. Unfortunately, there are not enough chairs to accommodate everyone at the same time. Therefore, you will be allowed to occupy a chair for a maximum of two hours if others are waiting. You may reserve one (and only one) chair next to the one you occupy.
6. The ship's elevators cannot simultaneously serve all passengers at the same time. We ask you to be patient, and not crowd the elevators any more than necessary. When the elevator stops, please allow people to exit before getting on, or step off the elevator if necessary to allow them to pass.
7. We know you love your children, and think they can do no wrong. Please keep in mind that your children are YOUR responsibility, not that of the ship's personnel. We realize that children are not "little adults," but repeated bad behaviour, running, screaming, pushing in line, and so forth, especially in your presence, reflects badly on YOU. We have seen parents actually encourage such behaviour, and act proud of it, which goes completely against the mores of most civilizations. As per Rule 1 above, your rights, and those of your children, end where the rights of your fellow passengers begin. The most eggregious behaviour may result in your entire family being put off the ship at the next port, with forfeiture of your fare.
8. Strollers and luggage carts need to be used with care and courtesy. Repeatedly butting them into other passengers, using them to block elevator doors, trying to roll them down stairs, etc., will result in their confiscation for the remainder of the voyage.
9. We will do our utmost to provide the finest service on the seas. We are not perfect, and we may miss the mark here and there. We request that you not become hysterical when this occurs. We will provide grievance forms for these situations, and a partial refund will be issued if deemed appropriate by an unbiased third party arbitrator.
10. Respect other cultures. If a shore excursion takes you to a church, for example, and signs clearly state that one must cover one's head, arms, or legs, and not take photos, please heed these requests. They are not in place to annoy you, but to maintain the sanctity of the place of worship.
11. At our entertainment extravaganzas, the show is on the stage, not at your table. Please respect the others attending the show by keeping your voice down. Those who feel the need to shout over the music will be asked to leave the venue.
12. Enjoy your cruise!

Agfa Offers?

I'm currently onboard the Celebrity Millenium, en route back to Ft. Lauderdale. We were supposed to stop in Haiti yesterday, but the weather kept the ship out of port, so we had an extra day at sea. I really enjoy those anyway, so it wasn't a total loss, but the seas were as rough as I've seen them in the Caribbean, and we were all staggering about like, well, drunken sailors. No one became sea-sick, at least not obviously.

A friend who works for a PACS company (not Agfa) sent me this exerpt from Diagnostic Imaging:

From DI Scan Jan 3, 2008

Rumors that Agfa is for up sale gained credence this week. After vehemently denying this scuttlebutt for months, the company acknowledged that offers have been made and that it would be following up on them. CEO Jo Cornu has been instructed by Agfa's board of directors to "actively look into the expressions of interest that the company recently received," according to the company. Since the spring, Agfa has been working on a demerger that would split the company into three pieces. One will be healthcare. A source at Agfa told DI SCAN that the sale of any part of Agfa is highly unlikely until the demerger is complete. The process, which was to be completed by the end of this year, could take until spring or summer 2008.

I reported most of this in a previous blog entry. Now, I wonder which company has offered to purchase Agfa Healthcare. Hmmmm. Seems to me there aren't all that many who could pony up that kind of cash. Again, the first two on my list would be Siemens and Cerner. But you never know. There might be all kinds of venture capitalists out there wanting to take on a challenge.

Speaking of Agfa, I had the chance to read Alan Cooper's , "The Inmates Are Running The Asylum" from cover to cover as my "cruise book," and I found it very educational. Yes, Agfa Impax 6.x was the PACS designed theoretically with Cooper's methods, personnas and so forth. As near as I can tell, the process got derailed somewhere between the creation of the radiologist personna and the design of what this personna might actually want in a PACS. They should have used ME as the personna. Then the thing would have been perfect (or might not have worked at all!!)

NEWS FLASH!!!!

I was sent this link from Reuters concerning a possible suitor. This is the company that bought Chrysler from Damlier Benz. Interesting possibility, eh?

BRUSSELS, Dec 12 (Reuters ) - U.S. private equity firm Cerberus is considering a takeover of troubled Belgian imaging technology group Agfa-Gevaert (AGFB.BR: Quote, Profile, Research), a report in Belgian daily De Standaard said on Wednesday, quoting anonymous sources.
The company, which specializes in hospital imaging systems and top-end printers for publishers and newspapers, reiterated last week that it planned to split into three listed companies next year but also said that its board, which is meeting on Wednesday, was open to outside offers.
Agfa had planned to list Agfa Graphics, Agfa Health Care and Agfa Materials this year but has postponed that until mid-2008.
Previous press reports said senior company officials had been approached by potential investors.

Since its listing in 1999, Agfa has undergone a seemingly endless restructuring to cut costs and switch its products to digital from analogue technology.

I guess we'll have to wait and see. This would certainly be an interesting combination...Chrysler and Agfa. Perhaps I can predict the next PACS line. How about Viper PACS? Fast and sleek. Or perhaps the Town and Country practical line? Nah....we'll probably just get a Neon.