Thursday, April 25, 2013

Sunday, April 21, 2013

Adding A Trackpad, or (Jail)Breaking iBad

As a reward for surviving his operation in 2010, we gave Dalai, Jr. one of the original iPads. He never really took to it, preferring his laptop instead. Even so, in  those heady, early days of the iPad, I was quite certain it would become THE radiology accessory, as seen in this cartoon which I made even before the iPad was released, and then this one after it was out. Later, I wrote an early review of the radiology viewing software then available. Some of my comments in that piece were rather prescient, especially those concerning the eventual increase in screen-resolution.

My son's iPad ultimately languished in a drawer for several years. On a lark, I dusted it off and used it for a teleprompter with the proper app (dvPrompter), which worked very well. It occurred to me that perhaps it was time to revisit the iPad, and maybe even pop for the iPad 4, with the Retina Display I had correctly predicted, and the Lightning connector which I had not foreseen.

The closing paragraphs of my software review referenced Apple's potential to redefine the PC world (in the more generic sense), with tablets taking over from laptops and desktops. This hasn't quite happened. It is rather ironic that Microsoft itself ran with the idea...right into a brick wall. The Latest and Greatest Windows, version 8, tries to add a touch interface and some flashy graphics to the venerable GUI. But it isn't selling, as noted by Yuval Rosenberg in the Fiscal Times:
Windows 8, meanwhile, hasn’t won over consumers since being launched in October, accelerating the popular shift away from PCs. Microsoft looks to have a flop on its hands – and one that, despite Ballmer’s talk of devices and services, remains very much at the heart of the company’s strategy. "At this point, unfortunately, it seems clear that the Windows 8 launch not only failed to provide a positive boost to the PC market, but appears to have slowed the market," IDC’s Bob O'Donnell said in releasing the quarterly data. IDC’s data doesn’t include tablets or the new wave of laptop-tablet hybrids, so the slump in Windows-based computing may be slightly less pronounced than its figures show, but rival tracking firm Gartner found an 11.2 percent decline in year-over-year PC shipments so Windows 8 clearly hasn’t helped turn the tide.

The new operating system, designed to enable touch screens, has failed to win over users accustomed to the old user interface, or UI. Plus, PCs with touchscreens are still expensive compared to tablets. "While some consumers appreciate the new form factors and touch capabilities of Windows 8, the radical changes to the UI, removal of the familiar Start button, and the costs associated with touch have made PCs a less attractive alternative to dedicated tablets and other competitive devices,” O’Donnell said. “Microsoft will have to make some very tough decisions moving forward if it wants to help reinvigorate the PC market."
And therein lies the problem. I came to the conclusion independently, but CNet's Scott Stein stated it better than I could in a 2012 article, "Why My iPad Can't Replace My Laptop:  It's The Trackpad":
Adding a keyboard to an iPad, like the Logitech/Zagg Keyboard Case for iPad 2, solves the problem of text entry. That's great for when you have to write a long essay, or are working on a chunk of your Great American Novel, or just want to jot down some notes. It's not so great when you have to edit a document, or create a blog post with embedded links, or do simultaneous Web research and writing. To do anything more than text entry and a few other commands, you'll have to reach up and touch the iPad's screen, which isn't exactly ergonomic or time-efficient when you have the iPad propped up and a keyboard attached. In fact, it's downright awkward.

This is why touch-screen laptops haven't taken off. No one wants to touch a screen while typing on a keyboard. I want a trackpad when I work, or even a mouse. Touching the screen makes no sense in "laptop" mode. I'd rather use the iPad as a straight-up tablet, which brings me back full circle and defeats the purpose of the keyboard.
So, the key to high-level iPad happiness is a keyboard and a pointing device. Several keyboard cases exist, and work well. There are all sorts of Bluetooth trackpads out there as well, but they don't work with the iPad as yet...because they aren't supported by the IOS (operating system). But, there is a way...

You've probably heard of jail-breaking an Apple product, and I won't bore you with the details. Suffice it to say that with the proper software, one can take control of one's iPod, iPad, or iPhone, freeing it from the shackles of the iTunes store, not to mention the Kupertino Kops and their vision of exactly how your interface should behave. In my research, I found that there IS software to allow the use of a Bluetooth mouse or trackpad with an iDevice...IF it's jailbroken.

Legal opinions in the past few years have declared that it is not illegal to jailbreak the Apple progeny, (but it is of course illegal to then download software for free that should be paid). If you jailbreak, you will void Apple's warranty, but, well, my old iPad 1 is waaaaaay out of warranty...

So I did the deed. I jailbroke my son's iPad.

Once processed, the only initial change to be seen is the appearance of a new app named Cydia, which one could think of as the iTunes Store of a jailbroken, parallel universe, or perhaps a Bizarro world (any Superman fans out there?) Navigating Cydia is an experience somewhat less refined than browsing the iTunes store. The interface is cruder, and not for the faint of heart. To be honest, I felt sort of dirty being there, like wandering through an Earth-Fare and being the only customer without Birkenstocks. But it works, and once you get the hang of it, there is a tremendous amount of stuff that will transform your iWhatever into something the late Steve Jobs would probably haunt you over if he could.

Aside from the various downsides of not being able to upgrade to the latest IOS until the mad geniuses out there upgrade their jailbreaking software, and losing the warranty, there isn't too much of a downside. BUT, if you were expecting everything to be free, you would be sadly mistaken.  So...I have yet to spend the $5 for the Bluetooth software. But I will. Eventually.

What I envisioned is a keyboard case for the iPad with a trackpad built in, something like this:

The Crux "Loaded" clamshell iPad case, prototype pictured above, was to have transformed your iPad into a mini-laptop for the small fee of $250. But for whatever reason, Crux seems to have dropped the project. Probably because the small fee of $250 was a little steep for the purpose. Add the cost of a souped-up iPad and you've about hit the $1,000 minimum price of an 11" MacBook Air:

15, 13, and 11 inch Macs, image courtesy
Personally, I'm thinking the Air would be the better choice after all. I wonder if you can jailbreak an Air...

In the meantime, the Android world does have trackpadded options; Stein cites this Asus Transformer:

Credit: Scott Stein, Josh Miller/CNET
While the radiology apps for Android is not yet as numerous as for IOS, some do exist, and in fact Calgary Scientific's ResolutionMD is the first to receive clearance from the FDA for diagnostic reads.

In the meantime, I'm just going to wait for the iPad 5, before making any purchase decisions.  The '5 is said to be thinner and more powerful then ever before. I wish I could say that about myself...

Sunday, April 14, 2013

The Final Four And Other Unfairness

While I'm not that much of a sports fan, Mrs. Dalai and I bid successfully on tickets for the Final Four offered by one of our favorite charities, Camperships For Nebagamon, and so we got to tick one more item off of our bucket list. (Still to come, not necessarily in order: Superbowl, college and professional baseball World Series, visits to Giza and the pyramids, Angor Wat, the Terra Cotta Soldiers in China, African Safari, Paris, Scotland, Ireland. And while I've been to Israel, Hawaii, and Australia, Mrs. Dalai hasn't, so our shared list includes these spots as well.)

Courtesy Kevin B. Cox,
I won't begin to analyze the Final Four semi-final and final games, as most any one of you out there could do a far better job of it than I. Still, we thought Michigan had a stronger performance against Syracuse than Louisville did against Wichita State, and we were a little surprised by the outcome of the final game. While we had no dog in the fight, as USC (our USC, not that usurper in California) has never made it into the Final Four, we did favor Louisville out of sympathy for the injured Kevin Ware.

There is nothing like seeing a sport played at the highest levels, even for someone like me who doesn't really appreciate the finer points of the game. I was somewhat surprised that the President, who is a very big fan of the game, didn't show for the finals. Mr. Obama does get all the nuances, I'm sure. But everyone understands this: there will be a winner and there will be a loser in each and every game. And no one seems to have much of a problem with that. It is accepted that in competition, the outcome is determined by some magical melange of luck, skill, timing, phase of the moon (the tides might affect the spin of the ball, you know), and Heaven knows what else. The Wolverines, while disappointed, haven't been quoted as saying that the Cardinals had some unfair advantage. Rick Snyder, the Governor of Michigan, who sat about 20 seats away from us, isn't calling Greg Fischer, the Mayor of Louisville, to chastise him over the loss, and request an equalization of the points scored.

Clearly, we all understand the concept of winning and losing, and the implied fairness therein. But somehow that feeling doesn't seem to translate into real life, which is essentially a series of competitions that pit one of us against another in some form or fashion. I had to compete with other applicants to get into college, then medical school, then residency, then to find a job. You could say I "won" these clashes, and others lost. My salary might therefore be higher than someone else's. The general feeling, at least among approximately 53% of the population, give or take a percent, is that somehow this is not fair, and my largess must be equalized. I must be forced to pay my fair share, although no one has bothered to define what my fair share really is, not to mention what makes this fair in the least. Fair has become the purview of the majority, and as the old saying goes, democracy lasts until the public realizes it can vote itself stuff from the public coffers. Which the public expects to be filled by the "winners" of society giving back points (I mean money) that was earned, well, fairly.

Was it fair that Louisville beat Michigan? From my vantage-point in section 116, about 40 rows up, I think so. But there are those who attribute the win to bad calls such as the foul called on the block pictured above. If we go there, however, we have to postulate some sort of bias on the part of the officials; otherwise, it's rather safe to assume an equal number of bad calls for each team. And maybe that is the origin of the fairness thing. All men (and women) are created equal, but the second we draw our first breath, that equality diverges into a zillion different directions. The outcomes of our various endeavors simply cannot be equal, and this angers a lot of people. It just isn't fair, they cry. But I say this: it wouldn't be at all fair to FORCE equality where it doesn't belong. Someone who is smarter and/or more clever than I am deserves to make more money and have more toys than I do. It's that simple. And that trickles down to those who had the luck to be born to those with those skills, in my humble opinion. Again, it is NOT the job of the government to equalize the outcome, only to remove impediments to the success of anyone and everyone with the ability to achieve it.

Congratulations to the Louisville Cardinals, who played hard and deserved their win and title, even with the unfair loss of Kevin Ware. I guess to be fair, Michigan's Trey Burke should have volunteered to have his leg broken as well, eh? That would have leveled the playing field... Fair is fair, after all.

Did You Ever Wonder...

Mark down Thursday, May 23, on your calendars...that's the date of the next Virtual Conference, and your favorite Doctor Dalai of PACS will have a supporting roll:
"Did You Ever Wonder...Some Musings On What Radiologists REALLY Want Out Of PACS"

Dr. Sam Friedman, the self-proclaimed "Dalai Lama of PACS" shares his (occasionally tongue-in-cheek) views on PACS and how it works (or doesn't) in the hands of the average radiologist. Developed by visionaries and co-opted by Information Technology, PACS had great potential to revolutionize the daily grind of the radiologist, but can just as easily thwart any attempt at efficiency. It would be nice if those who wrote the software actually asked what PACS should do. Did you ever wonder just what that is? The next few moments should cast some light on this mostly-ignored subject.
I hope you will find the entire conference, and my presentation in particular, interesting and informative. I do, however, need your help. Please contact me at doctordalai(AT), and let me know what YOU think! What does your PACS do that you like, and what features do you detest? If you could make your own PACS interface, what would it include? All ideas will be read, and the best will be rewarded with a free mention on this very blog!

Seriously, I would be very grateful for your thoughts on PACS. send them to me at


Thank you!!!!

Tuesday, April 02, 2013

Merge Re-Refinances

While it's not yet up on Merge's website, the company has sent out a press release to those of us on their  email list announcing a new "Tender Offer" and "Consent Solicitation". Here it is:

Merge Healthcare Announces Tender Offer and Consent Solicitation for 11.75% Senior Secured Notes Due 2015

CHICAGO, April 2, 2013 (GLOBE NEWSWIRE) -- Merge Healthcare Incorporated (Nasdaq:MRGE), a leading provider of clinical systems and innovations that seek to transform healthcare, today announced that it has commenced a cash tender offer (the "Tender Offer") for any and all of its $252,000,000 outstanding aggregate principal amount of 11.75% Senior Secured Notes due 2015 (CUSIP Nos. 589499AB8 and 589499AA0) (the "Notes"). The purpose of the Tender Offer is to improve Merge's financial position by refinancing its indebtedness outstanding under the Notes at a lower interest rate.

In connection with the Tender Offer, Merge is soliciting consents (the "Consent Solicitation") to effect certain proposed amendments to the Notes and the indenture governing the Notes (the "Indenture") that would eliminate substantially all of the restrictive covenants and certain events of default contained therein, would release all of the collateral securing the Notes, would shorten the minimum redemption notice period required for Merge to redeem Notes from thirty days to three business days prior to the redemption date, and would modify certain other related provisions contained in the Indenture. The Tender Offer and Consent Solicitation are being made pursuant to an Offer to Purchase and Consent Solicitation Statement dated April 2, 2013 (the "Offer to Purchase"), which more fully sets forth the terms and conditions of the Tender Offer and Consent Solicitation.


As described in the Offer to Purchase, the "Total Consideration" for each $1,000 principal amount of Notes validly tendered and related consents delivered at or prior to 5:00 p.m., New York City Time, on April 15, 2013 (such date and time, as the same may be extended, the "Consent Expiration Time") and accepted for purchase will be $1,066.96 per $1,000 principal amount of such Notes, which includes a consent payment of $30.00 per $1,000 principal amount of such Notes (the "Consent Payment").


The Tender Offer and Consent Solicitation are conditioned upon, among other things, (a) the receipt of tendered Notes from the holders of at least two-thirds of the aggregate principal amount of the outstanding Notes (excluding any Notes owned by Merge or any of its affiliates), (b) receipt of funds from certain refinancing transactions, on terms and conditions acceptable to Merge, in an amount sufficient to enable Merge to purchase the tendered Notes, make the Consent Payments and pay related costs and expenses, and (c) certain other general conditions, each of which is described in more detail in the Offer to Purchase...
Now, I'm no financial genius, as my wife the accountant will tell you. But adding up the numbers, it looks like Merge is offering 6.7% on the purchase of the note, but then taking back 3% in "consent payment" thus yielding 3.7%. But the holders of Merge's debt were to be paid over 11% when the $200 million + in notes were originally tendered in 2010. They might not be very happy about the lower rates.

I'm a firm believer in refinancing, having done so on my home loan several times over the years to take advantage of prevailing interest rates. But I have to be a little worried about this consent business. One could read this as ways to get out of the note's provisions...that couldn't possibly be the case, now could it?

Oh, well.  It was suggested to me years ago that GE was funding Merge's purchase of AMICAS to piss me off, a thought I dismissed at the time. Now that GE has finally come up with a usable GUI, their Universal Viewer, one wonders if they might decide to just squash Merge/AMICAS out of existence altogether. But I'm being paranoid, right? While Merge is a scrappy company run by savvy people, no one ever got fired for picking GE.  Just sayin'...    ;-{)}

Monday, April 01, 2013

The Apple Of My iEye: iVision

With all the hype about Google Glass and Pebble watches, it would appear that Apple has been left far behind in the innovation game. Nothing of this caliber seems to be coming from the magical workshops of Cupertino.

Until today, that is. Secret documents leaked from Apple's headquarters indicate something quite revolutionary, a product that will firmly plant Apple back at the top of the heap for years to come.

If it were up to me, I would want something that would encompass everything I want and need to do during the day into one neat package. It seems that Steve Job's ghost has heard me, and the result is to be called iVision., a site that monitors Apple patents, strangely enough, documents some of the technology behind the new miracle:

This image from the patent application shows us the optical projection approach to delivering images to both eyes. The technology can be modified such that the screen transparency can be modified, and thus the display can either be projected over reality, or seen as the exclusive image, creating a virtual-reality experience for 3D movies, games, and the like.

Processing for this first version will have to be off-board, as the power and communication ability required for this ambitious product is too great to be contained in any headset that might possibly be acceptable to Apple's hipster customers. Thus, a souped up iPhone, tentatively labeled the iPhone5V, will connect to iVision via Bluetooth. Control will be via an advanced version of Siri that actually recognizes your commands.

It is, of course, the superimposition of virtual on top of real that will be iVision's big selling point. Various functions will be controllable by iPhone5V apps. Pedestrians and tourists will of course want the site-labeling that Google Glass already offers, and certainly iVision will outdo this:

I'm assuming that the iPlace app will have extended capabilities, perhaps connecting with the appropriate databases to provide local information:

iVision will have tremendous applications in the medical realm. A virtual display of PACS, called iPACS, assuming Apple can buy back that trademark, will free us from our workstations. For the surgeons, iOperate will provide step-by-step assistance:

The most exciting app of all, to those (over 18 years old, please) with no lives, will be iStrip:

Simulation courtesy of
What? You were expecting more of a surface view? We'll have to adjust the settings....

Of course, Apple won't stop with iVision. The logical progression of all this is something more personal, more internal...iSight!

Image courtesy
Based on the ground-breaking work on artificial vision at MIT, iSight will indeed be an implanted optic replacement, able to interface directly with the user's brain, bypassing Siri. Expect a version for early (and brave) adopters sometime in 2015.

Oh, yes...I completely forgot to show you the iVision wearable device.  Here it is!

This glimpse of the future is available only on this particular day. Have a good one.