Friday, July 25, 2008

Dineen New President of GE Healthcare
. . .becoming Hogan's Hero


John Dineen has been named president and CEO of GE Healthcare, replacing Joseph Hogan.

Dineen, 45, has served as president and CEO of GE Transportation since 2005. He will work from GE Healthcare's headquarters in Chalfont St. Giles, U.K.
Prior to GE Transportation, Dineen served as vice president and general manager of Plastics at GE Advanced Materials and held various assignments in corporate finance.

He also served as general manager of GE Power Equipment; general manager of the company's Meter business; general manager of the Microwave and Air-conditioning businesses; manager of finance for GE Asia in Hong Kong; and president of GE Plastics-Pacific during his 22 years with parent company General Electric of Stamford, CT.

Hogan, who joined GE in 1986, is leaving to become CEO of the ABB Group, a Zurich, Switzerland-based provider of power and automation products, systems, and services. ABB's U.S. headquarters is in Norwalk, CT.

Here's wishing Mr. Dineen and Mr. Hogan the best of luck in their new positions.

Saturday, July 19, 2008

Mystical Brain
. . . Virtual Theater from

The Wall Street Journal's Walt Mossberg is great at finding new technological toys and tricks. He recently discovered, which allows all of us with websites, or some semblance thereof, to participate in movie distribution:

Thousands of feature-length documentary films are produced every year, but almost nobody gets a chance to see them. A few dozen are shown to small audiences at major film festivals, and a handful make it into theaters. For every blockbuster like "An Inconvenient Truth," there are hundreds of documentaries that never find an audience.

Starting Thursday, however, there will be a new online service that aims to change all that. The service, called SnagFilms, allows anyone with a blog, a Web site, or even a page on a social-networking site, to open a virtual movie theater and show these documentaries, free. The virtual theater is a small widget that contains the film, and that can be embedded easily and quickly in a wide variety of popular social-networking services and blog platforms. No technical knowledge is needed.

For my contribution, I chose the feature "Mystical Brain", a Canadian documentary that asks:

Is it possible to shed light on the states of grace experienced by mystics and meditators? In MYSTICAL BRAIN, the documentary filmmaker Isabelle Raynauld shows us the most recent discoveries of scientific research on this phenomenon.

I was actually attracted by the PET and MRI images contained within.

Get out your popcorn and enjoy!

Wednesday, July 16, 2008

"i" Is For "iSite"
. . . and not IMPAX

It looks like Philips isn't interested in Agfa after all. From's Simon Nias:

Agfa-Gevaert chief financial officer Kris Hoornaert has been forced to deny rumours that the company has received an offer from Dutch electronics company Philips.

Hoornaert spoke out yesterday after Agfa's share price leapt 39% to €5.65 (£4.50), following rumours that Philips might make a €9 per share offer for the Belgian company.

"Agfa-Gevaert does not know of any acquisition proposal. We are very shocked. We have not received anything in the form of a communication or piece of news," said Hoornaert.

Shares fell somewhat following Hoornaert's statement, but still closed up 24.5% at €5.06.

The news follows Agfa's appointment, in April, of German-based investment bank Lazard to conduct a strategic review of its operations, after a planned demerger of the company's three division – Graphics, Healthcare and Materials – fell through.

Agfa blamed the demerger's indefinite postponement on disappointing results, which also spurred a massive drop in its share price over the past 12 months – down 77% from a high of €19.10 to a low of €4.38.

Oh, well. Another suitor bites the dust. Romeo, oh Romeo, wherefore art thou, Romeo?

Saturday, July 12, 2008

A Nation Of Thieves?

The "Nigerian Scam" has been around for a long time, having graduated from paper-based snail-mail messages to the more modern e-mail spam version. It seems that my main e-mail address has been discovered by some of these vermin, and I'm getting a dozen such spams per day.
So what is this "Nigerian Scam" anyway? From comes an example and further explanation:

The scam starts with a bulk mailing or bulk faxing of a bunch of identical letters to businessmen, professionals, and other persons who tend to be of greater-than-average wealth. A typical letter might look like this:

FROM: Mr. Ben Ahore

Central Bank of Nigeria

Lagos, Nigeria[Phone Number]

TO: Dupe Address

Dear Sir:

I have been requested by the Nigerian National Petroleum Company to contact you for assistance in resolving a matter. The Nigerian National Petroleum Company has recently concluded a large number of contracts for oil exploration in the sub-Sahara region. The contracts have immediately produced moneys equalling US$40,000,000. The Nigerian National Petroleum Company is desirous of oil exploration in other parts of the world, however, because of certain regulations of the Nigerian Government, it is unable to move these funds to another region.
You assistance is requested as a non-Nigerian citizen to assist the Nigerian National Petroleum Company, and also the Central Bank of Nigeria, in moving these funds out of Nigeria. If the funds can be transferred to your name, in your United States account, then you can forward the funds as directed by the Nigerian National Petroleum Company. In exchange for your accomodating services, the Nigerian National Petroleum Company would agree to allow you to retain 10%, or US$4 million of this amount.
However, to be a legitimate transferee of these moneys according to Nigerian law, you must presently be a depositor of at least US$100,000 in a Nigerian bank which is regulated by the Central Bank of Nigeria.
If it will be possible for you to assist us, we would be most grateful. We suggest that you meet with us in person in Lagos, and that during your visit I introduce you to the representatives of the Nigerian National Petroleum Company, as well as with certain officials of the Central Bank of Nigeria.
Please call me at your earliest convenience at [Phone Number]. Time is of the essence in this matter; very quickly the Nigerian Government will realize that the Central Bank is maintaining this amount on deposit, and attempt to levy certain depository taxes on it.

Yours truly, etc.

Ben Ahore

At its essence, this is a scam for those who think they are too smart for scams. The strategy is to lure one into thinking that they are actually scamming the Nigerian government, when it may be just the opposite that is occuring. Those foolish enough to follow the instructions and send money will at best lose their "investment". Should they actually be so bloody stupid as to go to Nigeria (or whatever God-forsaken place they are lured to), they may lose their life as well.
These scams are often called the 4-1-9 scam, named after the Nigerian Penal code section 4-1-9 which talks about fraudulent stuff like this. This is quite funny, really, as it seems that the 4-1-9 scam is the third (or maybe the fifth, depending upon your source) largest industry in Nigeria! notes:
There have been numerous reports of high-level officials of the Nigerian government and the Central Bank of Nigeria personally participating in this scam, even to the extent of giving dupes tours through government buildings and showing them piles of cash in the vault of the Central Bank!

You have to wonder why Nigeria of all places has become the home for this garbage. says:
The Nigerian government says the country is a hotbed for scammers because of mass unemployment among an educated population and large extended families for whom people have to provide for, according to an advisory issued by the Secret Service.
That could apply to any third-world country. But that doesn't for one minute justify criminal behaviour such as this. Robin Hood mentality, anyone? How about the government helping people get jobs instead of helping them scam foreigners? Somehow, this has become part of the underground culture in Nigeria, and apparently it is well-integrated into the upper eschelons as well.

For what it's worth, other scammers have adopted this approach to separating you from your money, and they operate out of a number of nations.

On a personal level, about all you or I can do is to report the spam/scam to the proper authorities (forward the email with full header to I also use to report the email back to the originating ISP. Not that this will do much good if it actually comes from Nigeria, but every hole we can plug is a start.

I'm not sure there is much our government can do here. I suppose it would be possible to cut off all internet traffic to Nigeria, but in the end that would probably hurt more innocent people than criminals. Sanctioning and fining Nigerian ISP's probably wouldn't work either. I'm not sure how much aid the US sends to Nigeria, and maybe the threat of its withdrawl would get someone's attention, but again this would likely hurt those who have no involvement.

So, I guess the only solution is to report and delete. Again, and again, and again.

Wednesday, July 09, 2008

. . . iSite Users Beware!

An eagle-eyed anonomyous commenter spotted THIS article from Forbes, and assumed I would be interested.

It seems that Philips NV has joined the pool of Agfa suitors, according to "independent market sources." From the Forbes article:

Dutch electronics company Philips NV may launch a bid for Belgian peer Agfa-Gevaert NV, independent market sources said.

'Agfa's (share price is) higher because we heard Philips might launch a bid,' one trader told Thomson Financial News.

Another said he had heard the bid would be priced at 9 euros per share, well above Agfa's current price of 5.23 euros.

Agfa and Philips were not immediately available for comment.

Apparently, this is not yet substantiated, but it seems to be making the rounds in Europe:

Analyst Bart Jooris at Fortis (other-otc: FORSY.PK - news - people ) said he had heard the report, saying that while he did not know if they are true, Philips had downplayed the possibility of it aquiring Agfa in the past because its 'not interested in a restructuring story'.

He said any potential buyer would have to take the healthcare, graphics, and materials units, not just one of the three divisions.

'If, as a competitor, you want to buy Agfa, you have to buy the whole company,' Jooris told TFN, noting that in the absence of a bid, it may sell some divisions to a private equity partner.

Interesting turn of events. Maybe Philips will buy Agfa and sell off the PACS division. Maybe it will keep Agfa PACS and sell iSite to someone else. Siemens still needs a PACS, maybe they would be interested?
Stay tuned for further details as they become available....

Dalai For President!!!

My friend Mike Cannavo, the One and Only PACSMan, informed me today that I am somewhat more popular than I might have guessed. It seems that there is a movement afoot to draft me for the highest office in the land. I can't say that I'm terribly surprised, as I'm sure I could do a very good job at it, and I wouldn't mind the accouterments that go with the office, such as tootling around on Air Force One.

I've even received news coverage on one of the big New York Stations, News3 as seen on THIS web-page (I can't get the video to embed properly. . .)

Vote for me and I'll deliver tax-cuts to everyone except those that work for large imaging equipment companies, I'll bring the price of gasoline down to $1 per gallon, and I'll ban all Prisuses.

Yes, anyone in America can grow up to be President! Now, all I have to do is grow up! And stop playing practical jokes on my readers. . .

Thursday, July 03, 2008

Killer SPECT/CT?

OK, wrong Hawkeye, but the title is correct.

To keep at the bleeding edge of nuclear technology, my hospital is in the market for a hybrid SPECT/CT. This latest and greatest idea in nuclear medicine recapitulates the brilliance and innovation that brought us PET/CT, and applies it to PET's cousin SPECT.

I'm going to assume that you know what these modalities are all about. PET uses positron-emitting radioisotopes to produce an image, while SPECT, Single Photon Emission Computed Tomography, uses more conventional radiopharmaceuticals, generally labelled with Technetium 99m, or Indium 111, or Gallium 67. PET is acquired with a ring detector, and SPECT uses two rotating gamma camera heads (sometimes one, rarely three) to produce an image. You really don't want me to get into the mathematics of the process, not that I really could; suffice it to say that by rotating all around the radiation source (the patient), the radioactivity detected by the heads is reassembled into a series of slices. This technology has been around for a long time.

In the early days of PET, there were attempts to modify gamma cameras to act as cheap PET scanners. We had one, the ADAC Vertex, which used thicker NaI (Sodium Iodide) crystals to stop the higher energy annihilation gamma rays (511 KeV vs 140 KeV for the main gamma emission from Technetium). It was a good way to get our feet wet, but the images weren't great.

One of the SPECT gamma-cameras that was marketed as having PET capabilities started life as the Elscint Varicam:

This was a camera well ahead of its time, with body cowling designed by Jaguar (or was it Porsche?). Its computer was a little esoteric, and I'm not sure many were ultimately sold. But with thick crystals, it could be made to do PET imaging.

In 1998, GE bought Elscint, and assimilated the Varicam into its collective product line, where it became the Hawkeye. (As an interesting historical aside, I was actually talking MRI with some of the developers at Elscint HQ in Haifa, Israel, the very week everyone else at Elscint was in Milwaukee completing the deal.)

I think the innovation to put a CT in the same machine as the SPECT gantry came from UCSF, where an old GE 9800 and a GE 600 XR/T SPECT were sort of loosely combined:

I suppose I should stop at this point to answer the question of why one would want to do this. As with PET and its marriage to CT, there are two reasons. First, the human body is inhomogeneous, i.e., it is full of things that block x-rays to varying degrees. Bones block more than watery structures (like organs), which block more than air in the lungs. To properly reconstruct a tomographic, SPECT image, the computer should know what the anatomy looks like. Most of the time in SPECT we ignore this, although in cardiac work, where chest wall or breast or diaphragmatic attenutation (blocking) could create false defects in the image of the heart, attenuation correction is critical. This correction can be accomplished by sweeping a radioactive source across the area in question, sometimes during the scan itself, or one could use CT. CT actually works much better, because it is designed to look at anatomy, not physiology. Second, linking CT and SPECT gives me a better chance to localize those pesky little hot-spots, just like we see with PET/CT.

Anyway, under GE tutilage, the Varicam became the Infinia. A bit later, a low-resolution CT was added to create the Hawkeye:

The "bump" to the right of the ring holds the x-ray tube, and the black strip to the left, inside the ring, is a detector. Thus, a rather limited CT is created. GE continues to sell this device today, and it now has 4-slice capability (Hawkeye Infinia 4).

Philips and Siemens have gone more traditional, with offerings hearkening back to the original UCSF design with a real CT scanner. The Symbia from Siemens uses their Emotion CT scanner (in various slice increments, either one, two, or six, and soon 64) mated with a dual-head gamma camera. Very pretty cowling; you have to love that Bondi-Blue made famous by the original iMacs.

Philips Precedence SPECT/CT mates a Philips CT (which is coincidentally a descendant of an Elscint design as well) to an ADAC (I mean Philips) Skylight gamma-camera:

I've heard that the Skylight, a room-sized framework suspending two gamma camera heads, was commissioned to do bone scans on racehorses, and having two in my lab (Skylights, not racehorses), I can see where this might have been the case.

So, once I get my hands on one of these, what will I do with it? The possibilities are really endless. Anything we do with SPECT, we can do better with SPECT/CT. A lesion on a bone scan can be precisely located with the CT component. The blobs of activity that are almost unreadable from a ProstaScint scan suddenly become diagnostic of nodes invaded by prostate cancer when I can see where they actually lie. Cardiac scans gain accuracy with the improvement in attenuation correction. And so on. But there is one theme common to these new and exciting applications: They depend heavily on the CT component. The nuclear literature is chock-full of reports of improvements in diagnosis when using SPECT/CT, especially with diagnostic quality CT's done with IV and oral contrast.

Which leads us into the editorial part of this opus.

The Medical University 100 miles down the road is getting four Symbias. Yes, I said FOUR. Our community hospital here in the boonies has to be competitive, but with luck, I will get one SPECT/CT scanner, so I had better choose the right one.

Equipment vendors are in the business of selling equipment, oddly enough, and they try hard to convince you that their machine is the best, and the other guy's is trash. When I was looking at PET/CT scanners, GE sent me at least a dozen articles that "proved" their older BGO crystals were better than Siemen's LSO crystals. I didn't fall for it, and I'm happy with my PET/CT choice of the Siemens Biograph. (However, I'm very UNhappy with the fact that Siemens released their higher resolution TruePoint machine within a year of our system's purchase, which can't be retrofit our older model.)

GE knows very well that I'm not a Hawkeye fan, but they continue to try to convince me of the error of my ways.

I'll make the assumption that the gamma camera (i.e., the SPECT) components are similar, and that the attenuation correction on each will yield good images. The only reference I could find indicates that the Hawkeye's SPECT resolution is slightly better than that of the Symbia series.

But.... When my Chief Tech asked about the quality of the Hawkeye's CT, she was told, "Why would you need more than attenuation correction?" Excuse me? Obviously, there is a little lack of understanding of one's product here. Attenuation correction is only part of the story, and as the interpreting radiologist, it is the lesser part. When I see hand-waving like this, I know there is something to hide. And it is indeed the CT component.
The Hawkeye's CT (we'll be generous and call it that) can acquire 4 slices simultaneously, although I'm not sure how fast it rotates. You sure as heck wouldn't want the open gantry rotating beyond a snail's pace, or someone is going to get hurt. Slice thickness is (per RT-Image) 5mm. OK, but the darn thing puts out only 1-2.5 mA with a 350 Watt generator! Compare this to the Symbia T6, with a 6-slice CT, that has a 50 KW (50,000 Watts), that can develop 20-345 mA. The Emotion CT platform can scan down to 0.63 mm. That's a real CT, with diagnostic images for correlation. In a departmental pinch, a Symbia can even be used as a stand-alone CT.

Why do I need more than attenuation correction? Because CT is what SPECT/CT is all about, folks. Yes, attenuation correction is important, and it greatly improves the image. But I need the diagnostic CT, and it needs to register perfectly with the SPECT image. In this way, I can match the anatomy to the physiology, and that is what I need to do. Sadly, GE doesn't want to acknowledge this, mainly because its product doesn't have a diagnostic CT component. No doubt they will couple their gamma camera with a proper CT someday, but until then, this little deficiency doesn't seem to bother them. In fact, their strategy takes a rather different turn:

The following link is to an article regarding the possible link between multiple CTs and cancer risks, especially in children. Aiding us in our cause for our low-dose SPECT/CT Infinia Hawkeye 4 system. Maximum patient dose with the Infinia Hawkeye 4 is 2.5ma. Why more dose for Attenuation Correction and Anatomical Mapping in Nuclear Medicine environment?
Maximum patient dose is 2.5 ma? I'm not quite sure what that is supposed to mean. The initials "mA" stand for milliamperes, a measure of current, or loosely, flow of electricity. The Hawkeye's tube current is indeed rated at 2.5 mA. Yes, this lower-powered tube does yield a lower radiation dose.

The article in the link discusses the supposed danger of too much radiation from too many CT scans, and was inspired by a now-infamous New England Journal article. There has been tremendous debate in our literature, both before and after this somewhat inflammatory piece, concerning the carcinogenic potential of diagnostic radiological procedures in general, and CT in particular. I won't rehash that now. But most agree that it is desireable to keep the amount of radiation to the lowest reasonable level.

GE deserves accolades for its attempts to reduce radiation exposure from its devices, especially in the realm of cardiac CT. But in the SPECT/CT venue, the argument is hollow at best. Because the Hawkeye's CT images are not diagnostic, the patient will have to undergo another CT, and the dose will be added to that from the Hawkeye. In other words, the total dose will exceed what the patient would have received had he or she been scanned on a SPECT/CT unit that had a diagnostic CT in the first place.

Now, being board-certified in both Nuclear Medicine and Radiology, I rather take offense to that last line in the quote from GE about the "Nuclear Medicine Environment". The implication here is that Nuclear Medicine doesn't need diagnostic images. Well, sorry to disappoint you guys, but likely the majority of nuclear medicine exams are read by diagnostic radiologists, and because of PET/CT, most pure Nuc Med physicians are now pretty well versed in reading CT's, so don't even think of going there.

One simply cannot justify the purchase of a SPECT/CT camera on the basis of attenuation correction alone, and that seems to be the majority of what the Hawkeye offers. So, let's not play the radiation dose card, when ultimately a patient scanned on the Hawkeye might get a higher dose than someone scanned on a Symbia or a Precedence. If the extra radiation is so dangerous, and it needs to be limited as much as possible so the scans don't turn out to be harmful (or maybe fatal?), then we need to do only one CT scan and not two, yes?

I'm anxiously awaiting the day that GE delivers a SPECT/CT camera with a real CT in the box. No doubt this will occur. But you will forgive me if I have to pass on the Hawkeye. It just isn't going to be my "killer app".


Several comments to this post have led me to look further into the Philips BrightView XCT SPECT/CT device, which will be available early 2009. From the Philips website, we learn that this device differs significantly from the other contenders:

CoPlanar FP uniquely integrates Philips BrightView SPECT in a co-planar design with advanced Philips flat-detector X-ray CT technology.
This is the only application of flat-panel detectors in this realm that I could find. Sadly, I didn't look closely at this machine at SNM, but RT-Image gives us the CT specs for the Hawkeye, the BrightView, and the Symbia T16:

I don't know how the flat-panel detector will change things, but physics is physics, and the CT appears underpowered relative to the Symbia, although it is significantly better than the Hawkeye. I'll post further when I get to see some images.

Wednesday, July 02, 2008

Agfa's TWO Suitors

The Slaying of the Suitors, image courtesy of

I've written before about Agfa being for sale, and Siemens needing a PACS product. In an article yesterday, put these seemingly disparate facts together like chocolate and peanut butter in a Reese's cup:

Agfa-Gevaert of Mortsel, Belgium, reportedly has spoken with Erlangen, Germany-based Siemens about the possibility of selling Agfa HealthCare as part of its strategic review process, according to published reports.

The Financial Times reported that Los Angeles-based equity group Gores Group also has shown interest in acquiring Agfa HealthCare. If Gores were to acquire the division, the story added that Gores is likely to leave management of the healthcare operations in place.

Gores already has holdings in the healthcare market. In July 2007, the group purchased the diagnostic imaging division of HealthSouth of Birmingham, AL. The new company, Diagnostic Health, is one of the larger imaging center chains in the U.S.

The report also noted that an acquisition of Agfa HealthCare by Gores could generate opposition from organized labor in Belgium, adding that the transaction would result in some short-term layoffs.

In 2007, Agfa HealthCare posted net sales of approximately $2.2 billion (U.S.).

Representatives for Agfa and Siemens Healthcare of Malvern, PA, declined to comment to on the report.

Just remember, boys. As the Mossad (the Israeli equivalent of the CIA) puts it, "Never say 'No comment.' 'No comment' is a comment."