A Tale of Two Systems

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to heaven, we were all going direct the other way - in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only.  Charles Dickens, A Tale of Two Cities. 

I'm standing at one of dozens of laptops set up near the Technical Exhibit Hall B at McCormick Place, in sunny, frigid Chicago.  It's been an exhausting first day, and I have miles to go before I sleep.  Still, I want to commit to the ether my thoughts of the day.  I've visited a number of vendors, and I'll be discussing my observations with a series of separate posts.  Many have noticed the sparsity of my postings lately, and I.. can only apologize and try to make it up in one fell swoop.  I've just been to Florida for Thanksgiving with the extended family, and did a rapid turn-around to get here last night.  All things being equal, I'd rather be in Florida, but we all do what we must. 

Let me start the barrage with a post I've been composing for several days.  The Tale of Two Systems refers to the iterations of Agfa IMPAX I've dealt with recently.  We had, until a few weeks ago, version 6.3.x, and my friends in Western Australia had 6.4.x.  At least ours worked most of the time, which sadly wasn't the case in Perth and environs.  Definitely the worst of PACS, I mean times. 

Over the past few weeks, Agfa has been fine-tuning the next edition, version 6.5.  It has major improvements, but the greatest upgrade of all has been the way Agfa handled the upgrade.  Distilling it down to two words, THEY LISTENED.  This next step is far from perfect, and it still has a lot of the legacy garbage from the previous 6.x's (and 5.x's, and 4.x's, and 3.x's, and probably 2.x's).  Still there are a number of things that actually work very well, markedly better than what we had before.  I won't go into vast detail, but suffice it to say that linking thge series of a multiplanar study is nearly automatic, and not an exercise in agony as it was before.  We have spine labelling, albeit a somewhat more complex version than I would have liked.  (Yes, the complex parts can be turned off, and we are left with a nice simple version that could have been written in a day and not take 5 years to implement, but I digress.)  We have voice clip capability so we don't have to type long missives to the ER.  And there are other improvements.  There are still problems.  There is no usable hanging-protocol arrangement.  There is still the nasty old tool-toggling. And so on. 

So why am I so upbeat?  Because Agfa made an incredible effort to keep us radiologists in the loop.  We received a pre-sale (but still FDA cleared) version, which has been tweaked almost daily in response to our requests and observations.  There were Agfa personnel onsite for much of the time, and we rads were invited (invited!!!) to participate in conference calls to keep the developers informed.  (And I can tell you that Version 7.x is being assembled in the same manner with input from us and several other groups.)  This is what I'm talking about!

In our discussions, it became very apparent why progress has stalled up to this point.  We bantered about the proper way to block someone from taking away a study someone is reading.  Most every product locks out everyone after the first.  In other words, if I open up Mrs. Jones' CT, no one else can read it.  They can look at it, but they can't dictate it or annotate it, at least with most systems.  With IMPAX, however, unless I click the "Start Dictate" button, the next guy can jump in and snatch the study away.  Years ago, I spoke with some of the principals about this.  I was told that Agfa's academic customers wanted it this way, and so it would stay.  That is not what I would call listening to the customer, at least not the customer standing in front of you with a serious complaint.  I would like to think Agfa has turned over a new leaf in this regard.

Time will tell.

In the meantime, I'm going to do my best to have the "best of times" at RSNA.  More to come.  It's 6 PM, and they're kicking us out of the building