Wednesday, September 29, 2010

Grumpy Grand Rounds

If you haven't visited the site of fellow blogger Dr. Grumpy (Dr. Grumpy in the House), you should.  Dr. Grumpy is a neurologist whose ". . .patients and practice drive me NUTS!  Some days I’m so sick of patient shenanigans, the stupidity of insurance companies, and just the daily insanity of this field that I write this blog as my gripe forum. I’m a neurologist, and although I practice in an upscale suburban area, I sometimes seem to attract some remarkably “special” folks. I have no idea why. It just seems that weird crap happens to me or my patients. So this is where I vent about it."

This week, Dr. Grumpy hosts Online Grand Rounds.  He asked for submissions of blog posts about "things that make us grumpy," and I provided my post about the Blunder Down Under.  Dr. Grumpy found this grumpy enough to be included, and so it landed in the Grumpy Doctors section.  I really appreciate his introduction to my piece:  "Dr. Dalai, a radiologist who specializes in the "I'm tearing my hairs out by the roots" field of IT, sends in his grumpiness over trying to set up a PACS system."

I would be REALLY grumpy if I had to deal with some of the other issues posted!

The Health Care Law Dissected

Note: Tim Farrell is a radiologist practicing in Virginia. In his own words, he's "done a lot research on the 2010 Health Care Act for a lecture I'm giving at a medical meeting in a few weeks. It's taken me several months to complete the research. In preparation, I compiled a lot of notes, put together in outline/text form.

I know that it's lengthy, but in it I've briefly outlined the history of health care reform, reviewed the reasons behind reform and tried to condense the highlights of over 2,500 pages of legislation.The analysis is my opinion, based on my position as an "insider" in the medical profession who has had to deal with the insurance industry and the state and federal legislature for more than 15 years. A lot of it seems like basic common sense to me.

It's an interesting read, if you're into that type of stuff. If not, it will be boring as hell, so it's your decision whether to read it or not. After spending THIS amount of time on it, I know the law about as well as one can (and a good bit of the stuff "going around", is false)."

Without further ado....

Healthcare Law

Sunday, September 26, 2010

Another Correct Prediction

In my February, 2008 post titled "A New Cellphone Accessory", I requested that someone invent a combined bluetooth headset and video camera, mocked up as below:

On this occasion, I was only a few years ahead of my time.  Behold the Looxcie (Look-see, get it?) wearable camcorder:

Looxcie takes a sound-bite/tweet approach to video.  It is always on, but if you see something you wish to capture, press the button on the back, and Looxcie saves a clip of the last 30 seconds it, ummmm, saw.  It can also function as a bluetooth headset.

Phone app is now available for Android devices, and support for iPhone and Blackberry is coming soon.

All this can be yours for $199.  Visit

Tuesday, September 14, 2010

RadNet Buys eRad

I seem to have a lot of contacts in the PACS business, so many that they keep turning up in unexpected places.  I received a note yesterday from a friend at eRad to let me know that the Greenville, SC-based RIS/PACS company had just been bought out by outpatient imaging provider RadNet.  About 5 minutes later, I received a phone call from Ranjan Jayanathan, RadNet's CIO to tell me the same thing.  I met Ranjan a few years back, when he still worked for Dynamic Imaging (and there still was a Dynamic Imaging).  He walked me through one of the best product demonstrations I have ever experienced.  (I wonder if that particular product will ever be seen again, eh, Ranjan?) 

I've got an appointment with Mr. Jayanathan next week to discuss this acquisition further, as I think the story is newsworthy for my illustrious readers.  Stay tuned!

Saturday, September 11, 2010

Doctor Dalai's Health Minute

As a physician, I am supposed to help patients, at least periodically. While I would like to think I do so every working day, I have two personal experiences outside of radiology to report, which I think will benefit you, my faithful readers.

First, let's deal with a bit of technology. In perusing Medgadget a few weeks ago, I came across this intriguing tidbit:

Solar-Powered Toothbrush Supposedly Makes Toothpaste Obsolete

Researchers at the University of Saskatchewan have developed a solar-powered toothbrush that doesn't require toothpaste. At the base of the brush is a solar panel, which transmits electrons to the top of the toothbrush through a lead wire. These electrons react with acid in the mouth, breaking down plaque without the help of toothpaste. It is an advancement of a model described 15 years ago using a titanium dioxide rod which released electrons when illuminated. The researchers are currently recruiting 120 teens to test the brush. The model is named Soladey-J3X and is manufactured by the Shiken company of Japan.

I had a peek at the Shiken web-site, and my curiosity was really piqued:

After a bit of back-and-forth with the Shiken rep, I was able to purchase a sample version, as full production and distribution of the J3X has not yet ramped up. I've been trying it for the past couple of days, and...the damn thing works! I've been using a Philips Sonicare brush, recommended by my dentist, for many years. After two days with the J3X, my teeth feel significantly cleaner, with a definite (although subjective) decrease in my perception of film/plaque as compared to the Sonicare. And this clean feeling lasts all day. I'll keep you informed, but I think we have a winner. I am adding a bit of toothpaste at the end of brushing to keep all my lovely teeth fluoridated, and to keep my breath from lethal levels, but so far, this new toy does what it promises. And it looks really modernistic to boot! (I have the blue one.)

Moving now to the other end of my aerodigestive tract, I finally did something every 50 year-old needs to do: I had my colonoscopy. Sadly, I am actually 51.5 years old, and so this little party was a bit belated. That could have been a disaster, as you will see.

The worst part of the procedure was, of course, the prep. I mean, the induced diarrhea is bad enough, but drinking a gallon of GoLYTELY is sheer torture. This crap has a faintly salty taste and slimy consistency, and by the time I had my last 8 oz. cup of the stuff, I was ready to croak. My green Jello tasted wonderful after that.

The procedure itself is easy as can be. The worst part is anticipation, and the insertion of the angiocath for the IV. After that, a pop of Demorol and Versed sent me off to La-La land, and I awoke in the recovery area with some minor gas pains but no other discomfort. I do have a millisecond-flash of memory from the test itself, in which I think I complained of cramping. That's it. Well, I did get a little woozy about 48 hours later, probably a delayed reaction to the drugs, which gave me an excuse to bail early on Rosh Hashana services. Fainting in Temple is bad form, you know. But I'm absolutely fine now.

Another famous physician, Dr. Mehmet Oz, of the Dr. Oz Show, just recently had his colonoscopy. Being a TV celebrity, he had to do his on time, at age 50. Rather frighteningly, Dr. Oz had an adenomatous polyp, which is considered precancerous, although the potential for malignant degeneration is rather low. Still, someone with as healthy a lifestyle as Dr. Oz is considered at low risk for development of polyps, and of colon cancer. If he can get one, we should all worry.

And indeed, my encounter with the Big Black Snake yielded a polyp as well:

Behold my sigmoid colon, and a 1.8 cm partially-pedunculated polyp within. My gastroenterologist snared this little sucker, and sent it off to pathology. He then skipped town for a much-deserved vacation. Fortunately, I have access to most of the local EMR's, and against my better judgement, I checked the path myself. This is, of course, a bad idea, but thanks to God, Dalai's Polyp was hyperplastic, and this is the most benign variety, with very little chance of ever turning malignant. Still, as the little SOB was over 1cm, I'm compelled to repeat the colonoscopy every three years instead of every five. Since my son has Crohn's Disease, and must be scoped every year or two, I get no sympathy at home for the increased frequency, and frankly, the procedure wasn't really a bad experience at all. I do hope, however, that there are some advances in the prep by 2013.

I want you all to learn from my experience. I was very, very lucky. Had Polly Polyp been adenomatous, I would be in greater danger for having been a wimp delayed my colonoscopy 18 months past the point I should have done it. So, if you are close to age 50 (or 45 for African-Americans), call your gastroenterologist and make the appointment ASAP! Don't fool around with your health. Colon cancer is almost completely preventable, but far more so if the precursor lesion is caught in its very early stages. Don't die young because you are afraid of the prep or the discomfort. It isn't that bad, and this procedure could save your life. Literally.

Now, as a radiologist, I have to add one more thing: Based on my experience, I'm going to skip virtual colonography, and go straight to the 'scope. VC is a good procedure, and it would have found my little friend with ease. But, I would have had to wait for another appointment, and I would have had to reprep.  And, VC involves radiation. Had I come out negative, I might be singing a different tune, but for me, for the moment, the Big Black Snake is my new best friend. Apologies to VC affectionados world-wide.

I suppose my next foray into self-improvement will involve CCTA. Hopefully I won't fall asleep from the beta-blockers.

Wednesday, September 08, 2010

The iPad--Radiology's Sharper Image?

I'm still naive and vain enough to be impressed when something I wrote makes it to a real publication, i.e., a professional operation hoping to sell copy or at least advertising, and not self-published like my blog.

The good people at AdvanceWeb recently asked me to write a piece on the available iPad radiology viewers.  Since their budget didn't allow them to buy me my own iPad, I stole my son's while he was in Australia and proceeded to download any and all viewing apps I could find.  At this stage, most are dedicated to the iPhone, but they work adequately well on the iPad.  There were a few pleasant surprises in this little technical odyssey, including the discovery of Calgary Scientific, which seems to "get it" far better than most in this particular venue.

I have to let you know that the title of the piece was selected by the editors over at AdvanceWeb.  Let's hope the demise of the Sharper Image stores has no bearing on the success of my writing.

To avoid copyright problems, and to keep from having to reproduce the images in the article, I will simply provide you the link to the AdvanceWeb site:

I hope you find it interesting.  Let me know if I've inspired you to go out and buy an iPad!

Sunday, September 05, 2010

The Actor Playing...ME!!

Chad Einbinder, Image Courtesy

Every so often, it pays to Google ones' self.  You never know what you might find.  As it turns out, there was a character in Episode 8 of the first season of Grey's Anatomy which aired on May 15, 2005, named....Sam Friedman!  Sam and his screen-wife Doris were the parents of an Orthodox daughter Devo (played by Lisa Kaminer and Sarah Hagan, respectively), who didn't want a valve-replacement from an un-kosher pig.  

Chad, has had a fairly busy, if non-descript Hollywood career, with several minor guest-starring roles in several TV episodes, and more recently Neanderthal #3 in "Night at the Museum, Battle of the Smithsonian".  Playing me, I mean Sam, probably was adequate prep for that one. 

So tell me folks, who is better looking, my alter ego Chad, or me? Don't everyone shout at once...

Friday, September 03, 2010

Another eBay PACS

A while back, I found an ad for a Dynamic Imaging PACS on eBay.  I don't know if it ever sold, but the opening bid was $45,000. 

On a lark, I tried searching for PACS on eBay again today, and indeed there is another system available.  Actually, the seller has two separate but identical listings for the same package. 

Here's the deal:

Brand New PACS system for an affordable price. buy it complete for $8,999. purchase includes hardware, software & licensing. one year complete parts & labor warranty. Order today and have it up and running in 48 hours. Contact Rudy at (see the listing) to get this great deal. STOP buying jackets, STOP buying films, STOP printing & faxing reports. GO DIGITAL Today!. this system will pay for itself in 1 month. be ahead of your competition and offer your physicians instant access to their referred patient images & reports. your success story starts from here. Contact Rudy at (see the listing) TODAY!. Do not pay thousands of dollars more for another system with less features. this is the one and only PACS you need for the life if your imaging center. Future Proof. Feature Rich, Affordable.
Here are the specs:
Included With Your PACS System:
  • UNLIMITED Patients
  • UNLIMITED Studies
  • UNLIMITED Referring Physician
  • HIPPA Compliance
  • Modality Work List
  • Auto Route
  • CD/DVD Burning
  • Digital Laser Label (uses laser to print your clinic's logo & Patient's information on CD's/DVD's)
  • iPhone Compatible. (access your PACS server, view images, read reports from your iPhone. Anytime, Anywhere.)
  • Windows, MAC, Linux Compatible.
  • Referring Physician Portal for your physicians to log-in and view the images for their patients, download reports or print images if they want to.
  • Full imaging center Reporting System. Based on modalities, referring physicians, date, Application Entity (AE), patient ID or any combination.
  • Web Based Radiologist access. your radiologist can read from any computer at any location at anytime.
  • Built-in VPN server. secure connection for outside access. e-Film, digital jacket or any other dicom viewer software.
  • Optional HL7 Interface

Server Configuration:
  • AMD ATHLON 64 X2 5200+ C2 2.70GHZ
  • Windows Server 2003 Standard Edition
  • Your Choice of 2TB Hard Drive (RAID0) or 1TB Hard Drive (RAID1). Need more storage? No Problem we can upgrade your storage to meet your needs.
  • Optional UPS
  • Virus, Spyware, Malware, Firewall Protection
  • One Year PARTS & LABOR warranty   

Optional Modules & Services:

  • Dragon Naturally Speaking Voice Recognition Software
  • Transcription System. Available in both digital (digital recorders) or analog (dial-in)
  • Remote Server Backup

What a deal!  I'm particularly intrigued by the UNLIMITED stuff.  I have to pay license fees and buy more storage on my SAN to add patients.  Has Rudy found a way to store an UNLIMITED amount of data on the server?  When you say UNLIMITED, it should mean UNLIMITED, yes?  Well, Rudy?  What say you?
I'm also taken with the thought of a platform-independent PACS.  Rudy was kind enough to include a screen-shot of his GUI, something many vendors never get around to doing, by the way. 

This is a rather busy interface, with cute and occasionally informative icons.  No doubt there are tool-tabs in actual use.  I would assume this was designed by an engineer working with a graphics designer, with no radiologist in the immediate neighborhood.

You'll notice the title-bar refers to this viewer as "RemotEye".  A quick googling reveals the source:  NeoLogica, from Italy.  NeoLogica also provides PACS Connector to connect RemotEye to any DICOM server: 

Thanks to the PACSConnector software option, RemotEye can now be deployed as a "ready-to-use" solution, without requiring development of custom integrations for a specific DICOM server or archive.

Searching for patients and studies, sending DICOM files to server, reporting, downloading and displaying images from server and all operations typically supported by RemotEye are now available through the special module developed by NeoLogica: PACSConnector.

PACSConnector works as a bridge between the DICOM server (PACS) and the RemotEye client, implementing the DICOM protocol on one side, and the RemotEye-specific HTTP/XML protocol on the other side.
RemotEye now also supports a new integration mechanism, based on the HTTP and XML standards. This mechanism is particularly suitable when RemotEye shall be configured as the viewing front-end for a DICOM back-end system or archive. In this mode, RemotEye sends queries to the back-end through the HTTP protocol, based on the search parameters entered by the user in the search window. After performing a query on the DICOM storage archive, the server will send XML-formatted answers to RemotEye, containing the matching patients, studies, series and images. RemotEye will now be able to retrieve and display the relevant studies and series, as requested by the user, even using compression techniques. In order to better support this new integration mode, RemotEye is now also able to execute as a Java Web Start application, in addition to as a Java Applet.
The Java origins explain the cross-platform abilities.  Rudy doesn't tell us which DICOM server is in use, but I would assume it is NeoLogica's LogiPACS

Is this worth $9K?  Well... I'm not sure how much the software costs, but the hardware isn't much more than $1,000 or so.  If you're capable and adventurous, you can use open-source PACS software, such as Conquest and/or ClearCanvas (about which I know virtually nothing) for free.  There's also the free OsiriX client, which can be used with the free dcm4che server.  I'm not sure what the FDA implications might be, however.  You could also use the free PacsOne (their capitalization, not mine) system.  I downloaded it and they proceeded to cold-call me while I was in Costa Rica, costing several dollars and souring me on their product.  Other low-cost solutions (at least initially) include using remote servers as we see with Co-Activ

I guess PACS is now a mainstream product, with its regular appearance in eBay.  I'll be really impressed when we can buy a system at Wal-Mart, along with the EMR they already sell.