"If I Wanted America To Fail..."

What's Up With EMC?

I don't like SPAM, and I don't like cold-calls from vendors. Today, I received both from representatives of EMC. For about the 10th time. My storage needs for the present time have been met, thank you, and I'll be sure to call EMC if I should decide that I need their services.

In the meantime, as I told the young lady who called my cell wanting to speak to someone who made IT decisions in my organization, if I receive one more unsolicited contact from EMC, my next communication will be with their CEO. We'll see how HE likes cold calls...

Phear Of Photons

I never pass up an opportunity to throw in a Star Trek reference...

I had the usual joy of taking call last night, and the discussion about a particular case prompts me to put pen to paper, or fingers to keyboard as it were.

The call came through from the ER at 10 PM or so. The rather agitated ER doc related this scenario to me, desperate for advice: "I've got an elderly man with history of lung cancer, now presenting with dyspnea and wheezing after probably aspirating a beet. You know, the little red vegetables? Yeah, those. Anyway, he also had some EKG and lab abnormalities, and some chest pain. I just don't know what to order. I suppose he needs a CT pulmonary arteriogram, but I'm so afraid to give him any more radiation...."

Ummm, excuse me? The ER doc is afraid to give more radiation? The same ER department that just ordered about 30 CT's in the last four hours? The same ER that has no hesitation in ordering a CTPA-gram on teenagers? You're afraid to order a scan on someone whose already had a malignancy and is already on up there in years? You're AFRAID??

Clearly, we radiologists have shot ourselves in the foot on the issue of radiation. Because of a small number of scary articles (the latest now definitively states that we'll get meningiomata from dental radiographs), our ordering docs are now terrified of using radiation on those whom it will affect the least.

I've had the honor and privilege to participate in the most amazing technical miracle ever to happen to mankind. The diagnostic tools which we use daily, sometimes with some degree of nonchalance, are nothing short of magical wonders of the sort that could only be dreamt of not very long ago. Between CT, PET, MRI, SPECT, and the other members of our alphabet soup of toys, we can literally look inside the body without benefit of knives or getting our hands bloody. We can filet you open without filleting you open, and isolate abnormalities down to the molecular level (at least that's coming to a hospital near you soon). I could go on, but I might get emotional, and we can't have that. But when you think about it, what we do in Radiology is nothing short of amazing.

I've often said radiation is a lot like electricity. Use it carefully, and it's your friend. Stick your finger in the socket, and you'll get shocked. Proper use of our diagnostic tools saves lives. Improper use can cause trouble. Sadly, we've again got a disconnect between the truth and perception. Somehow, we've allowed the belief to flourish (or fester) that the next scan might cause a malignancy, even in the face of a more immediate threat. We need to do a better job of educating our clinicians. Somehow.

Set phasers to dumb....

By the way, the patient had a large piece of beet in the right lower lobe bronchus.

Attention Blog Spammers...

I've probably received about 100 comments posted to this blog over the years which are clearly Blog-Spam. They have little to no connection to the post they are supposedly commenting on, and usually advertise something else entirely. Many of them relate to medical software or websites that originate in India or elsewhere in the third world. There is a significant dump (as in defecation) from those wishing me to link to their less-than-illustrious blogs as well.

These blog-spammers are attempting to co-opt my readers and obtain free advertising. My personal opinion is that anyone who needs to resort to this sort of bottom-feeding activity knows full well that his/her product is an absolute piece of garbage, and won't sell to any but the least sophisticated out there. I'm assuming my audience would not appreciate being exposed to such filth.

My first instinct is to actually give these dirtballs what they want and publicize their sites, with the understanding that you, my intelligent readers, won't patronize them beyond perhaps sending a little note to their ISP's informing them of the behavior of their low-life clients. However, if only one of you actually does patronize the spammer's site, rather than electronically spit on them, they win, and we can't have that.

For the moment, these scum shall remain nameless, but if I should hear a great outcry, and promises from you that you will indeed ummm, inform the miscreants and their ISP's of the misdeeds, well, then, I might just be persuaded to publish a little list of the jerks in question.

As an aside, the VAST majority of SPAM e-mails I receive, something like 98%, comes from overseas, generally from Russia, Nigeria (I still get dozens of 419 scam emails per week), Ukraine, China, Korea, Romania (I started forwarding these to the Romanian Ministry of Communication, or the equivalent, and they stopped, or at least slowed), Poland, Portugal, Iran, Saudi Arabia, Israel, and many more. Clearly, the laws or at least the enforcement thereof outside the US is sadly deficient. I'm wondering if there is a way to completely block the receipt of any mail from foreign lands until the ISP's over there can get their act together. Frankly, I wonder if those ISP's are actually in cahoots with the spammers. As a matter of fact, the 419 scams are said to be the third-largest industry in Nigeria. I would think the world internet community would consider cutting that nation off of the 'net completely until they clean house. And newly-"capitalist" Russia seems to be the major source of this garbage these days. Remember, this isn't capitalism, it's unwanted refuse. I guess Mr. Putin has other things to do than monitor his nation's internet spew.

Anyway, I would advise human blog-spammers not to waste time on my blog. Those who use 'bots to troll other's blogs should consider reprogramming them to avoid this one. Or better yet, find a REAL job and stop trying to peddle crap. Or see if you can find Jack Kervorkian's instruction manual and follow it to the letter.

April 5 2063: Happy First Contact Day!

First Contact...Image courtesy of Startrek.com

Rather than restate everything, here is the official description from StarTrek.com:

It was – or will be – in the evening of this day in 2063 that the Vulcan survey spacecraft T’Plana-Hath landed in Bozeman, Montana, after following the warp signature of the Phoenix, a ship that represented the human race’s first successful attempt at achieving warp drive. Soon after, a robed Vulcan, offering the Vulcan salute, met Dr. Zefram Cochrane, pilot of the Phoenix and the inventor of warp drive. First Contact was now etched in history, and it paved the way for the formation of the United Federation of Planets.

While it’s true, of course, that First Contact and First Contact Day are fictional creations, they have been well developed across the Star Trek franchise. Anyone interested in the finer details should be sure to check out some of the following:The TOS episode “Metamorphosis” features Glenn Corbett as Cochrane. 

The TNG film First Contact, with James Cromwell playing Cochrane as a man with a penchant for booze and rock and roll, and the nickname “Z.” Cromwell later reprised the role, in a blink-and-you-miss-it cameo, in “Broken Bow,” the pilot episode of Star Trek: Enterprise.

The books First Contact (a novelization of the film), First Frontier, Starfleet Academy,Imzadi and Federation, as well as the TOScomic book, A Warp in Space.The Voyager episode “Homestead.” In it,Neelix and Naomi Wildman throw a party celebrating the 315th anniversary of First Contact Day. There’s a retro jukebox, lots of Cochrane’s favorite munchie (cheese pierogies), and the particularly amusing moment in which Tuvok very reluctantly raises his fingers in the Vulcan salute and intones the legendary phrase, “Live long and prosper.”

So, everybody, are you going to let your kids skip school? Will you stay home from work? After all, it is First Contact Day.

Displaying The Future: Project Glass

Google and Apple, two companies that didn't exist for much of my lifetime, are out to change the world and the way we interact with it. Today's post examines a new way of looking at our world, courtesy of Google, although I'm sure we'll hear about project iGlass from Apple one of these days...

Google's Project Glass follows the same philosophy I advocate for PACS:

We think technology should work for you—to be there when you need it and get out of your way when you don’t.

A group of us from Google[x] started Project Glass to build this kind of technology, one that helps you explore and share your world, putting you back in the moment. We’re sharing this information now because we want to start a conversation and learn from your valuable input. So we took a few design photos to show what this technology could look like and created a video to demonstrate what it might enable you to do.

The lead photo above shows what this mobile heads-up display might look like to those outside the Matrix.

The YouTube concept video is quite compelling...not only does Google envision the mating of the real to the virtual in this manner, they seem to think they can outdo Siri, and without the annoying metallic female voice to boot.  More power to them.

Naturally, the second thing I thought of was how this technology might be applied to PACS. The possibilities here are endless. How about displaying the pertinent anatomy to a surgeon who is knee-deep in someone's abdomen? Or maybe utilizing computer aided diagnosis (CAD) while reading studies. Or maybe reading studies without a monitor altogether. I wonder how many pixels this thing may ultimately manifest?

What's that? What was the first thing I thought of? Well...we all know what has driven most other technology over the years. Think Gutenberg and I Modi. Now you know why the young lady in the photo is so happy.


Hat tip to 23 Skidoo.

From the Gyn Oncologist:

Comment from the GynOnc whilst watching me make the PACS do something no one else understands: "You touch things I would never have even thought of..." Probably a complement from anyone in OB-Gyn.

Thank God For Big Brother...

The tears welled up in my eyes. A passing waiter noticed that my glass was empty and came back with the gin bottle.

I took up my glass and sniffed at it. The stuff grew not less but more horrible with every mouthful I drank. But it had become the element I swam in. It was my life, my death, and my resurrection. It was gin that sank me into stupor every night, and gin that revived me every morning. When I woke, seldom before eleven, with gummed-up eyelids and fiery mouth and a back that seemed to be broken, it would have been impossible even to rise from the horizontal if it had not been for the bottle and teacup placed beside the bed overnight. Through the midday hours I sat with glazed face, the bottle handy, listening to the television. From 3 to closing-time I was a fixture in the bar. No one cared what I did any longer, no alarm woke me, no television admonished me. Occasionally, perhaps twice a week, I went to a dusty, forgotten-looking office in the hospital and did a little work, or what was called work. I had been appointed to a sub-committee of a sub-committee which had sprouted from one of the innumerable IT committees dealing with minor difficulties that arose in determining Meaningful Use within the Affordable Care Act. We were engaged in producing something called an Interim Report, but what it was that they were reporting on I had never definitely found out. It was something to do with the question of whether commas should be placed inside brackets, or outside. There were four others on the committee, all of them persons similar to myself. There were days when we assembled and then promptly dispersed again, frankly admitting to one another that there was not really anything to be done. But there were other days when we settled down to our work almost eagerly, making a tremendous show of entering up our minutes and drafting long memoranda which were never finished - when the argument as to what we were supposedly arguing about grew extraordinarily involved and abstruse, with subtle haggling over definitions, enormous digressions, quarrels - threats, even, to appeal to higher authority. And then suddenly the life would go out of us and we would sit round the table looking at one another with extinct eyes, like ghosts fading at cock-crow.

The television was silent for a moment. I raised my head again. The bulletin! But no, they were merely changing the music. I pictured vote tallies behind my eyelids. The trends were a diagram: a red arrow tearing vertically southward, and a blue arrow rising rapidly. As though for reassurance I looked up at the imperturbable face in the portrait. Was it conceivable that the red arrow did not even exist ?

My interest flagged again. I drank another mouthful of gin. A shrill trumpet-call had pierced the air. It was the bulletin! Victory! It always meant victory when a trumpet-call preceded the news. A sort of electric drill ran through the bar. Even the waiters had started and pricked up their ears.

The trumpet-call had let loose an enormous volume of noise. Already an excited voice was gabbling from the television, but even as it started it was almost drowned by a roar of cheering from outside. The news had run round the streets like magic. I could hear just enough of what was issuing from the television to realize that it had all happened, as I had foreseen; a vast electoral surge, the blue arrow tearing across the tail of the red. Fragments of triumphant phrases pushed themselves through the din: "Vast strategic manoeuvre - perfect co-ordination - utter rout - half a million counties reporting - complete demoralization - control of the whole of the Electoral College - greatest victory in human history - victory, victory, victory!"

Under the table my feet made convulsive movements, and I felt a thrill going up my leg. I had not stirred from my seat, but in my mind I was running, swiftly running, I was with the crowds outside, cheering myself deaf. I looked up again at the portrait of Big Brother. The colossus that bestrode the world! The rock against which the hordes of Republicans dashed themselves in vain! I thought how ten minutes ago - yes, only ten minutes - there had still been equivocation in my heart as I wondered whether the news would be of victory or defeat. Ah, it was more than a right-wing party that had perished! Much had changed in me since those first days of the Administration, but the final, indispensable, healing change had never happened, until this moment.

The voice from the television was still pouring forth its tale of electoral booty and slaughter, but the shouting outside had died down a little. The waiters were turning back to their work. One of them approached with the gin bottle. I, sitting in my blissful dream, paid no attention as my glass was filled up. I was not running or cheering any longer. I was back in the hospital, with everything forgiven, my soul white as snow. I was walking down the white-tiled corridor, with the feeling of walking in sunlight, and an armed guard at my back. The long hoped-for bullet was entering my brain.

I gazed up at the enormous face. Four years it had taken me to learn the smirk of a smile. O cruel, needless misunderstanding ! O stubborn, self-willed exile from the loving breast ! Two gin-scented tears trickled down the sides of my nose. But it was all right, everything was all right, the struggle was finished. I had won the victory over myself. I loved Big Brother. Thank God for Big Brother.

But only for today...