Catching Up

OK, OK.  I've been lax about posting, but there's been a lot going on.  Last weekend, I gave a talk to our state chapter of the Society of Nuclear Medicine.  It was a real snoozer, discussing the application of PACS to Nuclear Medicine, or is it the other way around?  Perhaps the high point of the talk was this picture of an early PACS, Picture Applied to Cave Surface:

A second item of note is that I actually wore a tie, and a PET tie to boot:

Some people have a Pet Rock, I have a PET tie. 

After returning from the meeting, I turned right around and headed for Orlando with Mrs. Dalai.  Yes, we did do Disney, but the point of the trip was to attend the Johns Hopkins CT meeting, chaired by Dr. Elliot Fishman.  Elliot is acknowledged to be the world's finest radiologist.  I wouldn't know about that, but he is certainly one of the best lecturers on the circuit, and the rest of the faculty was superb as well.  Best of all, most, if not all, of the slides were given to us on a USB drive, eliminating the need to furiously scribble notes that I wouldn't be able to decipher later anyway. 

The weather in Orlando was nasty, cold, and rainy.  However, it beat the 7 inches/18 cm of snow we had back home in South Carolina:

My poor baby still has some lingering snow on her roof!

With bad weather comes poor attendance at Disney, although the economy and the fact that a lot of North-easterners couldn't escape from their own snowy prisons didn't help.  Of all the rides in all the parks, only Everest and Soarin' had much of a wait.  The Great Movie Ride at Disney's MGM Hollywood Studios was so sparsely utilized that we had to wait until enough people showed up to fill the tram before the ride started.  Some of the robots in the various movie scenes are showing their age, and don't look quite as real to me as they did in years past.  Maybe I'm just getting jaded.

Certainly a highlight of the trip was meeting up with Mike Cannavo, the One and Only PACSMan, who joined us for dinner at a Brazilian restaurant (off the grounds; there is no Brazil pavilion at EPCOT, but there should be!)  The "gaucho" approach to meals suits me well:  every few moments there was another skewer of luscious beef, lamb, ribs, or whatever coming by to be loaded on my plate.  This was certainly a testimony to the old anti-vegetarian saying, "If God hadn't meant us to eat animals, he wouldn't have made them out of meat."  Don't tell my daughter I said that!

I won't bore you with the details of our other meals save this unfortunate event.  Mrs. Dalai and I tried the German Biergarten restaurant for dinner one night.  After waiting our turn (we had made on-line reservations) we were herded with a family of six to the eight-person table.  The other family promptly jumped into seats, scattered hither and yon about the table, preventing Mrs. Dalai and I from sitting next to each other (yes, we still want to do so!)  We nicely asked if they would shift around a bit, but Big DamYankee Daddy (based on his accent and attitude) wouldn't budge, and in fact growled at us, "I wanna sit by my wife too.  You wanna sit by your wife, and I wanna sit by mine."  I wasn't asking him not to sit by his wife, even though said wife had been in the bathroom for 30 minutes anyway, but simply to shift his nasty DamYankee carcass and maybe some of his progeny around a bit.  I turned to the hostess (a college kid from Germany) and asked to be seated elsewhere, which she promptly accomplished.  I'm amazed that some of us blame George W. for our poor reputation amongst our European comrades.  Try looking in the mirror first, guys.  OOOMPAH!

The trip home was marked by a two-hour delay trying to bypass Daytona Beach on race-day.  I'll never quite understand why thousands and thousands and thousands of people want to watch cars that from their viewpoint are about the size of bugs going round and round and round the track for hours on end.  Maybe everyone is hoping for a wreck.  Yes, I know, the fans all have their favorite driver and team and all that, but really, to tie up I-4 and I-95 in both directions for hours just to see this spectacle, come on.  Oh well, it could have been worse.  Those same fans could have all descended upon Disney World while we were there.  

My poor puppy Sophie was quite distraught at being left in the boarding kennel and showed us just how worried she was that we wouldn't return:

  

Finally, a bit of advanced warning to all my readers in Australia:  I'm coming back!  I've been in touch with one of the physicians making up the program for RANZCR 2010, and I've been asked to give a reprise to last year's extravaganza, this time at the meeting and not in private (although a private audience might still take place.)  It seems the rads in Perth (where the meeting will be held this year) are not terribly enamored with their new PACS:

Perth public hospitals are about to undergo their much delayed (since October) “up”grade to Impax 6 (only 2 years old I think). Even the PACS admins (a minority of whom are A*** fanboys) are embarrassed about it as it seems even more pointless clicks that the previous version. I figure there’ll be plenty of locals at least who will be keen to hear other points of view.

I didn't know A*** was a bad word in Australia, although it approaches that status amongst some of my partners.  

By the way, can you guess what the main difference is between signage, labels, etc. in Australia vs. the US?  Answer:  Everything in Australia is in ENGLISH, and only in English.  Throw some shrimp on the barbee, mates!  I'm on my way. . .

EU Disturbs The Magnetic Force

When we're done here, I want you to sign THIS petition.  You'll see why momentarily. 

The European Union, perhaps the prototype for a world-government that some in our country seem to desire, is about to do radiology, and thus humanity, a disservice.  It seems that the folks over there in charge of such things issued a Phyical Agents (Electromagnetic Field) Directive in 2004, which was to take effect in 2008, but has now been postponed to 2012.  Feel free to read the entire Directive at your leisure, but here are some of the salient Whereases: 

(1) Under the Treaty (creating the European Union) the Council may, by means of directives, adopt minimum requirements for encouraging improvements, especially in the working environment, to guarantee a better level of protection of the health and safety of workers. Such directives are to avoid imposing administrative, financial and legal constraints in a way which would hold back the creation and development of small and medium-sized undertakings. . .

(4) It is now considered necessary to introduce measures protecting workers from the risks associated with electromagnetic fields, owing to their effects on the health and safety of workers. However, the long-term effects, including possible carcinogenic effects due to exposure to time-varying electric, magnetic and electromagnetic fields for which there is no conclusive scientific evidence establishing a causal relationship, are not addressed in this Directive. These measures are intended not only to ensure the health and safety of each worker on an individual basis, but also to create a minimum basis of protection for all Community workers, in order to avoid possible distortions of competition.

And then, the commandments:

Article 1

 Aim and scope

1. This Directive, which is the 18th individual Directive within the meaning of Article 16(1) of Directive 89/391/EEC, lays down minimum requirements for the protection of workers from risks to their health and safety arising or likely to arise from exposure to electromagnetic fields (0 Hz to 300 GHz) during their work.


2. This Directive refers to the risk to the health and safety of workers due to known short-term adverse effects in the human body caused by the circulation of induced currents and by energy absorption as well as by contact currents.


3. This Directive does not address suggested long-term effects.


4. This Directive does not address the risks resulting from contact with live conductors.


5. Directive 89/391/EEC shall apply fully to the whole area referred to in paragraph 1, without prejudice to more stringent and/or more specific provisions contained in this Directive.

Article 5

Provisions aimed at avoiding or reducing risks

1. Taking account of technical progress and of the availability of measures to control the risk at source, the risks arising from exposure to electromagnetic fields shall be eliminated or reduced to a minimum.

.and in the Annex (I think we Yanks call that an Appendix):

A. EXPOSURE LIMIT VALUES

Depending on frequency, the following physical quantities are used to specify the exposure limit values of electromagnetic fields:


— exposure limit values are provided for current density for time-varying fields up to 1 Hz, to prevent effects on the cardiovascular and central nervous system,


— between 1 Hz and 10 MHz exposure limit values are provided on current density to prevent effects on central nervous system functions,


— between 100 kHz and 10 GHz exposure limit values on SAR are provided to prevent whole-body heat stress and


excessive localised heating of tissues. In the range 100 kHz to 10 MHz, exposure limit values on both current density and SAR are provided,


— between 10 GHz and 300 GHz an exposure limit value on power density is provided to prevent excessive tissue heating at or near the body surface.

Well, I, for one, don't approve of any nasty effects upon my cardiovascular or central nervous system, and we certainly don't want any whole-body heat stress.  But, the protective action of the EU might have some unforseen consequences.  From S. F. Keevil, writing in the British Journal of Radiology in 2005: 

Not that I mind US researchers getting the upper hand in something, but you know very well that if the limits go into effect in Europe, they will eventually find their way across the Pond, given our admiration for all things European. 

In the absence of a static field limit, the gradient field limit poses the greatest problem. It will exclude staff from the vicinity of the bore during imaging, with the extent of the exclusion zone depending on magnet and gradient system design and choice of sequence. Since the limits are absolute, without scope for time averaging or relaxation for brief exposure, it will become illegal for an anaesthetist to lean into the bore even for a moment to check a patient, or for a radiographer or nurse to hold an anxious patient’s hand.


Incorporation of these limits into law will make many interventional MR procedures illegal in Europe, closing off development of a field with tremendous clinical potential. It will make it more difficult to provide appropriate care for anaesthetised, monitored and anxious patients. It will affect manufacture of MR equipment, particularly if a static field limit is adopted, and hence threaten the UK’s global position in this sector. It will give US researchers a significant advantage over European competitors, both in th development of MR methodology itself and in the growing exploitation of these techniques, for example in the pharmaceutical industry. Most importantly, it will mean that current and future MR techniques may be denied to patients, in many cases necessitating an examination with X-rays instead, with the resulting dose of ionizing radiation to both patient and staff.

But Keevil then reveals the basis for the proposed limits: 

What are the known short-term adverse effects that the Directive seeks to avoid? A recent paper [4] has considered ICNIRP and NRPB documents [2, 5] in more detail than is possible here. In the gradient frequency range, peripheral nerve stimulation (PNS), due to induction of electric currents by time varying magnetic fields, is an adverse effect that forms the basis for limitation of patient exposure [6, 7]. PNS occurs at a threshold current density of around 1 A m22 – 100 times higher that the limit set in the Directive. The difference arises because ICNIRP occupational exposure guidelines rely on less well-established phenomena, such as alteration of visual evoked potentials and subtle cognitive effects. Evidence for most of these effects is sparse, often dating from the 1980s, in some cases presented in preliminary form at conferences rather than in full papers, and in other cases reported only in the 10–100 Hz frequency range but extrapolated to higher frequencies in the absence of more appropriate data.


ICNIRP concludes from these data that thresholds for acute CNS effects are exceeded above 100 mA m22, but in view of the sparse evidence, applies a safety factor of 10, resulting in the 10 mA m22 limit. In supporting the same limit, the NRPB acknowledges adoption of ‘‘a cautious approach… to indicate thresholds for adverse health effects that are scientifically plausible’’ [3]. Many things are scientifically plausible, but the exposure limits are supposed to be based not on hypothetical possibilities but on ‘‘known adverse health effects’’ causing ‘‘detectable impairment of… health’’, as opposed to biological effects that may or may not be harmful [2] if they exist at all. There is no substantial evidence for any such effects in the gradient frequency range below the PNS threshold.

Could it be that the EU overreacted?  Keevil hammers the point home in in a report prepared for the Institute of Physics in London: 

Keevil goes on to outline the actions taken by the MRI community, as well as possible outcomes and alternatives.  The Directive is, as noted above, currently on hold until 2012. 

The members of ICNIRP are internationally acknowledged experts in their fields, but the guidelines that they produced are based on the cautious interpretation of sparse data and are essentially precautionary in nature. It has since come to light that the possibility of the directive causing problems with MRI was raised by some MEPs at an early stage. However, it was dismissed because the European Commission received assurances from ICNIRP that the ELVs would not be exceeded by MRI workers. It has not been possible to determine the precise nature, timing and basis of this erroneous advice. . .

For practical reasons, when an MR scan is performed the operator normally leaves the room and operates the scanner from a separate control room. However, there are instances in which a member of staff remains in the examination room and close to the scanner while it is operating. Examples of these situations include:


● interventional MRI, where a radiologist or other clinician may be reaching inside the bore of the magnet to carry out invasive procedures during scanning;


● some types of functional MRI, such as research studies on deaf-blind subjects where a member of staff touches the palm of the patient’s hand during scanning;


● imaging of children, where the close presence of a nurse or radiographer may avoid the need for anaesthesia to obtain satisfactory images;


● imaging of patients who are anaesthetised or require monitoring, where it is common for an anaesthetist to remain in the room and visually assess the patient during scanning;


● research applications, where a researcher may need to adjust experimental equipment during imaging.


Initial estimates showed that for workers remaining close to the magnet bore in these situations, when the switched gradients are operating, the exposure is likely to exceed the AV for 500–1000 Hz magnetic fields by a factor of around 504,5 and the ELV by an order of magnitude. . .

(I)t is difficult to avoid the conclusion that a range of current and emerging MRI procedures would be rendered illegal by the directive. Some of these techniques simply cannot be performed in other ways, and in other cases the only possible option would expose both the patient and workers to ionising radiation. So, far from protecting worker health and safety, in the context of medical imaging the directive might have quite the opposite effect: a recent study found that almost 40% of interventional radiologists who perform X-ray-guided procedures have signs of radiation damage to their eyes.

Electromagnetic radiation is scary to the public, be it X-rays, gamma rays, or even magnetic and electric fields.  In its zeal to protect EMF workers, the EU appears to have used questionable science and just a tincture of panic, without complete understanding of the consequences of its actions.  I am sorely tempted to compare this to the Cap and Trade/Global Climate Warming Change fiasco, but at least in this case, the data was probably misunderstood and not falsified.  That counts for something. 

I would urge all of my readers to go HERE and sign the petition that reads in part:

I urge decision-makers at all levels in Europe to endorse the position of the Alliance for MRI requesting an EU-wide exemption for the medical use of MRI and related research from any exposure limit values set in the Physical Agents 2004/40/EC (EMF) Directive and the implementation of user guidelines.

Please sign, even if it helps our European friends get ahead of us in research.  While politics may be local, science is global, and there needs to be no unnecessary restriction on this aspect of imaging.

FREE iPAD! Really!

Through extensive research, I have found a site giving iPAD away for free!  Yes, folks, it's true.  Would I lie to you?  Of course not!  Click THIS LINK for details. 

Oh, wait, you thought I meant a free Apple iPad?  Oh, sorry, silly me, I can't get that for free.  It isn't even for sale yet!  It seems that Stanford offers its iPAD software free to the radiologic community, at least those who have Mac's and use OsiriX.  From Stanford's BIMM (Biomedical Image Metadata Manager) website:

iPAD is an annotation tool for radiology images, to make the semantic content (the meaning and other key metadata) explicit and machine-accessible. iPAD, a plug-in to the popular OsriX image viewing workstation, implements the AIM standard (Annotation and Image Markup) of the caBIG project. The problem iPAD addresses is the medically-important content in images--the anatomy, radiology findings, and quantitative features, are not recorded in a way that machines can access the information--they are either in graphical overlays or in unconstrained text in the DICOM header.

With iPAD, we can store and share information about image anatomy, visual features, and quantitative assessments in a computable format. The user draws an ROI on the image, and then types into the iPAD, recording the observations and anatomic location information. Behind the scenes, iPAD records all this information in the AIM format (XML). This can then be stored in a database or serialized to DICOM-SR.

Here is what it looks like:

Not bad for the price, if you happen to need something like this. 

I'm guessing iPAD won't work with the soon-to-be available OxiriX for iPad.

Star Wars Vs. Star Trek

Finally, someone answers the question:  which is better?

Fantastic amateur videography, although any Trekkie knows the sensor dish on the front of the Enterprise is not a phaser emitter!

The Doctor Dalai Show Looks At The iPad

The Tablet

I have to admit some level of curiosity about the upcoming Apple Tablet, the iSlate, or the iPad, or the iTablet, or the iWhoCaresIt'sCool, or whatever.  By this time tomorrow, we'll all know whether the hype is deserved or not. 

Some photos of the device have supposedly leaked already:

and

The only things we know so far is that there will be something introduced tomorrow, almost certainly a tablet, and whatever it is, it will have a 10" screen, based on Apple's orders from its suppliers. 

Having had a Newton 110 way back when, I can attest to the fact that while Apple was always innovative, it didn't always hit the mark.  The Newton

was certainly ahead of its time, but it didn't work all that well.  It was based on a handwriting recognition algorithm that wasn't quite ready for prime time, and the applications were very limited.  I've still got the thing in the back of a closet somewhere.  $1,000 for not too much functionality.  The cost of the iTablet is supposed to be about $1,000 as well. 

Will the iTablet be a boon for Radiology?  Well.....

Maybe.  The lack of a keyboard might prove to be somewhat of a problem, and frankly, that's the one glitch I've found in my iPhone.  The gesture-based Multi-Touch approach might work quite well for PACS.  One could pinch and stretch to zoom, use a flick of the finger to set a MIP spinning, and so on.  If the screen resolution is adequate, we'll certainly see some PACS viewers ported to the iTablet.  Of course, we don't know if the thing runs MAC OS (Snow Leopard cub version?) or some yet-to-be-announced flavor of the iPhone OS.  But where does this thing fit in the great scheme of things?  It is better than an iPhone for PACS applications, certainly, but likely has far less horsepower than even a basic laptop.  It might be good for field-viewing, or other limited approaches, but will it replace a workstation?  That seems unlikely.

Tomorrow, tomorrow, we'll know everything tomorrow, it's only a day away. . .

ADDENDUM:

It's here!!!  Steve Jobs himself announced the new. . . iPad!  From Gizmodo:

It does indeed run a flavor of the iPhone OS.  PACS developers, start your engines!

Did someone ask about pricing?

 

3G service is provided by AT&T for $30 per month.  I think Kindle and all the other eBooks just became obsolete. 

This is not a Newton.  The iPad is certain to be a winner.  I sure wish I had bought some Apple and AT&T stock yesterday. . .

Here's a better PACS paste-up:

A Sign at the Hospital

Ummm. . .OK, stop them from what?  OHHHHH, they are supposed to wear masks!  Gotta read the fine print! 

You're Welcome!

(Click "Play" and give it a minute to load. It'll be worth it!)

What You Don't See Can Hurt You

Imprint of a fine feathered friend who wasn't looking where he was going. . . from within the glassed-in walkway connecting two of our hospital buildings.  Poor little birdie. . .

Credit to Wendy for the photo!

Two For Us

I'm going to do something I have never done before on this blog.  I'm going to ask you to contribute money.  Not to me, of course, but to two gentlemen who might just be able to interrupt the abominable health-care juggernaut bulldozing through Congress as we speak.

First, let me mention Scott Brown, candidate for Ted Kennedy's seat in Massachusetts.  A friend emailed this to me, and I can't state the case any better:

After almost five decades spent represented by Ted Kennedy in the U.S. Senate, Massachusetts is on the verge of electing a Republican to replace him.

Frankly, it’s astonishing.

This morning, the liberal Huffington Post online blog announced, “Republicans Have Already Won Massachusetts Special Election.”  “This race is not about Ted Kennedy…,” says the article, “This is about how in one year, the day before Obama's first inaugural anniversary, Democrats have gone from Superpower status to beating back anything moderate or Republican in philosophy.”

Republican candidate, State Senator Scott Brown is ahead by one point in a recent Public Policy poll, and recently picked up major endorsements from the State Police Association and the Boston Herald newspaper.

By all accounts, this race is going to be a squeaker.

The stakes are huge. If elected, Brown would deprive Democrats of the 60th vote needed in the Senate to sustain their filibuster-proof supermajority. Assuming Obama’s healthcare bill doesn’t pass the Senate before Massachusetts' new Senator is sworn in, it is even possible that this single election could cause a sea-change in consideration of the healthcare bill.

Recapturing one more seat in the Senate will allow us to stop “Cap and Tax,” and the gamut of liberal proposals being advanced by Nancy Pelosi and Harry Reid.

Scott Brown is close, and needs our help. Your contribution right now can make a real difference in what’s happening in Washington, D.C. Losing a statewide race in a typically blue state like Massachusetts will send shockwaves through the Democratic Party establishment and bring Barack Obama’s administration back to the center from the far left.

Please, please, PLEASE go to Scott Brown's site, http://www.brownforussenate.com/ and contribute something.  Anything.

The second fellow I would like you to meet is our state's Attorney General, Henry McMaster.  I've known Henry a long time, and he is a good and honest man.  He is currently running for Governor of South Carolina, but in his post as AG, he has the potential to disrupt that horrible bill I've mentioned.  Here's Henry's take on the situation:

The Obama health care bill is an assault on the US Constitution and our basic freedoms.

It's so flawed, so unpopular, that Democratic leaders had to load it up with special interest deals, kickbacks, and payoffs just to get Democrats to vote for it. Sadly, this has become part of the culture of corruption in Washington, DC.

It is clear to me and many state Attorneys General that the most shameless payoff - given to Nebraska Senator Ben Nelson in exchange for his vote, the last vote Democrats needed for passage - is unconstitutional and must be challenged.

This "Cornhusker Kickback" requires the federal government to pay for 100% of Nebraska's share of Medicaid costs, while the taxpayers in the 49 other states have to pay their share and pay Nebraska's share too!

Fourteen states attorneys general have joined me in warning Nancy Pelosi and Harry Reid that they must remove the unconstitutional "Cornhusker Kickback" or face action.

So far, they have refused. So has President Obama. Senator Nelson has even asked me to "call off the dogs." But we will not stop because our American way of life is at stake.

While a contribution toward Henry's Gubernatorial campaign won't directly help this fight, it will tell him that we stand with him, and he needs to know that he has our support.  So, please consider sending a donation to Henry's campaign. 

Actions speak louder than words, especially typed words on a screen.  Click the links and help those who are trying to help us and the rest of the country.

President For A Day

David Rice Atchison, Images Courtesy Wikipedia

My partnership is governed by a five-man executive committee.  I happen to be a member of this elite group, with the lofty title of Chief Technology Officer, by virtue of the fact that I'm the most computer-savvy radiologist among us.  In other words, no one else wanted to do it.  But that's OK, I'll take the glory any way I can get it.  Sadly, there isn't much glory involved.

This week, three of the other guys are at a meeting in Mexico, and another is off doing something else.  Thus, I'm the only EC member actually working, and so I am the Acting President of the group.  Yawn.  In honor of my temporary ascendancy to the X-Ray Throne, I issued the following message to the gang:

I hereby double your salaries, effective immediately.  However, various fees, bookkeeping, withholding, and so forth will require the deduction of half of your new salary.  Your pay stub will reflect this lack of change.

I'm reminded of someone else who had a very brief reign.  Have you ever heard of David Rice Atchison?  Few have, actually.  He claimed the title of "President For A Day", which may or may not have been deserved.  From the official United States Senate website:

A proslavery Democrat, David Atchison served in the U.S. Senate from 1843 to 1855. His colleagues elected him president pro tempore on 13 occasions. In those days, the vice president regularly attended Senate sessions. Consequently, the Senate chose a president pro tempore to serve only during brief vice-presidential absences.

Until the 1930s, presidential and congressional terms began at noon on March 4. In 1849, that date fell on a Sunday, causing President Zachary Taylor to delay his inauguration until the next day. For some, this raised the question of who was president from noon of March 4 to noon of March 5. Of course, we now know that Taylor automatically became president on the fourth and could have begun to execute the duties of his office after taking the oath privately, a day before the public inauguration.

In 1849, the Senate president pro tempore immediately followed the vice president in line of presidential succession. That era's ever-present threat of sudden death made it essential to keep an unbroken order of succession. To ensure that there was a president pro tempore in office during adjournment periods, the vice president customarily left the Senate chamber in an annual session's final days so that the Senate could elect this constitutional officer. Accordingly, the Senate duly elected Atchison on March 2, 1849. His supporters, to the present day, claim that the expiration of the outgoing president's and vice president's terms at noon on March 4 left Atchison with clear title to the job.

Unfortunately for Atchison's shaky claim, his Senate term also expired at noon on March 4, thereby denying him the chance to become president. When the Senate of the new Congress convened the following day to allow new senators and the vice president to take the oath of office, with no president pro tempore, the secretary of the Senate called members to order.

No one planning to attend Taylor's March fifth inauguration seems to have realized that there had been a "President Atchison" in charge. Nonetheless, for the rest of his life, Atchison enjoyed polishing this story, describing his "presidency" as "the honestest administration this country ever had."

You might wonder what "President Atchison" accomplished in his day of possibly being President.  By one account, not very much.  From the Wiki: 

Family lore suggests that Senator Atchison told his housekeeper on the evening of March 3 that he was going to his bed and under no circumstances was to be awoken before Monday, March 5. Despite an attempt to rouse the good Senator from Missouri by a delegation of Senators on Sunday March 4, Mr. Atchison slept through his alleged 'one day presidency', hence the reason he never acknowledged it in the first place.

So it seems he didn't do much at all.  However, in other legends, Mr. Atchison made a few proclamations of his own:

He used his executive powers in a playful manner for that day, calling for a national day of celebration of pandas, granting a raise in salary "to all gentlemen with attractive teenage daughters," declaring war on Lake Superior, and ending slavery. These executive orders were all rescinded the next day, but they provided a source of fun for a crabby nation.

History doesn't seem too impressed with Mr. Atchison's one day term, and clearly there is much confusion as to whether he actually served it at all, and if so, if he was even supposed to do so.  There will, of course, be no question about my term of leadership.  The history books of the future will refer to this week as the "boringest" in the history of our group.  At least I won't sleep through my entire term. 

2009: Obama's First Year In Review

From "Why Are We Tiring of Obama?" by Victor Hanson at Pajamas Media:

Constant apologies abroad for everything from slavery to Hiroshima

Bows to Saudi royalty, the Japanese emperor, and Chinese autocrats

The on-again/off-again Guantanamo shut-down mess

The fight with the former CIA directors

The public show trial of Khalid Sheik Mohammed

The reach out to Ahmadinejad Castro, Chavez, and assorted thugs

The Honduras fiasco Czars everywhere

The serial “Bush did it”/reset whine abroad

The Queen of England/I-pod fiasco

Gordon Brown gets snookered in his gift-giving

Unceremoniously shipping back the Churchill bust

The end of the special relationship with the UK

The New York on-the-town presidential splurge

Anita Dunn and her Mao worship

Timothy Geithner/Tom Daschle/Hilda Solis and their taxes

What ever happened to Gov. Richardson?

“No lobbyists” = gads of them

The Podestas’ insider influence-peddling empire

Sotomayor’s “wise Latina” chauvinism

The Special Olympics silly quip

Trashing Nancy Reagan

The Skip Gates/police acting “stupidly” mess

The get-Chicago-the-Olympics jaunt to Copenhagen

Cap-and-trade boondoggle

“Millions of green jobs”

Ignore gas, oil, coal, and nuclear power production

Cash-for-clunkers

The Joe Biden gaffe machine

Jobs “saved” or “created” rather than references to the actual unemployment rates

Van Jones, the racist and truther

Desiree Rogers won’t testify

The blowback from, and silence about, the Rangel/Dodd corruption

The White House party crashers plan to take the 5th Amendment

The ‘bipartisanship’ con

The pork-barrel stimulus spoils

The demonization of the Town-Hallers

The Acorn Mess

The Kevin Jennings/Safe School Czar embarrassment

The SEIU direct access to the White House

The Asian Tour comedown

The politicization of the take-over of GM and Chrysler

The Obama readjustment in the order of paying back car creditors

Car dealerships closed on shaky criteria

Obama as “Caesar”

The Emanuel “never let a serious crisis go to waste” boast

The Black Caucus/Rangel/Waters bid to bail out the inner-city radio stations

Yosi Sergant and the NEA $1.7 trillion deficit

The planned $9 trillion added to the national debt

New income tax rates; health care surcharge talk; and payroll tax caps to be lifted

Rahm Emanuel’s promised payback to those states that trash the stimulus

The supposed C-span aired health care debate

The promised website posts of pending legislation

Czechs and Poles sold out on missile defense

Sermons to and finger pointing at the Israelis

The failed ‘Putin helps to stop a nuclear Iran’ gambit

Voting present on the Iranian reformers in the street

Serial but empty deadlines to Ahmadinejad

The good war/bad war twisting and turning on Iraq/Afghanistan

The months-long dithering over Afghanistan

Renditions, tribunals, Patriot Act, etc. once trashed, now OK

Healthcare take-over

The 2,000 page proposed new health code

The embarrassing Nobel Peace Prize nomination

The attacks on surgeons, Chamber of Commerce, Rush Limbaugh, Fox News, etc.

The Islam mythologies in the Cairo Speech

The al Arabiya “Bush did it” interview

Obama’s TV “my Muslim faith” gaffe

If I were over-the-top emotive, and took everything personally, I would be screaming like a petrified child watching a slasher movie. This administration, and the enabling Congress, is a complete and utter disaster. Thanks to everyone who helped this happen: the media, the white-guilt-mongers, the leftists, George Soros (his background deserves a separate post which I'll provide someday), ACORN, and most of all Senator McCain and the Republican Party, who bungled the 2008 election.

I can only hope for change (ha ha) in 2010. November is coming fast, and maybe, just maybe, some of the Socialist damage will be reversed.

By the way, the list left out the latest insult to our sovereignty by our very own Dear Leader, I mean President:

http://threatswatch.org/analysis/2009/12/wither-sovereignty/

Last Thursday, December 17, 2009, The White House released an Executive Order "Amending Executive Order 12425." It grants INTERPOL (International Criminal Police Organization) a new level of full diplomatic immunity afforded to foreign embassies and select other "International Organizations" as set forth in the United States International Organizations Immunities Act of 1945. By removing language from President Reagan's 1983 Executive Order 12425, this international law enforcement body now operates - now operates - on American soil beyond the reach of our own top law enforcement arm, the FBI, and is immune from Freedom Of Information Act (FOIA) requests.

For Immediate Release December 17, 2009

Executive Order -- Amending Executive Order 12425

EXECUTIVE ORDER- - - - - - -AMENDING EXECUTIVE ORDER 12425 DESIGNATING INTERPOL AS A PUBLIC INTERNATIONAL ORGANIZATION ENTITLED TO ENJOY CERTAIN PRIVILEGES, EXEMPTIONS, AND IMMUNITIES

By the authority vested in me as President by the Constitution and the laws of the United States of America, including section 1 of the International Organizations Immunities Act (22 U.S.C. 288), and in order to extend the appropriate privileges, exemptions, and immunities to the International Criminal Police Organization (INTERPOL), it is hereby ordered that Executive Order 12425 of June 16, 1983, as amended, is further amended by deleting from the first sentence the words "except those provided by Section 2©, Section 3, Section 4, Section 5, and Section 6 of that Act" and the semicolon that immediately precedes them.
BARACK OBAMA
THE WHITE HOUSE,December 16, 2009.

What does this mean? From http://patriotroom.com/article/obama-exempts-interpol-from-search-and-seizure-on-us-lands:

It means that we have an international police force authorized to act within the United States that is no longer subject to 4th Amendment Search and Seizure. The "property and assets of [INTERPOL], wherever located and by whomsoever held, shall be immune from search, unless such immunity be expressly waived, and from confiscation."

INTERPOL, an international criminal police organization, is now poised to reside above the United States Constitution - in a place of sanctity beyond our FBI, CIA, DIA, and all other criminal investigatory domestic organizations.

President Obama has just placed our Constitutional rights under international law.

For all of those who howled like wounded animals about Bush and the Patriot Act. . . this is your reward. INTERPOL agents can come into your home in the UNITED STATES and do whatever they want, without fear of interference from any US law enforcement agency. What is it about Europe that makes Leftists salivate and prostrate themselves? Now we entrust INTERPOL with our very freedom. This is absolutely unbelievable.

Romanian Spam, And Other Thoughts On 2009

I hate Spam with a passion, the electronic kind, that is; I don't think I've ever tasted the Hormel version. The spams I hate most are those from the same source that keep coming and coming and coming. In the past several months, I've been receiving literally hundreds of Spam e-mails from some degenerate in Romania, and according to SpamCop, it's all being sent from the Romanian ISP, netcomsolution.ro. I've alerted them dozens of times at the email listed on their contact page, but to no avail. So, I sent an email to the Romanian Ministry of Communications and Informational Society, asking for their help in shutting this jerk down. We'll see what comes of it.


2009 has been a year of changes, some good, some bad. On the other hand, some things didn't change at all. Here are just a few items that come to mind from the PACS world, not in any particular order:

1. AMICAS buys Emageon, and is in turn bought by venture cap firm Thoma Bravo. AMICAS comes out with a higher stock price than has been seen in years (although the vultures disagree with the valuation for some reason). They also gain access to a vendor-neutral database (joining several other companies), a cardiac package, and a large number of customers they hope to keep happy. Emageon was a pretty good system, as evidenced by the loyalty demonstrated by some of its users. There may be a few more elements that AMICAS could utilize before sending the Emageon GUI into the Ethernet for the last time. AMICAS Version 6, affectionately known as simply AMICAS PACS, is deployed, although it took quite a while to get from prototype to production. We hope to get ours sometime in early to mid 2010.


2. GE continues to slog away with the reimagination of Centricity. To my knowledge, and someone please correct me if I'm wrong, Centricity IW, the GUI purchased with the Dynamic Imaging acquisition, has yet to be completely and successfully deployed. We'll cross our fingers for 2010.


3. Agfa IMPAX is once again the bane of my existence. I'll give credit to Agfa for fixing some of it's problems, but many remain. I'm expecting an upgrade in early 2010. Frankly, if I were Agfa, I would concentrate all possible resources on IMPAX 7, and get it out the door. Assuming it actually works properly at that point, which is a major leap of faith for me right now.


4. Cloud computing/storage becomes the rage, with offerings from LifeImage and even DR Systems, amonst many others. To me, this is truly the future of PACS. I'm going to get around to writing a full article about the cloud concept sometime in 2010. (That's about the only resolution I'm making this year.)


5. Enterprise PACS, with universal worklists blanketing multiple sites and multiple systems, appear from several vendors, notably Intelerad, Carestream (with the boldly-named SuperPACS™), and eRad, amongst others.


6. Thin-client advanced imaging packages proliferate, with varying degrees of integration to PACS. Visage takes a unique approach, touting the ability of their system to serve as an overlay, if you will, to a legacy PACS.


7. Siemens revamps their IT offerings with the new syngo.x platform. Look for syngo.via advanced imaging, and syngo.plaza PACS in the near future.

The major medical story overall is, of course, the nearly-complete passage of the health-care bill by Congress. This abomination will certainly change health-care . . . for the worse. Yes, more people will be insured, at tremendous cost, with the eventual erosion of what once was the best system in the world. Please don't bother citing statistics that "prove" otherwise. Those "facts" are gerrymandered and twisted to make us look far worse than we really are. Infant mortality, for example, is "worse" in the U.S. because we count every single live birth in the denominator. Most other nations don't. Our cancer survival is significantly better than elsewhere. You are twice as likely to live through a myocardial infarction here than in many other countries.

Those celebrating the "historic" passage of the bill may be deluded into thinking they have done some good. Sadly, the real reason behind this legislation is power. The Democrats have just snatched 1/6 of the economy for themselves, and they won't let it go until death do them part. My trite little phrase, "If the government controls your health-care, it controls your LIFE," is quite apropos. Once the government steps in and manages, if not provides, health-care, the majority of the public will become dependent upon the ruling party, and will vote them back in again and again. Feel free to disagree, but you won't convince me otherwise.

Our Attorney General, along with those of several other states, is investigating the legality and constitutionality of the gift given to Nebraska as a bribe to Senator Ben Nelson, and they are also looking into the propriety of forcing everyone in the country to buy insurance. We can only hope that the laws of this nation will be visited upon our out-of-control Democratic Congress with the same level of vengeance they have shown to us. And make no mistake, 2010 will be the year of revenge of the average U.S. citizen upon the power-mad Democrats who would have our nation emulate the socialism of their European idols.

Terrorism has reared its ugly shorts in the form of the Crotch-Bomber. We knew we were in line for more terrorist attacks, and I'm really surprised we haven't seen one until now. The Administration is deeply involved in the finger-pointing as to who didn't do what to prevent this near-tragedy. Sadly, until the Democrats acknowledge the fact that we are at war with the terrorists, we are in danger. It was with some trepidation that I put my kids on planes this week to visit friends. We aren't safe, and I don't trust our government to make much progress in this regard.

Climate-Gate should have altered the global climate warming change debate, but that was not quite the case. Emails, ummmm, liberated (supposedly by a hacker, but possibly by someone on the inside) from the Climate Research Unit at the University of East Anglia in England show that the data has been manipulated, altered, corrupted, and otherwise trashed to come to the anthropomorphic conclusion desired by these left-leaning "scientists". But the fact that there is now no "fact" in existence concerning mankind's responsibility for global warming (which isn't really even happening) doesn't bother those who are convinced of our guilt. Talking with these folks is a very surreal experience. "The data was faked," I say. "But we're killing the planet and we need to all change our ways!" the accolytes cry. "But there's no proof of mankind's involvement," I reply. "But we're killing the planet and we need to all change our ways!" the accolytes cry. What can you do? The only truth in all of this is that yet again, this issue becomes the excuse for a power-grab, a path to more and more government control and domination. And no, I don't think the government is acting in anyone's best interest.

You'll be amused to know that I intend to buy a hybrid vehicle when the time comes to replace something in my family fleet. I'm anticipating gas going up to European levels ($8/gallon) before too much longer, and once that happens, prices on hybrids will also skyrocket. While I don't approve of gratuitous pollution, I'm not convinced that my SUV and I are personally responsible for the death of the polar bears (which isn't really happening, either).

I haven't even begun to touch the specter of a nuclear Iran, the quagmire in Afghanistan, and many other critical issues.

Much is bleak on this New Year's Eve, but there is much promise as well. We can either look forward to the future and hope for change (not the hope and change delivered by Washington so far, thanks) or we can wallow in despair and anger over what is being done against us by our enemies, not to mention to us, supposedly for our own good. Best, of course, to choose life, hope, and optimism. 2010 will bring good things for the country and the world. We hope.

Maybe 2010 will deliver a working version of Centricity IW, and a more functional IMPAX 6.5. I can dream, can't I?

I'll be back next year, much to the chagrin of some of you, and perhaps the amusement of one or two of you.

And with that, I wish you all a most happy and healthy holiday! Don't drink and drive, by the way. Let me know if you need a cab, and I'll call one for you. Happy New Year, everyone!

Bravo, AMICAS!

Now that the press-release has hit the wires, I can reveal the nature of the "Big News" from the last teaser post:

BOSTON, Dec. 28 /PRNewswire-FirstCall/ -- AMICAS, Inc. (Nasdaq: AMCS), a leader in image and information management solutions, today announced that on December 24, 2009, it entered into a definitive merger agreement to be acquired by an affiliate of Thoma Bravo, LLC, in a transaction valued at approximately $217 million. The AMICAS Board of Directors unanimously approved the agreement and resolved to recommend that the shareholders of AMICAS adopt the agreement.

Under the terms of the agreement, AMICAS shareholders will receive $5.35 in cash for each share of AMICAS common stock they hold, representing a premium of approximately 24 percent over AMICAS' average closing share price during the 30 trading days ending December 24, 2009, and a 38 percent premium over AMICAS' average closing share price during the 90 trading days ending December 24, 2009. . .

"We look forward to continuing our mission to provide the best solutions for image and information management in healthcare," said Dr. Kahane. "We believe that working with Thoma Bravo will enable us to focus our resources on our business and our customers. With the additional capital and operational expertise available to AMICAS through Thoma Bravo, we will be able to grow as the needs of our customers evolve and will be enabled to better serve our market."

"Thoma Bravo is excited to partner with the AMICAS management team to continue growing the company into the leading provider of image IT solutions for the healthcare industry," said Orlando Bravo, a managing partner at Thoma Bravo.

"Thoma Bravo will further strengthen the industry leadership position of AMICAS through organic growth initiatives, acquisitions, and implementation of operational best practices," added Seth Boro, a principal at Thoma Bravo. "We look forward to helping AMICAS better serve the evolving needs of its healthcare industry customers."

This bodes well for AMICAS, while delivering a late Christmas present to their shareholders (which I am not). Based on my perusing of investment chat rooms and bulletin boards over the years, the market has absolutely no idea what PACS is or does, or which companies to trust. Being freed from the demands of shareholders should be very good for AMICAS. I guess time will tell.

When I heard the details of the merger/acquisition, I breathed a sigh of relief. The call to me and several other long-term AMICAS customers came on a Sunday evening during a holiday weekend. I had the sinking suspicion that AMICAS had been bought, and in my limited view, the only likely suitor left was Cerner. That would have spelled doom for AMICAS. Fortunately, I was wrong about that part. I just wish I had purchased some stock over the years, especially when it was below $2.00. But then, I would have lost credibility with the crowd that thinks I'm an AMICAS spokesman, which I'm not. And besides, I'm always skittish about putting my money where my mouth is. . .

ADDENDUM

My friend Mike Cannavo, the One and Only PACSMan, let me know about a couple of lawsuits pending on this merger/acquisition. A quick Google shows several somewhat predatory-smelling listings. Here is one example:

(Lawyers-R-Us) has commenced an investigation into possible breaches of fiduciary duty and other violations of state law by members of the Board of Directors of AMICAS, Inc. ("AMICAS") (NASDAQ: AMCS) in connection with their actions in causing AMICAS to enter into a definitive merger agreement with an affiliate of Thoma Bravo, LLC ("Thoma Bravo"). Under the terms of the agreement, AMICAS shareholders will receive $5.35 in cash for each share of AMICAS common stock they hold. AMICAS expects the transaction to close in the first quarter of 2010.

(Lawyers-R-Us') investigation concerns whether AMICAS' Board of Directors' acceptance and recommendation of the offer was fair and designed to secure the best possible price for all AMICAS shareholders.

If you are a shareholder of AMICAS and would like more information about your rights as a shareholder, please contact attorney (Mr. Lawyer) at 800-BITEME or by e-mail at MrLawyer@LawyersRUs.com.

Lawyers-R-Us is a law firm with significant experience representing investors in merger-related shareholder class actions, shareholder derivative actions, and securities fraud class actions. For more information about the firm, please go to http://www.LawyersRUs.com.

Many of these gentlemen are stating that AMICAS should be selling for $6/share, even though the stock price hasn't been quite to that level in quite a long time. And people wonder why we don't have any respect for lawyers. . .

As an aside, I've been posting about AMICAS for years without properly using all-caps. I shall endeavor to do it right from now on. Sorry about that, guys.

Big News

I'm sworn to secrecy, but there is big news coming tomorrow morning about a major PACS vendor. Watch the wires. You heard it here first!

Christmas Musings

Being Jewish, I don't do Christmas lights, but if I did, the display would look (and sound) something like this:

More information on this holiday extravaganza can be found at this link.

I'm on call for the day, working from 8AM through 11PM. Business is slow but steady, with a number of chest radiographs ordered for cough, various extremity studies for "pain", and a dozen or so exams for the aftermath of a fall. Overall, I think falls bring us more business than car wrecks, although the latter usually prompts a full-body CT. Of course, today's carnage includes head CT's on two 95-year-old's. Both showed atrophy. Imagine that.

I continue to be amazed at the minimal symptoms that bring someone into the ER, especially on a holiday like Christmas. Americans have been trained to seek care for the slightest twinge. We'll see how we like it when the lines are longer and the pampering is eliminated. That's where we're headed.

One of my friends was working the ER this morning, and we had a nice chat about IT's control over our lives. My friend is a very reasonable and easy-going guy, who orders far fewer CYA-type scans than some docs I know. This morning, however, he was not in a good mood. It seems his password quit working, and he couldn't get into the PACS system. Several calls to our "Help(less) Desk" yielded the message, "We are experienceing technical difficulties. Please leave a message." This did not go over well. I had to let him access the system with my login (don't even think of punishing me or him for that) while waiting for someone from the PACS team to get him back on. In the course of this snafu, he made a rather ominous statement, something we all need to think about. I'll paraphrase it and remove the expletives.

"IT needs to help us," he said. "Standing in the way of me getting to see the data and images on my patient will lead to someone getting hurt. And if that happens, I'm not going to take the rap for it."

I have to try to see both sides of this, but in the end, we have to err on the side of patient care. I understand that all the rules and regulations, and HIPAA and so on are there to protect the patient's privacy and that is critical. However, in an emergency situation, there has to be some compromise, some mechanism to go above and beyond the rules, for the good of the patient. If IT takes its rightful place as master of the computer/network end of PACS, then it has to be there with us to solve problems like this, even at 8AM on Christmas morning.

And now, if you will excuse me, I have to go look at the next dozen images of a 95-year-old who fell down while coughing. And as noted above, I am Jewish, not Christian, but I have great respect for the faith of my friends. After all, Jesus was just a nice Jewish boy who went into His Father's business. To Christians, the greeting of "Merry Christmas" conveys their joy and happiness of the birth of Jesus. It is a greeting borne of caring and not of malice. So, while it isn't politically correct, and I don't celebrate the holiday per se, I still want to wish everyone a very Merry Christmas and a Happy New Year!

Addendum: I just stumbled across this clip from the old TV series Northern Exposure. I hope you enjoy it as much as I did. (Many said at the time the show was running that I bore a strong resemblance to Rob Morrow, who played Fleischman. Of course that was one beard, and many pounds and gray hairs ago...)

An XtraNormal Visit From W

Dell, Windows 7, and Faulty Drivers

My wife LOVES Facebook, and she is, in particular, addicted to FarmVille, the game that glorifies shoveling manure and milking recalcitrant cows. To be fair, I play it too, but mainly because I can't let her beat me at a computer game! (And it's kind of relaxing in a mindless fashion.)

As CIO of the Dalai household, I get to decide who gets what computer. My wife's old Dell Dimension was starting to get a little long in the tooth, so off to the Dell Outlet site I went, and found a lovely Dell Studio Slim, with 6 (SIX!!!) G of RAM, a 600 Gig hard drive, and a 2.9 MHz Intel Core Duo processor. Not bad for the price I paid.

This morning was grand opening time for the new baby. I untangled all the wires and cables from the old installation, teased the old CPU out of the mess, rather like removing a dying heart in preparation for a transplant, and then gingerly plugged in the new, sleek Studio. Everything powered up nicely, and I walked through the preliminary set-up without difficulty. BUT. . . then came the attempt to connect to the internet. Epic Fail! To make a long story short, the RealTek (straight from Taiwan) network card wouldn't admit that it was connected at all, but it did claim to be otherwise functioning normally. I spent two hours on chat (on a different computer, obviously) with Dell, trying various possibilities, none of which seemed to budge anything. We tried uninstalling and reinstalling the NIC, and downloaded the latest software from the Dell site. Nada. (The RealTek site wouldn't even download the latest drivers, having links that just endless-looped back to the main download page.) I did discover an Ethernet service that wasn't on, and asked if that might do the trick. But at this point, the rep simply gave up. He said via chat,

I would have been glad to help you in this regard but I am sorry to inform you that we are not trained on Software issue because we are Hardware technicians. As I see that your system warranty only covers the Hard ware support, where in the current issue with your system is a Software issue and it is not covered under your system Hard ware. All the Software /Wireless /Virus /E-mail support /Data backup will be provided by the Dell DOC team and it is a Fee based support. They shall charge you a nominal fees only. (I would personally suggest you to go with DOC option). DOC will firstly determine the issue and than provide you the Fee details. If you feel the Fee as economical you can provide payment details and proceed with the resolution (or) you can decline it. Please let me know if you are interested, I can provide you the DOC Team phone number (or) Transfer chat to DOC support?

I was not impressed. This is a brand new, just out of the box (OK, it was refurbished, but they are supposed to be good as new, right?) machine, and I was not about to pay MORE for warranty support. Either it works today, or back in the box and back to Dell. My agent backpedalled a bit, especially after I mentioned that I was personally responsible for the purchase of hundreds of thousands of dollars worth of Dell equipment. After a pause, he suggested that I reinstall Windows 7, as that "might help".

Having nothing to lose but the added Dell trash-ware, I went ahead with the reinstall. And lo and behold, it worked! Green light on the Ethernet port, all systems go for internet and LAN connectivity!

Now, here's the interesting thing. I let Windows Update do its thing and install a newer driver for the RealTek NIC, and BAM...back to non-functionality. I rolled back the driver, and there we are, back online. At this point, I don't know if the driver is bad, the NIC is bad, Windows 7 is bad, or I've been bad and I'm being punished by the gods of Microsoft.

What lesson is there to be learned from all this? Perhaps most important is the power of the consumer. I was not about to pay extra for service on a brand new machine, and I made sure this was known. Maybe that made the difference and prompted the one suggestion that actually worked (mostly) or maybe that was just sheer dumb luck. But I was not about to keep a computer that didn't work, nor was I going to pay another $50 to make it work (and I'll bet the Dell DOC team wouldn't have found the problem anyway.) We should not accept expensive hardware and software that doesn't work, and doesn't do the job it was purchased to do.

What applies to a $500 refurbished computer applies to a $13 Million PACS system. Or at least it should. But somehow, the more we pay, the less likely we are to demand excellence. We don't want to admit that we made a mistake, and we swallow errors that we wouldn't tolerate in something we bought from Dell for $500. Or from Mercedes for $100,000. Does anyone see something ironic here?

For what it's worth, the Studio continues to run well, even after I turned it over to my wife. Her FarmVille farm has never looked better.

On The Twelfth Day Of PACS-mas, My Vendor Gave To Me...

A friend of mine is part of a large group in a large city, and they are none too happy with their Fuji Synapse PACS. As his (unaltered by Doctor Dalai) wish-list below nicely outlines, there are a number of features that are not found on their Fuji system (but are available from Amicas!) Without further ado...

1. I should be able to make custom window level settings so when I hit "7" I get MY bone settings.

2. I should be able to customize my right-click generated side bar. When I right click, there are probably 25 options and I only ever use 3 of them.

3. When I reserve a case from the list I should be able to see I've done so.

4. I should be able to pre-select cases on a list I do NOT want displayed if I start F8-ing through a list.

5. Synapse is very unstable. I've never worked with another program that spontaneously crashes at a rate near Synapse. It is unacceptable.

6. In the notes window there should be a single click button to add the word "dictated" without typing that also removes the case from the list and displays my next case.

7. We need a PACS that can support cine for ultrasound, especially vascular.

8. We need a PACS that has full Nucs and PET/CT capability to read on the fly as one reads all other cases.

9. I expect a customized worklist that populates every case I am responsible for covering and none that I am not, so I can access ALL of my cases from a single worklist (as Amicas does). I want a separate worklist also visible that shows any other cases I could read when my list is clean (as Amicas does).

10. I expect a smart worklist that allows me to move from one case to the next without ever returning to the list to look. A smart list needs to manage the order cases appear based on acuity and chronology (as Amicas does).

11. I want to perform MIP and 3D reformats on the fly, when needed, without having to request the study is sent to Terarecon. I expect to be able to SAVE those images (which Fuji can not do with its limited MPR function--Amicas can).

12. I expect images to pre-cache to my PC without me moving a finger. I want every case on my list to have every image loaded before I open it (as Amicas does).

13. I expect a single button click to send my case to OPS with notification to call ordering physician and transfer them to me (as Amicas does). I should never have to open multiple folders and drag a case.

14. I expect a separate single button click to send case to OPS for OPS to call the report (as Amicas does).

15. I expect a single click on my worklist to display all cases I've read that day so I can quickly go back to a case for a clinician (as Amicas does).

16. I want a completely customized hanging protocol that puts every series of my exam and the comparison exactly where I want them every time (as Amicas does).

17. I want to send a email or text link to the ordering doctor that takes them straight to my report and includes annotated images (as Amicas does).

18. When I open a report from Synapse in a new window, I should not have to resize that window EVERY time. It should remember the size I made it last time.

19. I want a way to see a case is cached on my PC before I open it (as Amicas does).

20. I should not have to tolerate sending suggestions like this for 2 years without any being addressed or getting concrete responses from my PACS vendor (as Fuji has).

21. I expect a PACS that mines all databases we access for relevant priors without the extra fee Fuji charges, I want it free like it is with Amicas.

22. I expect to be able to open extra comparison exams in new side windows so I don't have to give up my primary reading space on my layout for another old series (as Amicas does).

23. I want a side annotation that is visible but not distracting to indicate what studies are comparisons so I never have mis-arranged series and read the wrong date's exam as current (which I've done with Synapse). As you've guessed, Amicas has this feature.

24. A PACS system updating a list or exam in the back-ground should not disable our ability to continue scrolling through the exam we are reading, as it true for Synapse.

The interface with our exams is a critical component of our practice. We need to demand excellence. It is currently available.

Just not from Fuji, eh?

My friend went on to speculate that even beyond the above list, what we really need is " a bowling alley order button analog- push the button and help comes." This is probably one of the best ideas I have ever heard. Think about it... a help button that actually helps, either accessing the proper page of the manual based on the state of the PACS GUI at the moment, or alternatively patching one through to the vendor's (or hospital's) help desk, letting them see the problem at hand. This would be simple to implement, but incredibly powerful, much more user-friendly and downright useful than anything out there right now.

Once again, all the vendors have to do to make their customers happy is to listen to them! Simple? Apparently not for some of the larger companies.

On the First Day of PACS-mas, my vendor gave to me. . . a PACS that will work as guaranteed.

The Dalai Can. . .

My Nuclear Medicine Techs have taken a page from my book of perverted songs, and wrote one about . . . me! Here it is with some minor changes to protect the innocent, and apologies to Willie Wonka, and Sammy Davis, Jr.:

Who can take an OctreoScan?
Actually read it, too?
Put in an impression
And add a suggestion or two. . .

The Dalai Man
Doctor Dalai Man can
Doctor Dalai Man can, cause he mixes it with knowledge and makes
The report sound good.

Who aggrevates scan patients,
With a multi-day delay?
Doesn't even matter if it's on a Saturday. . .

The Dalai Man. . .
Doctor Dalai Man can
Doctor Dalai Man can, cause he mixes it with knowledge and makes
The report sound good.

The Dalai Man makes
All that he dictates
Informative and insightful. . .
Talk about Technologist wishes,
He can even make knishes!

Who can run the Leo(nardo)
Better than the rest?
Set up a dummy button
That the other guys can press. . .

The Dalai Man
Doctor Dalai Man can
Doctor Dalai Man can, cause he mixes it with knowledge and makes
The report sound good.
And the report sounds good cause Doctor Dalai Man thinks it should....

Up Against The Wall, iPhone Charger!

From the Department of Stuff You Need, But Just Didn't Know It, well actually, from FastMac, comes something really brilliant: the TruePower UCS Power Outlet With Built-in USB Ports! How many times have you needed to plug in your iPhone, iPod, or other USB-power-gobbling device, only to find the charger misplaced? For $10, you only have to worry about the cord being misplaced, as you can place USB power outlets throughout your home or business.

And, not that I'm all that green (except around the gills after a weekend of call), but this outlet does something most USB brick-chargers don't:

Please also note that the USB ports only draw power when something is physically connected to the port. We didn't want a vampire port that continually sucks and wastes power when not in use so this was one of the features on the top of our priority list during the design phase.

The outlet should ship in early 2010 after it receives final UL approval. You can preorder if you want to be the first on the block to get rid of your bricks. Hat tip to Engadget for this little gem.

FTC's New Blog Controls

As indicated by the badge to the left, I am a member of Wellsphere's Blogging community. This morning, I received a note from Wellsphere, which I assume went out to all their bloggers, concerning some new guidelines put out by the FTC:

“We are writing to let you know about revised Guidelines issued by the Federal Trade Commission (FTC) on October 5, 2009 relating to endorsement and testimonial advertising. These new Guidelines go into effect on December 1, and reflect the FTC’s interpretation with respect to federal law relating to advertising. These new Guidelines specifically apply to bloggers and could impose liability on bloggers for endorsements or testimonials.

The revised Guidelines state that:

· The Guidelines apply to Bloggers and online word-of-mouth marketers and require them to disclose any material connection to a company when reviewing the company’s products or services (failure to disclose any payment or receipt of free product from an advertiser or someone acting on their behalf could expose you to liability);

· Both advertisers and endorsers can be liable for false or unsubstantiated claims made in an endorsement (if you were given a product for free or were paid to write a review, then the claims you make about the product must be accurate and substantiated);

· Advertisements containing consumer endorsements, or testimonials, must disclose what results a reasonable consumer could expect from the product and can no longer rely on a disclaimer that “results may vary”;

The full text of the new guidelines can be found here, and some further explanation from the FTC is found here. The salient points are:

The revised Guides also add new examples to illustrate the long standing principle that “material connections” (sometimes payments or free products) between advertisers and endorsers – connections that consumers would not expect – must be disclosed. These examples address what constitutes an endorsement when the message is conveyed by bloggers or other “word-of-mouth” marketers. The revised Guides specify that while decisions will be reached on a case-by-case basis, the post of a blogger who receives cash or in-kind payment to review a product is considered an endorsement. Thus, bloggers who make an endorsement must disclose the material connections they share with the seller of the product or service. Likewise, if a company refers in an advertisement to the findings of a research organization that conducted research sponsored by the company, the advertisement must disclose the connection between the advertiser and the research organization. And a paid endorsement – like any other advertisement – is deceptive if it makes false or misleading claims.

I have mixed feelings about this, like most things in life these days. I do believe the public needs to be protected from false advertising, which seems to be the main thrust of this program. However, this becomes rather intrusive on the individual, the blogger in this case, and in theory at least might infringe upon one's First Amendment rights. For example, I might want to say something like, "I love the New Nabisco PACS!" (I could have said I like the Nabisco product the late George Carlin mentioned with those Seven Words, but this is a family blog...) Here I am, with a disclaimer in my profile telling you that what I publish is my opinion, and nothing more. Well, that isn't good enough. Americans apparently aren't considered savvy enough to question the sources of their information, and must have legal protection against a rogue blogger like myself who might have received a shipment of Nabisco cookies to give a positive review of their PACS (which of course doesn't exist). What if Nabisco had rewarded me with cookies after I blogged about their fictional product? What if I'm lying about it completely? Doesn't the reader of a blog have some small duty to ask these questions? Do I have the First Amendment right to post anything I please, even if it's false?

It would be nice if the FTC (and the FCC) would have a look into the motivations of the mainstream media outlets, all of them, even Fox, in the same spirit of protecting the public from misinformation, but I suppose that's asking too much. I guess they have to start small, with measly little blogs. On second thought, the news outlets are supposed to be doing that to the government, not the other way around. And only Fox comes close to even trying.

To comply with the ruling, I now have to come clean. I am currently paid nothing by Amicas, or any other vendor. I have been flown to Boston and to Tucson for meetings of the (unpaid) Amicas medical advisory board. I recently traveled to Australia at the expense of healthinc, a redistributor of Amicas down there, and received a boomerang as an honorarium for giving a talk to some of their customers. It was a very nice boomerang, by the way. Visits to Koala Park and boat rides around Sydney harbor were paid for by me and not healthinc.

I have been taken to Israel and Germany several years ago by Elscint, just as they were being purchased by GE. I've had a few other equipment junkets, but no cash changed hands.

The only payment I have accepted was an honorarium from Daxor for giving a speech at a regional meeting discussing their BVA-100 blood volume system, which I had been using for several years before being approached to give the talk. Frankly, I didn't do a great job on the talk, as I tried to cram a huge amount of information into a small amount of time, and Daxor hasn't asked me to speak since!

The material I publish, aside from quotes, of course, is mine alone. It is my opinion, and it is not paid for. I do have my price, but probably only GE could afford me.

And that's the way it is. Have fun with that, FTC.

syngo.plaza

Close on the heels of syngo.via (did you get my subtle references in the syngo.x post as to the name of the new 3d product) comes syngo.plaza:

Welcome to syngo.plaza, the new agile PACS solution for the clinical routine from Siemens Healthcare. As the first Picture Archiving and Communications System (PACS) from Siemens where 2D, 3D, and 4D reading come together in one place, syngo.plaza is poised to change the way multimodality images are read today. Siemens is unveiling this innovation at the 95th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA) from November 29 to December 3 at McCormick Place (Booth #825, East Building/Lakeside Center, Hall D) in Chicago.

“Customer-focused innovation runs in our veins here at Siemens, and syngo.plaza is a true example of that,” said Arthur Kaindl, CEO, Image and Knowledge Management, Siemens Healthcare. “For the first time, we are now offering fast and accurate multimodality reading on one single workplace, with one intuitive user interface. And we are helping to protect our customers´ investment, as already existing hardware components can be leveraged.”

Prepared Reading

Once an image is obtained, syngo.plaza automatically identifies the type based on the scanner that was used and then, in line with the case complexity, calls up the corresponding 2D, 3D, or 4D applications. Through no-click integration to syngo.via, Siemens new imaging software, users can access the appropriate syngo.via applications directly through syngo.plaza. Combined with a unified user-interface, this allows for a smooth transition between different applications and helps speed up the reading workflow.

With its wide application range, syngo.plaza even helps users master complex multi-modality cases through access to syngo.via and syngo Multimodality Workplace applications. And, with its Patient Jacket functionality, syngo.plaza makes it easy to view patient history at a glance – including prior exams, reports, and Digital Imaging and Communications in Medicine (DICOM) presentation states.

Personalized Workplace

In addition to its one-of-a-kind prepared reading capabilities, syngo.plaza also offers two viewing modes for users. The first is a pre-configured intuitive interface. The second is a customizable option that allows users to define and use the layouts they prefer. This role-based view helps streamline the reading workflow and helps eliminate time wasted adjusting to strictly one-size-fits-all PACS technologies. In addition, the time-saving SmartSelect tool enables users to access their most frequently used functions directly in the diagnostic screen without taking their eyes off the images. Plus, syngo.plaza’s innovative system architecture allows clinicians to access the software within their facility or remotely4.

Secured Investment

Finally, syngo.plaza helps to protect customers' investment by offering users the ability to leverage their existing hardware components, functionality, and storage configurations. The system supports the IT components that fit users’ needs and that offer an optimized price-performance ratio. In addition, users can easily adapt to changes in their own environment, enabling their PACS to grow in-line with their needs and budget – and with continuous technical innovations that keep them a step ahead. Furthermore, scalable storage allows syngo.plaza to adjust its shape to users’ requirements – offering multiple solutions ranging from dedicated to shared storage, from single to multiple archives, and from a single workplace to an enterprise PACS, all without compromising performance.

Sounds pretty good, although it still seems to act quite a bit like Amicas 6/Amicas PACS. My friend, Mike Cannavo, the One and Only PACSMan, has seen .plaza in person. He was about to accuse Siemens of rehashing the same old same old, but after viewing the new stuff in Chicago, he came away impressed. Siemens actually, finally, appears to have a working PACS and a good one at that. I'm intrigued by the "leveraging existing hardware" comment: does this mean that syngo.plaza can be used as an overlay to an existing PACS, such as Visage proposes with their PACS/advanced visualization product?

Let's see. . . We have syngo.via, and syngo.plaza. What's next? I know! How about syngo.worksproperlyanddoeswhatitpromises? That would be something quite new amongst the large PACS vendors. . .