Great ExSPECTations

I'm on my way back home from frigid Ann Arbor, having just spent the morning in an amazing Nuclear Medicine department. It's embarrassing, really. Our entire Radiology and Nuc Med divisions would have fit easily within the confines of the U of Michigan Nuclear Cardiology Department alone! I lost count of the number of scanners I saw, and we never even ventured into non-Nuclear territory. Maybe there is something to this academic stuff after all.

I am very grateful to the folks whose schedules we disrupted, in particular Jeff M., and Dr. B., who gave very generously of their time to show us the Siemens Symbia SPECT/CT scanners (several of them...LOTS of them!), discuss their operation and go over images and protocols.

The Symbia series has been around for a few years, which means two things: the bugs have been worked out of the platform, and it may not be at the bleeding edge of technology. At this point in my career, a proven track record tends to trump all else. The CT component is a little long in the tooth, basically the older Emotion platform, but its images are fine. Really, the only thing it really lacks for my purposes is the ability to utilize iterative reconstruction. This could perhaps be added in software, but apparently that is not a likely event. I'm still satisfied with the dose in the setting of a SPECT/CT acquisition.

Symbia does offer IQ-SPECT for cardiac studies, which will allow either a reduction of injected tracer dose, or a significant time-savings. How about acquiring a cardiac scan in 4 minutes instead of 20? Or double the counts with a 6-minute study? Or cut the dose back with a longer scan? I'll let you read the brochure for yourself, but in viewing live studies, I can tell you that the IQ-SPECT scans look about the same as those from the conventional protocol. Key to the process is a focused collimator, the successor if you will of Siemens' old CardioFocal collimators we used to have on our Orbiters from 1990. Everything old is new again, as they say...

The physician (a cardiologist, actually) who had done much of the research for IQ-SPECT was not available today, but I did have a great conversation with Dr. B, a private-practice rad who had returned to academia, and two of the residents. It seems they were not familiar with me and the blog, but I gave them my card, containing my URL. Hope you guys aren't too disappointed in what you find here!

Dr. B and I commiserated on the joys and perils of Private Practice Radiology, not the least of which is having decisions about equipment often made by administrators and vendors, and having no recourse for bad equipment.  I sheepishly mentioned that I have on rare occasions used this blog to hold a vendor accountable (I believe I might have said something like "hold their feet to the fire" but that wouldn't be like me) for bad products. He nodded approvingly, and said, "I think you would fit right in with Academic Medicine." Which I take as an incredible complement.

The two residents were quite impressive themselves, and I wish we were hiring so I could rescue them from the horrendous weather up there in Michigan.

Due to various machinations, we won't be looking at the Discovery 670 NM/CT 670 this time around. However, I will say this now: we will never again buy a conventional gamma camera without integrated CT.  (I can act like a big-shot with other people's money, but it makes perfect sense.) I do believe we are to have a peek at the Philips Precedence before the final decision is made. I hope we have a room big enough for it! 

Doctor Dalai's Ultimate PACS Fix

Confirmed! iPad 3 WILL Have Retina Display!

The folks over at MacRumors were able to get hold of a display module for the upcoming iPad 3, and literally examined it under a microscope.

From the MacRumors story:

Clearly, there are four times the number of pixels on the new display, and this all adds up to a resolution of 2048x1536, as compared to 1024x763 for the old model. The screen is still about 9.7" diagonally.

The Barco 3MP monitor sitting on my desk shows the very same numbers as the new iPad display.

You realize what this means, of course. The iPad has the potential to become the de facto mobile PACS platform. Of course, there are a lot of hoops to jump through before that happens, but trust me, it will happen.

I do have to add my own personal slant. I've got an iPad 1, and I'm not all that fond of it. There are a number of things it just does NOT do well, not the least being the simple writing of a simple blog by a simple radiologist. However, I did get a case with a Bluetooth keyboard, and this may help things. As far as graphic tasks, however, the iPad/iOS approach does seem to work well, and with the new Retina screen, there can be no worries about resolution. Now, contrast will be another story...will we have to only use PACS apps in the dark? Only the Shadow readers know for sure...

And The Winner Is....

I know there is a lot of pent-up desire out there to know which advanced visualization solution we chose. Now, the decision was far from easy, as any of the five contenders would have done the job. Most likely, anyway.

In the end, we gathered everyone's notes and tally sheets, spoke to as many of the attendees as possible, and tried to synthesize their opinions.

All five products have some things they do well, and some they don't. There are actually few glaring deficiencies, such as the one product that won't be able to create AVI movies until the next release. Another requires an add-on bit of software for certain functions supplied by another vendor, and I am told said add-on won't work as a thin-client, and thus must be installed on every reading station.

At the host of this little party, I have been hearing lots of interesting tales... Did I know, for example, that one company did this, another didn't do that, and by the way, this company just got thrown out of a big-name academic center in favor of that company?  Sheesh.

Now, don't bombard me with queries such as, "but why didn't you like X?" It's not that we didn't like X, but we felt that one product would satisfy our needs in a manner better than the rest. Your mileage may vary, and I urge all potential customers to check out the software for themselves.

Many thanks to all of the vendors and all of those who attended our little shoot out.

And now, the winner is....

Wait for it.....

TeraRecon

I'm looking forward to having it up and running ASAP, so I can report on how well we did with our choice. More to come!

PeerVue Purchased By.....

McKesson!

http://www.businesswire.com/news/home/20120208006474/en/McKesson-Acquires-peerVue-Leader-Radiology-Workflow-Solutions

Today McKesson announced that it has acquired peerVue Inc., an innovative provider of solutions that simplify diagnostic medical imaging workflow, expedite communications for improved quality and efficiency, and support customer efforts to improve patient safety. The acquisition extends McKesson’s portfolio of enterprise imaging and information management systems with highly flexible workflow capabilities that address site-specific needs such as critical results management, peer review and emergency department communication for multiple disciplines.
“We can bring together new care coordination capabilities to close the gaps in workflow for clinicians and enable better health in this generation and beyond.”
“peerVue brings world-class capabilities that facilitate care coordination, which is essential for better care and better business as part of our Better Health 2020 strategy,” said Kevan Torgerson, president, Enterprise Medical Imaging group, McKesson. “By addressing critical imaging workflow needs, particularly for radiologists, our combined capabilities empower care teams to more effectively engage with one another and to make better informed decisions throughout the diagnostic workflow.”

Even McKesson folks didn't know. Good security, people!

The Merge PACS Roadmap

When Merge bought AMICAS last year, many of us were quite worried about the path our PACS would follow, especially with the loss of the main developers and programmers. As a customer, I'm happy to say that promises made at the time are being kept, and the future looks pretty good, at least for the next few years.

I had the chance to visit Merge HQ in mid 2010, and I filed this report:

But what I really came to Chicago to discover was the future of AMICAS PACS, and I think the answer here is satisfactory. The Merge people feel that Merge and AMICAS were more complementary than competitive, except in the realm of RIS/PACS. Everyone agrees that AMICAS had a great PACS, and Merge had a good RIS. These two programs, respectively, will be the go-forward products. Everyone at the table wanted to be certain I deliver this message clearly, so I will quote verbatim: "The approach to RIS/PACS will be the consolidation of the best practices of all of the applications into a single platform workflow and viewing solution." Well, there you have it. All Merge RIS/PACS customers, including those using AMICAS PACS, Fusion PACS, or RadStream (from Emageon) WILL BE SUPPORTED, and will have an upgrade path. How much the upgrades will be wasn't mentioned. What I will call AMICAS 7 will ultimately include the best of all worlds, blending the best of the legacy products, and using the ECM as the back-end.

So far, this has indeed been the course of events. In particular, AMICAS PACS lives on. I am somewhat distressed that it is now called Merge PACS, but I suppose I'll get over it. To the victor go the spoils, and all that.

A few days ago, some of the Merge folks gave me an update on their PACS roadmap. There were no huge surprises, but a lot of nice features are here or are at least on the way.

Our AMICAS, I mean Merge Hospital is still back on AMICAS 6.0.4, the first maintenance release by Merge, and there we sit for the moment. But we are behind the times.


Version 6.1 was released early in 2011. The most important change was the option to integrate to a Vulture Vendor Neutral Archive (VNA), preferably the Merge iConnect VNA (formerly known as Emageon AMICAS Merge ECM, or Enterprise Content Management.) 6.1 also offers tagging for teaching-file creation:

If you bought Merge PACS today, and everyone was REALLY efficient at getting it up and running, you would receive Version 6.2, which was released in Q3 of 2011. While previous versions would run in a 64-bit environment, 6.2 is a native-64-bit application, which can use more memory for larger studies or more studies viewed simultaneously. Yes, it will run on 32-bit stations, too. There are several fixes as well; our version has a weird glitch involving the display of some of the cursors, and that is now history. 6.2 also includes  instant messaging via Merge Messenger (do you get the impression that they like the name Merge?) which lets users communicate with each other and link to studies in real time.

DICOM SR reports and other such objects can now be viewed. There are some mammo enhancements such as skin-line localization. 6.2 has been more optimized to be launched from an EMR as an embedded viewer.

We will soon see Version 6.3, expected to be released Q2 of this year, and there will be a number of new features available. First in my heart, anyway, will be PET/CT fusion. Actually, any two modalities can be fused, so maybe I can avoid that PET/MRI purchase after all. (It would be nice if we had PET/CT at the AMICAS Merge hospital...)

There will be even more digital mammo enhancements, with linked magnifying glass and linked binoculars view:

Digital tomosynthesis display will also be included:

One of my partners has been whining about requesting user-customized keyboard shortcuts, and his wish is now granted:

6.3 has some back-end improvements, such as LDAP support, and better study-deletion rules. Its code has been streamlined for faster operation, and improved experience on lower-end workstations.

Sometime late in 2012 we will see the next edition of Merge PACS, Version 6.4. In an attempt to consolidate Stryker Ortho customers, Merge will, umm, merge the functions of Stryker PACS into the mothership code. There will also be teaching file worklist access from iConnect. There will be a new option to upload CD-ROM data.

Sometime in Q1 2013, we should see version 7.0, code named Ability (actually, it's not, but I thought it sounded like a nice counterpart to another version 7.0). We will see native DICOM printing (which now requires an add-on such as ePhlegm eFilm to accomplish, global user preference administration, and EMPI (Enterprise Master Patient Index) support, critical for true enterprise systems. There will be some enhancements to the Real Time Worklist (RTWL) as well.

No word yet on Version 8.0.

I'm personally pleased by what I've seen. Merge PACS remains eminently usable, and continues to evolve and improve.  I'll still put it up against anybody else's software. Now, if I could only come out with a new and better version of my abilities...

Today's Best Exam History

Found on an order for an abdominal and pelvic CT:

28 yo s/p GSW to left thigh on Saturday Jan 28, 2012.  Reports evaluation at (outside hospital) showing bullet lodged in muscle.  States this morning, having BM and heard "clink", dug through stool and found bullet.

This is why I went to medical school, folks.

The Best Part Of The Superbowl

I'm not the world's biggest football fan, but I generally do watch the Superbowl. While I don't really have much skin in the game, so to speak, I am very distantly acquainted with the family that owns one of the teams, so I guess I'll root for them.

But the real reason I watch is for the commercials. It has become a tradition for advertisers to put their best efforts into the VERY expensive Superbowl messages.

My all time favorite is still the FedEx Caveman Commercial from 2006:

Time and technology march on, and the offerings from this year are certain to be even more incredible. The productions from several automobile manufacturers have been posted a bit early to YouTube, perhaps to catch that portion of the audience that actually watches the game and goes to the bathroom during the breaks.

First, we have Ferris Honda's Day Off:

Next, a teaser from Acura, starring Jerry Seinfeld and Jay Leno:

Now, a frosty one from Suzuki:

And something a bit more blood-curdling from Audi:

And finally, let this farce from Volkswagen outwit you:

Lexus just barely got the ad out in time for the GS debut on Friday:

I wonder what the good folks at Bud Light will come up with this year....