Spam, Spam, Spam, Spam...Lovely Spam, Wonderful E-mail and Telemarketing Spam...

We've all likely had about a hundred calls from "Rachel" at "Cardholder Services". This telemarketing-robocalling scam has been around for years. Several of the vermin perpetrating this garbage were shut down, but others have taken up the call, so to speak, and "Rachel" lives on. Apparently there are quite a few idiots out there who will give out their credit card number to the piece of excrement cold-calling their phone. There is indeed a sucker born every minute.

I've reported every instance to the FTC

https://complaints.donotcall.gov/complaint/complaintcheck.aspx

and of course all of my phones are listed with the Do Not Call Registry. Sadly, there is one little problem: Criminals don't seem to care about breaking the law by robocalling, nor do they seem inclined to take the time to see if my number is on the DNC or not. The cads.

Robocalls are a subset of the wider universe of criminal behavior taking place on our communication wires and airwaves. In this cesspool, I include robocalls, junk faxes, spam emails, hacking of banks, stores, and other financial operations even including the treasury of my own state. The miscreants range from lone, bored teenagers creating crude phishing emails from "Bank of Amerika" to boiler room operations here and abroad, to massive hack attacks on our financial infrastructure. The scariest endpoint is having one of these rogue operations take control of a power plant, which is at least theoretically possible via the 'net; I don't want to think about the consequences of that one.

The question we are all asking is this: Why isn't someone doing something about it!!??

Someone is, but the effort isn't even close to adequate. Both in government and industry, experts are trying to keep ahead of the criminals. The technology of our networks themselves makes it possible to cover one's tracks to the point of being invisible to law enforcement. Thus, hackers, telemarketers, and other thieves can ply their trade without fear of discovery. There is even a "dark internet" hidden from those who don't know how to access it, where what happens on the internet stays out of sight. Supposedly one can buy weapons, drugs, and other stuff you don't find at Amazon.com. Perhaps most importantly, the politics of the situation perpetuates it. Many, if not most, of the major internet hacks come from China, and are most likely government-sponsored. Ditto for Russia. There are telemarketing sweatshops in India that call via leased VOIP lines here in the US, and show up as spoofed (faked) numbers on your caller ID.

I'm particularly upset today over a message from the "IRS", informing us that we owe $4,785 dollars and are in violation of some statue or other. Calling the number in the message (generally a bad thing to do) connected us to a boiler-room operation staffed by people with a very clear Indian accent. No racist connotations here, children, but that's the accent they had. They keyed their scam by telephone number, and were quite confused when I gave them the direct line to the real IRS. More on them in a moment.

It is a sad state of affairs that criminals have access to more and better technology than their victims and our protectors.

There are a few common threads here. First and foremost, this garbage is all perpetrated by criminals, hoping to separate the suckers from their money. And because their marks are either stupid, greedy, or both, many of them actually respond, thinking they are getting something they are not entitled to have, such as Viagra without a prescription, their share of a Nigerian prince's ill-gotten oil money, a no-interest credit card, and so on. Fear of the IRS is a corollary which can get the weasels in your electronic door as well. Caveat emptor, as always.

I'm not a Big-Government supporter by any means, but this is an issue where our leaders have failed us. Yes, some of the criminals have been caught, but many more jump in to take their place, and most of these newer and nastier vermin are located overseas, immune from prosecution. Add to that, the carriers themselves, phone and broadband alike, are either too overwhelmed to do anything about this inundation, or are simply satisfied to receive the fees from the bottom-feeders or those who resell the service to them.

The Internet is supposedly an international operation, and "solutions" such as isolating Russia or China, or Nigeria from US traffic would hurt more people than it would help. (Well, OK, maybe cutting off Nigeria wouldn't be a tragedy, but I digress.) Still, I DO think there should be sanctions based on the criminal traffic coming from a particular nation.

So, we come back around to what we peons can do about all this. We can try to recruit our Congressmen to get to work on this issue. Ultimately, that is how we will have to fix the problem. In this case, it takes a government to stop the juggernaut. In the meantime, the only thing left for us victims to do is to report, report, and report. Sign up for the Do Not Call Registry, and tattle on anyone who violates it. Forward spam emails (with headers) to a service like SpamCop, which will find and notify the ISP involved. Get the telemarketer's phone number from Caller ID, and trace it down, using Google to start. In other words, Fight Back!

I did track the phone number from the IRS (Indian Robbing Scoundrels) to its VOIP provider, and that particular number was shut down. I'm sure, however, that the Banglore Bad Guys were able to crank up another US number within a few moments maximum. Just like smashing a cockroach; a dozen skitter out to take its place.

Perhaps the saddest commentary is from the IRS (the real one) itself. Its website has a link for reporting scams such as the one attempted on us. The first question:  "How much did you give the scammer?" There's a sucker born every minute, I guess, and criminals are very adept at finding them.

Yosemite Slam

Yosemite Sam, character copyright Warner Brothers Studios, image courtesy of  dailyinspires.com

I've been a lover of Apple products from almost the beginning. My very second computer was a Mac Plus with a whopping one MEG (yes MEGABYTE) of RAM. (My first computer was a TI 99 that didn't do much but hey, it was a computer!) I've since owned or been responsible for the purchase of well over one hundred Apple Macs, not to mention an equal number of iPhones and iPads, half a dozen or so iPods, and even a Newton. I keep hoping for Apple to get into the PACS/EMR game, as their approach to an interface would hopefully provide us with the usability and friendliness so sadly and sorely lacking in the current offerings.

While some might accuse me of being an Apple fanboy, and willing to swallow anything and everything they deliver, I must go public with a huge complaint.

My brand-new Macbook Pro Retina came with MacOSX 10.10, code named Yosemite, after the park and not Sam. It has not quite been trouble-free. In particular, it is affected by some WiFi bug that causes a random disconnect on the average of every five minutes or so. When this happens, one has to turn WiFi off and then on again, and this usually resets the problem.  I will anticipate doing this about 5 or 6 times while writing this piece.

This issue has now been reported thousands of times on multiple threads on the Apple Support Community bulletin board. Apple has released a few updates and we are now on 10.10.2, but still no WiFi joy. If you google the issue, you will find thousands of additional reports.

There have been other Apple issues of this magnitude over the years, such as the infamous iPhone 4 antenna glitch, wherein touching the metal band surrounding the phone which WAS the antenna shorted it out and limited the range of the internal radios. It didn't take Apple too long to fix this, mainly by giving away bumper cases (large rubber bands) that insulated the antenna from the user's grubby, moist paws.

The WiFi debacle, however, has not merited a response from Apple, nor will you see much mentioned about it in the mainstream Mac Media (MacLife, etc.) which depend on Apple's goodwill for their livelihood. For some reason Apple has chosen to neither acknowledge or fix this issue, and some others associated with Yosemite. The consensus is that Apple shoved 10.10 out the door too quickly, perhaps trying to keep things current with the last hardware release. All I know is that the WiFi reception, which is rather critical in a laptop, sucks, and it isn't getting fixed. The crowd posting on the Community board has offered numerous solutions, erase this, redo that, go into the guts of the OS and tweak thus-and-so...and none of them work for any period of time.

Frankly, I've had some intermittent WiFi problems with various Macs and iPads over the years that I haven't been able to document, but task me none the less. I'm convinced, for example, that my wife's original Macbook Air disrupted other user's WiFi, but I could never get that to happen consistently. Given the fact that the WiFi protocols are out there to be matched by the folks that make the routers and receivers, there really shouldn't be a problem, right?

But there is. It has been said that President Obama chose Joe Biden to be his Vice President as an insurance policy: no one would even consider impeaching Mr. Obama because we would then be left with Biden as Commander in Chief. (Excuse me while I wait for the nausea to pass.)  Similarly, Apple knows quite well that Microsoft is its insurance policy. Having Windoze 8.1 installed via Bootcamp on my same Macbook Retina, I can tell you it is absolutely horrid to use, having been written more for their Surface tablet (which I'm told is also a dog) and not for a run-of-the-mill keyboard/mouse setup. It is splashy and colorful, and full of features that do nothing but get in the way of actually using it. For me, and most Mac aficionados, switching completely to WinBlows is a complete last-ditch resort, which won't happen unless MacOSX reaches the point of total shut-down.

Still, Apple, and CEO Tim Cook, need to realize that they are testing the patience of their users, especially those of us who use these (formerly) wonderful machines for mission-critical and even life-saving applications. Sooner or later, someone will step into the void you are creating with your indifference toward a really serious problem.

Fix this. Now. Please. Next time, I won't say "Please".

An Hour and Thirty-Five Seconds With George W. Bush

It's a hard life, but someone has to do it.

I'm writing from frigid Chicago, where the air temperature is something around 20 degrees, and the wind chill is 50 below numbness. I'm here for the 100th Anniversary Edition of RSNA, and one must brave adverse conditions to attend so momentous an occasion.

If you are reading my illustrious blog, you must have some connection to radiology, and thus you've probably attended RSNA at least once. If so, you know that the most important part of the whole meeting is the parties that come after hours. In years past, the big vendors have put on some really incredible soirees, with open bars and buffets overflowing with prime rib and other expensive delicacies. 

Then came the economic bust, and the parties became fewer and further between.  But this year, there seem to be a few more than I've seen recently. In fact, I received about four invitations for tonight alone. Fortunately, the decision as to which to attend was quite easy. Zotec, our billing company, delivered the most incredible RSNA experience I've ever, well, experienced: An evening with former President George W. Bush in the Grand Ballroom of the Trump Hotel. 

Zotec is apparently doing quite well; the teaser on the video screens behind the homey staging with two armchairs touted the processing of $1 Billion in charges. I'm not sure what the average percentage of their fees might be, but if we assume even a low 7%, the Law Brothers who run the company are raking in $70M. Not too shabby in this day and age. 

Anyway, as a very good Zotec customer, Mrs. Dalai and I, as well as one of my former partners/new bosses were invited not only to the event, but to a photo-op with Mr. Bush as well. We arrived early, donned our wrist-bands, and queued up for our few seconds with the Man. We were most amused by the Secret Service agents with somewhat ill-fitting suits and earphones scoping out the crowd of mostly older docs and their wives. 

When our turn for the photo came, the President turned and greeted us, and put his arm around Mrs. Dalai and I, and we all smiled for the camera. (I'll post it when it arrives in the mail.) In the process, I said, "Mr. President, we miss you dearly," to which he chuckled, and Mrs. Dalai followed up with "Can we get you back?" W chuckled again and shook his head. "I'd be going back alone!" To which we responded, "You would still have a lot of support." We said our goodbyes, and proceeded on to the Trump Grand Ballroom (which wasn't all that large...someone needs to be fired) where the armchair talk shortly commenced.  

The format was informal, with Scott Law, Zotec CEO, sitting adjacent to the President on the stage. Mr. Law would ask a question, and Mr. Bush would answer, to enthusiastic applause. I won't try to reproduce the conversation, but several observations are in order. First and foremost, W is a witty, humble, and eloquent (yes, I said eloquent!) speaker. Over the course of the hour, we laughed and (almost) cried with him. We were taken to the heart of the Oval Office, Ground Zero, and the classroom in Florida where Mr. Bush was informed of the 9/11 attacks. In all of these scenarios, Mr. Bush conveyed a sense of duty to his country, humility in face of unimaginable responsibility, and fierce devotion to the defense of the nation he led for eight years. His goal after hearing of the airliners hitting the World Trade Center buildings and the Pentagon, was personified as the protection of the little girl who was reading a story to him that fateful morning. 

Having heard President Clinton speak at RSNA a few years back, I was struck by the huge discrepancy in the perception versus the reality of both men. Mr. Clinton, whom some think the greatest President ever, spoke in a disjointed manner, and spent much of the talk tooting his own horn about how much he had been doing for the poor in Third-World nations, and chastising us rich doctors to help. Mr. Bush, on the other hand, was witty, humble when the moment called for it, and proud when appropriate. And he spoke very clearly, very articulately, and again, eloquently. Those who have developed a visceral hatred of the man won't want to hear it, but W may well have been the most honest, loyal, and capable man to occupy the office in a very, very long time. He was labeled a "cowboy" and "stupid" by a media and a Leftist bunch that couldn't stand the fact that he didn't act like their vision of a Harvard-trained leader (he did receive an MBA from the Harvard Business School). For your information, President Bush used the word "strategy" about a dozen times, and he pronounced it properly. 

I thank Zotec for giving us the opportunity to see how someone with character behaves when given the greatest and hardest task known, in contrast to what we have seen on the news daily for the past several years. I am humbled and honored to have been in the presence of a truly great man. 

And I should also thank Zotec for doing a damn good job with our billing!

Meeting With The PACS Giants And Other RSNA Tales

There is a touch of melancholy for me here at RSNA 2014 to go with the 20 degree nip in the air. I'm not one to dwell much on the deep meanings of beginings and endings, but while strolling the exhibits today, I realized that I've been attending this monster of a convention on and off since I was a Nuclear Medicine Fellow in 1990. And it occurs to me that since I'm now semi-retired, it is possible that I won't return next year. But we'll see how that goes.

One of the joys of RSNA, and my fame, or at least notariety in the field, is the chance to meet up with those far more promienent in the field than I. Hence the title of this piece. I had the wonderful opportunity to share a cappuchino with two giants of PACS, Mike Cannavo and Dr. David Clunie. Mike I've known for years, but I had only communicated via email and AuntMinnie forums with David. I was very fortunate to get both of them together on the same couch for a few moments today. These two gentlemen have been involved in the business since before anyone could even spell PACS. They both have an amazing level of knowledge, not to mention various documentation, of those early days, and I'm urging them to collaborate on a book.  Maybe I would qualify for a footnote...

I am occasionally accosted, I mean greeted, by some of my loyal readers. In fact, when I stopped at one booth to say hello, a friend who was mentioned in an earlier post and was apparently embarassed by the fact that it proves he's one of my readers spotted me and exclaimed, "It's the Dalai! Shall I kiss your ring? Shall I kiss your ass?" To which I replied, "Not unless someone gets it on camera!"

Today was my informatics day, and I heard some talks about portable platforms, and SOA's, and image sharing. SOA's, aka Service Oriented Architecture, as presented by Dr. Paul Chang  are fascinating constructs with huge potential. Dr. Chang showed an example from U of C wherein the SOA determines if the patient has appropriate labs ordered, and if not, it initiates the order to acquire them. So much for us humans.

I also stopped by a booth or two.  (This is starting to sound like a third-grader's rendition of his trip to Disney World, but for me, that's quite appropriate.)

In my feeble-minded semi-retired state, I've decided not to continue my practice of posting every last little detail about demos and things. You really have to get your own hands on the software (well, the keyboard and mouse, but you know what I mean) to determine if something will work for you or not.  I do pride myself on attempting to wear multiple hats when I evaluate a program, which I think is the key to my success as my group's CTO as well as the premier radiologist PACS blogger (still the only one, but I'll take it).  I'd like to think I can make any commercial PACS client work; that's my ex-engineer hat in action. But I think I'm reasonably good as well at figuring out if something will work for my least-technically-savvy former partner, the one who calls from airplanes wanting to know how to adjust the volume on his laptop. So, in my new, lazier, partially-retired personna, I'm just going to sketch out the very basics and leave the picayune details for another time.

Here we go. I stopped at TeraRecon, and had a look at their latest offering, deconstructed PACS, which basically utilizes TR as a PACS overlay, uniting data from multiple data silos (coming from the Midwest I'm not used to anything other than corn and grain being stored in silos) and adding in the magic of advanced processing for a sort of super enterprise PACS.  From what I could see, there are still a few details to be worked out before the ssytem will work as I would want it to, but the TR folks are on their way. Ultimately, the overlay will require the ability to check for priors in all the silos (which they seem to have almost mastered) and be able to talk back and forth to the underlying PACS to manage workflow, which seems to be on its way. I was most amused and honored to be treated with equal deference to the chairman of a very well-known radiology department who was there at the time. The chairman had actually heard my Laws of PACS talk a while back, and urged me to keep up the good fight. And so I shall.

To be scrupulously fair, Visage has a similar approach to overlying PACS with an advanced imaging platform, but I ran out of time before I could see their latest. Apologies to Sam and Brad. I'll look at it ASAP. ***

I should break off into a separate post, but the following entry will be fairly short.

About three weeks ago, Agfa placed a test version of IMPAX 7 Agility PACS in our reading room, and I was able to have a few hours of playtime with it. I had promised not to report anything until talking with the important people at Agfa, and I usually honor my promises.  As a followup to the home test, I met with some Very important people in a spartan back room of the lavish Agfa booth. You would think that Agfa would not be happy with me, given the rather brutal treatment I've given them over the years. You would be wrong. Agfa has always been gracious in accepting my acerbic criticism and improving where possible. Agility is no exception, save the fact that I didn't really have to criticize as much as usual. Gone (FINALLY) is the tool-toggling I've whined about for years.  Available (FINALLY) is workable user-level hanging protocol creation. And so on. I had some complaints/observations about the way the latter worked, and some of my ideas had already been incorporated between my two recent exposures, and others hopefully will appear soon. There is very tight integration with the "top three" vendors of things like advanced processing and nuclear medicine. For example, my Segami Oasis will come up within the PACS viewport as if it were part of the PACS itself. For better or worse, the port basically reverts to the incoming programing, mouse-controls and all. Could there be a more unified approach to this? I'll have to play some more. Agfa has utilized hot-spots on the image for common controls like window-level, an approach I'm not fond of, for what that's worth.

Agility is considerably different than IMPAX 6 (once code-named Odyssey). It is a worthy successor, and frankly is somewhat more mainstream in operation and appearance than 6. When asked how I would grade it, I said that with the current improvements, I would give it a B+/A-. It has a way to go, but it does represent a significant step in the right direction.

As always, more to come!

*** ADDENDUM!!

I wandered by the Visage booth on my way back to the educational sessions from my $20 mediocre lunch, and I stopped to see my good friend Brad. Given the 10 minutes I could spare, he and the apps folks managed to give me a quick but thorough view of the latest version. It is impressive, all the more so to realize that the system operates with server-side rendering. This allows platform neutrality (it will run on my Mac, iPad, etc.) and really rapid loading of huge datasets since they don't actually go anywhere. Visage has outfitted a Very large healthcare operation with its version of a Deconstructed PACS, operated from a single main server (of course with failover backup) and six rendering servers. Brad tells me this configuration can handle tens of millions of images and hundreds of simultaneous users and still be at only 20% of its capacity. 

Visage has some very nice features such as a lesion marking function that gives volumetric information as well as orthoganal dimensions, nice for RECIST reporting. In its PACS implementation, Visage can dive into silos and match exams, and has a better hanging protocol than a new PACS version I've examined recently. It can handle all modalities, and even can produce MIPS from breast tomosynthesis, something I haven't seen before, altough it won't make me want to start back reading mammograms.  There is of course very powerful advanced imaging as well. 

I do have to point out two deficiencies, which Brad tells me nicely are only problematic for old, senile vacuum-tube loving knuckle draggers like myself (OK, he didn't say it that way, but I don't want you to think I have any sort of elevated opinion of myself). First, the level of automation of things like coronary vessel segmentation is limited. Visage's philosophy is that automated detection is not perfect, and the human eye may better detect a more aberrant vessel path. That's probably true, but I do like the joy of one button operation. (Anyone remember the line from the Lost in Space Movie where Major West launches the Jupiter 2 by saying "...And the monkey flips the switch...")

Secondly, this deconstructed PACS is designed to be driven by an EMR/EHR, speech recognition, RIS, etc. What Visage has declined to provide, and Brad says I don't need, is a worklist! Here we disagree. I come from a PACS driven workflow shop, and I like it that way. Apparently there are third parties who can provide a worklist, but I still think Visage should write their own. I'll be glad to help. 

And to my friends at Merge, please don't worry about the omission of your booth. I walked by a few times and you have all been very busy, hopefully with paying customers. I promise to review the updated PACS and other offerings online with you at a later date. Two days at RSNA is just not enough!!