How Do You Like My Bodacious Tatas?

I guess nothing is sacred anymore. I have despised Ford Motor Company ever since it made the decision not to recall the exploding Pintos because it was cheaper to pay awards in wrongful-death lawsuits. I was very disappointed to see the results of Ford's buying spree of luxury nameplates; Ford presently owns Jaguar, Land Rover, and Volvo. But now, Ford will sell the first two to India's Tata Group, although this will be more of a partnership than a complete sale.

Tata is probably going to be the world's largest car manufacturer. It is actually a very large operation:

The Tata Group is one of India's oldest, largest and most respected business conglomerates. The Group's businesses are spread over seven business sectors. It comprises 98 companies and operates in six continents. It employs some 2,89,500 people and collectively has a shareholder base of over 2.9 million and market capitalisation of $66.9 billion as on February 21, 2008.

While the British (automotive) Crown Jewels are certainly a nice acquisition, Tata's greatest achievement is probably going to be the introduction of the Nano, a US$2500 "people's car":

There is a much larger draw for a US$2,500 mini-car than a US$75,000 luxury SUV. Nothing like covering both ends of the market.

I'm still stuck on Japanese quality, having been very pleased with my Lexuses and Toyotas for the past 20+ years. It will be interesting to see what Tata does with its new toys. So, if anyone out there wants to keep us updated on this topic, please feel free to send in photos of your bodacious Tatas. Thank you.

Stacks of Tiles

I like some degree of flexibility in my PACS display, but I like it simple. This has been a very difficult concept to convey to Agfa in the process of my occasionally-welcome attempts to help with Impax 6.x development. (I do have to tell you that Impax has been behaving quite a bit better these days, with crashes occuring only very rarely.) I have had a really hard time convincing them that any series should be deployable in any viewport. In other words, if I want to put the same CT series on the screen in 10 places, that should be possible. This idea just hasn't yet penetrated. The only way to do anything like this now is to create a "clone window", which can be set up to display multiple instances of the same series. However, I cannot link a "regular" series to one in the clone window, and there are some glitches in the implementation of window and level adjustments, rendering the clones limited at best.

Why is this important to me? An article that I rediscovered recently from the American Journal of Roentgenology by Drs. Kim and Lee, et. al., gives one possible answer. These radiologists from the Department of Radiology of Seoul National University looked at scans of hepatocellular carcinoma in two different modes. First, they used the old "tile" mode, showing a dozen slices from the scan on screen at once. Frankly, nobody does it this way anymore. Secondly, they used "multisynchronized stack" mode to view the multiphasic dynamic CT. While they didn't include any pictures in the article, I'm assuming the stack display looked something like this:

The key here is that you have multiple phases (with different series) of the same study, synchronized to the same level. A dynamic study of this type means that the patient was scanned as IV contrast was injected, and then at several fixed delay times thereafter. Thus, if the reader does stumble upon a lesion, he/she can see how the contrast material enters and exits the lesion, which yields a better depiction of the contents of the mass. With this display, you have all phases of the study up at the same time, and synchronization allows you to scroll through the study and view the lesion on all of the phases at once. This is much easier than trying to view "tiles" of all the series, and even better than viewing one stacked series at a time.

The flexible display lends itself to other approaches. I like to view abdominal and chest studies in this 4-up configuration with soft-tissue, bone, and lung windows, as well as the scout, all on-screen at once.

I do the same thing with head CT's, adding in a "blood" and a very narrow windowed viewport to aid in detecting subtle CVA's.

I guess the point of all this is that every rad reads just a little bit differently (although no one uses tile-mode much anymore). For my 30 rads, I need something that will adapt to our various ways of doing things. Many, if not most, other systems have the any-series-any-viewport approach these days. Most can actually handle the linked scrolling of the images, although our older installation of Centricity slows down markedly when windows are linked. Agfa still has its own version...send in the clone windows! Maybe we'll see the "any viewport" thing in Impax 7.x?

A New Cellphone Accessory

Now here's a good idea... I should probably patent this, as I came up with it all by myself, but since a search revealed that others have mentioned it (but not actually patented it or manufactured it), I won't bother. I'd just like to see someone actually make this thing.

We've all seen folks wandering around with Bluetooth headsets jammed in their ears, seemingly talking into space. I own one myself, but rarely use it because I can't stand to have something on my ear for more than a few minutes at a time.

But for those so inclined, I have invented (via paste-up, anyway) the Bluetooth headset/camera. Just what everyone needs! Note the camera lens grafted onto the headset's anterior tip. The concept here is that the camera points in the direction of your head (OK, not necessarily your gaze, but...) and lets you photograph or video whatever you are looking at. I think the bandwidth of Bluetooth is sufficient to handle this application, and otherwise it should work like any other cell-phone camera. Yes, it would add bulk to the headset, and drain the battery faster, but that's minor compared to the incredible convenience this will offer.

Do I have any takers?

Promiscous Blogs Contribute To Science!

When you think about it, this blog, and blogging in general, represents something totally revolutionary in the history of information. I can sit here in front of my computer, post some occasionally-good ideas, and publish them to the world. Literally! I have had hits from all over the globe, from Russia, China, Vietnam, Israel, Dubai, and many others. (For some reason, the plurality of overseas hits seem to come from Belgium and Canada.) The power of the individual to reach anyone else in the world has never been so great.

But a blog is not a static, isolated thing. It changes (when the blogger gets around to it), other people leave comments, and perhaps most importantly, other blogs or websites can be linked to mine. This is a property unique to the internet, allowing instant access to the thoughts of others within the body of your own writings.

Allison McCook, writing on the blog portion of the magazine The Scientist, quotes writer Clive Thompson as calling blogging "highly promiscuous" for this reason.

It's a basic concept. Thompson -- a surprisingly dapper (for a writer), well-coiffed, quick-talking presenter -- explained that he constantly feeds his blog, collisiondetection.net, because blogging is "highly promiscuous" -- meaning, you blog and link to another blog, then that person links to you in a future post, and so on. You find out who's linked to you (technorati.com ), check them out, and see other blogs by like-minded people, who might think about something you'd never considered before.

This leads to the concept of "crowdsourcing", "The idea is to use the internet to get large numbers of people to help with a task. They may do it for money — usually not much — or out of interest or simply because it's fun."

So, let's put this into practice. I get something upwards of 200 hits on this site per day. Not a lot, but still an amazing number to me. But only rarely, perhaps three or four times per week, will someone comment back, either by e-mail or through the comment field on the blog itself. So, I ask you to do your part for science. Post comments. Link to my blog. Ask questions. Help my blog become more promiscuous. Bet that got your attention!

SpaceNavigator...a tool for SpaceCadets and maybe PACS?

I can find inspiration anywhere, it seems. This morning I was perusing the Buy.com website, looking for bargains, when I stumbled upon this entry:

Is working in 3D frustrating? Feel like you can't get the model in the right orientation or move the world to the right location? If only you could put your hand straight into the display and directly interact with your 3D design. 3Dconnexion SpaceNavigator lets you come as close to that experience as you can get without actually putting your hand in the display. Push, pull, tilt or twist the SpaceNavigator's controller cap to interact with your 3D world or model with ease. SpaceNavigator PE supports over 100 popular 3D apps including Google Earth, Microsoft Virtual Earth, SolidWorks, Autodesk Inventor and lots more. Work in 3D as it was meant to be. SpaceNavigator PE is meant for non-commercial use and includes web based support.

Well, most of us do find working with 3D frustrating, as a regular ol' mouse is geared for 2D control. There are various kludges that give us the third dimension, but in general, they aren't very intuitive. You may remember my attempts to make a jog-shuttle device, the ShuttlePro2, work with the Amicas/Voxar 3D software. I really couldn't get it going properly. But keep in mind, Darth Vader's Codpiece was designed mainly for flipping video frames. It does work well for MPR viewing, but not so great for volume rendered images. It just doesn't have a control for the third dimension!

The SpaceNavigator does have a Z-axis control, solving this deficiency:

Pressure sensing technology allows the controller cap to become a virtual extension of you. Push, pull, twist or tilt the cap a fraction of inch to simultaneously pan, zoom and rotate 3D imagery. Increase pressure to go fast or decrease pressure to make intricate adjustments. . . The key advantage of a SpaceNavigator over a mouse and keyboard is the ease of performing intricate adjustments to camera views and models with out repeatedly stopping to change directions, zoom, or rotate models. With a SpaceNavigator you can do all three at once.

Click here for a video of the device in operation.

I guess we've gone from Darth Vader's codpiece to an excised BMW iDrive.

The SpaceNavigator is made by 3DConnexion, a division of Logitech. It lists for $59.99, but Buy.com sells it for $39.99. Having spent more than this on the jog-shuttle, I'm a little hesitant to invest more. But this one is pretty tempting...

eRad PACS

Mark Twain once received a telegram from his publisher stating:

NEED TWO-PAGE SHORT STORY TWO DAYS.

Twain responded,

NO CAN DO TWO PAGES TWO DAYS. CAN DO THIRTY PAGES TWO DAYS. NEED THIRTY DAYS TO DO TWO PAGES.

In the same vein, Dorothy Parker, an American poet and writer once said to then-Vice President Calvin Coolidge, "Mr. Coolidge, I've made a bet against a fellow who said it was impossible to get more than two words out of you." His famous reply: "You lose." (Ms. Parker stated upon learning of Coolidge's death many years later, "How can they tell?")

Those of you who have followed my attempts at writing over the years know that I am far from the Calvin Coolidge of blogging; I can yammer on and on for pages, and sometimes not say very much in the process. However, when it comes to PACS, I think Mr. Coolidge would have agreed with my minimalist philosophy, probably best outlined in my old post, Feature Fatigue and Lego PACS. There is such a thing as too many words, too many adjustments, and too many features, even if they are all relevant, useful, and powerful. And to pervert the spirit of Mark Twain somewhat, it is far more difficult to produce something with fewer features than a product with lots of them.

The folks from eRad gave me the keys to a web-demo, and then made the trip down to my average little town in the South from their average little town in the South to do a proper demonstration. In spite of my long lead-up, this is a powerful program with a bright future. However, you can guess where we're going with this in the end.

eRad's mission statement unifies one's view of their approach:

The Mission of eRad® is to unify diagnostic imaging processes and operations by:

• Applying unique technology which will present patient images, diagnostic reports and medical records to Physicians, Technologists and Clinicians from a single unified data base.
• Delivering images and information both error free and with high availability across a unified infrastructure.
• Enhancing patient care and reducing costs through improved immediate and long-term access to unified imaging information.
• Improving productivity through unified workflow.
• Delivering high value, scalable, cost effective unified diagnostic imaging solutions.

We invite you to look carefully at our product, its features and functions. This web site presents much of what a prospective user or institution may need to understand our solutions. In addition to a detailed description of the eRAD PACS® product line, you will find descriptions of the hardware components we use, demonstrations of our product, profiles of our staff and much, much more.

We recognize that a web site is no substitute for an informed account executive or service representative and invite you to contact us at any time by telephone or e-mail to open a dialog with eRAD. We are eager to assist you and look forward to the opportunity to do so.

Actually, these are lofty, admirable, and ultimately achievable goals. This is certainly in stark contrast to some companies out there with a mission statement of "Sure it works, sort of..."

One thing eRad can unify is an enterprise, or even a collection of disparate PACS systems. Uniting a (mostly) homogeneous enterprise shouldn't be that hard, but it certainly can be. eRad's approach. . .

is similar to most, with a server at each site feeding into the central server. Others call the peripheral computers spoke servers, and the effect is the same. At least they don't call for a separate computer for each scanner, like some systems are wont to do.

Trying to tie several different PACS together is a larger pain in the neck (or lower), but eRad has a better plan for this than most:

This is the sort of thing the VA has done with ScImage. Basically, it involves grafting their system over "legacy PACS" such as GE, Siemens, Sectra, and Agfa. This would really come in handy in an environment such as ours where our nighttime readers have to contend with two worklists from our Agfa system (even though it's one PACS, the two hospital worklists resident cannot be, well, united), one unified list from the Amicas dual hospital system, and others coming in on the group-owned Amicas. One single worklist would be a lifesaver. Of course, we would then have to come up with a way for the dictations to be routed to their proper site and so on. I'm not sure that one has been solved as yet. Still, the fact that eRad recognizes the need for such an umbrella is certainly important.

For me as a radiologist, the business-end of a PACS is its user interface. The web-demo as well as the live session gave me a good glimpse into eRad's GUI. I'm not going to do the features justice, but I'll try to give you a feel of what we have. Keep in mind that there are a lot of nice features. A LOT of them. Here is a screen-capture of their worklist:

and here is a snapshot of their viewer:

Clicking on the pictures above will expand them, and this is necessary to see what I'm going to talk about.

The worklist is customizable, and sortable on any column head. There is an indicator as to whether a study is locked, and there are various controls for batch reading, demographic editing, and for creating custom filters. ANY part of the DICOM header can be made a part of the worklist and subsequently a filter or search:

If one paid for PACS by the number of GUI features, eRad would be very expensive indeed. Here are just the extra modules that can be added when you first download the program:

These add some significant higher-level visualization to the package. Look at the viewer itself. The first thing that strikes me is the sheer number of buttons. The layout can be changed, by dragging the bars as you might with Microsoft Word. There are separate buttons for the major permutations of image and series layout. Most everyone else does this with popup menus and only one or two buttons. Many of the remaining functions have separate buttons as well. Notice that the buttons take up a lot of real estate that might otherwise go to the image viewports themselves.

There are good implementations of triangulation, linking, etc., and the ever-important mark-as-read-go-to-the-next-study button. When you click said button, there are various options as to how to leave the study status, or this can be determined from preset instruction. Window and level can be set from presets, slider controls, or the usual up/down/left/right drag. The series tray has a little indicator that tells if you have viewed all images. You don't want to miss the lesion on the last slice, now do you? There are separate buttons to reset image info, window/level, zoom, etc. There is a very nice report view that allows importing of key images. There is a pretty good spine-labelling module.

When going through the demo, I hinted at my discomfort with the multiple buttons and controls. My friends from eRad reassured me that there is a default configuration supplied out of the box that will get most rads up and running. But if you want to get in and change things, there is a way to do that. Oh, boy, is there a way to do that... Here are just a few of the 14 tabbed control panels for customization:

Oh, and the right-click menu brings up something like this:

This is where I have to say, "Whoa!" There is really a tremendous amount of power here, and in some respects, there is too much power. I have called this approach to a GUI the "Lego PACS", because of the high level of customization. As I've said before, this is to some degree a term of endearment, as Lego was my absolute favorite toy as a child, and it is still hard to resist when I go past a toy store or especially the Lego Store at the Mall of America. But I still prefer a simple, clean streamlined interface. Yes, the eRad default might give me that, but then there is the temptation that is hard to resist to go in and "tweak". OK, that's personal problem, and not eRad's fault, but still. . .

This is a program with great potential, one to watch closely. I think personally that the GUI needs a little smoothing and seasoning, but it is certainly usable. eRad has addressed a number of issues that are close to my heart, and some that the "big boys" haven't even solved as yet. I will expect to see great things from them in the future. In the meantime, if you ask me to say three words about eRad, I would say, "Pretty good."

Microsoft Enters PACS Game

Microsoft has been dabbling in the Healthcare IT space, and the fruits of their labor (and acquisitions) will debut at HIMSS later this month. The press release notes" The package is called Amalga, which to me is all too close to the word "amalgam," the mercury-containing metal that used to be used in dental fillings.

Microsoft Amalga: The new version of the product formerly known as Azyxxi, Amalga is part of a new software category called Unified Intelligence Systems that allows hospital enterprises to unlock the power of all their data sitting in isolated clinical, financial and administrative systems. Without replacing current systems, it offers an innovative way to capture, consolidate, store, access and quickly present data in meaningful ways for use by clinicians and executives of leading-edge institutions. Amalga is designed for hospitals and health systems that have invested in a diverse set of IT solutions.

Microsoft Amalga Hospital Information System (HIS): The new version of the product previously named Hospital 2000, Amalga HIS is a state-of-the-art, fully integrated hospital information system designed for developing and emerging markets. Amalga HIS is built around an electronic medical record (EMR) with complete patient and bed management, laboratory, pharmacy, radiology information system and picture archiving and communication system (RIS/PACS), pathology, financial accounting, materials management, and human resource systems.

Microsoft Amalga RIS/PACS: The new version of the product formerly known as GCS Amalga is now available as a stand-alone system as well as an integrated component of Amalga HIS. The integrated architecture means that a radiologist can use a single application to manipulate and study images and access the patient medical record. The workstation interface is optimized for radiologist workflow, including support for predefined templates, an intuitive report editor and voice recognition capabilities.

Of course, I'm more interested in the PACS product. The Microsoft Amalga website emphasizes the interconnectivity of the Amalga software:

Most companies don’t integrate their PACS and RIS software, translating into a forced fit between the systems. This often imposes the manual matching of studies between the PACS and RIS.

The Integration of Microsoft Amalga RIS/PACS provides a powerful, truly seamless system that can deliver quick, high-quality data to any department, which, in turn, can help hospitals increase patient turnaround time and enhance the patient experience. Integration also improves data integrity between PACS and RIS, can reduce transcription errors and duplication of data entry, and optimizes report turnaround. The system fully supports paperless, integrated workflows and facilitates easy access to patient medical information and order, scheduling, and study information.

The radiologist workstation is designed to optimize radiologist workflow. This unified system provides access not only to standard image manipulation tools, but also to the patient Electronic Medical Record (EMR), without requiring the radiologist to log on to external systems. Available information includes all previous laboratory and radiology results, the patient’s medication profile, and clinical notes. In addition, all historical studies are stored online rather than archived, which means historical films can be reviewed anytime, as needed, helping providers to improve their patient care.

The "key benefits" are mostly what you would expect:

• Automatic order management integrated from EMR and RIS.
• Automatic scanning and attachment of hard copies to study orders.
• Image manipulation tools include 3-D cursor location.
  Multiple language support provides patient demographic and screen label data in any Unicode language.
• Integrated database ensures patient medical information is accessible directly from the PACS.
• Template-driven options include reporting and voice recognition.
• Intuitive Report Editor accepts written or dictated reporting.
• Preference for radiologist worklist studies are customizable.
• Instant Study assignment to radiologist at time of ordering.
• Warning system provides real-time notifications to prevent radiologists from reporting a study that is being reported by another radiologist.
• Online Historical studies make historical studies available for quick retrieval, regardless of study age.
• Unlimited Study revisions save any or all key images, window-level settings, and image annotations.
• CD creation for PACS studies, Reports, and Electronic Medical Record. Options include DICOM and JPEG images, reports, and all or selected portions of a patient's EMR.

Frankly, this doesn't sound that much different than most modern web-based systems, at least those with online priors.

Microsoft, like some other big companies that come to mind, sometimes innovates and creates its own product, but often will simply buy the expertise and the software lock, stock and barrel. Such is the case here. Amalga started life as Azyxxi, which according to the Wikipedia, was "is a unified health enterprise platform designed to retrieve and display patient information from many sources, including scanned documents, electrocardiograms, X-rays, MRI scans and other medical imaging procedures, lab results, dictated reports of surgery, as well as patient demographics and contact information. It was developed by doctors and researchers at the Washington Hospital Center emergency department in 1996, and in 2006 it was acquired by the Microsoft Health Solutions Group, as part of a plan to enter the fast-growing market for health care information technology." Washington Hospital is part of the MedStar Health system.

As for the RIS/PACS module, this has been borrowed/purchased/liberated (and expanded) from

GC RRITS SDN BHD (GCR), is a Malaysian Company, which provide integrated information technology solutions to the healthcare industry. The business is built around its core product, Hospital 2000, was developed and will continue to develop locally, based upon a proven international standards.

The RIS/PACS module of Hospital 2000 is called....drum roll, please..... Amalga! Here is a link to the full brochure, and here are some screenshots:

Interesting look. No doubt Microsoft will add its own touch to the interface. But how well does it work? How will it be marketed? I guess we'll have to wait and see. Anyone want to send in a report from HIMSS?

Addendum:

Based on Aunt Minnie discussions, the RIS/PACS and other parts of the program may have been written by Global Care Solutions from Bangkok in cooperation with Bumrungrad Hospital. GCR may therefore be GCS's Malaysian reseller. However, in the statement above, which is no longer on the GCR website, they refer to local development, and local for a Malaysian company probably means Malaysia rather than Thailand.

The GCS website (http://www.hospital2000.com) now resolves to the Microsoft Amalga website.

In the end, it probably doesn't matter to anyone. Microsoft needed software in this space and found a reasonably good, and presumably reasonably priced product. Let's hope they learn the lesson from GE and avoid running it into the ground.

Letters Of Warning

The fellow that wants to sell us a Hawkeye so bad he can taste it sent out a press release the other day to just about everyone in my state that has anything to do with Nuclear Medicine. Except for me, of course. I've since seen the same release at a dozen other sites, including AuntMinnie, and it's probably common knowledge by now. No doubt its viral spread has been assisted just a little bit, so I'm not reporting anything new here. Within the press release is a link to the FDA that shows a copy of a letter to Siemens noting a software problem with PET/CT's installed prior to July, 2006. I won't quote the whole thing, but in essence there have been 4 complaints about the computer pulling the wrong PET to go with the wrong CT. Siemens fixed the problem, but didn't do proper risk analysis and according to the letter didn't actually issue a software patch. The letter goes on to say that Siemens has significant problems with their complaint process, and so on. The letter used the term "adulterated" which means that Siemens isn't completely conforming with with the "Current Good Manufacturing Practice (CGMP) requirements of the Quality System (QS) regulation found at Title 21, Code of Federal Regulations, Part 820 (21 CFR 820)." That means that they haven't addressed completely the concerns in the remainder of the letter.

Now, I won't tell you that this isn't serious, but we do have a Siemens PET/CT that was installed January, 2005, and we have not had the problem described. Frankly, it would be very obvious if the wrong PET image was trying to mate with the CT (get your minds out of the gutter!) as the activity in the various hypermetabolic organs would not match. We just haven't had this happen. (I found a reference to a SPECT/CT with a similar problem.)

The press release noted a second letter to Siemens within the past month (actually it was more accurately the prior two months) concerning their use of some marketing hype about the vascular software on some of the Siemens/Accuson ultrasound scanners, the Arterial Health Package, or AHP. It sees that Siemens didn't bother to obtrain marketing approval or clearance for the AHP, just the scanners themselves. So, selling the scanner with the AHP is illegal, and the scanners are "misbranded" and "adulterated".

And Siemens is working on fixing these problems ASAP. According to AuntMinnie:

A Siemens spokesperson said the company is working to comply with the requests in the letter.

"Siemens formally responded to the FDA to inform them of corrective actions to address the issues," said Tom Schaffner, Siemens Medical Solutions manager of media relations, in an e-mail to AuntMinnie.com. "Most of these actions have already occurred, and some necessary software updates are currently being tested that will be applied as soon as possible. With its warning letter, the FDA is now requesting detailed documentation of these corrective actions."

It is said that those who live in glass houses shouldn't throw stones, and that maxim is true here as well. It seems that my favorite larGE company has had some wrist-slaps as well. And in fact, they too received two letters, although these were just under nine months apart, much less embarassing than receiving them six weeks apart. I wonder why our caring salesperson has never sent us press releases about these particular letters of warning.

The letter from November 16, 2007, concerned a malfunction with an R&F room. Specifically, "(d)uring testing in both rooms on September 27, 2007, x-ray production was possible when the primary protective barrier was not in position to intercept the x-ray beam as required by 21 CFR 1020.32(a)." I could find no response as yet. At least the machine wasn't adulterated. The second letter of warning is from February 22, 2007, and had to do with a problem with MRI coils and breast biopsy plates. It seems that some of these were indeed "adulterated" in that they did not conform to the Current Good Manufacturing Practice, etc., etc. The biopsy plate sterilization process wasn't validated, although there was an adequate response to the FDA on this. There were coils shipped without verification and validation. There was identification of "soldering problems" as part of manufacturing errors, but inadequate documentation of how this was to be corrected. There was also an inadequate complaint mechanism.

No doubt these problems are fixed or being fixed as well.

Personally, I'm going to monitor the FDA website more closely. Press releases and word of mouth from the sales staff might not be adequate to inform us of the foibles of our vendors. But I'm sure glad that some are ready willing and able to keep us informed. . . about their competition, anyway.

Dalai Wins The American Spirit Award!

I received this fax today, and I got all excited. On the cover sheet, it was noted that "this fax and the attached documents are official documents of the Republican Party, and are confidential, and are intended solely for the individual named above." Which would be me!

The attached document said:

Dear Dalai:

I've just received word that based on your support of the Republican Party, you have been selected by the National Republican Senatorial Committee to receive the American Spirit Award. The American Spirit Award is a high honor -- the highest, in fact, that the NRSC can bestow upon an individual. This high honor has been endowed upon our nation's and our world's greatest defenders of liberty, economic freedom and military strength, including President Ronald Reagan and General Norman Schwarzkopf. I am thrilled that you have been selected and it is my sincerest hope that you will accept this honor....

Sincerely,

Senator John Ensign (Dalai's Note: (R) Nevada)

Chairman

National Republican Senatorial Committee

Now, that's what I'm talking about! I've finally been recognized for my selfless fight against certain large corporations, and blog-boredom. And I've voted Republican all my life.

But wait. There's a problem. Some quick Googling reveals something disturbing. Dozens of other folks reported receiving the same fax over the past several weeks and months. When they call in to claim their "award" they receive a high-pressure sales pitch to join up with NRSC at ever higher levels, for thousands of dollars, although for many, the price went down when they demurred. Sadly, this is nothing but a scam, designed to separate the mark from his money.

I don't know if Senator Ensign realizes that his name is being used in this manner, and I call upon the Senator to stop this low-class fund-raising tactic immediately. Who does he think he is, Hillary? I've actually e-mailed him with this request, but have yet to hear back.

Obviously, I'm not the only one to have this honor "endowed" upon him. There were several citations of the "award" being given to Democrats who never have voted Republican in their lives. The saddest story of all comes from Glasgow, Kentucky, where a poor fellow named David Thomas actually believed the hype, and so did his local paper, the Glasgow Daily Times:

Local wins mystery honor

Thomas still uncertain what American Spirit Award is

By BRAD DICKERSON Glasgow Daily Times

David Thomas was notified via fax that he was to receive a major award, yet it took some convincing before he accepted it as the truth.

The owner of Glasgow’s D&D Construction and Concrete received the correspondence last week from the office of Nevada Sen. John Ensign, chairman of the National Republican Senatorial Committee (NRSC), saying he was selected to receive the 2007 American Spirit Award.

Others who have been recognized with this honor were President Ronald Reagan, Prime Minister Margaret Thatcher and General Norman Schwarzkopf, the faxed notification stated.

“To be honest, I looked at one of my men and I said, ‘Somebody at work is really yanking my chain,’” Thomas said about his initial reaction. “We really didn’t know what it was. What we began to do is we began to call and we began to try to figure out what it was that we got.”

Thomas said he placed phone calls to representatives in both Frankfort and Washington D.C., to determine if the award was legitimate, which, he acknowledged, was.

“I was leery that it was probably someone just wanting money,” Thomas said. “I pretty much made them convince me of who they were. We ended up getting a number to the White House and we ended up figuring out that we had been given an award.”

Attempts to contact officials were unreturned, although operators answering calls referred to the office as that of the NRSC. Thomas believes someone wrote a letter and nominated him for the award, although he is unsure who it could have been or if he’ll ever know.

“What did I do to get this award?” he said.

After receiving confirmation that he was being recognized, Thomas tried to find out just what he would receive. That question, he said, is still a mystery.

“What the award is for, I don’t know right now,” he said. “I won’t know until I get there. They just needed to know if I would accept it.”

Thomas said that what he does know is he will be meeting President George Bush in March to get the honor. He added that he will also be sitting on a business advisory council.

Send me a postcard from the meeting, David. I think I'll have to pass.

As a reasonably staunch Republican, I am disheartened by this whole thing. My Democratic friends will laugh, but I think they have a few bad actors in their camp, too.

The Latest Contender For The Ultimate PACS Pointing Device

Meet the unpretentious-looking ZCam from 3DV Systems. What's new about this little camera?

3DV Systems has developed a unique video imaging technology and camera for sensing distance in real-time between an imaging sensor and the objects in its field of view (i.e. the objects' depth), at high speed and high resolution. The technology, which is based on the Time-of-Flight principle, is described thoroughly in several publications by the company's founders and engineers, and is well protected by international patents.

Follow the links to the presentations if you wish. The important thing is that this technology yields the same effect as waving around the Wii controller, but without the controller. Here is a video clip from 3DV Systems that illustrates this point:

I normally do a lot of hand-waving while reading my studies, but with this technology, that could actually be productive. I'm looking forward to playing with this as soon as I can get hold of one!

You Can't Get Lower Than Sub-Zero

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

When we moved into our present home several years ago, the kitchen was furnished with a relatively small GE side-by-side refrigerator/freezer. That unit had been installed five years before we bought the house, and continues to run to this day, well over a decade later, having never required service. (It is now the beer-repository for a friend of mine, certainly a happy retirement for a refrigerator.) Never let it be said that I don't give credit where it is due, even to GE.

My wife was enamoured with the Sub-Zero bottom freezer model from the day she saw one at a another friend's house. "It can hold casseroles and pizza boxes!" she exclaimed, and indeed, she was right. The more ubiquitous side-by-side machines chop up their shelving to a considerable extent, and definately cannot swallow entire casserole dishes and pizza boxes. So, off we went to the high-end appliance store in search of the Holy Grail of fridges. We were assured by the honest-appearing salesman that this was a very reliable machine, favored by builders of mansions and castles, and we should be ashamed if we went with anything less (like GE). So, believing the spiel and having great desire to please my wife and to refrigerate pizzas, I went for the Sub-Zero, spending easily FIVE times what a good GE or Whirlpool might cost. But we want the best, right?

Had I been a little more circumspect, I would have checked with Consumer Reports, which rates the reliability of these things as follows:

Guess who's on the bottom! Weighing in at problems with 24% of units sold is.....Sub-Zero!

To be fair, we had few problems with the unit while it was under warranty. But then the trouble started. We have since had 4 or 5 repairs on the darn thing, the latest was today, by the way, with new compressors, rewelding of tubing, and some other amusing stuff. And while the parts were covered by Sub-Zero, the labor was not, and I'm out the cost of, well, the GE I should have bought in the first place.

What does Sub-Zero say about this? From the ConsumerMan of MSNBC.com comes this:

It’s natural for anyone who gets a sub-par rating to challenge the validity of the survey. So I was not surprised when Paul Leuthe, corporate marketing manager for Sub-Zero, told me, “The numbers are not accurate.” Sub-Zero is the only built-in refrigerator on the survey. “So it has a lot more potential for problems than a free-standing refrigerator that is just plugged in,” Leuthe says. “Someone who buys a $5,000 to $8,000 refrigerator is less tolerant than other customers,” he adds.

But Leuthe admits there could be another reason why this top-of-the-line brand rated at the bottom of the reliability survey. He says about four years ago they got a bad batch of copper tubing. It was used in the evaporators for models made from 2003 to 2006. That tubing is now rusting and causing leaks. “These evaporator problems could be skewing the ratings,” Leuthe says. He points out with some pride that Sub-Zero is making free repairs with no questions asked.

Yup. Someone who pays top dollar for a refigerator is less tolerant. You bet your freon I am less tolerant of an expensive fridge that stops cooling all of the sudden six months after the last repair. And free repairs? Try free parts (maybe), but no free labor, and here, the parts include 6 inches of solder. No more Sub-Zero's for me, thanks.

Naturally, I have to relate all this to PACS; this is a PACS blog, you know. Perhaps the greatest lesson to be learned here is to avoid the purchase of the wrong product simply because it has one particular feature you like. Had we not had to store pizza boxes, I would have saved thousands, and avoided much heartache. Similarly with PACS, diving into the wrong product simply to acquire one particular feature is asking for trouble. We had that experience with a certain small company that I've promised not to trash anymore, and I'll keep my word on that. More or less. Secondly, be very sure about the product, and don't fall for the hype. I thought a fridge from the World's Best Refrigeration Company would be trouble-free. I should have read the reviews and talked with more than one happy customer. Finally, don't let said company off the hook when the product doesn't work as it should, and don't be intimidated when they suggest you are being picky or whiney. YOU are the customer, and you may feel free to vote with your wallet.

How's that for a frigid response?

Rolling With The (CCTA) Punch

Image credit: http://www.heartandmetabolism.org

NightHawk Radiology is the premier remote reading operation in the US. Based in Coeur D'Alene, Idaho, it started life as a night hawk call service(surprise) and has morphed (or metastasized, depending upon your point of view) into something more (from a CNN.com report):

(NightHawk) is leading the transformation of the practice of radiology by providing high-quality, cost-effective services to radiology groups and hospitals throughout the United States. NightHawk provides the most complete suite of solutions, including professional services, business services, and its advanced, proprietary clinical workflow technology, all designed to increase efficiencies and improve the quality of patient care and the lives of physicians who provide it. NightHawk's team of U.S. board-certified, state-licensed, and hospital-privileged physicians located in the United States, Australia, and Switzerland, provides services 24 hours a day, seven days a week, for more than 750 radiology group customers and the 26% of all U.S. hospitals they serve.

Rather impressive. So impressive, in fact, that it was selected to read exclusively for the High-Risk Plaque Initiative. NightHawk will read "Chest CT's" for approximately 6,000 participants. No doubt some of these subjects will get more than one CT over the course of the study. Why NightHawk?

"NightHawk was chosen because it was the single teleradiology provider with the strategic experience managing the complex technical aspects and reporting requirements of CCTA reconstructions," said Cherrill Farnsworth, President and Chief Executive Officer of HealthHelp, a radiology benefit management company that is coordinating the teleradiology aspect of the HRP Initiative. "NightHawk's resources, flexibility, and expertise place them at the forefront of CCTA and the 3D reconstruction. They are the only global provider with a viable solution that is available today."

Now why, do you suppose, am I reporting this with my tongue approaching my cheek? Perhaps you have heard about CMS/Medicare's proposal to

. . .eliminate all Medicare reimbursement for coronary CTA save for two indications, further stipulating that coronary CTA must be performed within the confines of a controlled clinical trial to be reimbursed.

The wisdom (or lack thereof) of this limitation has been debated ad nauseum, and I smell an attempt by CMS to thwart cardiologists from buying and (ab)using CT scanners. Of course, they won't state this for the record, but you can bet someone in Baltimore thought of it.

I certainly applaud NightHawk's interest in validating CCTA in this setting. The data needs to be produced and in the end it might be better for a relatively homogeneous group to do the reading. But you just have to admire them for getting paid to read those 6,000 plus scans, when those who have been in the trenches doing CCTA on a clinical basis for quite a while, such as Dr. David Dowe of Atlantic Medical Imaging, might get bupkis. I guess that's the way the plaque crumbles, eh?

Mold and Morality

We had some work done recently on our house, and in the process, our electrician noticed some mold in our crawlspace. He seemed concerned, and it made me worry, since I figured he had seen lots of nastiness crawling about under peoples' houses. Thus started a rather depressing odyssey into mold mitigation services. My wife called a number of such services, and the standard line went something like this: "You have a mold infestation/contamination problem, it's really bad, you don't need testing, and we can fix it for $10,000." We were almost ready to proceed, but something told me to keep asking questions. We finally stumbled upon an honest fellow, whose main business is restoration, but not mold mitigation. He noted that just about every home in our hot, humid region has mold, that it is rarely toxic, and even more rarely does it penetrate into the house. He showed us this video from KNBC TV in Los Angeles, which really tells the story of many of the mold mitigators. To summarize, many of them are frauds, spotting "mold" when none is there, and extracting thousands from those less wary than we were.

Sadly, this sort of behaviour is becomming more and more common, and trusting someone you don't know well is harder than it ever was. Another example: we had to repaint a small hallway in our garage due to water damage from a burst pipe, and went to the painters that we had used for the past 15 years. They quoted a price three times higher than they had charged us for the same job one year previouly. They backtracked after we hired someone else, but once burned, you know...

The Internet has made it ever so much easier to rob the unsuspecting. Everyone gets spam, and within are contained spoof emails that try to separate the innocent from their money. Every time I bid on something with eBay, for example, I get about five spoof email offers trying to sell me the same item from the same auction. Some of these are so poorly written as to be laughable, but some are very good mock-ups of an official eBay offer. Many of these originate from the newly-democratic Russia, where Internet crime has become rampant. I haven't fallen for one of these yet, but I know of many smart people who have succumbed.

It seems very few are immune from being victims, and frankly, some of the perpetrators are those one would expect to behave differently. Large companies aggressively push products they know are inferior to those of their competitors, rather than trying to improve them. Professionals generate unnecessary business to pad their pockets. (If you think I'm being a little oblique on these examples, you're right.)

I'm speaking here only of the manifestations of greed, but the moral decline certainly goes further than that. Politicians pander to whatever group they are speaking to at the moment, then speak ill of that same group when addressing some other demographic. Our schools are degenerating by the moment. Academics become less and less important, while worship of athletics reaches levels not seen since the days of ancient Greece and Rome. The athletes that our children idolize are rarely worthy of this adoration, and many are about the worst possible role-model for our youth. Bullying in school as well as elsewhere in life is tolerated and even encouraged, as long as the perpetrator is careful not to get caught. Hollywood stars proudly breed without benefit of marriage, or even much of a commitment. Their substance-induced antics and personal crashes are fodder for the evening news.

I guess there isn't anything new under the sun. A certain predatory or immoral sector of the population has always existed, and targeted the rest of us to some degree. The Internet of course makes this easier for those so inclined, but I cannot help but think that things are worse today than they have ever been, at least in my nearly half-century lifetime (I just turned 49). There hasn't been an abrupt slide over the precipice, but rather there has been a very slow degredation of our moral fibre. There is no global explanation for this decline, but if I had to cite specific causes, I would go with the loss of religious orientation, and the loss of parenting.

Religion, if taught properly, gives a moral grounding, a sense of worth as well as a sense of duty, and a code of decency. Yes, religion is often perverted and twisted to coax the masses into doing horrible things, but I submit that this is not true religious training at all. It is hard to tell the difference sometimes. We all should know right from wrong, but if a respected religious (or political) leader says it is alright to do thus-and-so in the name of faith, that can be taken as absolving one from guilt. It takes tremendous courage to rise above this sort of thing, something that true faith will help bring about. Notice that I do not specify which faith to follow. I have a rather naive instinct that all faiths at their core are moral. I could be wrong...

The other factor is the distressing and disgusting lack of parenting we see in the 21st Century, and by this I mean mainly the complete loss of discipline. When I was a kid, there was no talking back to parents, teachers, or other authority figures. The attitude of "my child can do no wrong" simply didn't exist. There were limits to behaviour, and they were enforced. There were consequences to actions. Parents didn't buy alcohol or condoms or birth control pills for underage teenagers to ensure their popularity. They didn't automatically assume that a boy who could throw a football reasonably well was on his way to the Heismann Trophy. Lawyers didn't line up to sue schools that "infringed" on the rights of out-of-control youth. In essence, parents were not their children's best friends, and they weren't afraid of losing the love of their little darlings as they are today. When kids know no limits, and they are told they can do no wrong, it is not a far leap for them to take advantage of others, is it? What is really frightening to me is that the first generation of kids raised under these conditions has come of age and now have children of their own. The legacy is not very pretty.

What is there to do about all this? I don't know about the big picture, but on a smaller level, my wife and I have tried to instill faith and discipline into our children. It's a start. I know like-minded people are already doing the same with their children, but it is the folks that don't see any of this as a problem who are the problem. I haven't a clue as to where to go with them.

Oh well, forgive my rantings. Maybe the mold is getting to me.