Thursday, April 28, 2011

Tornadoes Happen Here

The South has experienced more tornadoes in the past few days than ever seen before. I'm waiting for someone to blame global-warming-climate-change, but hopefully the dirt-worshipers will keep that opinion to themselves out of respect for those injured. An unprecedented 280+ people were killed in this unholy battering from Mother Nature, and thousands more were injured or lost their worldly possessions.

I would urge you to donate to the Red Cross, or whatever agency you prefer. There is tremendous need, right now.

My heart goes out to those who were caught in these horrific storms. I had the joy of riding out a tornado in Omaha in 1975, and it remains the most frightening experience of my life. Below is an artist's rendering of the storm, that coincidentally depicts the funnel roughly one minute before it hit the building I was in at the time, Temple Israel Synagogue. The steeple of the church across the street is visible to the left of the image; the church was hit as well, but the steeple remained standing. (Image courtesy

Here is an aerial view of the Temple (to the right) and the adjacent Playhouse Theater after the storm (image courtesy

I got a few scratches, and a few of the other kids got cut up a little, but we were otherwise OK. "Only" three people died in this terrible storm.

We tend to forget just how powerful these natural events can be, but trust me, the view from the middle of a tornado is pretty awe-inspiring. That is if you happen to be looking and not kissing your ass goodbye as I was...

Seriously, be generous to the Red Cross or the charity of your choice in this time of need. Tell 'em Dalai sent you, and when they stop laughing, give. From the heart.


Sometimes I hate to be right.  Here's a dirt-worshiper's comment on the storms:
Storms Kill Over 250 Americans In States Represented By Climate Pollution Deniers
Today, news agencies are still tallying reports of deaths from the most devastating storm system in the United States in decades:
Dozens of massive tornadoes tore a town-flattening streak across the South, killing at least 250 people in six states and forcing rescuers to carry some survivors out on makeshift stretchers of splintered debris. Two of Alabama’s major cities were among the places devastated by the deadliest twister outbreak in nearly 40 years.
 “Given that global warming is unequivocal,” climate scientist Kevin Trenberth cautioned the American Meteorological Society in January of this year, “the null hypothesis should be that all weather events are affected by global warming rather than the inane statements along the lines of ‘of course we cannot attribute any particular weather event to global warming.’”

The congressional delegations of these states — Alabama, Tennessee, Mississippi, Georgia, Virginia, and Kentucky — overwhelmingly voted to reject the science that polluting the climate is dangerous. They are deliberately ignoring the warnings from scientists.
So "ignoring" the proclamations from the dirt-worshipers' High Priests of Gaia brought about tornadoes that killed 300 people, eh?  Talk about supreme arrogance....I just can't wait to see what they'll come up with next.

Read 'Em And Weep

I'm a little leery of Klas results on occasion.  The surveys are not quite scientific, and commentary is occasionally several versions behind on any particular product.  Still, Klas is about the only compiled source of such information, and it cannot be ignored.

Klas just published the latest Ambulatory RIS/PACS review.  I've seen it, but I don't want to violate copyright laws by reproducing it here.  But I'll share a few results:

Number 1 out of 18, with a score of 88.9....Intelerad IntelePACS.
Number 13 out of 18, with a score of 79.8....Merge/AMICAS PACS.
Number 17 out of 18, with a score of 73.6....ScImage PicomEnterprise.
Number 18 out of 18, with a score of 64.6....Agfa IMPAX.

Now I realize this is for the ambulatory space, which not Agfa's strongest market.  But...

Listen to the customers.  They are saying something, although it isn't always clear just what that might be.

Toshiba Acquires Another Advanced Visualization Company

It's deja vu all over again. I reported back in 2008 that Toshiba had purchased Barco's Advanced Visualization Imaging System (AVIS), which used to be Voxar, Ltd. Today, we have this report:

Toshiba Medical Systems and Vital Images have signed a definitive agreement for Toshiba to purchase Vital Images’ stock for a total of $273 million, putting the cap on a decade-long partnership between the two companies.

Under the agreement, which is expected to close by the second or third quarter of 2011, a Toshiba subsidiary will acquire all outstanding shares of Vital Images’ stock at $18.75 per share. The merger has been unanimously approved by the boards of directors of both companies, Tustin, Calif.-based Toshiba said.

Minneapolis-based Vital Images, which develops advanced visualization software and other health IT products, has relied heavily on a partnership with Toshiba over the last ten years.
"After a decade-long successful partnership spanning more than 50 countries, [Toshiba] is taking the partnership to the next level. We have enormous respect for Vital Images' products, pipeline and people, and look forward to working with their highly skilled team to enhance clinical value for patients throughout the world,” saidSatoshi Tsunakawa, CEO of Toshiba Medical Systems.

Michael Carrel, CEO of Vital Images, expressed enthusiasm over the deal, saying “This transaction means we can now accelerate our global presence with the strength and backing of [Toshiba].”

The $18.75 share price Toshiba agreed to pay for Vital Images represents a 39 percent premium over the volume-weighted average of the company’s 30-day stock, Toshiba reported.

The bid follows Toshiba's 2009 purchase of Barco's advanced visualization business, which resulted in the formation of Toshiba Medical Visualization Systems Europe.
I guess TeraRecon and Visage will be next, eh?

My dealings with Vital have not been spectacular over the years, as I reported a while back. Hopefully, Toshiba can make good use of its Advanced Acquisitions.

Hat tip to 23 Skidoo.

Wednesday, April 27, 2011

Dalai's Rules, II

Since my last post on the topic, I've acquired more classroom-sized slide rules.  At this point, I've got a reasonable sample of most of the brands and variations of these things.  There are really only two or three that I need to have a really complete collection.  But as you can see, I'm running out of wall space.  My ultimate plan is to donate the entire collection to my alma mater, if they have enough wall-space.  At least my old engineering school will know what a slide rule is...

Dalai's Birth Certificate

I've resisted and stonewalled all I can. I must now bow to public pressure and reveal my actual, long-form Certificate of Live Birth. Now, can we drop the silliness and get on to really important PACS issues? Please?

Monday, April 25, 2011

And The Answer Is....BGO!!!

I tried and tried to confirm which crystals are being used in GE's new PET/CT, the Kia Optima PET/CT 560, but GE just wouldn't answer my emails.

Fortunately, I have friends in high places. I posed the question to MedGadget, wherein we find another review of the Optima. Somehow, their email was answered, and here is the response:

You can tell him/her we chose the BGO crystal as it delivers a proven track record of speed and performance and is optimized for oncology imaging especially for Fluorine-based tracers.
I don't like to parse words, but this basically says that "we've used it before and we're using it again." And the energies of the other PET tracers all peak at 511 KeV, standard for positron/electron annihilation. So what's this about being best for F-18? (As we will see below, F-18 might be best for a machine with BGO crystals, but not vice versa.) If BGO is the end-all to end-all, why not mention it in the extensive Optima product brochure? If BGO is the best choice, pat yourselves on the back for making it.

Personally, I'm not buying any of this. Literally or figuratively. As I mentioned in the initial post, this is a deal-breaker, not that I have the funding to buy a new PET/CT in the immediate future.

I think we can assume that the rationale behind the decision not to go with LYSO as used in the Discovery 690 was cost. BGO is cheaper, and adequate (barely) for the job. (Ummm, by the way, did GE ever actually make any 690's? Did they sell any? Reports from the field appreciated...)

As I've said again and again, LSO beats BGO hands down for positron imaging.

AuntMinnie has a great reference paper on PET fundamentals.  Therein, we find this passage (emphasis mine):
Bismuth germinate oxide (BGO) crystals are generally used in conventional PET imaging systems. BGO crystals have a high stopping power (high efficiency), high spatial resolution, and are 50% more efficient than thallium-doped sodium iodide -- NaI (Tl) -- crystals. Most crystals are 3-6 mm thick and they are not hydrophilic. The detection efficiency for 25 mm BGO crystal is approximately 80% [31]. The spatial resolution approaches 5 mm, which nears the theoretical limit of resolution. The disadvantages of BGO crystals are that they have a much lower light output (15% of NaI (Tl) crystals), long photofluorescent decay times (decay constant of 300 ns which limits count rates/coincidence timing resolution [31]), and poorer energy resolution than sodium-iodide crystals. Energy resolution of BGO is normally worse than 20-25% in FWHM at 511 keV. A typical energy window for a BGO scanner is 300-350 keV to 650 keV [18]. This poor energy resolution makes it difficult to remove scattered events by energy discrimination. Therefore, lead-tungsten septa are interposed between detector rings to reduce interplane scatter [18]. The coincidence time window is normally set for 10-20 ns. The inferior time resolution causes larger accidental detections and greater dead times. BGO detectors are best suited for imaging isotopes with long half-lives such as F-18 and C-11.

Lutetium Oxyorthosilicate (LSO) crystals offer the best combination of properties for PET imaging [2]. LSO has a higher effective Z (number of protons per atom) and density compared to BGO which results in an equal or higher detection efficiency [3,31]. It has very good energy resolution (about 12% [21]- with a typical energy window set to 425-650 keV), a short decay constant for good coincidence timing (a decay constant of 40 ns and coincidence time window of 4.5 ns), and higher light output (five fold more light compared to BGO crystals [31]) [2]. The coincidence time window is set to 4.5 ns. These characteristics enable image formation is less time when LSO crystals are used [31]. The crystal is rugged and nonhygroscopic.

BGO versus LSO detector: The images below were acquired in 2D mode with a scan time of 5 min/bed emission and 3 min/bed transmission. The upper row of images were acquired on a BGO camera system and the lower row of images were acquired on a ECAT Accel LSO PET camera system. The data was reconstructed using normalized attenuation weighted OS-EM reconstruction. Image courtesy of Northern California PET Imaging Center, Sactamento, CA and CTI, The Power Behind PET.
'Nuff said.  The great Crystal Caper is solved at last.  Many thanks to MedGadget!

Saturday, April 23, 2011

Advancing The Cloud

I've been a TeraRecon fan for quite a while now. Sadly, I'm not a customer as yet, since we cannot convince our administration to cough up come up with the cash in these hard economic times.

But TeraRecon has recently provided a very economical alternative. How does FREE sound? Yes, for the time being, you can have the power of TeraRecon at no charge.

In a recent article in, TR president Robert Taylor, PhD, outlines the problem many of us out in the boonies face when trying to implement (or justify) advanced imaging:
Advanced visualization—for all of its benefits—also comes with its challenges, said Robert Taylor, PhD, president and CEO of TeraRecon, who outlines the challenges in this way: it is expensive (you have to have enough volume to justify investment in a complete system); it is an IT deployment (you need an IT department to deploy and manage it); and it is confined to your organization (if you need to reach outside your organization to share or collaborate, it can get complicated).

In order to respond to these challenges, the company announced iNtuition CLOUD late last year. With this new solution in place, new customers can have their iNtuition UNLIMITED licenses hosted within the company's cloud solution. To date, more than 400 users have signed up for evaluation accounts, which were offered free of charge to professional attendees at RSNA '10 and continue to be available at
I'm one of those 400 users, and I can vouch for its functionality. Maybe it isn't quite as seamless as having an in-house installation, but iNtuition CLOUD does work, and it works very well. For all intent and purpose, you have a full iNtuition product at your disposal via the Internet, I mean Cloud.
On the client side, iNtuition CLOUD functions as a browser link, according to the company. After logging in, the user can start to work with their studies. On the server side, when a user connects and logs in to their account, the cloud establishes a secure link to an appropriate server from the company's global network that has the user's data and is located in a geographically appropriate location.
To be fair, I haven't tried it out on the iPhone or iPad, but I see no reason why it won't work on these devices, as the image above suggests.

Naturally, there are a few areas where one must convince the IT folks and lawyers that this is a kosher approach:
Taylor concedes that one of the biggest challenges is that health care providers have to get comfortable with the legal, regulatory, and security aspects of putting patient data into the cloud and entrusting it to a third party like TeraRecon. He's aware that legal and regulatory departments within health care facilities will need to develop the right contractual and policy frameworks that will allow them to use iNtuition CLOUD and still comply with HIPAA, HITECH, and all of the other applicable obligations. The company's immediate goal is to get health care facilities talking about the possibilities related to iNtuition CLOUD.
Hey, if you can't trust TeraRecon, who can you trust? Stated differently, if you can trust certain larGE companies, you can certainly trust TeraRecon.

Dr. Taylor concludes:
"2011 will be the year that iNtuition CLOUD 'arrives' in a very meaningful way as a part of the advanced visualization landscape."
It has definitely arrived. Anyone looking into advanced visualization should certainly check out iNtuition CLOUD. Having the power of TeraRecon for free is like having Hanukkah in July.


Dr. Taylor sent some comments on this post:

The article references 400 users but we're actually past 1000 now and just made a PR about it. You can find a link to the PR at the top of the press releases column on the right of our homepage:

iNtuition Cloud is working out really well, and some surprising ways. We are starting to commercialize it now, with several heavy evaluators turning into paying customers, even at their own request - people need a contract in place to use the service formally, I suppose.
But in addition to this, we have found Cloud to be very helpful for our prospective customers to user in a "try before you buy" mode. We used to feel that if we didn't provide a carefully controlled demo with a specialist there in person, we couldn't do our product justice and we may leave a sub-optimal impression, but with Cloud, people are trying it, digging in, figuring things out, asking us questions, and getting a sense of comfort that our solution will work for them, without any major issues. It's very exciting.

I would say that in 2011 so far, I can point to several significant purchases that were driven by Cloud evaluations. One was an extremely famous cancer center that wanted to first make sure we could load their data and perform the specific measurements they needed, and another was a major radiology group that wanted to see how the system could work for their distributed group of interpreting physicians, before jumping in to buy a tool to enable them to offer wider interpretation services, including brain perfusion, cardiac, EVAR, etc.

In some cases, people try the Cloud and buy the Cloud. In others, they try the Cloud and then buy a system. In a couple of cases, we have even sold "Private Clouds" where the customer buys a set of the equipment we use to operate the Cloud, and then sets it up in their own datacenter and operates and controls it for their staff only (e.g. radiologists working from a wide range of remote locations needing access from a browser).

We have also been adding features, like automatic anonymized, compressed DICOM routing to the cloud, relay back to the site of derived results, and PACS integration, so you can launch the Cloud client from a supported PACS system (instead of needing a local client installed).

It's definitely picking up speed and we're having a lot of fun with this!

Friday, April 22, 2011

Watch The Birdie!!!

LEICA 'BIRDIE" from Philip Escobar Jung on Vimeo.

Speaking of civility, or lack thereof....

And Be Civil About It!

This post should be filed under "Social Commentary", so if you are going to get upset about a non-PACS entry, then feel free to GTFO (which means Gallantly Try Finding Other sites, I believe).

I had to travel last night to be with the rest of the family for a relative's birthday. Flying is the usual drudgery, with the added joy of every last possible piece of luggage being brought into the cabin so as to avoid the $20 fee. I hope the airlines are pleased with themselves for this rather nasty money-grubbing move, and the unintended consquences thereof.

Anyway, I made it through the hub airport without difficulty, and boarded my next plane. I settled into my seat, and tried to catch a nap on this 45 minute flight. Unfortunately for me and the rest of the passengers, two rows behind me, a bearded gentleman in his thirties began nattering away at the top of his lungs about various engineering topics to his seatmate. And he continued without pause through the entire flight, the taxiing to the gate, the retreival of everyone's life-possessions from the overhead bins, the lineup out the door and even down at Baggage Claim. Naturally, his voice and the volume thereof carried quite nicely through the remainder of the DC-9. Often, I can simply block out such things, but having the engineering background myself, and being in just the right state of fatigue, I kept latching onto familiar phrases. So much for my nap.

At the end of the flight, I turned around to see several other gentlemen, who were wearing suits and ties, balling their fists and rolling their eyes, as Mr. Nerdy continued his unending, LOUD babbling.  How we all managed to keep from delivering an even louder chorus of "STFU!!!!" I'll never understand.

I wish I could say this sort of thing is an isolated incident, but it isn't. One of our X-Ray techs, who is a great person, and does incredible work, cannot speak in tones softer than a freight train at 10 feet.  By some wonderful bit of luck, my reading room is indeed 10 feet from the patient prep area, and I'm interrupted every 5 minutes by a blast of "HI!  I'M JOE AND I'M GOING TO GET YOU READY FOR YOUR CAT SCAN!!" or "TIME FOR YOUR CHEST X-RAY!  ARE YOU WEARING A BRA? GOOD! COME ON IN HERE AND HUUUUUUUUUUUUG THIS BOARD!!!"  I've tried slamming the door to my office, but the message never gets across.  Perhaps JOE can't hear (or grasp) the slam.  And there are similar examples in my workplace, and elsewhere.

Please understand, I'm not thinking all of the ultra loud folks in my life are trying to annoy me, even though they succeed quite readily. I have to wonder if the new norm of CONSTANT music via iPod/iPhone/etc. headphones is literally deafening our society. And maybe some have been affected by undertreated otitis in their youth, yielding deafness near and far.  I was of the generation that received antibiotics for earaches.  Lots and lots of antibiotics.  I'm told this is (or at least was) passe, and I've run into docs who are petrified to hand out a Z-Pack to a kid with otitis for fear of causing the next flesh-eating-bacteria epidemic.  (I'm not kidding.)  Could we have thus created a generation of kids with hearing loss? 

Realizing that you are annoying other people is one facet of courtesy.  Rather ominously, there is a general trend away from gentility, and toward such selfish, and even entitled behavior.  (And by the way, I'm not accusing either the Very Acoustic Engineer or JOE of this, but the description will apply to some of the LOUD folks.)  More and more, we see the tendency for some to do what they please, without regard to how it might affect others.  I'll stick my iPod in my ears, and turn it up so loud everyone around me can hear the music coming out of the headphones.  I'll then shout because I can't hear, or maybe I just feel like shouting.  The yellow light, or even the red light at the corner simply means I'm supposed to speed up and be the last one through, even if your light has been green for 10 seconds.  That's not my problem.  I demand my entitlements, and I demand that you pay for it, because you are richer than I am, and that just isn't right.  And so on.

I have to ask, is there some connection between political orientation and civility?  From Georgetown's Patrick Deneen in the Washington Post:
For all the the lamentation about the rise of incivility in our culture today, there was little understanding of the deeper sources of modern incivility - indeed, the connection between incivility and liberalism itself. Civility requires a certain set of preconditions and even deeper prevailing norms about the nature of political life itself. Modern liberalism has systematically sought to disassemble those conditions, and those prevailing norms. Complaints about the decline of civility are thus more than a little disingenuous.

One should expect little deep thought about such a matter as "civility" in contemporary political and social life, but there seem to me to be fewer more important questions facing our society today. Yet, the fact is, for all the hew and cry about the dearth of civility in our lives and times, as a culture we are actually more deeply opposed to civility than might even be suspected by its passing proponents. Modern - especially liberal - society is designed largely to undermine civility. Rather than lament its dearth, we should understand more fundamentally the deeper systemic causes of its decline. . .

To hear contemporary liberals lament the decline of "civility" is thus more than a little galling. Modern liberals are the heirs of a longstanding effort to liberate people from the "little platoons" that tempered individual self-expression. Hearing their decrying of contemporary "incivility" is a bit like the man who, after insisting on his wife dress as revealingly as possible, gets upset that other men are leering at her. By that same token, "conservative" defenses of "incivility" are even more aggravating, perhaps even more than the well-publicized "conservative" re-introduction of polystyrene coffee cups in the House cafeterias.

Civility is indeed a lost art of our time, but not because of talk radio or growing partisanship. These are symptoms of a deeper disease. Until we frankly diagnose our condition, we remain a patient whose diseases continue to metastasize, all the while complaining that what really bothers us is a hang-nail.
And what is that deeper disease?  It isn't something we can cure with antibiotics.  I've heard that the lack of civility has much to do with the increasing pressures of our day.  But when we look at the incredible patience, and, yes, civility, of the Japanese victims of the earthquake and subsequent tsunami, I have to question that. These are a people who have endured a huge tragedy, and must be under incredible stress.  But they stand patiently in queues for water and supplies, there is no pushing or shoving, and no price-gouging on the part of the stores.  No, I fear the deeper disease is the false narcisism, the "Me, Me, Me!" of entitlement and the false generosity of gallantly demanding justice for the needy via confiscation from others. 

What? Sorry, I couldn't hear you over my loud little rant...

Number Three Blog!!!! has this to say about Radiology Blogs:

Everytime you get an X-Ray, something special takes place: your insides are put on black-and-white display right before your very eyes. It may seem like a commonplace medical practice (and it is), but still, there's something really cool about what radiology allows us access to when it comes to our bodies and minds. Learning how to interpret these charts and graphs is not particularly simple, but it's a much needed skill. Radiologists (and those in training) sacrifice a lot of time and energy to perfecting their science, and luckily many of them are blogging about their toil. Here's the best selection of fifty radiology-related blogs out there.
Here's what they say about
Dalai's PACS Blog: The first thing that intrigued us about Dalai's blog was his inclusion of the term "PACS" in the site's title. Though at first glance it's easy to assume he's making an allusion to political funding, he quickly defines the word as a picture archiving and communications system, or also pain and constant suffering. That sense of wit and redefinition permeates this site.

Why We Love It: A clever and comprehensive blog reflects the jovial expertise of its head radiology writer.

Favorite Post: Radiology App
(The link to the Favorite Post should probably have been: and not the link to the FDA website...)

Sometimes, my expertise isn't jovial, and sometimes there isn't much expertise in my joviality, but I do appreciate the sentiment.  Also, while it's true that I'm the head writer, for the foreseeable future, I'm the only writer.  As for wit, well, I'm reminded of a little poem often inscribed where few women may see it:

Those who write on sh*thouse walls,
Deserve a monument in Heaven's halls.
Something fitting for their wit,
A monument of solid sh*t.
But, once again, I am very honored to be on the list, let alone showing at Number Three!

I have to republish something that was republished on Blog #5, Scan Man's Notes, which was in turn copied from Life in the Fast Lane

The ‘Ten Commandments of Emergency Radiology’ according to Touquet et al (1995):
  1. Treat the patient, not the radiograph
  2. Take a history and examination before ordering a radiograph
  3. Request a radiograph only when necessary
  4. Never look at a radiograph without seeing the patient, and never see a patient without looking at the radiograph
  5. Look at every radiograph, the whole radiograph, and the radiograph as a whole
    - remember the ABCS: alignment/ adequacy, bones, cartilage (joints) and soft tissues.
  6. Re-examine the patient when there is an incongruity between the radiograph and the expected findings
  7. Remember the rule of twos
    — two views, two joints (above and below the injury), two sides (for comparison), two occassions (may need a follow up x-ray) and two radiographs (compare to a normal radiograph)
  8. Take radiographs before and after procedures
  9. If a radiograph does not look quite right ask and listen: there is probably something wrong.
  10. Ensure you are protected by fail safe mechanisms
    — establish a quality control system
Are you ER docs listening?  I didn't think so...

Congrats to my fellow Radiology Bloggers!

Tuesday, April 12, 2011

Thursday, April 07, 2011

Texas Two-Step

The University of Texas Medical School at Houston is a fine institution, although it has lived somewhat in the shadow of its more famous neighbor, Baylor College of Medicine.  I'm a proud alum of the latter, although Baylor might not want me to publicize that fact.

UTH has found a way to stand out, although not in the way I would recommend.  On a web-page that appears somewhat cobbled-together, UTH offers us a wonderful new service:
Need answers? It's easy!
Offering second opinion and medical legal consultation for patients, medical professionals, and legal professionals.
Sharing this banner is an introduction to the UTH Radiology Consultation services from Dr. Susan John, Department Chair:

A message from Dr. John…

Susan D. John, M.D. Professor and J.S. Dunn Distinguished Chair In Radiology

It is my pleasure to welcome you to the Department of Diagnostic and Interventional Imaging at The University of Texas Medical School at Houston. The need for prompt, readily accessible, high quality consultation with experienced imaging subspecialists is growing in healthcare. We have created this website to help fill that need, providing you, our visitor, with the opportunity to seek a Second Opinion Consultation or a Medical Legal Consultation service with one of our distinguished faculty members. Our staff consists of board certified radiologists who have outstanding training and extensive experience in all imaging subspecialties. All faculty are actively involved in academic medicine and are conversant with state of the art imaging techniques and modalities. We are committed to providing the highest quality of information with competitive turnaround times.

To view our services, please select the service that you desire, and register with the site. One of our faculty will in contact you in the manner of your choosing. We look forward to serving you!
And serve you they will...on a silver platter.
Medical Legal Consultation

The Department of Diagnostic and Interventional Imaging at The University of Texas Medical School at Houston feel we have a responsibility to patients, society, and the medical profession to participate in medical legal consultations that ensure that these cases are properly, ethically, and accurately assessed at the highest level of integrity. We consider these services to be an essential part of the practice of medicine as advocated by both the American Medical Association and the American College of Physicians. No direct remuneration is received for these services, with proceeds from these activities used to fund medical student, resident physician, and faculty educational and research activities and services vital to the competent and excellent practice of diagnostic radiology at the UT Medical School.

Legal consultation is performed at an hourly rate to be negotiated between the attorney and the consulting radiologist. Cases will be reviewed by the most appropriate or requested expert subspecialist with a 3-hour advance payment for the confidential and full review of all of the initial documents and images as a consultant medical expert, including the radiologist’s analysis of the case and a verbal preliminary medical opinion on the merits of the case.

Following this review, if the consulting radiologist is requested to become an expert witness and agrees the case has merit, and after both the radiologist and requesting attorney sign the Health Care Consultant, Medical Expert Engagement Agreement, a 10-hour initial fee will be paid to the consultant as detailed in the contract, and the radiologist can then be officially named as an expert witness for the case. Further fees and expectations of payment for expenses, travel, deposition, reports, etc. are as detailed in the contract.
Try as I might, I can't torque this into anything that sounds at all like help for the defense.  The oft-repeated clause "merits of the case" speaks volumes.  If you are being sued and need an expert to testify on your behalf, the "merits of the case" don't affect you in the least.  Of course the case has no "merit" in the eyes of the defendant, but so what?  Clearly, UTH's efforts are directed toward helping the plaintiff and his attorney, and not their colleagues.  Nice.  Really nice.

If you have a problem with this practice, you might want to contact someone at The University of Texas Medical School at Houston and let them know.  Yee-haw.

Dalai's Missed Files

We radiologists do a pretty good job overall, but we are human, and we miss things. After all, we are expected to read 100-200 or more examinations a day, and some of those studies might have upwards of 1,000 images. It would be miraculous if we only miss a few things every day! 

Finding each other's (and our own) errors is a daily occurrence in this business. The question then becomes: What should I do about it? Some of us simply forge on ahead, and don't let the prior reader know of his or her miss. Some of us call or email with details. Some mention the miss in the current report, with phraseology such as, ". . . in retrospect, this lesion was clearly present." What these folks don't realize is that to a plaintiff attorney, such language is tantamount to saying, "The idiot who read the prior study missed something a large as an elephant, but I, The Great Doctor OZ of Radiology, have saved the day." You think I'm exaggerating? I wish.

After being the recipient of "the call" telling me I had missed something, I got to thinking of a better way to accomplish this distasteful task. I generally don't make "the call" for a perceptual miss. Sometimes, the lesion hides from our vision, or the PACS skipped a slice, or the phone rang, or the clinicians wanted the study reviewed RIGHT NOW while the patient was still getting off the gantry, etc., etc. I really doubt there is much to be learned from getting poked with a sharp stick every time this happens.

That being said, it is doctrine that we can and should learn from our misses, and I firmly believe this to be true. So I have established a new blog, Dalai's Missed Files ( as a safe-haven for us to share the misses we find in daily practice, our own, and those of others. Please send the pertinent image(s), ANONYMIZED (or I'll do it for you) to me, and I will post them. Add a line or two of explanation if needed.

I would ask that you NOT tell the person that missed the finding that you have submitted it to the new blog, or I'll probably receive a bunch of angry comments...("I didn't miss that!" "No one would have seen that!" "Dr. X is after me!") I don't need that grief, and I won't post such things if I receive them.  Ultimately, I would like to see the new blog become a regular stop for those surfing around for radiological information.  I want to facilitate better understanding of our field and our perception, and occasional lack thereof.

Please send cases to doctordalai(AT), and visit Dalai's Missed Files regularly.

Wednesday, April 06, 2011

Safe Strutting

The Okra Strut is a big deal in a neighboring small town here in the Deep South.  From the looks of things, Mr. Okra is well-protected for his next, ummmm, strut.

Saturday, April 02, 2011


I've just spent another afternoon, and a significant amount of money, at the hoity-toity fashion mall in the Big City nearest our average small town in the South. Dalai Jr.'s birthday approaches, and he needed some clothes. Lots and lots of clothes. What ever happened to a pair of Levi's and a T-shirt being the standard kids' uniform?

Plenty. Have a look at True Religion Brand Jeans, and you'll see. Here, you will find delightful blue jeans, with signature detailed pockets, and prices up to $400 per pair. Pictured below is the Ricky Old Multi Super QT model in Nashville wash.

Through some good fortune, these lovely things don't fit my son, so we avoided this $400 joy. And equally fortunately, he wasn't interested in the $70 T-shirt (OK, this one's only $60 but others are $70):

And he scorned the $75 baseball cap as well:

Hmmmm. $550 for jeans, a T-shirt, and a baseball cap. I'm in the wrong business.

Perhaps I'll remedy that. Here is the symbol for True Religion Jeans:

Remind you of anyone you know? Yup. So, I hearby coin the term "True PACS" and I plan to build a PACS with fancy detailing on the home screen. In the next few days, I'm going to copyright the phrase and apply for a trademark for my symbol:

Ha! Two can play this game, Bucko! And to complete the scenario, any study read on Dalai's True PACS carries a quintuple charge. Why?'s from True PACS! What more do you need!

Please stand by for more details on a True PACS retailer near you...

Friday, April 01, 2011

A Very StranGE Document

Dalai's Note:

The Internet is a wonderful place, truly the rival of the Library of Alexandria, which once contained all the world's knowledge.

While surfing around, my son, Dalai, Jr., stumbled upon this document, buried in a government archive.  I have a feeling he shouldn't have been in that particular database, because what he found will completely change the way we view our world.  Sadly, though, I think I knew, deep down, that the truth was out there. . .