Thursday, August 24, 2017

Flavors of DVI

I just completed (a rather long) Day 4 at Aga Khan Hospital, here in Dar es Salaam, Tanzania (in case you didn't know where I was). As usual, time flies when you're having fun, and I really am enjoying my time here.

Today was a day of many hats. In the morning, I played "real doctor" and attended an OB Gyn lecture series beamed over from the Aga Khan University Hospital in Nairobi. The full title was "Female Sexual Dysfunction and its Effects upon Fertility" and it was quite well done. While the lecture will have little impact upon my medical practice, I'm trying to get the staff used to me hanging around, and I had high hopes of amusing the residents with my tales of the wonders of Nuclear Medicine. Which didn't happen today. That will hopefully come tomorrow, when I give the "Introduction to Nuclear Medicine" talk. Maybe there will be a great turnout. They sometimes offer breakfast with the talks around here, and residents anywhere in the world will do anything for free food. 

The rest of the day I became everything from Nuclear Medicine junior technologist to junior Nuclear Medicine Staff to IT assistant. Raghu, the absolute genius running this department, had an onslaught of patients, as the Molybdenum/Technetium generator arrived yesterday from South Africa:

In many ways, this symbolizes the problems of Nuclear Medicine in a place like Tanzania...even something as simple (to us) as a Technetium generator must be shipped by air from South Africa, via Nairobi. And due to various regulations, it can take several days to arrive in country. This generator actually got here almost a day early. (I'm told of an incident wherein the guards at the airport wanted to disassemble a generator...the doc in charge said something like, "Go ahead, I'll be on my way to Zanzibar as fast as I can go.." 

Because of all this, Raghu must tightly schedule his patients for the days following delivery. He can hope to have some extra activity remaining for emergencies, and it is possible to get a dose here and there from the Cancer Center down the street. (Their cameras have been out of service this week, and Aga Khan hospital has stepped up to scan some of their patients.) I am constantly reminded of just how spoiled I really am back home. We NEVER have to wait on a generator, and something like a CCK shortage is an incredibly rare pain in the backside about which we whine incessantly. 

I was able to help with some of the clinical duties as well, taking histories, and even writing notes for the patients! I signed them all, "Visiting Nuclear Medicine Physician". I hope I don't get in trouble with any boards here. 

The Siemens Symbia SPECT (sadly not SPECT/CT) is a battleship of a camera, and Aga Khan Hospital is incredibly fortunate to have one. I'm a reluctant fan of the eSoft computer system, however, and at several points, Raghu and I struggled a bit to force the thing to do what we wanted it to do. Scaling of one image vs. another for subtraction of a parathyroid image should be easy, for example, but Siemens hides the key to activating the Scaling feature. So I put on my Engineer cap, and started clicking buttons until I found the right one.

Soft-tissue attenuation can be a problem in cardiac Nuclear Medicine. Now, I'm somewhat removed from this as the Cardiologists have stolen/taken over now read the MIBI perfusion scans. My newly minted Chief Tech back home reminded me before I came here that prone scanning would help here, and I suggested we try this with today's solitary MIBI patient. (There was a second, but he had to meet with government officials, and apparently my letter did not get him out of whatever it was he had to do.)

The Siemens eSoft interface is not incredibly intuitive for setting scan protocols (but the hardware is bullet-proof, so I give them a pass), and we had to resort to hand-drawn schematics to confirm to ourselves that when prone, the patient should be scanned from LPO to RAO, and that a 90-degree orbit of the two heads opposed at 90 degrees would yield 180 degrees of coverage. The things I do for my patients...

The rest of the day was consumed with monitors and their connections to Ultrasound scanners. While the Radiology Department is about to go completely digital with Agfa PACS (don't say anything), moving off the venerable Clear Canvas (which actually works quite well here), the U/S scanners do NOT have DICOM licenses. This is a sad situation I faced in Ghana. It seems that over here, the vendors charge EXTRA for DICOM. Not nice, folks. Not nice at all. So the three U/S machines here aren't connected to anything except printers. Now supposedly there will be funds allocated to get the DICOM running once full PACS is here, but in the meantime, there is the desire to view the images in real-time. Which means looking at the monitor. Originally, the thought was to purchase a large monitor and a KVM switch to multiplex the inputs from the three scanners into one station. But by the time I got here, the idea had gelled a bit and the Chairman realized that three small monitors cost less than one big one and a multiport, multi connection KVM. So I spent a good bit of time with one of the guys from IT, connecting a monitor to the various scanners. One scanner, fortunately in the room right next to the reading room, has only a DVI output. The other two have VGA. So it now becomes a matter of figuring out how to string cables to connect the various rooms. That one is above my pay-grade at the moment.

We did discover whilst trying various DVI cables in various sockets that there are two main (actually more) versions of DVI, DVI-I and DVI-D. (And DVI-A, but that's beyond our scope)...

DVI-I has extra pins not found with DVI-D, and so a male DVI-I plug won't fit in a female DVI-D socket. Sounds like some dysfunction to me after the morning lecture. But the good news is that we now know what cables we need, and the only remaining question is how to run them.

But here's a question for the audience...the hospital would like to be able to transmit studies outside the hospital, say a NM study to me or the NM doc down the road, or an MRI perhaps to my place back home. HOW do we go about this? Keep in mind, WAN bandwidth is limited.  A signed DoctorDalai business card to the person with the best answer.

And all that solved, I shall now have some dinner, finish my packing for my quick trip to Ngorongoro Crater tomorrow, and turn in early to be ready for my early morning talk.


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