Saturday, May 30, 2015

Universal PACS Progress

I will take only the most minimal credit, but GE is addressing our Universal Viewer PACS issues. From a GE VIP:

(GE) has escalated your top 3 issues for assistance in resolution. I was out of the office last week, but will be meeting this afternoon with our Leadership Team for needs in our zone and I have added your site to the agenda. This will ensure that GE Leadership is fully aware of the need and issues at your site.

I have also forwarded the tickets to a manager of the Customer Center asking for a dedicated resource to be assigned to all of your open tickets that either you or the GE team have opened on your behalf. I expect to have this update this afternoon.

. . . I will work to remove any roadblocks to getting your issues reviewed and updates to you and your team as soon as possible.

The top red issues identified on your tracker that I will attack first are listed below, if any others are more critical or just as critical let me know so I can keep the appropriate focus on your most important issue resolutions first and then we will continue working through the list.
  • Pet Fusion Hanging protocols not displaying properly. SUV values are not reliable. Images not displaying correctly in g/ml.
  • Measurements not saving on Image.
  • CT Series slices dropping out.. Viewer on shows the message 0% Loaded.
Thank you and please reach out to me directly if you have any concerns.

I am very grateful for this response. I don't expect immediate miracles, but this is progress, folks.

So far, though, much local effort has been directed toward figuring out why the timestamp on our notes reads one hour later than every system and workstation clock. I suggested that there might be some Time Zone setting buried in the PACS backend, but I don't think my credibility is adequate to participate in the process.

A correction/addition...the UV PET/CT fusion does not work correctly. It was not DESIGNED correctly. Please see my previous post.

In the meantime, we are all very meticulously dictating all measurements and the number of the slice on which the lesion is found. I suppose that is good etiquette regardless of the annotation malfunction. And I may have a solution to the slice disappearance; I have found that if I don't start scrolling until the entire display has loaded, in other words, when things stop moving, more often than not all slices are present and accounted for. I'm guessing there is some faulty code somewhere that allows the impatient radiologist to interrupt the loading of the scan data. I do believe IMPAX had a similar glitch years ago. Perhaps GE could buy Agfa, and create Universally Agile IMPAX, therein solving the problem.

I can't believe I just said that...

Wednesday, May 27, 2015

"Overcoming 10 Barriers To Happiness As A Radiologist"

Dalai's note:  There has been considerable discussion on in recent years as to the level of happiness (or lack thereof) among radiologists. Flounce, a frequent contributor to the forums, has authored this piece for AuntMinnie, and I believe his recipe is applicable to most everyone, not just radiologists.

May 26, 2015 -- Much has been written in the Forums on about why radiologists are unhappy. Increasing volume. Cuts in reimbursement. Busier days. Difficult job market.
These trends all have some truth and are largely outside the control of any individual radiologist. There is no question that radiologists are less happy now than in the past. But I find that dwelling on things outside of our control is disempowering and leads to self-pity.
We do have a choice of what jobs we pursue. Discussions of what a "good job" is tend to focus on income, vacation, and work volume.
When I ponder what a "good job" means to me, the above three factors are not the first things that come to mind, though they are important (especially moderate work volume). Rather, I think about the things that are most important to my happiness.
I consider a good job in radiology one that allows you to achieve a reasonable degree of satisfaction in all of the following categories, where high marks in one category cannot compensate for a deficiency in another:
  • Satisfaction in your daily work life and level of morale
  • Satisfaction in your professional and career development, be it clinical, administrative, research, or whatever combination
  • Satisfaction in the relationships you develop at work, be it with fellow radiologists, technologists, clinicians, or even the nice lady who takes my trash every morning
  • Satisfaction in your health and general sense of well-being
  • Satisfaction in your family or home life
  • Satisfaction in your ability to cultivate and develop your interests outside of medicine, be it a hobby or something else
  • Satisfaction in your current material needs
  • Satisfaction in your ability to plan for your future needs
Yet a number of obstacles stand in the way of achieving happiness in radiology. While I'm no psychiatrist, here's my take on what they are:
  1. Overemphasis on salary and vacation in the job hunt, instead of focusing on job quality, people quality, and group work culture. The latter will determine your happiness more than the former.
  2. Unrealistic expectations of the type of material lifestyle you can afford, i.e., trying to match the homes, cars, and vacations of most other physicians -- and the resulting anxiety when the numbers don't add up. This forces you to work overtime to pay the mortgage on a house and leases on cars that you can't afford.
  3. The assumption that work must be painful, and therefore you should maximize productivity at work to maximize partner vacation time, which is when you hope to truly "live." When your work is reasonable and somewhat enjoyable, you don't feel a dire need for vacation.
  4. Not trying to cultivate your enjoyment of radiology. It's what we do with much of our time; liking it should be a priority.
  5. Not having a specific plan for professional/career growth, whether this means becoming a more knowledgeable radiologist, a better clinician, a radiology group/hospital leader, an accomplished author, etc.
  6. Failure to invest in relationships at work. The greatest secret to making friends is to be willing to show your friendship first, whether with a smile, a compliment, or treating someone to coffee or a meal. These small investments will be repaid to you in spades and will bring you more happiness than that black BMW M5 or Tesla. Ask me how I know. (Yes, I sold it.)
  7. Failure to give priority -- and protected time -- to other things in life. Buying the spouse flowers on the way back from work every few weeks; lunch with aging parents; flying a kite on Sunday mornings with your son: These should be recurring events on your calendar in the same way that partner meetings or radiation safety meetings are, and nothing should be allowed to squeeze these "small" things out of your schedule. Give them the priority you know they deserve.
  8. Seeking pleasure in owning/acquiring rather than doing/experiencing. It's more enjoyable to spend $800 to take a one-week bicycle mechanic's course -- and spend more time riding a basic road bike -- than to spend $4,000 more to get the high-end, carbon-frame road bike and expensive components that will just collect dust in the garage. Make art, don't collect it.
  9. Forgetting to maintain the most valuable piece of machinery you own: you. If you had a Ferrari, you would baby it and make sure everything is oiled and maintained. Your person -- i.e., your body and mind -- is the most valuable piece of operational machinery you have. It can generate a ton of income over the next 30 years. It can bring much joy and benefit to those around you, especially your patients. Maintaining your own wellness is not a luxury, it's a necessity. That refers to getting enough sleep; being in good physical shape; and being of sound mind, unperturbed by unnecessary stressors, with plenty of reserve capacity to deal with whatever challenges arise each day.
  10. Fear of poverty. Why someone who makes $200,000 a year -- or more -- should fear poverty is beyond me. Nothing is guaranteed in life except death and taxes, so, sure, you could be Warren Buffett and somehow end up on the street. But fearing it is something else. Dangers are outside you, but the fear is in your head. Live within your means, enjoy things that do not break your budget, plan for the future, and remind yourself that you make a choice every day to go to work: You are not a slave to your bills, nor will you become homeless if you decide today that you want to walk away from a bad job situation. And no, you do not need $1 million saved up in cash to walk away from a bad job. Compared with other humans on this planet, you are relatively powerful and capable, and there is no reason to disempower yourself in your head, such that you feel locked into anything.
Finally, a few parting thoughts ...
Keep the money in your hand -- to do things with -- and not in your heart. Don't worry, there is enough.
Be passionate about whatever you are doing. Life is too short just to go through the motions. If you must do it, then fully own it and take pride in it.

If you can't go to where you love, then find ways to love where you are.

Saturday, May 23, 2015

A Note To GE PACS Service

Image courtesy


I don't believe I've had the opportunity to meet any of you, but I am one of the radiologists who provide imaging interpretation at a site using GE PACS. I have some familiarity with PACS in general as well, and so I wanted to touch base with you on the issues we are having with the Universal Viewer. I was very disappointed to learn that GE would not have someone on site today; we had rearranged the schedule so I could be here to work with you. Since that is the case, I wanted to outline some of the difficulties we are facing with the new UV software in lieu of a personal meeting,   While UV represents a significant improvement over the old Centricity PACS/RA-600, we have encountered several problems with the software, some with severe enough impact upon patient care that we must request a patch on an emergency basis.

The most serious problem we face is the inability to save annotations (measurements, etc.) placed on an image. In the clinical oncology setting, it is absolutely critical that we have the ability to follow a lesion from scan to scan, and if the measurements are not preserved, the lesion on a comparison study must be remeasured, taking additional time and leading to possible inaccuracies.

An equally serious defect leads to one or more slices of a CT series simply dropping out, leaving a blank screen within the viewport showing only the text "0% loaded". Closing and reopening the study may reveal the missing slice, but usually this requires multiple attempts and sometimes causes other slices to disappear. Clearly, we cannot interpret what we cannot see.

At least one of us is experiencing intermittent zooming of slices when scrolling through a CT series. This is an unnecessary distraction at best which could lead to inability to visualize structures beyond the aberrant field of view.

On at least one occasion, and probably several others, a prior study does not appear to have been properly retrieved. I believe the most glaring case has been submitted to GE. The report from the prior study (multiple priors in this particular case) refer to images that are not present. Is there some reslicing taking place on the stored prior exams, particularly if they were performed on the old CT's which have since been replaced?

There are other lesser but still annoying and potentially dangerous glitches in UV. Scrolling though the prior report with the mouse wheel is disabled once the user clicks back into a viewport. The report can still be scrolled with the left mouse button using the cursor to drag the side-bar control. The Navigator window is hidden initially by the exam information window. To retrieve it, we must press "N" twice. I suspect both of these are state problems stemming from the use of Internet Explorer intermixed with your ActiveX viewer. Perhaps this legacy from Dynamic Imaging isn't playing well with the newer code?

We had high hopes of using UV for reading PET/CT scans. As it stands today, this cannot be done. Synchronization is not possible (at least on some patients) between the PET and a prior CT only exam. Perhaps this could be fixed with a new hanging protocol, but I haven't been able to make this work consistently. We are unable to get SUV readings, without which we cannot interpret a PET exam. In addition, the fusion function does not work correctly. Proper PET/CT fusion requires an "alpha" control which varies the contribution of the PET and the CT slice to the fused image. The only control you have on the fusion pane is for PET intensity, and this does not yield a usable image. This is properly executed on our old Advantage Workstation, and I would refer you to this display to see how fusion should work.

Finally, the search function of the worklist perpetuates the rather annoying requirement that ONLY GE has insisted upon for years and years, the placement of a space after the comma when searching for a patient by name. Yours is the only software out there that does not simply parse the input for the comma. Yes, it's a minor thing, but for those of us who have to bounce back and forth between multiple PACS systems, this uniqueness is really not appreciated.

I should add that the new Zero Footprint Viewer does work much better than the old Centricity Web client, which was truly one of the worst pieces of PACS software ever created. I had anticipated being able to utilize the full UV client remotely; I had thought it to be a zero-footprint product itself rather than an ActiveX app. I assume UV could be used remotely, but apparently our site is not allowing it to be distributed beyond the DMZ as we are doing elsewhere with Merge and Agfa clients. But that's another topic for another day.

The problems above that affect the display of the images, particularly the image drop-out and the inability to save annotations, represent impediments to patient care. I would urge GE to patch these as quickly as possible.

Thank you.



Tuesday, May 12, 2015

Watching The Apple Watch

My birthday present from Mrs. Dalai arrived yesterday, just a few months past the event itself. The much ballyhooed Apple Watch now rests comfortably on my wrist, wresting my restless attention from the rest of what I'm supposed to be doing. (Mrs. Dalai is getting a complete kitchen redo for her birthday...I think she wins.)

I won't go into much detail on its function and so forth, as that is available ad nauseum on the internet. Suffice it to say, I'm happy with my present, and I think it has a great future. When you read some of the reviews out there, you'll think this little gem is nothing more than a flash in the pan, because quite a few of the IT pundits out there have panned it rather mercilessly. As Mike Cannavo, The One and Only PACSMan once put it:
A lot of these folks making the postings suffer from a disease known as LDS, and I'm not talking about the The Church of Jesus Christ of the Latter Day Saints either. It's Little D*ck Syndrome- where you have to make up for your "shortcomings" somehow so you mock on the first person who seems to know what the hell they are talking about. I live it every day.
Absolutely NONE of the Commie Windows-Loving Apple-Hating nay-sayers out there on the net, in the Twitter-verse, or anywhere else in the electronic or print media could envision, let alone put together, something like the Apple Watch. Or an iPhone. Or a Mac. Or even a PC. Well, maybe a PC. Of course, I've done my share of panning of PACS products, but I really could make a better PACS. If I ever got around to it. Which I will. Someday. Eventually. I promise. Really.

Like PACS, a smartwatch is something you have to play with yourself to see how well you interface with the interface. What works for some won't feel right to others in both venues. But since the Apple Watch only works with the iPhone, its users are essentially guaranteed to be well-versed in, and generally lovers of, the way things are done in the Apple Universe. The Watch GUI fits right in with the rest of the toys.

Being a bleeding-edger can cause some minor cuts and bruises. So far, though, the only physical injury I've endured is a few snagged hairs, mostly grey, which were caught in the tightly-woven steel Milanese band. Said band actually looks good, and the magnetic tab closes securely. Functionally, I've had some minor hiccoughs. Upon first activating the Watch, it is supposed to put something on the screen to automate pairing with one's iPhone. It never did show whatever it was supposed to show, and I had to pair "manually" which involved entering a 6-digit number into the phone. Big deal. I've seen some minor stuttering when shifting between apps, but that's really the extent of the difficulties.

It took me about 30 minutes to become familiar with the three controls and what they do. The screen itself is a touch-screen, with Apple's new Taptic Engine yielding haptic feedback to your taps. There's also Force Touch which senses how much pressure you are putting on the screen and acts accordingly. The digital crown turns, of course, but it is also a button that can be pushed. There's a side button as well.  The whole package is quite nicely finished, worthy of a piece of daily-wear jewelry.

The software and interface work fine as far as I'm concerned. The ability to answer the phone from the watch itself, and to engage in limited texting go well beyond the capabilities of my old Kickstarter Version Black Pebble. (I might just start an essay contest for those who would like to be the proud owner of Dalai's Pebble...Dalai Junior doesn't want it...)  If I could request one change in apps or functionality at this early date, it would be something that lets me add my own images to the watch faces. There are already quite a few permutations built-in, but I still like to use my own pictures, something the Pebble could do, although the image had to be downgraded to a 1-bit dithered black-and-white facsimile.

My friends and loyal readers (all three of you) knew I couldn't resist buying an Apple Watch. Such are the joys of being a fan-boy, I guess. You might ask if the Watch is right for you. I'm not sure I can answer that, beyond saying that if you like the other iOS products, you'll most likely appreciate this one as well. Keep in mind the usual caveats...this is the first generation of a very unique product. It WILL change yearly. I'm hoping that new functionality in years to come will be applicable in retrograde fashion to the older models, and Apple is usually pretty good about doing so.

But spare me from the endless carping I've seen on the web from the nay-sayers. No one is holding a gun to anyone's head to buy the darn thing. If you don't wear a watch, you don't like watches, you think watches are a Commie plot, then by all means, DON'T buy the Apple Watch! The rest of the world doesn't really care if you don't get one or if I do. Hate to break it to you, but Steve Jobs won't be spinning in his grave either way.

You'll find a number of articles released in the past few days saying things like, "I've beta-tested the Apple Watch so you don't have to" and "I've got buyer's remorse" and "The Apple Watch sucks" and so forth. And there are one or two positive reviews as well. The main theme of those who've received their Watch in the same shipping dump that brought me mine seems to be that it doesn't meet expectations. I'm sorry, folks, but just what DID you expect? The basics of the thing have been out there since Tim Cook tried his hand at the "Oh, and one more thing" thing. Lots of whining but little if any productive talk about just what would have satisfied the whiners. Really, some of them sound like a kid at Christmas who had been pining for some popular toy and then realized that playing with the box was more fun. As Spock might say, the wanting for some is more fun than the having. (Apologies to the writers of Amok Time).

I'm thinking what the milquetoasts really wanted but couldn't seem to vocalize was a porn-app that utilized the taptic engine to its full potential. They might need to attach a much smaller watch band.

In the meantime, I am hoping at least one of my friends gets an Apple Watch so I can send them my heartbeat to confirm that I'm alive. Lub Dup!