Sunday, August 30, 2009

Dual-Screen Laptop? reports on the new GScreen Spacebook, a laptop with a little something extra:

The Alaska based company, started by Gordon Stewart (yep, that is where the G in gScreen comes from), is aiming its dual screen laptops at professional designers, filmmakers, photographers and really anyone who can't live without a dual screen for everyday productivity. They have also been in talks with the military. The chassis (which we expect is at least 12 pounds) is built around the 15.4 inch screen (though the first units that come to market will have 16-inch or 17-inch screens) and its twin, identically sized screen slides out from behind the first using a uniquely designed sliding mechanism.

"We designed this knowing that many may not need the extra screen at all times," Gordon told me. But when you do use both screens you'll get about 30-inches of screen space. GScreen plans to release dual 13-inch models at some point.

At 12 pounds, I think we're in the realm of "luggable" rather than "laptop". But still, this certainly delivers a far more satisfying, workstation-like experience in a (more-or-less) portable package. The first model is expected out at the end of the year, and should cost about $3K. Here is the detail of the sliding screen configuration:

Here are the current advertised specs:

- 2 LED backlit display screens

- Windows VISTA/ WIN XP PRO (optional)

- Intel Core 2 Duo P8400 2.26-GHz

- 4 GB of RAM (2GB DDR2 SO-DIMM x 2)

- 320GB 7200-rpm HD

- NVIDIA® GeForce® 9800M GT with 512MB dedicated memory (or) - NVIDIA® Quadro FX 1700M Graphics with 512MB dedicated memory

- 9-cell battery

For those with lower budgets and weaker backs, the Lenovo W700ds (dual screen, duh...) might fill the bill:

Here it is in use:

The 10" secondary screen would be perfect for a worklist display (or an SR screen for those unlucky enough to be forced to use such. Personally, I would have liked the option to have the extra screen on the left instead of the right, but I guess you can't have everything. Still, with the main screen a huge 17", and a sale price of $2,300, this is a pretty good deal, with much if not most of the functionality of the Spacebook. And, Lenovo has a much longer history in the business.

I guess a three-screen and a four-screen laptop can't be too far behind.

Doctor Dalai's Something Blog?

Anonymous, from Sydney, writes:

Sam, I'm glad you feel so compelled to discuss your thoughts about the Healthcare bill on your blog. But perhaps you should rename your blog to something else. "Dalai's PACS Blog" certainly doesn't fit with the most recent line of discussion.

I am an avid reader of your blog due to your excellent, humorous and well justified commentary on using PACS in your day to day life. Not to be-little the topic of socialisation of the US Healthcare system but being Australian, I don't really care at all about it and am missing the daily quips, opinion and other related material based around PACS.

No Offence intended - and of course its your blog and you can right about what ever you like, but as a reader I can express only what I would hope to continue seeing on your blog.

No offense taken, Mr./Ms. A., and I do take your comments to heart. I am thrilled like you wouldn't believe that someone actually reads the stuff I write, and I'll strive to provide what you actually want to see. More about that in a moment.

My browser displays the last eight posts of this blog. Of those, five relate to PACS, and three discuss the health care bill or something related to it. (I'm rather proud of my Harry Plotter satire, by the way, and you do see how it fits in with the health care theme.) That's not such a bad ratio, now is it? I've never had the inspiration, intelligence, creativity, gumption, or time to blog daily, and Mrs. Dalai would not be pleased if I did so anyway. I have many more important duties around the house, you see.

I have to agree with my Australian friend to some extent, as I do want to have more PACS content. I've had some trouble finding stuff that you might find interesting, however. Maybe I'm not looking hard enough, or maybe PACS is in the doldrums over here. I can tell you that the exhibit floor at SIIM was fairly lean in vendors and VERY short on customers. Those who hold the pens that write the checks are quite skittish about the future of healthcare in the States, as am I. That might explain the slowdown of PACS news, at least to some degree.

I'm not sure I can adquately convey the sense of frustration I feel about what is happening in Washington, D.C. The blog is really the only way I have to vent that might actually reach a few people. Based on the comments to the more controversial posts, I have definately made contact, both positively and negatively. I'm going to keep on doing so, and I would urge those who aren't interested in that facet of my existence to please stay tuned for the next entry (or maybe the one after that.)

As for PACS, I am going to emulate my more esteemed colleague, Tim from HISTalk, and ask you to send me (anonymously, of course) tips, rumours, innuendos, questions, observations, etc. I'll do my best to follow up on these and publish those that might be amusing or educational to my highly-intelligent audience. Just use the comment field below, and thanks in advance.

For the time being, the title will remain, "Dalai's PACS Blog," as that is still my main theme. "Dalai's Miscellaneous Blog" or "Dalai's Bullsh*t Blog" just doesn't have the same ring to it.

My Australian friend notes that the American health care system holds no interest to him/her. I, however, would like to learn more about the Australian system, which seems to be a decent blend of private and public operations. Rumour has it that I might just show up at the RAZNCR meeting in Brisbane this fall, and if so, I might get the chance to be educated on the Aussie version of healthcare.

G'day to those down under (and up over?) in the meantime. . .

Wednesday, August 26, 2009

Harry Plotter and the Socialist Stoned

Harry Plotter looked about at his friends, Herownmoney Grandeur and Robbed Easily as they rode the Porkwarts Express back to school.

"My scar is tingling something awful," moaned Harry, rubbing the site of his attempted craniotomy.

"Harry, does that mean He Who Must Not Be Slurred is nearby?" asked Herownmoney.

"You mean Valdobama?"

"Oi, don't say it out loud!" cried Robbed.

"Sorry. Yeah, he's around here somewhere, he and his Tax-Eaters."

"What do they want, Harry?"

"Very simple, Herownmoney. They want control over the entire country. They can't stand the magic of self-reliance and capitalism. They want to turn us into the Socialist Stoned, zombies that rely on them for everything, especially our health care. You know what they say. . .'If we control your health care, we control your life!' "

Just then, the train arrived at the gates to Porkwarts, the secret school of governmental financial witchcraft. As Harry, Robbed, and Herownmoney approached the platform, Drecko Pelosifoy shoved them out of the way, and ran toward the castle, seeking out other Sliberalins like himself.

"Ha!" he shouted over his shoulder. "This year is OUR year! You Cashandmore Capitalists don't stand a chance! We Tax-Eaters are going to turn you all into Socialist Stoned!"

"Just ignore him," Herownmoney muttered. They raced up the hill, and soon entered their wing of the castle, bounding up the stairs to the dormatories of the House of Cashandmore.

At dinner that night, the Headmaster of Porkwarts, Ronbus Reagandore, addressed the students. "These are dark times. The Tax Eaters and He Who Must Not Be Slurred believe they have the upper hand. The majority of the populace has been swayed to their way of thinking, believing the promises of free health care and redistribution of magic." There were hoots and catcalls from the Sliberalin table, but Reagandore ignored them. "You must be strong," he continued, "since our adversaries are powerful indeed. Watch yourselves, lest you be tempted to indulge in the Dark Deficit Arts."

The weeks and months passed uneventfully, though a sense of trepidation hung over Porkwarts. The students all knew the Final Battle would soon be upon them, and many were making side-wagers as to the time of Harry Plotter's likely death. But others were quietly gathering in protest of the inevitable takeover, chanting various economic incantations and working hard in their Alchemy classes to create more gold to stash away for a rainy day.

It happened on a bright, sunny morning in late May. Harry, Herownmoney, and Robbed were headed toward their least-favorite class, Crisis Management with Professor Rahm Snapemanual, their heads bowed in anticipation of another tongue-lashing about their selfish, greedy attitudes.

Suddenly, right in the corridor, there appeared none other than Valdobama himself, surrounded by Tax-Eaters wearing black suits and narrow, unfashionable ties.

"Give it up, Harry!" howled Valdobama. "You have to share the wealth, you know, spread it around! Change is good! Give me all of yours! Yes you can!"

Harry quickly dropped his books, and plucked his magic HP 12C financial calculator from his Brooks Brothers robe. "Hey, Valdobama!" he cried, "did you know your plans will take more magic than has been used in the entire history of the world? We will be paying for you for the next thirty-nine thousand years!"

The Tax-Eaters snickered, brandishing black briefcases as shields. Valdobama simply laughed. "Harry, Harry, Harry. Do you think I really care about costs? Foolish little boy! This isn't the chocolate-covered bat-wing concession stand at the Quidditch match, kid, this is the real world! Now join me and together we will rule over all of the sheeple, I mean we will stand with our brothers and create equality!"

"Join you? NEVER!" shouted Harry.

"We almost had you when you were a little baby," chortled Valdobama. That scar on your head. . . all I wanted to do was remove your frontal lobes, but NOOOOOOOO. . .your dear mommy and daddy wanted you to be able to think for yourself. How droll. How middle-class. Why would they want that when we can do it for you? You see where their resistance got them. . .Audited!" Valdobama threw back his head and laughed haughtily.

Harry screamed in rage, and hurled the calculator at Valdobama's head. It caught the still-burbling figure-head straight between the eyes, and lodged somewhere near his corpus callosum. He crumpled to the ground like a marionette with severed strings. The Tax-Eaters looked at each other, quickly shed their black jackets and briefcases, and ran off into the woods, where they debated tax codes until they all died of boredom. Drecko Pelosifoy was seen picking the pockets of the corpses for several weeks after the massacre.

The students and staff of Porkwarts gathered about Harry, and Robbed and Herownmoney escorted him to Professor Reagandore's office. Harry walked in and shut the door, then sat down to face the great wizard across his disheveled desk.

"Well, Harry," Reagandore began, "there you go again." You have defeated Valdobama one last time. Congratulations, my boy."

"Thank you, Sir," Harry demurred, with his head bowed. He looked up at his mentor. "Sir, how did I do it? I'm just one guy. . ."

"Ah, Harry, you mustn't underestimate the power of individual responsibility. You stood up and fought, instead of letting your personality fade into the Socialist Stoned. Valdobama had no way of protecting himself from that. You see, Harry, individuality is what the he and the Tax-Eaters feared most." Reagandore scratched the orange hair on his massive pate. "With the magic of capitalism, one person can excel, can magically create wealth, and opportunity for himself and others. The Socialist Stoned simply sat around, contemplating their navels, waiting for Valdobama to deliver them their daily pittance. But thanks to you, Harry, that's over now. So, let's celebrate! Tax cuts for all!"

Harry gratefully shook Reagandore's hand, and then ran out to join Herownmoney and Robbed. They hugged and then then laughed with relief and joy. They knew their future would now hold great promise. . .

But, a thousand miles away, in a dark, dank bunker, the last of the Tax-Eaters, Scabbers Biden and Narcissistica Clinton were holed up, plotting the revenge of the Socialist Stoned. . .

Please stay tuned for the next volume in the Harry Plotter saga, "Harry Plotter and the Chamber-Pot of Secrets."

For Those Who Think Britain's NHS Is The Answer. . .

From an article in the UK's Daily Mail today:

Thousands of women are having to give birth outside maternity wards because of a lack of midwives and hospital beds.

The lives of mothers and babies are being put at risk as births in locations ranging from lifts to toilets - even a caravan - went up 15 per cent last year to almost 4,000.
Health chiefs admit a lack of maternity beds is partly to blame for the crisis, with hundreds of women in labour being turned away from hospitals because they are full.

Latest figures show that over the past two years there were at least:

  • 63 births in ambulances and 608 in transit to hospitals;
  • 117 births in A&E departments, four in minor injury units and two in medical assessment areas;
  • 115 births on other hospital wards and 36 in other unspecified areas including corridors;
  • 399 in parts of maternity units other than labour beds, including postnatal and antenatal wards and reception areas.
Yup. Socialized medicine at its finest. I would certainly urge those who believe in this failed program to head over to England have their babies. Show us how it's done, blokes.

Sunday, August 23, 2009

Doctor Dalai's Do-It-Yourself Healthcare Plan

"Free people can treat each other justly, but they can't make life fair. To get rid of the unfairness among individuals, you have to exercise power over them. The more fairness you want, the more power you need. Thus, all dreams of fairness become dreams of tyranny in the end."

Andrew Klavan

"If the government controls your health care, it controls your LIFE."

Doctor Dalai

I'm clearly not a fan of the healthcare bill being rammed through Congress. I think it is a thinly-veiled attempt to take over a significant chunk of the US economy, one that is critical to our very health and our lives in general. This is being done in the name of "insuring the embarrasing 47 million uninsured" or "trimming our horrible healthcare costs" or some similar, high-minded excuse.

What it truly hopes to accomplish, and I am totally convinced of this, is to send us down the path toward a European-style Socialist government, with more and more citizens dependent upon the State. This is the sort of thing those on the Left drool over, although they become angry and indignant when you point it out. If you troll on liberal blogs and websites, the main topic these days is how important it is to have a single payer Government system, like Canada or England or Australia, or Denmark, or. . . The proponents cite statistics showing better outcomes in various metrics with such a system, the detractors cite other stats showing worse results. I'm finding the data hard to reconcile, but I think it is obvious that such plans have much longer waiting times for just about everything, the level of care is no better, and often worse, and the cost in terms of taxation is horrendous.

An interesting aside about cost. In many articles about the British National Health Service (NHS), expat Americans go on and on about how there is no bill presented to them. The implication is that they see the care as "free," totally ignoring the huge amount of tax revenue that supports the system. I wonder if we Americans are the only people who anxiously await our income-tax refund check, thinking of it as free money from the government, and not wanting to realize that it is simply our own money that was loaned to Uncle Sam at no interest whatsoever.

I do not believe in complete governmental withdrawl from our lives. The government exists to regulate, but it does NOT exist to provide. I do not agree with a complete laissez-faire approach, nor do I think the goverment should be involved much beyond guiding people to do what they are supposed to do. The Bernie Madoff scandal shows us that letting the free-market run without control will lead to the greedy and unscrupulous taking advantage of the, well, greedy, as well as the innocents. Alan Greenspan, the supposed genius of the Fed, couldn't grasp this simple premise that any five-year-old understands from playground interactions. But, the recent home-loan bubble tells us nicely what happens when the government dictates who should be allowed to have what, and the subsequent crash again demonstrates what happens when regulations are inadequate. I guess I neither a fan of government or of human nature.

I've attempted to read through H.R. 3200, ‘‘America’s Affordable Health Choices Act of 2009," but the damn thing is 1015 pages long, and written in inscrutible legalese designed specifically to make governmental documents as obtuse as possible. The Official Summary notes key provisions of:
It's rather hard to find these individual pieces in the bill, and there is a lot more in the 1015 pages than meets the eye of this summary, which is, of course, quite favorable and reasonable-sounding. The public-option is heavily touted:

One of the many choices of health insurance within the health insurance Exchange is a public health insurance option. It will be a new choice in many areas of our country dominated by just one or two private insurers today. The public option will operate on a level playing field. It will be subject to the same market reforms and consumer protections as other private plans in the Exchange and it will be self‐sustaining – financed only by its premiums. . .

Innovation and delivery reform through the public health insurance option. The public health insurance option will be empowered to implement innovative delivery reform initiatives so that it is a nimble purchaser of health care and gets more value for each health care dollar. It will expand upon the experiments put forth in Medicare and be provided the flexibility to implement value‐based purchasing, accountable care organizations, medical homes, and bundled payments. These features will ensure the public option is a leader in efficient delivery of quality care, spurring competition with private plans.

Oh, but the competition will be healthy, just like Fed-Ex and UPS survive when up against the US Postal Service, according to an unfortunate analogy presented by Mr. Obama himself.

It occurs to me that we should discuss just what we want or don't want in a healthcare plan, i.e., let's look at some of the pieces that may or may not exist in the House bill. I'm going to present these as options one could include if assembling a piece of legislation Lego-style. I wonder if this is the way Congress goes about it. . .

  1. Universal Coverage. We truly don't know how many uninsured there are in the United States. Estimates vary from 10 million to 52 million, with 47 million being the most commonly cited figure. But, these numbers do include people that can afford insurance, but don't want to buy it, illegal aliens, and so on. So, your first choice is this: Do we want to cover absolutely everyone? Do we do so in the name of the value of each individual life? If so, how do we reconcile abortion (and I'm reluctantly pro-choice, by the way.) How do we pay for this? Should we simply tax everyone? The "rich" only? Do we hit business owners harder than individuals? Should we alternatively just declare that anyone can walk into any doctor's office, clinic, or hospital and get care? If they cannot pay, the health care system eats it (which is pretty much what happens now in a lot of areas.) Does the healthcare provider (or the government payor, or the insurance company forced to cover) have the right to investigate the patient claiming poverty to see if their plea is legitimate? Can the funding entity refuse a freebie to someone driving up in an Escalade and chatting away on a Blackberry? Would there be jail-time for someone trying to game the system?
  2. Extent of Coverage. Do we wish to pay for any and all treatment? Yes, it is clear that if a young person develops cancer or other serious disease, a full court press is necessary and desireable. But, are we to cover liver-transplants for a drunk picked up off the street? And of course, there is the question of care in the last days of life. Nasty as it may sound, do we ultimately want "death boards" to limit futile expenditures? Do we give 99-year-olds pacemakers and artificial hips? Are we willing to pay the price to do so?
  3. Catastrophic Coverage. An unfortunate number of Americans are bankrupted by a severe illness or accident. Should there be a major-medical/catastrophic illness policy for all? How much should be covered? What should be covered?
  4. Insurance Reform. Should we require the insurance companies to cover everyone, in particular, those with pre-existing conditions? Should coverage be portable? Should it be tied to the job or the individual? Should insurance execs make millions while refusing to pay for care in certain instances?
  5. Preventative Care. Ironically, the more preventative care we introduce, the longer people live, and the more healthcare will cost. Do we choose to do this anyway? Will there be penalties for those who continue to smoke, drink, and overeat? How will the government/insurance company find out about your indiscretions? Will they have access to your credit-card bill and grocery-discount card to oversee your purchases?
  6. Medical Decisions. A big part of HR 3200, not mentioned in the summary, is something called COMPARATIVE EFFECTIVENESS RESEARCH, establishing a Center which will "conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically." This gives the government a path to controling healthcare decisions. Do we trust the government (or insurance companies) to do this? Will we allow the "Center" or its equivalent to override the judgement of the individual physician?
  7. Profit. It can be argued that healthcare is so important that profit should be eliminated, with the removal of any financial incentive, fee-for-service, etc. Do you agree with this?
  8. Tort-Reform. HR 3200 has absolutely no mention of tort-reform. We all know that a tremendous amount of expense comes from CYA tests, scans, and so forth. But the lawyer-dominated government, from the President on down, shun tort-reform, on the premise that someone horribly harmed by a bad outcome should be able to recover hundreds of millions of dollars in compensation. Which do you want?
  9. In-Office Imaging. The loopholes in Stark II allow for in-office imaging. The clinicians who own imaging equipment utilize scanning at 2-8 times the rate of those who don't. They claim added convenience to their patients. Do we wish to pay for this or not?

I've certainly left out a lot of possibilities, but you get the idea. These are very hard choices, which are being made in the intelligence vacuum of Washington, without our input. To me, the fact that tort-reform is not included in this bill tells us that the goals are far more political than generous and magnanamous. Well, I'll take back that last clause: Mr. Obama and Congress are planning to be very generous with other people's money.

Having a child with a chronic illness, who will be uninsurable once out from under my coverage, seeing the waste in the system daily as a physician, I understand very well the need for reform. But this bill, and the current drive to ram it through come Hell or high water, will not fix the problems. It will not cover all of the uninsured, it doesn't address tort-reform, but it certainly does attempt to insinuate the government further into the healthcare system, in ways obvious and not so obvious. This is a giant stride toward socializing the nation, and making us dependent on the State for our very lives.

Certainly, there are problems to be solved, very, very serious problems. But the best approach is for government to regulate, not provide. The insurance companies have to be brought in line. They need to make a profit to survive, but they cannot be allowed to just do their own thing. To throw in an entity that makes no profit might sound good to those who hate capitalism and fair competition. But you must realize that profit, properly regulated, is a far better motivator than any other. If you think otherwise, I'll invite you to visit your local Post Office or DMV.

Make your choices, and tell Congress what you really want to see in healthcare reform. Otherwise, we'll get what they really want. I, for one, don't want to see that happen.

Thursday, August 20, 2009


One of the joys of being the Dalai Lama of PACS is that people in the industry occasionally seek out my opinion on some product or other. Some of these folks are big names in the business, and I'm always honored to share what little wisdom I might possess.

I first spoke with Hamid Tabatabaie when he was CEO of Amicas. He was about to come down to my little operation in the Deep South to see how things really work in the boonies. Sadly for me, Hamid left Amicas just before his proposed trip, and I didn't get to meet him until a few years later at an Amicas RSNA party. Amicas is one of those companies that doesn't make too many enemies along the way, and I have always been impressed to see a number of former employees (and one former CEO!) at their various events. When I finally did get to speak with him in person, Hamid, the consumate enterpreneur, hinted at a new, revolutionary venture. He asked for my help when the time was right, and of course I agreed.

Hamid's new baby is called lifeIMAGE, and it's potential is almost literally unlimited. Here's the premise:
The U.S. healthcare system wastefully spends $10–15 billion each year on redundant radiological exams that stem from a provider's lack of access to patients' prior imaging exams. Though most diagnostic exams are already available in standard electronic formats, a void exists in the sharing of existing imaging data. By filling that void, the healthcare system can save billions of dollars, eliminate needless exposure to patient radiation, and significantly reduce medical errors. . .

Before long, patients in the U.S. will choose to trust their health records to one or more health record aggregators in much the same way that they currently manage their money online in banks. Accessing and exchanging health records will be modeled after some current banking methods including PINs, routing numbers, wiring instructions, and deposit or withdrawal transactions. In this model, a number of major and specialty aggregators will service the market.

Much remains to be done in extracting and organizing quality data from the originating systems and information silos within the walls of hospitals and other healthcare settings. lifeIMAGE can provide a highly specialized and valuable service by focusing on the imaging component of the medical record. . .

The lifeIMAGE product platform will more effectively connect patients and providers to medical imaging studies and reports through two core components. First, for hospitals and imaging centers, the lifeIMAGE Local Appliance (LILA) will provide a better way for enterprises to manage imaging exams introduced by patients on portable media such as a CD. Next, a secure, cloud-based environment, that will provide the basis for more convenient image sharing and storing between patients and referring physicians.

Trust me, lifeIMAGE is addressing problems that need to be solved. A huge number of exams have to be repeated on an emergency basis because the original, performed at St. Elsewhere, cannot be retrieved in a timely manner. In fact, a Brigham and Women's study from 2008 found that 32% of patients transported to their ER who DID have CD's with them still got additional exams. 40 of those CD's didn't have reports, and 27 of those that did have reports had discrepancies.

We all know about the joys of exams coming in on CD-ROM. Even if the disk does actually load (which doesn't always happen), what do you do with the data? Do you pull it up side-by-side with the PACS? Do you load it into PACS? HOW do you load it into PACS? This all begs the question of the "portable patient," the little old lady who has been to St. Elsewhere last week, Mayo the week before, and the Doc-In-The-Box down the street yesterday. This situation of course is truly the bane of my existence. You may recall that I tried years ago to get our big hospital to partner with all of the other hospitals in town on a city-wide PACS to solve some of these issues, but of course, the then-CIO looked at me like I had three heads.

lifeIMAGE acknowledges the various realitites in our current system, and has found ways to deal with them effectively. Here is the general overview of their operation:

Basically, lifeIMAGE becomes the conduit, and repository, for images that need to be, well, portable.

The first part of this daunting task is to simplify it, and lifeIMAGE does make it easy to upload, nominate, and share studies:
  • Let anyone upload from any desktop

  • Upload images from CD to an inbox with a universal, zero-download viewer
  • Allow all physicians to nominate exams for inclusion in RIS/PACS and worklist for secondary read

  • Equip the system gatekeeper(s) with means to electronically accept or reject nomination requests

  • When accepted, automatically generate an accession number, and if needed, an order number

  • Gives physicians in boxes so that they may share for clinical and personal reasons

  • Enables sharing for collaboration
The first step in all this is the LILA, the lifeIMAGE Local Appliance. This is a server box that facilitates the uploading of a study into PACS. Unlike the "fire and forget" approach, this system creates the proper trail into (and out of) the RIS/PACS for the exam handed to the doc on CD.

Here's how it works in practice...just view the slideshow to see how you would upload a new study and nominate it to be included in PACS. The gatekeeper allows normalization of patient demographics and so on, and creates an accompanying order in the RIS. You can also see the concept of the "inbox" which houses studies for the particular physician, or patient. The inbox can be searched, tagged, or shared.

What you see above is primarily LILA version 1.0, the Local Appliance itself. One interesting point here: the viewer is actually written in Adobe Flash, allowing it to work across different platforms.

LILA 1.2 includes the Enterprise Indexer:

  • Index every report and image dataset in RIS & PACS

  • Instantly locate and display all cases of interest by:
    o Relevance
    o Modality, procedure, keyword, tag, and synonyms
    o Natural language & medical lexicon based searches

  • Bookmark or save any search

  • Add personal tags

  • Use for decision support, research, or education

  • Interactive and customizable charts for refining search criteria

  • Research mode for clinical analysis

  • Dashboard elements for tracking operational efficiencies
    o Imaging business intelligence

  • Investigating trends and discovering anomalies
LILA 2.0 adds something very critical to the future: cloud distribution to referring physicians, and sharing and communication via LILA 3.0 adds an inbox for the individual patient, as well as searching across the LILA.

While the initial components are remarkable in their own right, is the cloud distribution that takes my fancy. The cloud is a virtually-unlimited space in which to store data, and should be able to handle just about any amount presented to it. (Cloud storage and computing are offered by a number of vendors.) Here is the opportunity to create a regional, national, or even a world-wide database. The possibility finally exists for a repository of every image of every patient, no matter where in the world they may be. Ultimately, I'm thinking lifeIMAGE's technology could prove to be the ultimate (vendor-neutral, of course) PACS database. In the meantime, simply streamlining the process of CD-ROM loading into PACS is a monumental achievement in and of itself.

I'm looking for great things to come from this, folks.

Sunday, August 16, 2009

Shootout at the 3D Corral! And the Winner Is. . .

The Visage Team

The TeraRecon Team

My inspiration: Shootout at the OK Corral

You might recall from my post about advanced imaging systems at SIIM that we intended to pit Visage against TeraRecon in a side-to-side (or back-to-back, or head-to-head, or toe-to-toe) competition. GE more or less invited themselves to the party, and they were welcomed, but a scheduling snafu seemed to prevent their attendance in the end. Which is probably OK, as a preliminary demo disclosed that they really didn't have some of the functionality we needed to see. The competition finally occurred a few days ago, with a couple of rads, our entire PACS team, and a few other assorted rogues in attendance.

Each vendor had the chance to do their usual presentations, and then we saw live processing. We submitted a few cases, in addition to the usual samples, so as to allow viewing of similar data on both products.

My previous report noted that Visage was a very powerful system, but wasn't quite up to the level of TeraRecon. Still, it's a pretty good package for the price, which is MUCH lower than TR's. TeraRecon is still the 900 pound gorilla, with Visage maybe hitting 750-800 pound gorilla status.

I'm not going to torture you with a click-by-click rendition of the demonstration. However, a couple of points should be related. First, both produce pretty pictures, make nice movies, and both can process most of the same stuff. The similarity ends at the level of automation. With the optional AquariusAPS (Advanced Processing Server), many onerous tasks, such as processing a coronary CTA study, can literally be accomplished with a single click. My friend and colleague, Dr. Killer, who is one of the biggest fans of the GE AW you are likely to meet was absolutely bowled over by TeraRecon's capabilities. He described them as "leaving GE in the dust."

There is of course much more to all this, such as Visage requiring more hardware for every six simultaneous users, something TR says is not necessary for them. TR can make really fancy movies, with variance of position, rotation, windowing, etc., something Visage cannot do anywhere near as well.

I reported last time that Visage could automatically register an old PET/CT to a new study. The demonstrators this time were not aware of this, but I have made it work on web-demos on my own computers. Last time, TeraRecon didn't have this functionality, but today, two months after SIIM, there it was.

Bottom line: TeraRecon does the job better, but it is much more expensive. Visage is an up-and-comer; it will advance and improve, and become a more and more worthy contender as time goes on. To be brutally honest, however, TeraRecon absolutely MUST come in at a lower price-point than initially promised to make this sale. I like Visage, I liked their team, both those I met at SIIM and those who made the trip deeper into the South. This is a good bunch of very capable folks. On the other hand, I've known our TR rep for many years, and he is a character of the first order, but truly a great guy, and very, very knowledgeable about his product and how it would fit in with our enterprise. In the end, I would be very happy to work with either company. However, I have to acknowledge the current superiority of TeraRecon's Aquarius iNtuition. If price were no object, that is the direction I would go. I'm not spending my own money here, but I still want to be cognizant of costs. So, I can only hope that there is some give to TeraRecon's sticker price. If not, I can rest assured that there is a very good alternative.

Tuesday, August 11, 2009

Guess What I'm Thinking

I made another discovery whilst on call this weekend. Impax has a "clone window" feature which spawns a window duplicating the series that is currently on-screen. Our PACS people have created Wizards that use the clone tool to create a four-viewport rendition of the current series displaying the same data in multiple window/level settings. We have a Wizard for head and body studies, and this is quite valuable. We need to go through this rigamorole because Agfa does not allow us to deploy the same data in multiple viewports as does just about every other vendor from Merge eFilm on up. With Amicas, for example, I have a hanging protocol that automatically gives me this display. But I digress.

Over the weekend, I was asked to look at a patient with two separate CT series contained in a study. I had the first series displayed on Monitor One, and the 4-window clone on Monitor Two. I was told that the data had been reformatted to thinner slices, and that this data was contained in the second series of the study, so I dragged the second series' thumbnail to Monitor One, an action that should have displayed it. There was no change, no indication that anything had gone wrong, no electric-shock to my chair to tell me that I had violated the rules. Since the data had the same slice thickness, I could only assume that the techlings hadn't done the reformatting, and so I called and yelled at them.

But alas, I was wrong. The second series DID contain the reformatted data. It seems that the clone window locks its parent display. Most embarassing for me.

When I bitched complained about this, our PACS folks did some investigating:

I just spoke with AGFA GSC. Once the Wizard has been activated, you can go to the next series by hitting the arrow key at the top of the Wizard- then IMPAX will allow you to drag that series into display.

Oh, of course! Why didn't I think of that? Mainly because it is not intuitive for the clone window to be controlling the rest of the display, now is it?

Here again we have an example of a tool or function that made sense to its designer, but doesn't actually work very well in my real-world busy radiology practice. This is one of those things that should have come out in testing, but obviously didn't.

I don't think anyone has to guess what I'm thinking at the moment. . .

Sunday, August 09, 2009

All Around The Mulberry Bush....

My faithful readers know by now that when I'm on call at our local Trauma Center, little annoyances become BIG PROBLEMS. And so it is today.

There has been yet another ongoing problem with our IMPAX installation. In brief, when I try to look at a study, say a CT, which has more data coming in from the modality, say a sagittal reformat, the client crashes. We get the error dialogue below:

which contains the following text:

Application_ThreadException unhandled exception
Object reference not set to an instance of an object. at AgfaHC.Pacs.Application.ApplicationController.OnStatusUpdateEventArgs(IController source, StatusUpdateEventArgs statusArgs) at AgfaHC.Pacs.Application.ApplicationController.OnApplicationEventOccured(IController source, ApplicationEventArgs aeArgs) at AgfaHC.Framework.BaseController.FireApplicationEvent(IController source, ApplicationEventArgs appEvent) at AgfaHC.Pacs.Application.DictationControllers.StudiesByStatusListBuilder.FireUpdateStatusEvents() at AgfaHC.Pacs.Application.DictationControllers.ClassicDictationController.StartDictation(Object sender, ArrayList workListItemList) at AgfaHC.Pacs.Application.DictationControllers.BaseDictationController.OnDictationApplEventOccured(Object sender, DictationEventArgs args) at AgfaHC.Pacs.Application.ApplicationController.OnDictationEventArgs(IController source, DictationEventArgs args) at AgfaHC.Pacs.Application.ApplicationController.OnApplicationEventOccured(IController source, ApplicationEventArgs aeArgs) at AgfaHC.Framework.BaseController.FireApplicationEvent(IController source, ApplicationEventArgs appEvent) at AgfaHC.Framework.BaseController.FireApplicationEvent(IController source, ApplicationEventArgs appEvent) at AgfaHC.Pacs.ImageDisplay.DisplayController.dictate(DisplayToolbarButtonDictation dictationButton) at AgfaHC.Pacs.ImageDisplay.DisplayController.displaycontroller_FeatureClick(Object sender, FeatureClickEventArgs e) at AgfaHC.Pacs.ImageDisplay.DisplayBaseToolbar.OnFeatureClick(Object source, FeatureClickEventArgs eventArgs) at AgfaHC.Pacs.ImageDisplay.DisplayBaseToolbar.button_FeatureClick(Object source, FeatureClickEventArgs eventArgs) at AgfaHC.Pacs.ImageDisplay.DisplayToolbarButton.OnFeatureClickEvent(FeatureClickEventArgs e) at AgfaHC.Pacs.ImageDisplay.DisplayToolbarButton.OnClick(EventArgs e) at System.Windows.Forms.Button.OnMouseUp(MouseEventArgs mevent) at AgfaHC.Pacs.ImageDisplay.DisplayToolbarButton.OnMouseUp(MouseEventArgs e) at System.Windows.Forms.Control.WmMouseUp(Message& m, MouseButtons button, Int32 clicks) at System.Windows.Forms.Control.WndProc(Message& m) at System.Windows.Forms.ButtonBase.WndProc(Message& m) at System.Windows.Forms.Button.WndProc(Message& m) at System.Windows.Forms.ControlNativeWindow.OnMessage(Message& m) at System.Windows.Forms.ControlNativeWindow.WndProc(Message& m) at System.Windows.Forms.NativeWindow.Callback(IntPtr hWnd, Int32 msg, IntPtr wparam, IntPtr lparam)

Have lots of fun reading that, folks.

The crash occurs AFTER I have clicked the study into "Dictation Started" status, and so when the client comes back to life, I have to remember the name of the victim, or the study runs the risk of being lost to me, only to turn up later in the "you didn't read this on time!" pile. Dare I even hint at the possibility of an impact upon patient care?

Here's the problem as I understand it: We don't want people reading studies before all the data is in. Thus a study has a built-in delay that should keep it off the worklist until it's ready. But sometimes there is an even longer delay between the acquisition of the various parts of the study, and it appears on the list anyway. But if we access the study whilst more data is coming in, the system gets confused, since we shouldn't be reading it, and it crashes. Hence, my image of the monkey chasing the weasel. POP goes the Impax!

There ought to be a solution for this. If there is, please let us deploy it. If there isn't, please create one. Very quickly, please.

POP goes the Dalai!

Tuesday, August 04, 2009

Aloha Oy Vey, or, Dalai the Polemical

Image courtesy of

When you place yourself in the public eye, even in such a limited fashion as I do with my blog and my Aunt Minnie postings, you invite criticism. When you use this very short soap-box to voice controversial opinions, you really are asking for it. So I have found with the recent post about the Health Care bill. To refresh your memories, my brief message was as follows:

If the government controls your health, it controls your LIFE. Are we sure we want to go there? I don't.

Apparently, I stepped on some toes with this simple statement. David Clunie, whom you certainly know of if you have come to this blog had the following comments:

So you would prefer to have a company whose only motive is maximization of their PROFIT control your health, and hence your life? That's where we ARE NOW and many folks want to LEAVE, and go somewhere else.Not to mention all those who aren't anywhere and have NOWHERE to go right now.

I suggested that profit might be a better motivator, and besides, would you buy a PACS assembled by the government? David responded:

And I dare say that the original MDIS PACS, for its day, was a pretty good thing, specified by the government and built to those specifications by a contractor. Not to say that the military procurement system is necessarily ideal either, of course. And the VA's Vista system is held up as an example of electronic medical records working.

Anyway, I am not arguing for or against any particular approach, just trying to make the point that your jumping on the fear mongering bandwagon with exaggerated assertions is pretty lame.

When asked, David actually came up with a good basis for reform:

I don't claim to have any insight into the complexity of the system, and hence no easy solution to offer, but I believe that mandatory insurance, a proportion of mandatory pro bono care by all providers, prohibition on pre-condition exclusions, decoupling health insurance from employers and employment, tort reform (malpractice liability limitation if not prohibition), no fault compensation, rigorously enforced community outcome driven nationally standard appropriateness criteria, elimination of self-referral, device and drug product and service price control including requirements for economies of scale, elimination of fee-for-service billing, prohibition of balance billing and prohibition of for-profit private payers, would all help.If the risk pool can be spread sufficiently to still allow for multiple payers and still cover the indigent and the chronically ill, then so much the better, but I am not "afraid" of a single payer system.

After all, we do have a "single payer" "non-profit" defense force, do we not ? And frankly, the health care system has a lot more impact on the lives of most folks in this country than the defense department.

Actually now you come to think of it, maybe we should just militarize every single individual in the country (even if not fit for active duty) and have the DOD run health care :) They could control diet and exercise too and help with the prevention side as well. Maybe the different branches of the services could compete with each other for "members" based on quality of care, to keep the CAPITALISTS amongst us content.

Well, he did make a lot of sense until the DOD-run health care stuff, but perhaps that was meant to be sarcastic. Fear-mongering? I'm the one who's afraid!

Most biting was a comment from an anonymous fellow in Honolulu:

You certainly can post whatever you want on your blog. However, you've been gradually eroding your credibility as a balanced observer of PACS-related issues by going off topic and by being polemical.

The "Dalai" title no longer fits. Not even on PACS. You used to have thoughtful posts about user experience and other matters. Now you have thumbs up and thumbs down. The more often you write, the less you seem to have to say.

I appreciate the industry gossip, some of which doesn't show up on any of my other sources. But your signal-to-noise ratio is not what it used to be.

I guess he uses LavaNet for a reason. To be honest, I had to look up "polemical" to be certain I understood what my moloi`eheme (Hawaiian for friend) had in mind. From the Wikipedia:

Polemics is the practice of disputing or controverting significant, broad reaching topics of magnitude such as religious, philosophical, political, or scientific matters. As such, a polemic text on a topic is often written specifically to dispute or refute a position or theory that is widely viewed to be beyond reproach.

I think it's clear that Honolulu (and David) are disturbed by my conservative leanings, and my willingness to publish them. I have stepped on some liberal/leftist feelings, with a simple statement concerning my disdain at the imminent government takeover of our health care system. More on that shortly. But lest I have to remind anyone, it's my blog, and I'll publish anything I please, short of yelling "Theatre!!!" in a crowded fire. The callous answer to all is to say, "if you don't like it, don't read it". But that's really not the feeling I want to impart. I am saddened by this at several levels. Lava-burst, whilst citing no specifics, did his best to demean what I do here. Well, folks, I'm not out to be the CNN of PACS, nor even the Fox News PACS channel. This is just a collection of my personal musings, and stuff that entertains ME. I am gratified if you like what you read, and even more so if you come back for more. If you don't like something, please comment appropriately and specifically, and we can have a discussion. The ad hominem attack serves simply to make trouble, and in the words of fellow blogger Dr. Sanity (when I asked her about this sort of thing), ". . .he just wants to make it appear to others reading the blog that he is superior and that you are found wanting by his superior intellect." Perhaps so. It seems that he only comes here for dirt and gossip on PACS companies. Let me know which PACS you use out there in Hawaii and I'll try to come up with more for you, eh? I guess he wants me to author the National Enquirer of PACS, full of gossip and innuendo, but my non-liberal opinions are to stay out of it.

As for my opinions on PACS in general, I have taken to heart comments about certain vendors as well. I seem to lean towards those who tend to listen when I talk and change their products to make it easier for a radiologist to use so if that is wrong shoot me. And yes, I do bash other vendors who go on talking about their imagination at work when it's obvious they have none except when it comes to buying and subsequently destroying yet another really good small vendor. As hard as they try more often than not they fail to properly integrate the new product into their own ending up with a great big mess on their hands and for those who try to use it. I'm still waiting for my chance at that one. I have to cite Agfa as a company I have bashed, but which on their end takes my comments to heart and actually attempts to fix and improve what they have. I can tell you that IMPAX 7 is going to be a great product, if it ever gets out the door. Thumbs up or thumbs down? Maybe someone isn't reading entire posts. I love to give picayune details.

It seems that there are some in this country who become very upset with those of us who do not like the leftist/socialist direction the United States is taking. We conservatives are selfish, right-wing nut-jobs, or worse. Voicing a dissenting opinion is considered "polemical" (not a nice term).

The health care debate in particular seems to be a lightning rod for ill-will on both sides. Look, I agree with much of what David Clunie said, and I'll be the first to tell you that we need reforms. As we speak, I'm fighting with my insurance company over their desire to practice medicine without a license and sell me a generic drug for my son when his physician wants him to have the brand name stuff that has worked well for him for 7 years.

I will still stubbornly insist that the health care plan is a power-grab by the government. It will help few and hurt many. The basic assertion by those in favor is that we need to trash and rebuilt the system to cover the uninsured. I won't go into it here, but the figures on the uninsured show that the problem is often that people would rather buy an Escalade, expensive clothes and jewelry, and a $100/month iPhone than pay for insurance. Of the numbers bandied about, I think there are probably 10-20 million who are truly uninsured. Still, that is indeed too many. But do we need to destroy what we have to fix this?

No. Many of Mr. Clunie's suggestions are actually spot on, and would go a long way to solve the problem. Insurance companies need to be kept at bay, and tort reform needs to be put into place. Mr. Obama's denial of the need for tort-reform is key to the debate. This tells me he really doesn't want to fix anything, he wants to redistribute wealth, and punish achievement.

Ultimately, what has upset folks (and I step in it regularly on the Off-Topic board on Aunt Minnie) is that I don't want the government taking over our lives in the name of "HEEEEELLLLLPPPPPIIINNNNNNGGGGG" people. (I borrowed that elongation from Michael Savage, for better or worse.) The government doesn't do this well, and the more power it gets, the worse job it will do. High-minded altruistic thoughts are good, but in practice, the government has a very hard time translating such thoughts into something that actually does anyone any good. But let's not let that get in the way of our good intentions. From Dr. Sanity's much-missed blog comes one outlook on this:

The truth is that for all the lip service the Left pays to "fighting poverty" and "achieving social justice"--which makes them feel just oh so good about themselves--that not one single government program they have supported in the endless bureaucratic quagmire they refer to as the "war on poverty" has done more than those evil corporate bastards at WalMart to actually help the poor or anyone who suffers from the left's favorite disease: oppression.

Instead, the programs they support nationally and internationally inevitably reinforce their own latent envy, racism, and sociopathic selflessness.

So, many times in politics, programs that originate with the "best of intentions"--to help the poor; to achieve equality; to end some perceived injustice-- end up doing exactly the opposite of what was intended. This is the ultimate irony of a belief in egalatarianism, which holds that all outcomes must be the same for there to be "social justice". In the old Soviet Union and in Cuba we have a perfect example of the success of the egalatarian model. Everyone is equally poor and miserable. The 'poor' in America have a degree of wealth and opportunity that is unrivaled anywhere else in the world where they embrace egalatarianism.

Yet, the political left is so ideologically committed to the utopian ideal of egalitarianism which, in the real world simply makes everyone equally poor and miserable (except for the lucky elites who control the social system) that they reflexly keep pouring money into programs that can be shown to actively harm the people they are meant to help; and reinforce the stereotypes they are meant to end. That's why the left, who are in complete denial about their own racism, sexism and homophobia end up doing so much to hurt the people they claim to champion. Instead of having a color-blind society, they will create a society where the sanctioned color, race, ethnicity or lifestyle always trump ability, performance, and character.

The takeover of health care will be just another page in the same book of limited success and much more massive failure. There. I just really stepped in it. We are not to mention that the Emperor has no clothes, nor that he has feet of clay. . . but sometimes we must.

I'm going to continue to post what I feel, about PACS, and whatever else comes to mind. I hope you'll read it and think about it, and discuss the merit or lack thereof of specific points. Don't bother calling me a nasty Conservative. Everyone knows that about me already. And if you want to make political causes out of my statements, call Nancy Pelosi. I'm sure she'll listen.


I certainly hope Honolulu isn't aware of this. . . FoxNews reports:

The White House is under fire for a blog post asking supporters to send "fishy" information received through rumors, chain e-mails and casual conversations to a White House e-mail address,

Conservatives have pounced on the request, accusing the White House of acting Orwellian.

"If you get an e-mail from your neighbor and it doesn't sound right, send it to the White House?"said Sen. John Barasso, R-Wyo. " People, I think all across America are going to say is this 1984? What is happening here? Is big brother watching?"
Radio host Rush Limbaugh accused the White House of using heavy-handed tactics.

"They're looking for tattletales,"he said. "They're looking for snitches. They're looking for informants."

Sen. John Cornyn, R-Texas, charged the White House with compiling an "enemies list."In a letter to the president, Cornyn urged Obama to provide Congress with more details on what the White House plans to do with anyone reported for "fishy"speech.

"I am not aware of any precedent for a president asking American citizens to report their fellow citizens to the White House for pure political speech that is deemed 'fishy' or otherwise inimical to the White House's political interests,"he wrote.

"You should not be surprised that these actions taken by your White House staff raise the specter of a data collection program. As Congress debates health care reform and other critical policy matters, citizen engagement must not be chilled by fear of government monitoring the exercise of free speech rights,"he wrote.

The controversy is part of a larger debate on health care reform that has led Democrats to portray town hall audiences protesting a Democratic-sponsored bill as angry mobs duped into hostile actions by special interest groups.

The Democratic National Committee released a Web video and e-mail on Wednesday blasting opponents of the 10-year, $1 trillion plan.

Senate Majority Leader Harry Reid said lawmakers will continue to press for reform "in spite of the loud, shrill voices trying to interrupt town hall meetings."

Republicans say counter that lawmakers have a responsibility to listen to constituents and their concerns.

And lest you think that this is some fiction created by Fox, think again. Here is the post from the White House Blog:

There is a lot of disinformation about health insurance reform out there, spanning from control of personal finances to end of life care. These rumors often travel just below the surface via chain emails or through casual conversation. Since we can’t keep track of all of them here at the White House, we’re asking for your help. If you get an email or see something on the web about health insurance reform that seems fishy, send it to

I don't think this needs a lot of commentary. We are being asked to "flag" our neighbors who might be spreading "disinformation". Our government has just stepped over the line, in my humble opinion. Turning citizen against citizen, even in the name of a "good cause" is the road to destruction.

If this blog (or this blogger) suddenly disappears, you'll know why.

Monday, August 03, 2009

A Very Creative HP Ad

Tom Wrigglesworth and Matt Robinson, both from the UK, created this ad in response to a challenge from Hewlett Packard. I think you'll enjoy it! (Hat tip to PACSDesigner on

HP - invent (Click if the embedded version doesn't work on your machine) from Tom and Matt on Vimeo.

Sunday, August 02, 2009

Dalai('s) Rules!!

About 10 years ago, I went through a phase of collecting slide-rules, among other weird scientific things. My collection languished in my office at the hospital for quite a while, then moved home when the hospital needed the space. They gathered more dust until a few weeks ago when Mrs. Dalai decided that the house (the WHOLE house) needed cleaning. She found the rules above stacked in a corner, and said, "Why don't we put these on the wall?" Which I did, after shoveling out several years of accumulated trash, I mean stored items, in the home office.

Slide rules were once an absolute necessity amongst the engineering, math, and other intellectual folk. (I won't even try to tell you much about their design and function, but the Wikipedia article on the subject is excellent. And here is a great introduction into the actual use of slide rules.) Slide rules rode to the moon to augment the primitive on-board computers. (Buzz Aldrin's moon-flown rule sold at auction for $77,675 in 2007.) But then along came the electronic calculators, especially the Hewlett-Packard HP-35, and the slide-rule soon went the way of buggy-whips.

Well, not completely. Some of us still remember what they are, and maybe how to use them. I had a 1 week elective in the use of this archaic technology whilst in junior high in the 1970's, and a love for the elegance of the devices stuck with me. There were still stores selling slide-rules at that time, and a few of my high-school friends actually still used them into the mid-70's. My parents wouldn't let my buy one, however, rightly seeing the way things were going.

Slide rule collecting today has a limited but enthusiastic following. Some of the little buggers (the rules, not the collectors) have become quite valuable, and my old investment has done rather better than many of my stocks!

For a time, my mania led me to buy quite a few varied rules. I ultimately concentrated on the large school-demonstration rules, that are now on my office wall above. My pride and joy is the third from the top, a six-foot version of the Keuffel & Esser Decilon 10. As it turns out, there are quite a few different versions of the gigantic classroom rule, as catalogued in this page from the Slide Rule Museum (yes, there is one), although my Decilon did rate a large entry:

These things are rare enough these days that mine is probably one of those pictured above!

I also concentrated on the even more unusual clear versions that were used with the old overhead projectors, such as this Aristo (image from Rod Lovett's Slide Rules):

There is actually a Keuffel & Esser Deci-Lon projection version, Model 68-1955, and if you happen to have one, we need to talk!

The final piece of the collection is a totally in software, the Slide Rule App for the iPhone:

The mechanical versions work better, I'm afraid, but it's interesting to see how technology converges.

Thanks to the internet, and especially eBay, it is possible to connect collectors, buyers, and sellers of this old but still facinating technology. Slide rules rule!

Dalai's Opinion of the Health Care Bill

It's very simple.

If the government controls your health, it controls your LIFE.

Are we sure we want to go there? I don't.