Help Dr. Dalai Quiz Advanced Visualization Vendors!

I'm hoping my loyal and wise readers can give me a hand. As you know, we are set to have a "shoot out" between several Advanced Visualization vendors next Wednesday. The list as it stands includes GE, Philips, TeraRecon, Siemens, and Vital Images, narrowed mostly by our initial look at CT scanners.

This is a big decision with lots of money involved, and we want to do it right. Therefore, I'm turning to my friends out there for advice. Here are the basic questions we are asking the vendors. PLEASE let me know if we've left something out...

• Please provide a brief overview of your system. A drawing would be great.
• What is your licensing scheme for both thin and thick clients? 
• Are there two tiers of functionality? Please elaborate on which functions are included for each level. In particular, do you offer on thick and/or thin client:
• Coronary/cardiac evaluation
• Stent planning
• Brain perfusion
• PET/CT with automatic registration and propagation of lesion ROI’s from prior to new study
• SPECT/CT processing
• Fusion of any two modalities
• Creation of report-quality AVI’s
• Transparent/translucent bone rendering
• Vessel seeding/growing
• Is any special hardware required for the thick client?
• How many servers are required for full functionality? Is there a user or a slice limit per server? Please outline or provide a table to illustrate.
• Does the thin client require any additional software to be installed, i.e. Java, .NET, etc. If so, what version?
• Will the thin client work on a MacOSX, iOS, Android? Does either thin or thick client function well in a Citrix environment, the latter utilized on desktop machine or mobile device with iOS or Android?
• How does the user login to either product? Does the system have its own user database or can it authenticate to Active Directory? 
• Has your product been fully integrated with IMPAX 6.5? Please describe the usual workflow we would experience when accessing a study on your system via IMPAX.
• How will we handle routing of separate datasets to your system as opposed to PACS? (We will likely want to send full thin-slice images to your server but not to PACS itself.)

Have I forgotten anything? Oh, yes...Happy New Year, everyone!!!!

ADDENDUM

Here are the questions in final form as sent to the various vendors:

Advanced Visualization Demonstration Questions

General

• Please provide a brief overview of your system. A drawing would be great. Handouts are appreciated.
• How many servers are required for full functionality? Is there a user or a slice limit per server?
• Please outline or provide a table to illustrate.
• What is your licensing scheme for both thick and thin Clients?
• Are there 2 Tiers of functionality, as in Thin and Thick Client? Please elaborate on the functionality available for each Tier.
• Will both clients function well in a Citrix environment?
• What is the client to server ratio for each type of Client?
• Does the thick client require any special hardware?
• How does the user login to either product?
• Does the system have its own user database or can it authenticate to Active Directory?
• What type of auditing functionality does it have?
• Has your product been fully integrated with AGFA’s IMPAX 6.5? Please describe the usual workflow we would experience when accessing a study on your system via IMPAX. (Any images created on your system would be stored on IMPAX.)
• How will we handle routing of separate datasets to your system as opposed to IMPAX? We will likely want to send full thin-slice images to your server but not to IMPAX.

Thin Client

• How do you access the thin client?
• Is it URL based?
• Is it dependant on a specific browser or require any additional software to be installed, i.e. Java, .NET, etc? If so what version?
• Will the thin client work on a MacOSX, iOS, or Android?
• How many concurrent users can it support?
• In situations with low bandwidth (outside the Hospitals) how does the thin client perform?
• What happens if the connection between server and client times out?

Hopefully we haven't missed much.

My primary goal is to see how these various systems will perform in a pseudo-production environment. I do realize that some of the demonstrations will be hobbled by the restraints WE have placed on the vendors. We are asking them to use data from OUR scanners (which include both GE and Siemens), and we have NOT given the cases to them in advance. Some vendors noted that their automation depends on "learning" the scanners from their DICOM headers, and I almost caved on this issue, but ultimately decided to keep the playing field completely level, for better or worse.

Staging this sort of comparison is quite interesting, and the emotions and actions inspired can be amusing as well. One vendor wanted to place servers in our data center as a long-term demo. Another, as above, wanted the data in advance to train its automation on our particulars. Several requested connections to IMPAX for the demo. We said "no" to all of these, although I'm still wondering if we needlessly limited some of the vendors in our efforts to be "fair" to all. We'll see.

Doing my research at RSNA was fun as well. I had the chance to meet several of the CEO's of the companies involved, some after more or less showing up at their carpeted ranches unannounced. (I did not get to GE's mega-booth, which took some maneuvering to avoid, but I'm sure Jeff Immelt had better things to do than talk to me anyway.) All but one vendor seemed quite interested in making sure I saw what I needed to see; the outlier found an apps person who was clearly brilliant, knew the product inside and out, and barely spoke a word of English. Next time, I'll be courteous enough to make an appointment.

In the end, we probably won't go wrong with any of these fine products. I'm just hoping to find the marriage made in I.T. Heaven, although those are probably contradictory terms...

Duh...Importing Outside Studies Into PACS Avoids Repeats

See the recent Aunt Minnie article with a similar title. Basically, someone did some research and found that if a patient has an outside study on CD, AND it imports successfully, they are less likely to undergo additional imaging.

(Graph courtesy Sodickson, et. al., August 2011 Radiology, 260,408-413.)

Gee whiz, folks, is anyone surprised? We don't have to repeat studies performed an hour ago as long as we can actually see them? Knock me over with a feather.

This is such an obvious observation that I'm really surprised at Radiology for publishing it, although I guess one has to prove everything in this day and age. The AuntMinnie article cites a talk at RSNA by Michael Lu yielding similar observations about hepatocellular cancer patients.

My thought is, of course, to avoid even the CD, and have direct transmission of the prior exam into the system where the patient now resides. lifeIMAGE, for example, does this very well. In my humble opinion, there is no longer any need for the fragile and fickle CD-ROM's. The only impediment to switching away is politics, which will be overcome sooner or later. Why not get on the bandwagon now? This is such a no-brainer, it isn't even funny.

Hat tip to The Once and Former PACSMan.

Chicago Sun-Times To Be Sold...To Consortium Including Merge/Merrick's Ferro

Yesterday's Chicago Sun-Times reports that the venerable paper is to be sold to a consortium of investors including Michael Ferro, of Merge Healthcare and Merrick Ventures fame:

The sale of Chicago's No. 2 newspaper is imminent, sources close to the situation said.

Sun-Times Media is expected to announce Wednesday that it has struck a deal to be bought by a group of local investors led by Michael Ferro, chief executive of Chicago-based Merrick Ventures, a technology holding company. The group also includes John Canning, chairman of Chicago-based private equity firm Madison Dearborn Partners.

The new group plans to name Timothy Knight, the former publisher and CEO of Newsday, which was once controlled by Chicago-based Tribune Co., as CEO of its holding company, sources said.

Existing Sun-Times investors who will remain stakeholders include Chicago Blackhawks owner Rocky Wirtz as well as Mesirow CEO Richard Price.

Talk about branching out! There are some nay-sayers out there, however, who obviously aren't aware of Mr. Ferro's financial accumen:

Many industry observers have scratched their heads over why the new group is plunging into the newspaper business at such a perilous time for the industry and the economy. The Sun-Times emerged from bankruptcy with little debt, and the paper has dramatically reduced costs under Halbreich by, among other things, slashing its workforce and outsourcing its printing operations to Tribune's Freedom Center.

But as is the case for almost every newspaper company, the Sun-Times' revenue has been under pressure for years as advertisers, like readers, gravitate toward the Internet. Tyree's group (In 2009, an investor group led by Mesirow's previous CEO, Jim Tyree, rescued the Sun-Times from bankruptcy for about $25 million. Tyree died earlier this year. The Tyree group paid $5 million in cash for the company and agreed to take on $20 million in liabilities) tried to reverse the trend by emphasizing a digital strategy aimed at making the most of relatively strong Web traffic. But it is too early to tell whether a recent initiative to boost revenue by charging for some online content will pay off.

One longtime industry executive speculated that the risk the new investors are taking may be mitigated by the acquisition price. That has yet to be disclosed but will likely reflect the fact that the Sun-Times remains a work in progress in an industry under siege, the executive said.

Rescuing the Sun-Times might be harder than rescuing Merge, given the fact that print newspapers are going the way of the buggy-whip and corded telephones. Merge was purchased for pennies (?dimes?) on the dollar, and rapidly turned toward success. Look for some unusual paradigm changes that will turn the Times around in a way none of us would expect. Like maybe an iPhone/iPad app that checks your pulse as you read the e-newspaper and adjusts content accordingly. Who knows?

I'd like to be the first to apply for special PACS correspondant for the Sun-Times. There might be better writers on staff, but none who can write from the heart like yours truly..

Mar-Mar, Misses, and Madness

Not long before RSNA, we lost Marion, my mother-in-law, affectionately known as "Mar-Mar". Her health had been deteriorating for a while, and then she fell, compressed a couple of vertebrae, and spiraled down quite rapidly. Fortunately, she had left instructions to avoid all heroic measures, and she died peacefully with Mrs. Dalai and I and her long-term care nurse by her side. I hope to go in the same manner, although not for quite a while.

In the course of working up her fractures, it was discovered that she had a mass, which turned out to be malignant. I asked her physician to review her images with us prior to biopsy, and there was indeed a truly ugly lesion. The hospital used a PACS that shows thumbnails, and we could easily see a very tiny image from a study performed last year. And that thumbnail quite clearly showed the very same lesion, although somewhat smaller. Mar-Mar's cancer had been missed, and allowed to progress for at least 10 months.

In her particular case, this was a blessing.  Rather than prolong her dying with futile and probably painful therapy, the miss prolonged her living. She had 10 months of having lunch with the ladies, playing cards, and generally doing what she wanted to do. We have no regrets, and no anger toward those who made the error.

That last one is the most important item for today's discussion. Anger plays a huge part in the deterioration of our society, in general, and in the medical malpractice game in particular. Let me diverge a moment to tell you about something that happened to me a few days ago. Bear with me and the relationship will become clear.

I was at the neighborhood strip mall, having mailed a package at the Post Office branch. I started to pull out of the parking place with my lumbering, gas-guzzling SUV, when to my shock, I saw a beat-up little red sedan cruise right behind me. I slammed on my brakes, fortunately in time, and avoided the otherwise inevitable accident. I suppose it would have been my fault had I hit, but I had looked both ways, and I've got to assume the driver sped up as I started out of my parking spot. But that isn't the important detail. The driver, a girl in her 20's wearing a black chef's tunic, stopped about 20 feet from me, got out of her car, and started shaking her fist and yelling, while a young bearded male in the passenger seat sat and watched the show.  I waved gently, as if to say, "yeah, I know, but we're all OK." She kept it up, so I drove off the other way. She followed me for a mile or so, then got tired of it and went on her way.

What does this have to do with misses and malpractice? I've got enough friends who happen to be litigators to know that two things drive a malpractice suit: anger and greed/envy, and they go hand-in-hand. (And as an aside, the majority of cases appear to reach the attention of a lawyer because ANOTHER DOCTOR told the patient that something wasn't done as well as HE would have done it.) As with the young lady driving the beat-up car, an accident or even an incident that approaches such is enough to promote rage in some of us, perhaps even most of us. It doesn't matter that the act was unintentional. I did not set out yesterday to trash some kid's little red jalopy. I think it's also reasonable to say that no physician decides some morning to cause harm to his patient. A missed finding, like a parking-lot collision, is an accident. It is not meant to happen, and everyone would prefer that it doesn't. This is where greed and envy can augment the madness of rage. The young lady above, at some level, realized that my truck was likely worth 8-10 times what her beater might bring, and no doubt this got her all the more riled.  Why should that doofus have a nice car? Who gave him the right to almost plow into me? He must think he owns the road, having an expensive car like that. I'll show him! 

In the case of a miss or other adventure in medical errors, I think the same thing applies, although certainly with a little more justification. There is clearly a relationship between doctor and patient. If something goes wrong, the patient feels betrayed And the patient gets angry. Given the perception of docs as wealthy, the next step in the mental equation may become: he hurt me (or could have hurt me) and he's going to pay! He can afford it!

While a financial award could put a car back together again, it may not be able to fix what was broken by the medical error. Somewhere along the way, our society has decided that money can compensate for the damage, and maybe that is true. However, juries of our "peers" are wont to award huge sums as punitive measure to "punish" the "bad" doctor. And let us not forget the fact that the litigator might receive 30-50% of the proceeds.

This is wrong. The whole scenario is horrible, and accomplishes nothing but padding the pockets of the litigating AND the defending lawyers. It leads to millions and billions of dollars spent for "cover your ass" procedures and tests. And it's all predicated on the anger over an accident and the thought that there might be a gold-mine to be had having won the malpractice lottery. This must stop.

I want this to be Mar-Mar's legacy: we must forgive those who make honest mistakes. We need to remove  anger, greed and envy (and lawyers) from the equation, and somehow set up some entity, some body or board, that would determine actual damages and arrange for those to be made as whole as possible, but without multi-million dollar punitive, redistributive, awards . I know this is next to impossible, as there is way too much money to be made by trying "rich" doctors in front of a jury of their "peers" who would love nothing more than to sock it to them. But it is the right thing, and all but those who profit from the malpractice industry, not just the lawyers, but the plaintiff whores who sell their testimony, know that I'm spot on.  Mar-Mar would approve.

How The Kvetch Stole Chanukah

Dalai's Note:  I was trying to think of a Christmas theme to pervert for next year's RSNA article. Dalai, Jr. suggested something about the Grinch (or GErinch) stealing RSNA, and in my creative fervor, the phrase, "all the Joos down in Joo-ville" came to mind. I Googled this, and found that someone had beaten me to the punch (line). I present the absolutely hilarious piece by David Goldstein below. (If the terminology is confusing, ask one of your Joo-ish friends. If you don't have any Joo-ish friends, don't bother reading!)

Every Joo
Down in Joo-ville
Liked Chanukah as such…

But the Kvetch,
Who lived just north of Joo-ville,
… not so much.

The Kvetch hated Chanukah, the whole Chanukah season.
Now don't ask me why. What? Should I know the reason?
It could be he wasn’t a mensch, that is all.
Or his petzel, perhaps, was two sizes too small.
Such meshug’as comes from one thing or another,
But like most Joo-ish boys, we should just blame his mother!

But,
The reason, whatever,
His mom or his putz,
The Kvetch hated Chanukah. Oy, what a yutz!
For he knew every Joo down in Joo-ville tonight
Was busy preparing menorahs to light.

“And they’re giving out gelt!” he sighed as he said
“I need waxy chocolate like holes in my head!”
Then he nervously whined as his fingers tapped horas,
“I MUST stop the Joos from igniting menorahs!”

For,
The Kvetch knew that soon…

… All the Joo girls and boys
Would say the baruch’ha, then unwrap their toys!
And then! Oh, the oys! Oh, the Oys! Oys! Oys! Oys!
If it’s not what they wanted, the OYS! OYS! OYS! OYS!

Then the Joos, young and old, would sit down for a nosh.
And they’d nosh! And they’d nosh!
And they’d NOSH! NOSH! NOSH! NOSH!
They would nosh on Joo-latkes, and Gefilte-Joo-Fish,
Which was surely the Kvetch’s least favorite dish!

And THEN
They’d do something
Which made the Kvetch plotz!
Every Joo down in Joo-ville, Bar Mitzvahed or not,
Would sit down together, their proud ponim’s grinning.
Then dreidels in hand, all the Joos would start spinning!

They’d spin! And they’d spin!
AND they’d SPIN! SPIN! SPIN! SPIN!
And the more the Kvetch thought of this Joo-Dreidel-Spin,
The more the Kvetch thought, “I can’t let this begin!
“Oy, for fifty-three years I’ve put up with it now!
“Chanukah, Schmanukah! Stop it!
… But HOW?”

Then he got an idea!
And the moment he had,
He said
“I’m no Einstein, but this… not half bad!”

“I know just what to do!” Then he donned an old sheet,
And dug up some sandals to wear on his feet.
“I’m the Prophet Elijiah! They’ve set me a plate!”
(For the Kvetch couldn’t keep Joo-ish holidays straight.)
“The Joos ‘ll oblige ol’ Elijiah, no doubt!
“I will simply walk in. Then I’ll clean the place out!”

“All I need is a camel...”
He looked far and near,
But this wasn’t the desert, and camels are dear.
Did that stop the old Kvetch...?
That pischer? No, never:
“If I can’t find a camel,” the Kvetch said, “...whatever.”
So he called his dog, Max. Then he took an old sack
And he tied a hump onto the front of his back.

THEN
He climbed on this
dog-dromedaryish mammal.
You never have seen
Such a schmuck on a camel.

Then the Kvetch cried “Oy vey!”
As old Max started down
Toward the homes, while the Joos
Where still schmoozing in town.

All their driveways were empty. Just SUV tracks.
All the Joos were out last-minute-shopping at Saks,
As he rode to a not-so-small house on old Max.
“It’s a good thing I brought” the old Prophet Kvetch thought,
“All these bags with to stuff all the stuff the Joos bought.”

Then he looked at the chimney. It seemed quite a stretch
That a fat goy like Santa could fit, thought the Kvetch,
“Still, the goyim believe stranger things, that’s for sure.”
Then the Kvetch shrugged his shoulders, and walked through the door
Where the little Joo dreidels were all strewn about.
“These dreidels,” he grinned, “are the first to go out!”

And he schvitzed, as he shlepped, with an odor unpleasant,
Around the whole house, as he took every present!
Barbie dolls! Mountain bikes! Brios! And blocks!
Pokemon! GameBoys! And all of that shlock!
And he stuffed them in bags. Then his arms spread akimbo,
He shlepped all the bags, one by one, out the wimbo!

Then he shlepped to the kitchen. He took every dish.
He took the Joo-latkes. The Gefilte-Joo-Fish.
He cleaned out the Sub-Zero so nimbly and neat,
Careful to separate dairy from meat.
Then he shlepped the Joo-nosh right out the front door-a.
“And NOW!” kvelled the Kvetch, “I will shlep the menorah!”

And he grabbed the menorah, and started to shlep on,
When he heard a whine, like a cat being stepped on.
He spun ‘round with shpilkes, and coming his way,
It was Ruth Levy-Joo, who was two, if a day.

The Kvetch had been caught by this small shaina maidel,
Who’d been watching TV on her big RCA’dle.
“The Prophet Elijiah?” she quizzed the old fool,
“You visit on Pesach, they taught us in shul.”

And although the old Kvetch was surprised and confused,
It’s not hard to lie to a girl in her twos.
“Bubbeleh… sweatheart…” he started his tale,
“Your dad paid full price, when this all was on sale!
“And like any good merchant, I just want to please ya.
“I’ll ring it up right, then I’ll refund your VISA.”

Then he patted her tush. Put a Barney tape in.
And she spaced-out as fast as the spindle could spin.
And as Ruth Levy-Joo watched her mauve dinosaura,
HE went to the door and shlepped out the menorah!

Then the match for the shamas
Was last to be filched!
Then he shlepped himself out to continue his pillage.
On the walls he left nothing at all. Bubkes. Zilch.
And the one speck of food
That he left in the house
Was a matzoh ball even too dense for a mouse.

Then
He did the same schtick
In the other Joos' houses.

Leaving knaidlach
Too dense
For the other Joos' mouses!

It was quarter to dusk…
All the Joos, still at Saks,
All the Joos, still a-shmooze
When he packed up old Max,
Packed him up with their presents! The gelt and the dreidels!
The chotchkes and latkes! The knish and the knaidels!

He hauled it all up to his condo in haste!
(A Grinch might have dumped it, but why go to waste?)
“Shtup you!” to the Joos, the Kvetch loudly cheered,
“They’re finding out Chanukah’s cancelled this year!
“They’re just coming home! I know just what they’ll say!
“They’ll ask their homeowners insurance to pay,
“Then the Joos down in Joo-ville will all cry OY VEY!”

“All those Oys,” kvelled the Kvetch,
“Now THIS I must hear!”
So he paused. And the Kvetch put his hand to his ear.
And he did hear a sound rising up from the shtetl.
It started to grow. Then the Kvetch grew unsettled…

Why the sound wasn’t sad,
It was more like the noise
Of a UPS trucker
Delivering toys!

He stared down at Joo-ville!
And then the Kvetch shook,
As truck after truck
Replaced all that he took!

Every Joo down in Joo-ville, the Golds and the Steins,
Re-ordered their presents by going online!

Chanukah HADN’T been cancelled!
IT CAME!
…On UPS trucks… but it came just the same!

Then the Kvetch, staring down at the gifts where they sat,
Stood kvitching and kvetching: “For this, I did that?
“It came without traffic! It came without tax!
“It came without shopping at Bloomie’s or Saks!”
And he kvetched on and on, til he started to shvitz,
Then the Kvetch thought of something which might make him rich!
“Maybe stores,” thought the Kvetch, “don’t need mortar and bricks.
“Maybe toys can be bought with a few well-placed clicks!”

And what happened then…?
Well… in Joo-ville they say
That the Kvetch raised
Ten million in venture that day!
And the minute his web site was ready to go,
He raised ten billion more on his new IPO!
He sold back the toys to the homes they came from!
And he…

… he the Kvetch…!
Founded YA-JOO.COM!


©2000 by David Goldstein
All rights reserved
[An HA holiday tradition, with apologies to the late, great Dr. Seuss — but not to the greedy, litigious bastards at Dr. Seuss Enterprises, LLC. So there. Happy Christmukah.]

Water On Mars!Government To Level Planetary Playing Field??

From Fox:

NASA Rover Finds Convincing Evidence of Water on Ancient Mars

A well-traveled NASA Mars rover has found some of the best evidence yet that water flowed on the Red Planet's surface long ago, researchers announced Wed., Dec. 7. The Opportunity rover, which landed on Mars nearly eight years ago, has discovered a thin, bright mineral vein along the rim of a huge crater called Endeavour. This mineral is almost certainly gypsum that was deposited by liquid water billions of years ago, researchers said.

"This is the single most powerful piece of evidence for liquid water at Mars that has been discovered by the Opportunity rover," Steve Squyres of Cornell University, Opportunity's principal investigator, told reporters here today during the 2011 winter meeting of the American Geophysical Union.

I can see the headlines now...

The Obama Administration announced plans for immediate interplanetary water redistribution yesterday. "The water-gap between rich and poor planets is unfair and unsustainable; it must be addressed immediately," according to an unnamed spokesman...

You Might Just Be An Occupier If...

You just might be an "Occupier"

(from this week's Jewish Press, NY, Dec 2 issue)
By Steven Plaut (from stevenplaut.blogspot.com)

Many of us are scratching our heads, and in some cases other parts of our anatomy, trying to make sense of the "Occupy Wall Street" movement and its sundry clones around the US and now around the world.

Just what do these urchins really want? What do they think and believe?

Well, we thought we would recruit Jeff Foxworthy to try to assist us. Most of you probably are familiar with the great American comedian from the Deep South. He is best known for his comedy shticks based on the refrain, "Then you just might be a redneck." For example, if you have 24 pickup trucks and none of them work, then you just might be a redneck. That sort of thing.

Well, it occurs to us that Jeff Foxworthy could really clean up if he altered his shtick slightly to comment on those "who just might be Wall Street Occupiers."

Here we go:

1. If you dismiss anything you dislike as "neo-liberalism," then you just might be a Wall Street Occupier. Never be tricked into attempting to define that nonsense term.

2. If you refuse to recognize the fact that every idea of Marx's was debunked over 160 years ago, then you just might be a Wall Street Occupier.

3. If you wear Nike shoes, designer jeans, and carry your smart phone to the demonstrations against capitalism, then you just might be a Wall Street Occupier.

4. If you think that REAL communism could really work but it just has never been tried or tested, you just might be a Wall Street Occupier.

5. If you pretend that you have never heard that communism produces starvation and cannibalism, then you just might be a Wall Street Occupier.

6. If you pretend you think the United States controls an empire, even though you cannot think of any colonies it owns, then you just might be a Wall Street Occupier.

7. If you think other people must always be required to relinquish their material things so that you may pursue social justice and feel idealistic and righteous, then you just might be a Wall Street Occupier.

8. If you consider your own property to be sacred, while other people's property should be used for social engineering and doing good, then you just might be a Wall Street Occupier.

9. If you think it is the main purpose of universities to indoctrinate students in leftwing ideology, then you just might be a Wall Street Occupier.

10. If you think shooting terrorists constitutes "war crimes," then you just might be a Wall Street Occupier.

11. If you favor academic departments in which only enlightened leftist opinion may be expressed and where there is no room for non-leftist dissenting opinion to be heard, then you just might be a Wall Street Occupier.

12. If you believe that the only legitimate way for Israel to defend its citizens against terrorism is to capitulate to the demands of the terrorists, then you just might be a Wall Street Occupier.

13. If you believe that eating meat is murder, while partial birth abortion is not, then you just might be a Wall Street Occupier.

14. If you use the term Islamophobia often, but never use the term Islamofascism, then you just might be a Wall Street Occupier.

15. If you believe that everything wrong with the world is because of the United States, and that anything left over that is wrong with the world is the fault of the Jews, then you just might be a Wall Street Occupier.

16. If you think there is nothing useful to be learned from the fact that Cuba used to be the richest country in Latin America and today is the poorest country in Latin America, then you just might be a Wall Street Occupier.

17. If you are not aware of the fact that Cubans steal boats to sneak into the US but no low-income Americans steal boats to sneak into Cuba, then you just might be a Wall Street Occupier.

18. If you think there is nothing we can learn from comparing the histories of East Germany with West Germany before the unification, or North Korean with South Korea, then you just might be a Wall Street Occupier.

19. If you think that all arguments may be settled by telling a non-leftist that he reminds you of Rush Limbaugh or Glenn Beck, then you just might be a Wall Street Occupier.

20. If you claim that the fact that are proportionately more blacks in prison than whites proves that the courts and police are racist, but the fact that there are many more males in prison than females is because males commit more crimes, then you just might be a Wall Street Occupier.

21. If you support proposals that make real problems of the world worse, just as long as advocating them makes you feel caring and righteous, then you just might be a Wall Street Occupier..

22. If you think Israel is an apartheid regime, then you just might be a Wall Street Occupier.

23. If you prefer that poor people in the Third World starve rather than that they should embrace capitalism and live like you do, then you just might be a Wall Street Occupier.

24. If you believe that acts of violence against Jews or Americans are never terrorism but rather resistance, then you just might be a Wall Street Occupier.

25. If you think the US itself caused the 9-11 attacks on itself because of American insensitivity and racism, then you just might be a Wall Street Occupier.

26. If you believe that terrorism is caused by poverty, then you just might be a Wall Street Occupier.

27. If you believe that SUVs threaten life on earth, and - more generally - that the planet is in imminent danger of destruction unless everyone does what you want them to do, then you just might be a Wall Street Occupier.

28. If you assert passionately that Marxists care about people, while Conservatives hate all people and small animals and are not as smart as leftists, then you just might be a Wall Street Occupier.

29. If you believe that, if one country is rich and another poor, it must be because the rich one stole wealth away from the poor one, then you just might be a Wall Street Occupier.

30. If you demand social justice but have no idea how to define what it means or explain how to achieve it, then you just might be a Wall
Street Occupier.

31. If you do not think you need to get a job first before you become a leader of the working class, then you just might be a Wall Street Occupier.

I couldn't have said it better myself!

Farewell To Chicago and RSNA 2011

Even though it's a bit chilly down here in the Deep South, it is still considerably warmer than Chicago, and it's good to be back home.

My major concentration this trip was on Advanced Visualization, in preparation for our Shoot Out coming in January. I looked closely at the four major vendors involved. I got to meet the CEO's of three of the companies, and had prolonged demos at the same three. One company has invited me to its headquarters, which I must decline while we are in the midst of the decision process. I'm sure I'll still be welcome even if we chose one of the "other guys"...

On other topics...I was really amazed at the number of people who recognized me and/or admitted to being regular readers of this blog. I know I disappointed several of you by not making it back to your booths, and for that I apologize profusely. Contact me earlier next year, and I'll try to do better.

Finally, you may have heard by now that my good friend Mike Cannavo, still the One and Only PACSMan, has gone corporate. He now works for one of the large PACS companies (no, not that larGE company) and has had to hang up his pen. Mike wrote the annual RSNA wrap-up column for AuntMinnie.com for many years.  Now that he has retired, so to speak, I have been offered the chance to take over this prestigious piece. Rather than try to duplicate Mike's inimitable approach, I decided to go quite far afield with a piece of fiction and parody. So, without further ado, please enjoy my first (and possibly last) AuntMinnie RSNA column:

An RSNA 'Christmas Carol'

December 1, 2011 -- For years, the PACSman Awards were an annual tradition inAuntMinnie.com's coverage of the RSNA conference. With the PACSman hanging up his typewriter last year, the baton has now passed to the Dalai Lama of PACS, radiologist and blogger Dr. Sam Friedman, who shares his unique RSNA experience.

CHICAGO - The PACSman was gone, and radiology wasn't looking too good either, no doubt about it. The somber, funereal atmosphere in McCormick Place at the RSNA conference was pervasive, even palpable.

Radiologists wandered the halls, heads bowed, hoping to learn something that might make them a better hospitalist, or pathologist, or whatever the Affordable Care Act might actually support. But there were still some bright spots here and there. A new scanner, a novel technique. A shred of hope for some disruptive technology.

I entered the Technical Exhibit Hall, hoping more for some free candy to quiet my rumbling stomach than any particular revelation. I was immediately swarmed by salesmen in ill-fitting Men's Wearhouse suits.

"A happy RSNA to you, Dalai, would you be so kind as to have a look at our wares?"

"Bah, humbug!" I replied, looking for something to scrounge, or even some swag to take back to my family -- a key chain, a little flashlight, anything to justify my trip to this drab, cold place.

"But Dalai, this is the most incredible of all radiology meetings!" they said. "Surely you have found something amazing here!"
I shook my head and kept walking. There was nothing wonderful here. Why did I choose imaging anyway? Because I loved the field? Ah, the foolishness of youth.

Finding no solace, I turned on my heel and returned along the Grand Concourse to the North Building. In a small basement classroom, I found the session I was seeking, an uplifting little talk titled "Tales of Alleged Radiology Fraud and Abuse."

I settled into the chair and pulled out my iPhone, hoping to find a pleasant email from home. Instead, there were three angry emails from my PACS administrators, all expressing escalating desire to serve up my partners as Christmas dinner for the local wildlife.

As the speaker droned on about the loopholes in Stark II, I found myself becoming drowsy, and to my embarrassment, my head nodded, my chin hit my chest, and I shuddered, startled back awake once again ...

But ... something was wrong, very wrong. I looked about. The harsh lines of the plain McCormick Place classroom were gone. Rather, as I looked around, the room was plush and even gilded. The chairs were comfortable. A man with a bushy mustache at the podium was wearing a suit with narrow lapels and an even narrower tie, and he was speaking about the "revolutionary EMI Mark I." There was a heavily pixelated image on the screen that seemed to be a brain, but it was not very well defined. I blinked. On the podium, emblazoned in gold, was the inscription "the Palmer House Hotel."

Wait! The Palmer House? EMI Mark I? How was this possible? The Mark I was introduced at the RSNA annual meeting in ... 1972! Could it be?

"You bet your ass, goombah!"

I turned to the source of the booming voice next to me.

"PACSman!" I cried out in surprise. "How did you get here? How did I get here?"

It was then I noticed that while he was there beside me, he wasn't quite all there; I could see through him to the gentleman seated two chairs away. He was bound in Cat-5e cable, with broken hard drives lashed to his feet. Strangely, no heads turned in annoyance over our conversation.
"Dalai, buddy, you ate some bad shrimp last night," the PACSman continued. "I told you not to go to any parties put on by the big companies, but does anyone ever listen to me? Oh well, it's nothing but a thing anyway."

"But PACSman, I thought you were gone!" I exclaimed. "Why are we at an RSNA from 40 years ago?"

"One thing at a time, bubbie," he said. "Yes, I've departed your world for one I think will be better. Live and learn, or maybe die and learn, heh? As for the why, look up, friend. You've been brought here to RSNA Past so you can remember the joy and love you once had for medical imaging. Can't you feel the electricity in the air? This was the day when CT became king! Cross-sectional imaging, baby! It all started here!"

Indeed, I could feel the excitement creeping up on me. It was none other than Dr. Sir Godfrey Hounsfield himself speaking to the enraptured crowd at the Palmer House ballroom. What I wouldn't give to have been there -- I mean here -- I mean, whatever.

I listened for a few more moments, but again, my head started to nod, and once more I awoke with a start. I was back in the modern McCormick Place, but instead of re-emerging in the small classroom, I was seated in the cavernous Arie Crown Theater, front row and center. And the gaseous apparition of my friend the PACSman was seated next to me. Clearly, my strange journey wasn't over.

"Hey, Dalai! Pay attention," he admonished. "The president of the American Medical Association is schooling you guys about how much trouble you're in. Something about triple jeopardy and not getting paid. Sounds like a triple whammy to me."

And he was right about that. I couldn't take any more of this. I got up and walked out, magically disturbing no one, the PACSman trailing behind, broken hard drives clanking at his feet.

We wound our way over the bridge to the Grand Concourse, then wandered aimlessly to the Technical Exhibit Hall in the South Building. Before long, we encountered a booth that easily covered the area of a football field. There were hundreds of black-suited, brown-badged gents milling about, looking for anyone wearing the coveted blue-rimmed name tag. I had one on, of course, but I was now accustomed to my invisible status, and I expected to remain unaccosted. The shiny new scanners, lights blinking, spun their tubes in futile pursuit of customers.

"PACSman, what are we to see here?" I asked.

"Isn't it obvious?" he asked. "Here's the deal. No one knows where healthcare is going, so we're all going to start enjoying Thanksgiving again for the first time in 75 years. Instead of freezing our asses off, we'll do an interactive virtual conference with scheduled demos and everything. No muss, no fuss, and no 'free' meals. As a bonus, system prices will drop 30% because vendors won't have to pay for RSNA. It's sheer brilliance, I tell ya!"

I sat down on a PET/CT gantry and bowed my head. The room spun, and when I looked up again, we were seated on a bench beside Lake Michigan. It was a blustery day, with winds one only sees in Chicago in the winter. Strangely, I felt no chill, as I watched leaves blowing through the PACSman's shadowy figure.

I looked behind me and gasped. The once-stately Lakeside Center was in ruins, shattered black pillars and glass everywhere.

"PACSman! What happened here?"

"Oy, Dalai, you need to lay off the Kung Pao, OK? Welcome to RSNA 2045," he said. "Or, well, it would have been if there still was an RSNA. Which there isn't."

"But why?"

"What did you expect?" he said. "Between the UnAffordable Care Act, the doctors' 'fix' that fixed you guys good, and all of your good friends, the clinicians, you radiologists didn't stand a chance."

"But who reads imaging studies now?" I asked.

"Geez, Dalai, why do you even care? OK, OK," he said. "You've come this far. Look, imaging reached the point where it didn't pay squat, right? So no one wanted to do it anymore. Even physicians' assistants and nurse practitioners wouldn't touch it. Imaging got so cheap that people got their scans at Walmart and everybody's data were stored in the cloud or on some vulture -- I mean, vendor-neutral -- archive. Got that? So many images were crammed into all these interconnecting networks that ... badda bing, badda boom, they grew self-aware. So, the damn computers are doing the diagnosing themselves. Whaddya think of that? End of the line for radiology."

"No, PACSman!" I exclaimed. "It cannot be! This is an honorable profession, and it cannot end this way!"

I sat back down on the bench, staring at the frigid breakers on Lake Michigan, the wind whipping through my spectral presence by the ruins. I slowly drifted off to the crashing of the waves.

"Dammit, Dalai, watch what you're doing!"

I looked up quickly. The PACSman was standing next to me, very much alive and quite solid, nursing his foot, which I had apparently stepped upon in my delirium. We were in the Technical Exhibit Hall once more. Again, something was different. The booths were lit more brightly than ever before, the scanners positively glowed, and the salesmen were all grinning and patting each other on the back. The customers with blue badges were smiling too, several making excited cellphone calls, clearly happy with a deal they had just made.

"What ... what's going on?" I mumbled, totally disoriented by this, the final shift back to reality. But it was a different, better reality than the one I had left but a moment ago.

"Gawd, Dalai, you really need a cup of coffee or something," PACSman said. "They just announced record sales for this RSNA. All the big boys have sold more scanners in the past three days than they had in the past five years! It's a damn miracle!"

"Yes, PACSman, yes!" I exclaimed. "It had to happen! So many of us love radiology. What a relief! How were we rescued?"

"Probably something to do with that first Tuesday in November, goombah," he said. "Hey, I'd like to stand around and shoot the breeze, but I have to get back to my new home away from home. I'm in a good place now ... good company, good people, good product, and all that jazz."

As he walked away, he turned, smiled at me, and said, "Hey Dalai, guess who gets the Flashdance Award?"

I laughed, thankful that some things never change ...

I ambled my way to the glass portal of the Grand Concourse. The sun was shining brightly, and the traffic cops had shed their slickers in the warm afternoon.

I went outside and walked down by the Hyatt for a ways, then looked back at the sparkling edifice of McCormick Place. I couldn't help but notice the huge banner: "Welcome to RSNA, 2012."

In addition to regular posts in the AuntMinnie.com PACS Digital Community Forums, Dr. Friedman also maintains a blog at www.doctordalai.com. His observations and opinions are entirely his own.

I guess I should probably keep my day job....