A Healthy, Glowing Imagination

Certain larGE companies seem to have something to do with just about anything and everything. 

We have all watched with fascination and horror the televised images of the Japanese earthquake, the tsunami that ensued, and the aftermath of both.  In particular, those of us whose bills are paid by radiation have followed the potential tragedy at the Fukushima Daiichi electrical station with almost morbid interest.  Personally, I'm rather frustrated by the limited information available to the public.  Exactly what has been vented into the atmosphere?  Iodine?  Cesium?  What is the temperature of the reactor cores?  And so on.  But I'll leave that sort of thing for the main outlets, as I have no inside information on any of it.

Some of those same mainstream outlets are giving us some unusual pieces of information, some tidbits that are not complementary to the Administration's favorite larGE company.  It seems that the reactor in use was designed by said company in the 1960's. . .

From the New York Times:

The warnings were stark and issued repeatedly as far back as 1972: If the cooling systems ever failed at a “Mark 1” nuclear reactor, the primary containment vessel surrounding the reactor would probably burst as the fuel rods inside overheated. Dangerous radiation would spew into the environment.

Now, with one Mark 1 containment vessel damaged at the embattled Fukushima Daiichi nuclear plant and other vessels there under severe strain, the weaknesses of the design — developed in the 1960s by General Electric — could be contributing to the unfolding catastrophe.

When the ability to cool a reactor is compromised, the containment vessel is the last line of defense. Typically made of steel and concrete, it is designed to prevent — for a time — melting fuel rods from spewing radiation into the environment if cooling efforts completely fail.

In some reactors, known as pressurized water reactors, the system is sealed inside a thick steel-and-cement tomb. Most nuclear reactors around the world are of this type.

But the type of containment vessel and pressure suppression system used in the failing reactors at Japan’s Fukushima Daiichi plant is physically less robust, and it has long been thought to be more susceptible to failure in an emergency than competing designs. In the United States, 23 reactors at 16 locations use the Mark 1 design, including the Oyster Creek plant in central New Jersey, the Dresden plant near Chicago and the Monticello plant near Minneapolis.

G.E. began making the Mark 1 boiling-water reactors in the 1960s, marketing them as cheaper and easier to build — in part because they used a comparatively smaller and less expensive containment structure.

American regulators began identifying weaknesses very early on.

In 1972, Stephen H. Hanauer, then a safety official with the Atomic Energy Commission, recommended that the Mark 1 system be discontinued because it presented unacceptable safety risks. Among the concerns cited was the smaller containment design, which was more susceptible to explosion and rupture from a buildup in hydrogen — a situation that may have unfolded at the Fukushima Daiichi plant. Later that same year, Joseph Hendrie, who would later become chairman of the Nuclear Regulatory Commission, a successor agency to the atomic commission, said the idea of a ban on such systems was attractive. But the technology had been so widely accepted by the industry and regulatory officials, he said, that “reversal of this hallowed policy, particularly at this time, could well be the end of nuclear power.”

In an e-mail on Tuesday, David Lochbaum, director of the Nuclear Safety Program at the Union for Concerned Scientists, said those words seemed ironic now, given the potential global ripples from the Japanese accident.

“Not banning them might be the end of nuclear power,” said Mr. Lochbaum, a nuclear engineer who spent 17 years working in nuclear facilities, including three that used the G.E. design.

Questions about the design escalated in the mid-1980s, when Harold Denton, an official with the Nuclear Regulatory Commission, asserted that Mark 1 reactors had a 90 percent probability of bursting should the fuel rods overheat and melt in an accident.

Industry officials disputed that assessment, saying the chance of failure was only about 10 percent.

Michael Tetuan, a spokesman for G.E.’s water and power division, staunchly defended the technology this week, calling it “the industry’s workhorse with a proven track record of safety and reliability for more than 40 years.”

Mr. Tetuan said there are currently 32 Mark 1 boiling-water reactors operating safely around the globe. “There has never been a breach of a Mark 1 containment system,” he said.

Several utilities and plant operators also threatened to sue G.E. in the late 1980s after the disclosure of internal company documents dating back to 1975 that suggested that the containment vessel designs were either insufficiently tested or had flaws that could compromise safety.

The Mark 1 reactors in the United States have undergone a variety of modifications since the initial concerns were raised. Among these, according to Mr. Lochbaum, were changes to the torus — a water-filled vessel encircling the primary containment vessel that is used to reduce pressure in the reactor. In early iterations, steam rushing from the primary vessel into the torus under high pressure could cause the vessel to jump off the floor.

In the late 1980s, all Mark 1 reactors in the United States were also retrofitted with venting systems to help reduce pressure in an overheating situation.

It is not clear precisely what modifications were made to the Japanese boiling-water reactors now failing, but James Klapproth, the chief nuclear engineer for General Electric Hitachi, said a venting system was in place at the Fukushima plants to help relieve pressure.

The specific role of the G.E. design in the Fukushima crisis is likely to be a matter of debate, and it is possible that any reactor design could succumb to the one-two punch of an earthquake and tsunami like those that occurred last week in Japan.

Although G.E.’s liability would seem limited in Japan — largely because the regulatory system in that country places most liability on the plant operator — the company’s stock fell 31 cents to $19.61 in trading Tuesday.

From ABC News comes this piece, citing an insider to the design, someone whose futile attempts to warn those in charge are eerily remniscent of the Challenger fiasco:

Thirty-five years ago, Dale G. Bridenbaugh and two of his colleagues at General Electric resigned from their jobs after becoming increasingly convinced that the nuclear reactor design they were reviewing -- the Mark 1 -- was so flawed it could lead to a devastating accident.

Questions persisted for decades about the ability of the Mark 1 to handle the immense pressures that would result if the reactor lost cooling power, and today that design is being put to the ultimate test in Japan. Five of the six reactors at the Fukushima Daiichi plant, which has been wracked since Friday's earthquake with explosions and radiation leaks, are Mark 1s.

"The problems we identified in 1975 were that, in doing the design of the containment, they did not take into account the dynamic loads that could be experienced with a loss of coolant," Bridenbaugh told ABC News in an interview. "The impact loads the containment would receive by this very rapid release of energy could tear the containment apart and create an uncontrolled release."

. . . GE told ABC News the reactors have "a proven track record of performing reliably and safely for more than 40 years" and "performed as designed," even after the shock of a 9.0 earthquake.

Still, concerns about the Mark 1 design have resurfaced occasionally in the years since Bridenbaugh came forward. In 1986, for instance, Harold Denton, then the director of NRC's Office of Nuclear Reactor Regulation, spoke critically about the design during an industry conference.

"I don't have the same warm feeling about GE containment that I do about the larger dry containments,'' he said, according to a report at the time that was referenced Tuesday in The Washington Post.

"There is a wide spectrum of ability to cope with severe accidents at GE plants,'' Denton said. "And I urge you to think seriously about the ability to cope with such an event if it occurred at your plant.''

Bridenbaugh told ABC News that he believes the design flaws that prompted his resignation from GE were eventually addressed at the Fukushima Daiichi plant. Bridenbaugh said GE agreed to a series of retrofits at Mark 1 reactors around the globe. He compared the retooling to the bolstering of highway bridges in California to better withstand earthquakes. . .When asked if that was sufficient, he paused. "What I would say is, the Mark 1 is still a little more susceptible to an accident that would result in a loss of containment."

GE has placed a response of sorts on its website. 

GE’s thoughts and condolences continue to be with the people of Japan affected by the devastating impact of last Friday’s unprecedented natural disaster. And GE officials continue to closely monitor the events at the Fukushima Daiichi Power Plant, which suffered a loss of power after the tsunami struck the site.


During the magnitude 9.0 earthquake (the fifth largest earthquake in recorded history), the GE Boiling Water Reactors (BWR), performed as designed and initiated safe shut down processes. We understand that the back-up generators performed as designed to begin the cooling process. Shortly thereafter, we understand that the tsunami disabled the back-up emergency generation systems.

The fleet of GE Hitachi Nuclear Energy (GEH) BWR reactors has a proven track record of performing reliably and safely for more than 40 years.

GE has been in the nuclear industry for more than half a century. There are currently 92 GE-built BWR plants and plants using the licensed GE BWR design operating globally. Our BWR designs meet the rigorous regulatory requirements of the U.S. Nuclear Regulatory Commission (NRC) and other government regulators and have proven to be safe and reliable. Our reactors are one of the workhorses of the industry.

The Unit 1 reactor at the Fukushima Daiichi site went into commercial operation in 1971; it is a BWR-3, with a Mark I containment system. That means that the reactor is the third generation of the BWR design. The reactor in Unit 1 is the same type as several reactors in the U.S., although every reactor is designed specifically for each project and site. All GEH BWR designs meet all NRC requirements for safe operation during and after an earthquake for the areas where they are licensed and sited.

BWR reactors are designed to be able to safely shutdown in the event of an earthquake or other natural disaster.

A rather bare-bones explanation, but I wouldn't be saying too much at this point, either.

Is there any culpability here?  We will probably never know.  But as usual, it all really comes back to listening.  To your employees with expertise in such areas. Or to your customers.  It is all about remembering that one's ego, personal or corporate, needs to end where the life and livelihood of others begins.

It's rather ironic, really.  No one would have been at all surprised had the containment vessels ruptured outright in the 9.0 earthquake.  That would have been tragic, but acceptable at some level.  After all, the structures were never designed to withstand that sort of an impact.  But since the reactors did survive, only to fail from what may be a lesser design flaw, the pressure is on (pun intended). 

Let us hope and pray for the best.

Sorry I Missed HIMSS...Not...

I have never made it to the Healthcare Information and Management Systems conference, better known as HIMSS, and I suspect I never will.  My friend Mike Cannavo, the One and Only PACSMan, did attend this year, primarily because it was in his backyard, I suppose, and renders this report on his illustrious blog.

Based on Mike's review and others like it (well, there aren't any others quite like it but...), it seems that HIMSS has strayed mainly into the realms of informatics, numbers, demographics, and the like, and away from PACS and the picture-based information we radiologists know and love.  Heck, even SiiM is getting too esoteric for the likes of me.

There were some interesting sights at HIMSS, however, according to Mike:

Best Marketing- without a doubt XLR8r. They had it together.
Worst Marketing- No names will be used to protect the guilty, but it deals with infection control and I’ll leave it at that. I wish I could have taken a picture but guys tend to frown on you when you bring a camera in the men’s room so you’ll have to take my word on this one. I’m standing there getting rid of the morning's coffee and look down and there, written on the urinal screen, is the message “Your keyboard is 4 times dirtier that this” (or something like that). I’m like- “Is NOTHING sacred any more?” Now I’ve been in sports bars and such where they had the newspaper sports section posted above the urinal so you can look at the headlines while you take a leak but the urinal screen? And I really didn’t want to argue with the guys but in the absence of a disease condition urine is basically sterile and is greater than 95% water, with the remaining constituents, in order of decreasing concentration urea 9.3 g/L, chloride 1.87 g/L, sodium 1.17 g/L, potassium 0.750 g/L, creatinine 0.670 g/L and other dissolved ions, inorganic and organic compounds so what’s so dirty about a little pee. If it was good enough for Gandhi it’s good enough for me…. But alas I digress lest someone say I’m full of piss and vinegar.

Maybe next year. Or maybe not. Thanks for the info, Mike!!

Little Black PACS Station

Cyril Kornbluth, one of the most beloved Science Fiction writers of the '50's, died of a heart attack at the rather young age of 34. Perhaps his most famous work was the short story, "The Little Black Bag":

"The Little Black Bag" was first televised as a live act on the television show "Tales of Tomorrow" on May 30, 1952. It was later adapted for television by the BBC in 1969 for its Out of the Unknown series. In 1970, the same story was adapted by Rod Serling for an episode of his Night Gallery series. This dramatization starred Burgess Meredith as the alcoholic Dr. Full, who has lost his license and become a derelict. He finds a bag containing advanced medical technology from the future, which, after an unsuccessful attempt to pawn it, he uses benevolently — reclaiming his career and redeeming his soul...but not that of the guttersnipe he takes in as his receptionist/assistant.

The text is available at Gutenberg Project Canada. Here are the 1952 (Tales of Tomorrow) and the 1970 (Night Gallery) adaptations:

Gotta love Dr. Fullbright's persistent cigarette in the 1952 episode, and the different interpretations of the "guttersnipe" in both clips.

With all due respect and gratitude to Cyril, may I present my own (per)version of the story, The Little Black PACS Station:

---

Dr. David Fullerbrush was a radiologist, although he was not a particularly good at it. Which probably explained why he was working for ImagingTemps, the least-respected locums agency in the country. His current assignment was equally admirable, covering general radiology at the county hospital in Teaneck, New Jersey.

The job wasn't that bad, all things considered, for a 62-year-old who had finally learned to read CT scans five years before, and couldn't begin to differentiate a bleed on an MRI of the brain from a normal thalamus. This was, in fact, how he found himself working for ImagingTemps. It seems that he declared a growing opacity on chest radiographs a "normal cardiac silhouette" for five years running, a finding which didn't quite agree with the autopsy results of a cantaloupe-sized tumor. IT's policy, fortunately, was "don't ask, don't tell, don't check credentials," and they were usually on time with Dr. Fullerbrush's salary. He did end up working some colorful inner-city gigs, and he never stayed at any one site long enough for him to hurt too many patients.

Teaneck County was the sort of place that you might not want to visit at the wrong time of day. In fact, most of the physicians and staff wouldn't go out the door after twilight, as it was considerably safer to stay inside until dawn. It was the hospital of choice for the local knife-and-gun club, and when one of their members rolled into the ED, it was a certainty that friends of the patient would shortly inspire a member of one of the rival clubs to make a similar visit.

Having graduated from film to PACS only a few years before, Teaneck County was ahead of many of Dr. Fullerbrush's placements. The system, a bargain from Typical Electronics, actually did work, although it tended to choke on the 5,000 slice whole-body/head/total spine/triple extremity CT with head-to-toe CTA that was de regeur for all trauma patients. Fortunately, Dr. Fullerbrush was familiar with this piece of equipment, as TE was rather ubiquitous in the sort of hospitals he frequented.

But one night, about two weeks into his tenure, he entered the dingy reading room and found all the stations filled by the other ImagingTemps employees doing time in Teaneck. They barely acknowledged him, as they were trying desperately to read at least one part of an exam before their station crashed. David looked around, shrugged, and strode past his colleagues and into an alcove hidden in a far corner, hoping to find a place to sit and doze. In the darkened room, there was indeed a worn but serviceable chair, and he plopped down in it with a sigh of relief. But before he could drift off into the safety (more for Fullerbrush's patients than for him) of slumber, he spotted a faint glow on the battered desk in front of him. He sat up a bit straighter in the chair, and the glow came into focus. It was a monitor of sorts, although nothing like David had ever seen before. It was solid black, rather like a brick of black glass, and it had no markings or other identifying features. Save for the glow, which was an iridescent shade of violet.

"Identify."

Startled, David looked around. There was no one in his alcove, certainly no one who could have spoken in the soft feminine voice that seemed to originate from a spot near his own corpus callosum.

"Identify."

"Who, me?"

"Thank you. Voice print registered, Dr. David Fullerbrush session now active."

"Ummm, OK..." Fullerbrush had dealt with Speech Recognition at those hospitals which placed a higher value on saving the cost of transcriptionists than on accurate reports, but this didn't quite fit the template.

"Would you like to interpret the next patient, Dr. Fullerbrush?" requested the ethereal voice.

"OK, sure, whatever..." replied the wary rad.

"Thank you. Next patient is Ralph Rococo, 39 year old male, status post gunshot wound to the buttocks. Presenting image now."

And with that, the purple glow from the little black slab swirled around a bit, and settled into a three-dimensional, rather solid appearing rendition of a human torso. David sat back, utterly devoid of any thought as to what to do with this apparition. He brought his hands to his face, hoping to rub his eyes and make the image disappear completely. As he did so, however, the floating image twirled around, and the surface melted away on the side facing him, revealing the organs and blood vessels beneath. The more he moved, the more he found he could manipulate the ghostly form.

"Would you like to begin dictation?"

"Uh, sure. Ummm... Whole body CT is performed without contrast. 3D rendering is obtained." Dr. Fullerbrush, nonplussed as he felt, was not about to lose the reconstruction fees. "Ummm... no acute findings. Signed."

"Dr. Fullerbrush, perhaps you would like to mention the tract of the bullet that has entered the patient's buttocks and severed his right iliac artery and vein?"

And within the floating image, a bright yellow line appeared, presumably showing the path of the projectile. Pooling collections of blood, in neon blue and red, became visible at the level of the vascular injuries.

"Oh, yeah, I was about to take care of that. Please include it in the report," David replied sheepishly, hoping none of his colleagues could hear the exchange between him and the voice in his head.

"Would you like to treat this wound?"

"WHAT? I'm not a surgeon."

"Would you like to treat this wound?"

"Yeah, sure. Why not? I'll just wave my pinkie and everything will be fine!"

"Standard protocol requires only your verbal order. Treatment commencing. Artery regrown. Vein regrown. Muscular and cutaneous damage repaired. Foreign body teleported. Treatment complete."

Dr. Fullerbrush sat back with a mixture of awe and horror. Perhaps he should have attended RSNA at least once in the past few years. Certainly TE couldn't have come up with something like this.

Just then, the ED doc burst into the reading room, yelling at the top of his lungs.

"Basically, I have not been seeing anything of this sort in my long and illustrious career! The unfortunate patient was laying on the stretcher with blood pouring out of the wound in his tremendous backside, and then stopped it did! Right there! The bloody damn entrance wound closed like never it had been there! Unbelievable!"

David cowered in the back room, uncertain of what to do next. The pause seemed to trigger something in the black glass.

"Dr. Fullerbrush, I must perform some brief preventive maintenance. Please stand by."

And with that, the slab went completely dark for a few seconds, and then lit up once again. The purple glow again appeared, but this time, there were words solidifying in the display:

Welcome to MacOSM, copyright MMCCCXI.

MMCCCXI? thought David. 2311? NO! This is impossible! But it's here! My God, the advance in technology! How many people could I save with this? This could make up for all of my old faux pas!

"Uh....computer, show me the next patient, please."

"Yes, Dr. Fullerbrush. Next patient is Lilly Blanc, age 57, chief complaint diffuse abdominal pain."

And again, the purple light solidified into a spectral body, floating in the air in front of the desk. This time, David stopped to study the image more carefully. He waved his hands with more precision, and laid bare the peritoneum of the patient. He paused, and gasped. Wrapped around the pancreas was a 7 cm mass, displayed in pulsing, glowing mauve. The ugly lesion insinuated about the celiac and superior mesenteric arteries, clearly an inoperable cancer. Multiple glowing orbs, ranging from marble-sized to larger than a grapefruit, could be easily seen within the liver.

"Um, Miss, computer... can we fix this?"

"Yes, Dr. Fullerbrush. Please verbally request treatment."

"Yes, absolutely! Treat the patient!"

"Yes Dr. Fullerbrush. Treatment commencing. Sequencing neoplasm DNA. Tuning optimal resonant destructive frequency. Ablating tumor now. Regenerating normal pancreas and liver tissue. Treatment complete. Shall I rejuvenate the patient as well?"

"Why not?"

"Commencing rejuvenation sequence. Atherosclerotic changes reversed. Articular cartilage resurfaced. Emphysematous lung damage repaired. Biological age regressed approximately 13.7 years."

"That's INCREDIBLE, David!"

Fullerbrush turned around with a start, and was saddened to see the head of ImagingTemps, Nosi Hachoo, standing behind him, jaw slack with wonder. Hachoo was known to pay unannounced visits to keep his minions in line, and it seemed he had chosen this rather fortuitous moment to appear.

"Hachoo, this is some incredible technology from the future. I don't know how it got here, but it could revolutionize medical care. Just think of how many people we could save with this!" David cried.

"Yes, of course, you save people with it, hack radiologist! You're working for me, and so it's MINE. Can you imagine what people will PAY for us to take care of them?"

"No, Hachoo! You mustn't think like that! This belongs to all of humanity!"

"Great! All of humanity can pay me to watch it for them!" Hachoo chuckled.

With that, Hachoo grabbed for the black slab. David lunged after him, knocked him to the floor.

"Computer!" Fullerbrush yelled. "Delete Nosi Hachoo!"

"I'm sorry, Dave. I'm afraid I can't do that," whispered the soft, feminine voice. "An attempt has been made to commit a homicide with this station. License has now been voided. Have a nice day."

The sides of the slab separated from each other, and floated to the corners of the room, fading to nothingness as they approached the walls. Pinpoints of bright light emanated from the core of the slab, and exploded outward.

"Oh, my God!" David cried, as he slumped to the floor. "It was full of stars!"

---

THE END

Third Place....

Oh, well...  Third place (missed Second by ONE VOTE!!!) is certainly better than not even being in the race.  Congrats to the Winner, ScienceRoll!!!

---

The First DIAGNOSTIC Radiology Application For Mobile Devices

It's because of MIM Software that I have an iPhone.  I convinced Mrs. Dalai that I needed one since MIM's first app for the iPhone 3G would allow remote viewing of PET/CT's.  Of course, I never actually used it for viewing, but I did proudly show off the fused PET/CT images to anyone who would look.

I've been in touch with MIM since those early days, although I'm sadly still not a full-fledged customer.  Still, I had the opportunity to help out with the final testing and FDA certification of their latest iPhone/iPad app.  Yes, I'm a qualified radiologist.  (Disclosure:  I received a $20 light meter to allow me to check the ambient levels in various parts of the house and outside for the test.)  On February 4, the final approval came through:

FDA clears first diagnostic radiology application for mobile devices
Provides wireless access to medical images for iPhone, iPad users
A new mobile radiology application cleared today by the U.S. Food and Drug Administration will allow physicians to view medical images on the iPhone and iPad manufactured by Apple Inc.

The application is the first cleared by the FDA for viewing images and making medical diagnoses based on computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine technology, such as positron emission tomography (PET). It is not intended to replace full workstations and is indicated for use only when there is no access to a workstation. . .

Radiology images taken in the hospital or physician’s office are compressed for secure network transfer then sent to the appropriate portable wireless device via software called Mobile MIM. Mobile MIM, manufactured by Cleveland-based MIM Software Inc., allows the physician to measure distance on the image and image intensity values and display measurement lines, annotations and regions of interest.

In its evaluation, the FDA reviewed performance test results on various portable devices. These tests measured luminance, image quality (resolution), and noise in accordance with international standards and guidelines. The FDA also reviewed results from demonstration studies with qualified radiologists under different lighting conditions. All participants agreed that the device was sufficient for diagnostic image interpretation under the recommended lighting conditions.

The display performance of mobile devices can experience significant variations in luminance levels even between mobile devices of the same model. The Mobile MIM application includes sufficient labeling and safety features to mitigate the risk of poor image display due to improper screen luminance or lighting conditions. The device includes an interactive contrast test in which a small part of the screen is a slightly different shade than the rest of the screen. If the physician can identify and tap this portion of the screen, then the lighting conditions are not interfering with the physician’s ability to discern subtle differences in contrast. In addition, a safety guide is included within the application.

The app takes the thick client approach, or as thick as you can get with the iPhone/iPad, and it does function smoothly.  While it is a bit spartan relative to the full desktop program, but it does provide enough tools to truly perform a diagnostic read.  And that's now legal, thanks to the FDA.

I do have to add that while the app is free, the desktop software required for operation isn't, but for what it does, I think it's price is pretty reasonable.

However, there is another option, as MIM reminded me after this post first went up:

Appreciate the mention in your blog.

I feel obligated to mention that desktop software is not required for its operation. You may recall that you accessed MIMcloud for your clinical study.  The cloud is how most people will use it, and its an inexpensive "pay as you go" option.

We are already pushing to complete MIMcloud 2.0 which makes managing groups and individuals for sites way more convenient, as well as making the MIMcloud interface much more friendly (tricky business encrypting and decrypting data on demand in a timely manner...). We plan for that in the next few months.

People wanting to use MIMcloud now can either manually browse to, and upload files (from their computer) right from the MIMcloud website, or get a hold of a MIM 5.1 beta and try it out that way. MIM 5.1 integrates with cloud and makes it simpler.

For MIMcloud 2.0, we'll also have a simple utility which makes your MIMcloud as easy to access as a DICOM node on your local network. That will boil it down to pure-simple for those users who don't ultimately end up using MIM workstations.

Congratulations to MIM for this milestone.  This may well be the first of many, but it is certainly worthy of your attention.

Being away from your workstation is no longer an excuse.

The 2010 Medical Weblog Awards!

Sometimes self-promotion gets you somewhere.

medGadget.com, a great site in the spirit of Engadget and Gizmodo, but with a medical bent, has an annual Medical Weblog Award.  This year, I am very proud to announce that Dalai's PACS Blog is up for the award in the Best Medical Technologies/Informatics Weblog.  In fact, I'm first on the list, which is an accident of alphabetization, but I'll take it.  I do have to confess one thing...when this contest was first announced, my blog was not on it.  Fortunately, nominations were still open at that point, and with characteristic modesty, I did the honors myself.

In my category, I've got some stiff competition:  HIStalk, iMedicalApps, NanoTechGalaxy, and ScienceRoll.  Click the links to check them out.  These are all pretty high-class, but none deal with the information with my level of humor, sarcasm, and self-depreciation.

Please go to the medGadget site and consider voting for Doctor Dalai.  While you're there, have a look at the other categories, too!

So far, Dalai's PACS Blog isn't doing so well at the polls. I really don't need to win the prizes, but it would be awful to come in dead last...

TATtle-tales, Paranoia, and Unintended Consequences

My favorite saying of all time is this: "Just because you're paranoid doesn't mean they're NOT out to get you." Truer words were never spoken.

We all know at some level that our PACS stores various measurements, known as physician metrics. Depending on your system, these can get pretty detailed, and may include everything from TAT (turn-around-time) to how many studies you read in whatever time period to how long you spent on any particular study. This is valuable information, if used properly. As reported in HealthImaging.com:

Digital dashboarding uses data mining techniques to continuously, automatically process and visually display custom-set key performance indicators (KPIs) that provide operational data for a practices, departments or group facilities. Paul G. Nagy, PhD, associate professor of diagnostic radiology and nuclear medicine in the department of diagnostic imaging at the University of Maryland School of Medicine(UMD) in Baltimore, says dashboards not only give managers a greater holistic view of their practice, but also reduce costs and can improve productivity.

The majority of this effort seems to be geared to TAT improvement. That of course is a laudable goal, and my group does use data from the RIS to track how fast we sign off our reports once they become available. Hopefully the stopwatch starts at the time the report appears in the queue, and not when the order went in or something, because we would look a bit worse. Still, I think we have pretty good TAT, and that's without Speech Recognition, thank you.

This is all well and good. However, let's get a little paranoid and speculate about what could be done with all this mined data. Can you imagine what might happen if unfriendly types got hold of it?

"Dr. Smith, do you think the fact that you spent only 2.51 minutes reviewing my client's X-Ray had something to do with the fact that the tiny dot you missed turned into a cancer 15 years later? HMMMMM?????"

"Dr. Jones, how could you believe you were doing a good job on the day in question when your PACS system documents that you read 259 examinations without a break? Did you even have time to go to the bathroom? No?"

"Dr. Johnson, the PACS records show that you looked at my client's scan but didn't read it, leaving the life-threating finding for your partner to discover 18 hours later."

"Dr. Dalai, the logs show you were blogging when you were supposed to be helping out with the 368 examinations on the reading list at our seven hospitals."

You get the idea. Well, you say, this just keeps the damn doctors honest. Great stuff. Maybe, but hold your judgement for a moment or two.

Using physician metrics, especially as ratings, is nothing new. Our British friends at the National Health Service tried tying incentives to metrics, and, not surprisingly, the metrics improved:

In 2004, after a series of national initiatives associated with marked improvements in the quality of care, the National Health Service of the United Kingdom introduced a pay-for-performance contract for family practitioners. This contract increases existing income according to performance with respect to 146 quality indicators covering clinical care for 10 chronic diseases, organization of care, and patient experience.

CONCLUSIONS
English family practices attained high levels of achievement in the first year of the new pay-for-performance contract. A small number of practices appear to have achieved high scores by excluding large numbers of patients by exception reporting. More research is needed to determine whether these practices are excluding patients for sound clinical reasons or in order to increase income.

Just what we would expect. Except all may not be as it seems. Here's one analysis:

Really what they showed when they rewarded doctors for maintaining good health metrics in their patients was that doctors that treated the young, healthy, and rich did well, whereas those that served more patients, the poor, the elderly, and difficult patients were paid poorly. Also, those who filed lots of "exception reports" to justify the exclusion of a patient from the data set did the best of all.

Basically, they show that rewarding (and I suspect this will apply to penalizing as well) doctors based on patient health metrics led to doctors serving "easy" populations to do well, and those serving "difficult" populations to do poorly (or try and cook the books). There is no evidence it led to a significant improvement in care. I'm all for getting paid more, but the problem with penalizing or rewarding doctors based on how the patients perform is that it rewards doctors for avoiding difficult patients. ...

The next step will obviously be to make sure that doctors perform the cheapest procedures they can justify, and select the drugs the insurance companies prefer because of rebate deals they make with drug companies.

Here enters both the Law of Unintended Consequences and a bit of paranoia. Alan Greenspan never got it, but the rest of us do understand that people will modify their behavior in ways that benefit them. If you are going to measure something I do, I'm going to change what it is I do so that I look good on the measurement and get the prize. I can illustrate that well with our local TAT problem. As above, my group is monitored for the length of time it takes us to sign off a report. Since our Cerner RIS is a pain to sign on and use multiple times a day, many of us were a bit sluggish about getting this done. But once Big Brother, I mean our friends, started monitoring this, we found ways to improve this problem. My solution, which most of my partners have adopted, is to use a little macro program to keep the RIS window open and in fact flash it in my face every 30 minutes. Thus my TAT never gets much past one hour. Of course, this is a good result. However, with metrics that have more latitude, such as "difficult" patient populations, the practitioner is going to modify his or her approach to fit the metric.

Let's take this to the logical paranoid conclusion. "Meaningful Use" of the EMR is still pretty nebulous, as are most things the government foists upon us, but in reading through the mountains of legalese, one thing about it does become quite clear: for an EMR to be certified, it must be able to transmit data back to the Governmental Mother Ship in Washington, D.C. You can't convince me otherwise. Take the examples above and multiply them by some large fudge factor. The goal is for every doc in the country to report (theoretically anonymously...sure...) on every patient in the country. What a data-mine-field that will be! The potential for abuse is just beyond comprehension. Anyone ready to join me in my paranoia yet?

But I'll conclude on firmer ground with the PACS situation. I think it needs to be determined who owns and who can access the physician metrics stored on your friendly neighborhood PACs. Frankly, I believe this data should be non-discoverable, and available ONLY in anonymized fashion for peer-review and the like. There should be a facility for an individual to see his OWN metrics, but nothing beyond that, except perhaps for how he compares statistically to the rest of the group as a whole.

At this point, I don't know who legally owns this data, the docs, the hospital, the vendor, or the janitor. Also, I don't know if this has ever played a part in any litigation, but I guarantee you, it will someday. Because there are indeed folks out to get us.

The GrEening of America

I'm a little disturbed by GE, which probably comes as no surprise.

My readers know I've had some ups and downs with General Electric. Fortunately, the majority of that animosity has been put to bed. My group owns two GE MRI's, and I work with several other GE machines. If I ever get funding for a SPECT/CT scanner, I will give the Discovery 670 proper consideration. I still am no fan of Centricity PACS, but we'll still let bygones be bygones.

So why am I troubled? Just in the past few days, President Obama announced that Jeff Immelt, CEO of GE, will lead the President's Council on Jobs and Competitiveness:

“Jeff Immelt’s experience at G.E. and his understanding of the vital role the private sector plays in creating jobs and making America competitive makes him up to the challenge of leading this new council.”

Well, that isn't bad, is it? Mr. Immelt replaces former Fed Chairman Paul Volker. As the head of a Really LarGE company, Mr. Immelt ought to have a very good idea of how the private sector works. No doubt he can help the country. But I'm still disturbed.

Why? Because GE and Mr. Immelt are a little too cozy with the Obama administration. This sort of thing is nothing new, as I'm sure my more liberal friends will point out that former Vice President Richard Cheney (Aunt Minnie censors the name Dick, and I've been conditioned to say Richard instead) was head of Halliburton. But read on and decide if perhaps the current situation is a little different.

It seems there are quite a few areas where GE has made some inroads into the way the country works. Let's start with the Green initiative (rather ironic that GE's main color is a rather bright shade of green.) Who makes a larGE percentage of green energy equipment? Ever hear about the GE line of windmills, solar panels, and so forth? There's a lot of money to be made out of thin air.

And lest we forget, those nasty energy-wasting incandescent bulbs, which were sold mainly by GE, are to be phased out starting next year. The replacements, including mercury-containing compact fluorescent bulbs (CFL's), are offered in wide variety, from...GE. Sorry, Kermit, it is quite easy to be Green, or at least sell Green, if the President pushes your products.

NBC, which is about to be spun off to Comcast but still under GE auspicies, has had a pretty big Green initiative with Green Week and Earth Week. And no one will doubt that MSNBC has been rather pro-Administration. We'll see how they behave once they are under different management. Fortunately Keith Olbermann managed to leave MSNBC all by himself.

GE has been front and center in the health care debate, and has a huge presence on the CCHIT and HITECH boards, as I have mentioned in the past. GE's own site lauds this, and well they should:

GE Healthcare has actively advocated on behalf of our customers and participated in the development of the final rule, and we look forward to working within the final guidelines to help ensure success for our customers...GE Healthcare’s Stimulus SimplicityTM program is designed to help hospitals and physician offices accelerate EMR adoption by taking advantage of zero percent financing with deferred payments from GE Capital along with a certification warranty for the EMR solutions from GE Healthcare. It addresses the current obstacles to EMR adoption of stimulus complexity, uncertainty around future standards and affordability.

And we all know who sells a LOT of imaging equipment. Clearly, support for the Health Care Abomination has the potential to be quite lucrative. Indeed, Ken Terry from BNET.com noted in 2009:

General Electric’s announcement today that it will invest $6 billion in a worldwide “Healthymagination Initiative” raises familiar questions about the interplay of free enterprise and healthcare reform in the U.S. While some components of GE’s plan could help lower costs, raise quality, and increase access, as CEO Jeff Immelt contended in a press conference, the overall program seems designed to expand GE’s healthcare business and its profits. As Immelt put it candidly, “We don’t run a charity at GE. We’re in business to make money for our investors.”

But these piddly items are just the beginning. In 2009, Vanity Fair reported:

The issue at hand was this: Would Obama go against the signals he had put out earlier and dismantle the so-called Eastern European shield? By taking apart this defense system, he risked angering many of those who had voted for him, but he would please Putin. So what did Obama do? As the major news outlets reported at the time, he simply gave the go-ahead to have the shield dismantled. In exchange, according to Reuters, Putin agreed to meet with “several U.S. executives ... from firms including General Electric, Morgan Stanley, as well as TPG.” [Italics mine.] G.E. is supposed to bring good things to life; in this case, it powered Obama’s growing pragmatism.

In a similar development that proved greatly to the benefit of G.E., the Obama team apparently reversed course on another deal. For many months it sent out strong signals that it would not support a nearly $1 billion U.S. allocation that would allow the survival of a costly defense initiative called the Joint Strike Fighters engine program. Military buffs know that G.E. is teamed with the U.K.’s Rolls Royce in the development of this jet-engine project; so it should not come as a shocker that Obama last month quietly included the plan in the 2010 Defense Authorization Bill, which he signed with no apparent hesitation.

Making the G.E.-friendly developments more suspicious is the fact that Immelt was appointed to Obama’s Economic Recovery Board earlier this year. Soon afterward, The Washington Post reported that G.E. had become “the biggest beneficiary” of the federal bailout program. And Immelt was caught boasting, in a November 17, 2009, Wall Street Journal report, that he expected to gather in roughly $192 million for his struggling company in government-funded projects.

Chief among these, it now seems, is the coming Afghanistan surge. Available documents show that G.E. has made out quite nicely from the wars of recent years, gaining a $3 billion contract to provide power to the rebuilding of Iraq and a $5.9 million deal to provide power to air bases in Afghanistan.

To be fair, GE no longer does business with Iran:

GE doesn't do business in or with Iran. Due to the developing circumstances there, the concerns of our shareholders, and and our view of our corporate responsibilities, GE and its board decided in 2005 to stop doing business in Iran. There have been two exceptions to this: completing the work for existing contracts as quickly as possible and humanitarian activity, which is authorized by U.S. Government licenses. As of June 2008, we have completed all business in Iran. GE at all times acted in full compliance with U.S. and other laws. We have always required our businesses to follow U.S. sanctions and other applicable laws. In fact, our policies have been more restrictive than U.S. law.

Billy Hallowell of FrontPageMag.com, notes the ultimate irony in all this:

The U.S. government has always been . . . a viable GE partner, but the changing political landscape is paving the way for the company to receive transformational benefits and control. Immelt realizes this, which is likely one reason that Obama was the top recipient of GE contributions during the 2008 presidential campaign (after all, Immelt is a Republican and a former McCain supporter who has no other reason apart from profits to partner with Obama). With such extensive reach into sectors that impact the daily lives of Americans and with international policy at stake, it is in the public’s best interest that close attention be paid to the alliance between GE and the Obama administration.

In the end, Fox News sums up the problem, the reason I'm disturbed by Mr. Immelt's recent appointment:

It is unclear how the administration plans to deal with the ethics challenges created by having a CEO whose income is determined by stock performance leading a panel designed to recommend government policies. G.E. (2009 revenue: $157 billion) is a huge government contractor and is always in the market for new subsidies and incentives.

Yes, I'm a Capitalist, and a GE stockholder, and I do applaud GE's increased profits. But, still, I'm disturbed. Is it OK to unlevel the playing field via governmental intervention? Is it right for a larGE company to influence the government at the highest levels for its own gain? Perhaps. But I'm still a bit disturbed by the whole thing. Perhaps I just don't have a healthy-enough imagination.

iPad EMR's?

Since I authored the articles on radiology apps for the iPad, I've been contacted by various other medical iPad supporters. Austin Merritt, COO of Software Advice, a site dedicated to "free advice for software buyers" comments on the availability of EMR apps for the iPad. Are Vendors ready?

The answer to that question is a surprisingly resounding “No!” The medical software industry is far from supporting the iPad on a meaningful scale. Buyers would think that vendors eager to grow market share would quickly adopt new, flashy technologies, but software vendors are surprisingly slow to react. Electronic health records vendors need to get on board or face the prospect of losing market share to faster-moving competitors.

There is no doubt that buyer demand for the iPad is surging. A past Software Advice poll (below) found that nearly 35% of healthcare providers were “very likely” to purchase a tablet PC in the next year. Don’t forget that the iPad enjoys 87% market share of the tablet PC market. That’s a lot of potential customers looking for iPad EHRs.

Merritt cites the two companies that have so far built EMR's for the iPad from the "ground up," Nimble and Dr. Chrono. Of the two, Dr. Chrono seems a little more robust, with capabilities including image viewing, something close to my heart. Of course, these programs, and in fact the various iPad/iPhone/laptop apps and applications are essentially portals into the database, be it in the cloud or elsewhere. As Nimble puts it:

Nimble connects directly to the ClearPractice cloud via a secure internet connection so no data is stored on the device, making it both secure and HIPAA compliant. Because the ClearPractice servers do all the heavy lifting, the system is blazing fast, whether connected to a wireless or 3G network.

And therein lies the thought process behind most everything iPad. If you look at them critically, most apps are not much more than stylized portals to the web, i.e., they are thin clients.  Nimble's claim to fame is its interface:

Taking a typical point-and-click EMR system and moving it to the iPad environment often means fumbling fingers and a less than optimal workflow. In contrast, Nimble is a native iPad application, designed and built to be used specifically on an iPad and takes full advantage of the intuitive iPad user experience. Because Nimble is native to the iPad environment, we were able to rethink the EMR experience and remove all the common impediments of traditional EMR systems that slow down and frustrate busy doctors.

And here is a screenshot of this simple view:

But is it really desireable for the system to be completely iPad-based? Well, probably not. Keyboard entry of data on the screen would be tedious. Of course, there are Bluetooth keyboard attachments, which would help some:

Since there are only a few iPad-based EMR's, Merritt asks:

So where are the 300+ other EHR software companies? They have iPad apps “in the works,” but not ready yet. This really comes as no surprise. The medical software industry is notoriously slow to adopt new technologies. Have you ever seen your doctor’s office running a system that looks like it is from the 80s? We hear from these practices every day. Plenty of software vendors are still selling outdated, DOS-based systems with Windows interfaces (we will withhold names to protect the innocent).

As a result of this slow movement, we expect a number of newer software companies to quickly gain popularity and seize market share from vendors who are slow to move. Interestingly, a number of garage-based startups are already poised for growth: medical iPhone and iPad app developers.

Blogger John from EMR and HIPAA answers:

I’d have to argue the opposite. I think that almost all the EMR vendors that I see have an iPad strategy. Nothing wrong with a web based version for the iPad either. In fact, watch for the web to win out on the iPad eventually. At HIMSS I’m sure that one of the most common conversations will be EHR vendors iPad approach.

Also remember that even nimble, which you mention, is only parts of the EHR and not the full EHR software. I wrote about that.  I think that many more EHR vendors will adopt this type of approach to iPad EMR.

I tend to agree. I'm sure this is a foolish observation for all but the least-savvy on such things, but it does bear stating: The iPad is a wonderful window through which to view data, images, etc. It is convenient, portable, and dare I say, even cute. Obviously, it cannot stand alone as an EMR, and I have my doubts as to using it as the sole point of entry. Certainly, it will be a very nice adjunct to a "real" or a "larger" or whatever system, a nice addition to the physician's office. Can something like Nimble satisfy "Meaningful Use"? I'm thinking not, but then no one really knows what "Meaningful Use" is anyway...

Which Of These Does Your PACS Resemble?

Hat-tip to Not-Totally-Rad. 

A 24-Carrot Monitor

More than once, I've predicted something in tongue-in-cheek fashion, only to find my wish to have been fulfilled years later. 

Perhaps you remember this fanciful rendition of my new "reading room"?

Note especially the huge rotating monitors.

Enter Carrot Medical.  Their new C-View monitor system bears an uncanny resemblance to my weird cartoon idea:

From the C-View product description:

See the big picture like never before. Carrot Medical helps you See Better!

C-View changes the inefficiency of multiple monitors with a single 56-inch LCD display that is four times sharper than standard high-definition monitors. The advanced 3840 x 2160 panel has substantially more scanning lines than conventional HD screens for ultra-clear detail

C-View gives you the control and flexibility to:

• Integrate images from as many as 24 sources. (VGA, DVI, coaxial, light or room cameras, etc.)
• Display up to 16 images simultaneously, and expand any image to fill the entire 56-inch panel.
• Use preset configurations to display specified images for optimal size and orientation.
• Add, remove, re-position and re-size images as priorities change during the procedure.
• Control the screen with a variety of input methods. An iPhone app to manage presets from the palm of your hand. There’s an app for that!

I've always wanted an 8 megapixel monitor.  My birthday is rapidly approaching, folks...  No, I don't know how much this lovely Carrot costs.

I Want To Talk About...

We all have friends like this, don't we?

Green Advertising?

Even Green River in North Carolina isn't this green.  The photo above, courtesy of the National Post (Canada) is not retouched, at least not by me.  Apparently, someone threw something in the Goldstream River in Victoria, British Columbia, which turned it flourescent green for several hours.  No dead fish or animals were found, so the colorant was thankfully something benign. 

Now, just who would consider doing such a thing?  Some teenagers looking to pull a prank?  A mad chemist?  Or perhaps some larGE company that favors this lovely shade of green?  Just askin'...

The "6.5" Thousand Dollar Question

We are extremely fortunate to have three in-house Night-Hawks (not related to Nighthawk or VRC!) who work from 8 P.M. to 8 A.M. on weeknights, and 6 P.M. to 8 A.M. on weekends.  They are very, very sharp, and stand up to the punishing schedule and workload without complaint.  That is, until now:

All, I am fit to be tied. I had to restart my IMPAX workstation 11 times in 12 hours last night because I can't get the work done. All i want to do is my job. I can't with this system. We all know the issue, when you try to read CTs or MR back to back to back the cache seems to be full, then skipping images starts, etc. its worse with large CTA and MRA exams. Plain films are not an issue. This problem is progressive, it gets worse and worse the longer you go before restarting. I got a new error last night, black box with X says "problem downloading images, will attempt to retry". One of the other guys started seeing this same error last week also. I can't get my work done. I refuse to cut corners, though it is tempting to not review the images as I normally would. My nerves are shot.

We have seen this problem minimally before the 6.5 IMPAX upgrade, but several of my partners are now experiencing the laggy scrolling issue on a routine basis.  Interestingly, several of us have never had this happen, leading us to think that the problem lies in some obscure setting in the individuals profiles. 

I'm happy to say that Agfa has been working very intently on this problem, and I have no doubt it will be fixed.  These are truly conscientious people, and they want things to be right.  I'm sure avoiding blog appearances such as this play only a miniscule part in that.  Really.

It does speak, however, to the complexity of the IMPAX client software, that one setting buried deep in someone's profile settings could knock out the function of the workstation.  Here are two clues that our local Agfa technical guru has found, which may help someone in Waterloo get to the heart of the problem. 

First, at one point I had activated the "Display Pointer Trails" option, which leaves a trail of little cursors to help us old folks figure out where we are on the screen.  At about the same time, IMPAX started to balk at scrolling color images from PET/CT's displayed on the third monitor.  We turned off the trails, and things went back to normal. 

Secondly, I noticed one day that the cursor would not move properly across one of the Barco monitors.  The fix here was to adjust hardware accelleration for that particular monitor.

Subtle clues, yes, but the answer is in there somewhere.  I'm thinking there is some nasty glitch that doesn't play well with video display, which is a major problem given the fact that this business is all about video display!

Again, I'm sure Agfa will fix this problem.  I wonder why it didn't show up in the testing phase...

EPILOGUE

A followup from the 'Hawk in question:

I am happy to report that our PACS Goddess reset my profile last night and has continued to help me rebuild on the fly. The issue with scrolling and skipping has resolved. Looks like this whole time "the profile" was the problem. I worked through last night with no forced restarts or other related issues.   I am very grateful to have my old life back. Thank you all!

Another crisis resolved.

The Soviet Story (WARNING: EXTREMELY GRAPHIC!)

I will apologize in advance for the horrific images in this documentary. Well, on second thought, perhaps I won't. We need to realize, understand, and digest the truth about our once and future ally, and moreover, the philosophy behind its actions.

From the film's producers comes a brief synopsis:

The film tells the story of the Soviet regime.

- The Great Famine in Ukraine (1932/33)
- The Katyn massacre (1940)
- The SS-KGB partnership [in the late 1930s the KGB was called NKVD (more info)
- Soviet mass deportations
- Medical experiments in the GULAG.

These are just a few of the subjects covered in the film.

“The Soviet Story” also discusses the impact of the Soviet legacy on modern day Europe. Listen to experts and European MPs discussing the implications of a selective attitude towards mass murder; and meet a woman describing the burial of her new born son in a GULAG concentration camp.
The Soviet Story is a story of pain, injustice and “realpolitik”.

In other words, the USSR and Nazi Germany were only a hair's-breadth apart in their thinking. The Soviets persecuted anyone they thought disagreed with them, and the Nazis, anyone who was part of a group they disagreed with, Jews, Gypsies, homosexuals, Catholics, etc. Stalin provided tremendous aid to Germany in the early part of World War II, enabling Hitler to proceed with his plans of domination of Europe. Stalin hoped to step in and pick up the pieces after Hitler paved the way. In their own right, the Stalinist Soviets murdered 20,000,000 of their own citizens, generally in most horrible ways.

Sadly, modern Russian leaders aren't so terribly far removed from this mentality, and there are still many in Europe who think Marx and Engles had it right (pun intended), that if only the inferior folks who are incapable of understanding what they were trying to accomplish were eliminated, a whole new era, a new race of human, would be forthcoming.

From Dr. Sanity:

Human nature is what it is. This is not tragic, it is simple truth.
When it comes to understanding human nature, the left and their do-gooder utopian fantasies get failing marksMarx. They have a persistent biological fantasy that human nature is 'perfectable'; and that by some magical means, the implementation of their 'perfect' ideology will force people to behave in some 'perfect' fashion. Their delusional biological and psychological hallucinations about human nature always end in misery, suffering and death for large numbers of imperfect homo sapiens wherever it is implemented. No matter how many times this happens, the die-hard Marxists, communists, ocialists and all their variants and heirs keep trying force humans into some "ideal" state.

All their attempts and systems failed the real-world tests in the last century; and all current versions of these ideologies will also eventually fail and fade away (even Obama's). To the extent that they attempt to incorporate some aspects of "human nature" into their failing system, they may last a bit longer (e.g., China); but it is much more likely that human nature will transform the ideology than the reverse.

The one good thing about Marx's motivations is that, from all I have read about him, he genuinely thought of himself as a "humanist" who wanted to free the human spirit with his theories. Unfortunately, he never fully appreciated how his theories would be used to enslave the human mind (or, perhaps he had a some sense of the evil he had unleashed when he exclaimed later in his life, "I am NOT a Marxist!") Like his heirs today, he meant well.

Too bad, so sad that his 'good' intentions have caused so much fanatical revolutionary fervor and so much death and oppression.

So, what's the relevance to us today? Dr. Sanity continues:

These rich 'cultural Marxists' identify themselves as Democrats because it is just so cool and hip--and virtuous--to champion the 'poor and oppressed.' How unfortunate for them that this virtuousness requires them to nurture and maintain a never-ending supply of the 'poor and oppressed'; and to encourage and support victimhood and entitlement.

The truth is that the poor who are not brainwashed by this victimhood/oppression BS, aspire to the middle class and want to be free to improve their lives and those of their children. Most normal people don't want endless handouts, bailouts or pity. Nor do they want to be the recipient of some do-gooder's endless charity when it is based on the assumption that they are somehow inferior or defective and can't possibly be successful without being perpetually 'championed'. Funny, isn't it, that in spite of all the billions of dollars spent on the poor, it only seems to perpetuate their poverty? The old saying, "“Give a man a fish; you have fed him for today. Teach a man to fish; and you have fed him for a lifetime" comes to mind; but the last thing that the left or Democrats; or Marxists really want is for the poor to become independent of their virtuous and compassionate largesse.

. . .Here is where the Marxist garbage of "oppressor vs oppressed" has had the most impact on American society. Having been taught from kindergarden on that capitalism is a zero-sum game (and by definition, evil) many Americans have difficulty in thinking of resources or wealth as ever-expanding, and tend to think that someone else's gain must be their loss. If you have only two choices--to be either an "oppressor" or one of the "oppressed", most people would generally prefer the latter because it means they must be nicer people.
This kind of thinking inevitably leads to envy, and a cult of victimhood with all the associated social and political conflicts those emotions generate. Envy, in particular, is the lovely human emotion that drives all socialist systems; and it exists in pure, unadulterated and vicious form in those systems.

And, in answer to the unspoken question, yes; capitalism also thrives on envy--and even greed.
But, capitalism within a democratic and politically free system of government offers a healthy channel for the redirection of negative emotions like envy and greed into something positive for both the individual and the larger society.

Something, I might add, that Marxism, socialism and all its malignant variants completely fail to do. You cannot escape the reality of this dark side of human nature. You can either channel that dark side and use it constructively to benefit the individual and incidentally the society he lives in; or you can encourage and facilitate it in all its destructive power, and by doing so create the hell on earth we've come to associate with communist and marxist societies.

The Socialist/Communist model simply doesn't work. It never has, and it never will. There are still many who think it could work, if only the right folks (themselves, of course) were in charge. I'll get a lot of grief for this one, but I firmly believe that many of the people in high offices in the US believed just that. By the Grace of God, I'm hoping we are on our way back from that wilderness.

I've quoted this passage from Jacob Bronowski before, and it is apropos here as well:

It is said that science will dehumanize people and turn them into numbers. That is false: tragically false. Look for yourself. This is the concentration camp and crematorium at Auschwitz. This is where people were turned into numbers. Into this pond were flushed the ashes of four million people. And that was not done by gas. It was done by arrogance. It was done by dogma. It was done by ignorance. When people believe that they have absolute knowledge, with no test in reality--this is how they behave. This is what men do when they aspire to the knowledge of gods. Science is a very human form of knowledge. We are always at the brink of the known; we always feel forward for what is to be hoped. Every judgment in science stands on the edge of error, and is personal. Science is a tribute to what we can know although we are fallible. In the end, the words were said by Oliver Cromwell: "I beseech you, in the bowels of Christ: Think it possible you may be mistaken." We have to cure ourselves of the itch for absolute knowledge and power. We have to close the distance between the push-button order and the human act. We have to touch people.

Think about it. Which side of the political debate constantly calls members of the other "stupid"?

None of us possess the Absolute Knowledge Bronowski spoke of, and none of us can be absolutely correct, not the Right, not the Left, not the Church, Judaism, or Islam. It is when we dare to believe that we do posess the knowledge of the gods that we give ourselves the power to do the unthinkable. To kill so as to "purify". To steal so as to "give". To taunt so as to dominate.

Let 2011 be the year we touch people. Gently.

(Hat tip to Dr. Sanity.)

My Piece Of The Pile

While Nuclear Medicine probably began with the Curies, Frédéric Joliot-Curie and Irène Joliot-Curie, as well as Marie Curie (mother of Irene), the true Nuclear Era began in Chicago on December 2, 1942. From the Wiki:

Chicago Pile-1 (CP-1) was the world's first artificial nuclear reactor. CP-1 was built on a rackets court, under the abandoned west stands of the original Alonzo Stagg Field stadium, at the University of Chicago. The first artificial, self-sustaining, nuclear chain reaction was initiated within CP-1, on December 2, 1942. The site was designated a National Historic Landmark in 1965 and was added to the newly created National Register of Historic Places a little over a year later. The site was named a Chicago Landmark in 1971. It is one of the four Chicago Registered Historic Places from the original October 15, 1966, National Register of Historic Places list.

Reactor

The reactor was a pile of uranium and graphite blocks, assembled under the supervision of the renowned Italian physicist Enrico Fermi, in collaboration with Leo Szilard, discoverer of the chain reaction. It contained a critical mass of fissile material, together with control rods, and was built as a part of the Manhattan Project by the University of Chicago Metallurgical Laboratory. The shape of the pile was intended to be roughly spherical, but as work proceeded Fermi calculated that critical mass could be achieved without finishing the entire pile as planned.

A labor strike prevented construction of the pile at the Argonne National Laboratory, so Fermi and his associates Martin Whittaker and Walter Zinn set about building the pile (the term "nuclear reactor" was not used until 1952) in a rackets court under the abandoned west stands of the university's Stagg Field. The pile consisted of uranium pellets as a neutron-producing "core", separated from one another by graphite blocks to slow the neutrons. Fermi himself described the apparatus as "a crude pile of black bricks and wooden timbers." The controls consisted of cadmium-coated rods that absorbed neutrons. Withdrawing the rods would increase neutron activity in the pile, leading to a self-sustaining chain reaction. Re-inserting the rods would dampen the reaction.

First nuclear reaction

On December 2, 1942, CP-1 was ready for a demonstration. Before a group of dignitaries, a young scientist named George Weil worked the final control rod while Fermi carefully monitored the neutron activity. The pile reached the critical mass for self-sustaining reaction at 3:25 p.m. Fermi shut it down 28 minutes later.

Unlike most reactors that have been built since, this first one had no radiation shielding and no cooling system of any kind. Fermi had convinced Arthur Compton that his calculations were reliable enough to rule out a runaway chain reaction or an explosion, but, as the official historians of the Atomic Energy Commission later noted, the "gamble" remained in conducting "a possibly catastrophic experiment in one of the most densely populated areas of the nation!"

Operation of CP-1 was terminated in February 1943. The reactor was then dismantled and moved to Red Gate Woods, the former site of Argonne National Laboratory, where it was reconstructed using the original materials, plus an enlarged radiation shield, and renamed Chicago Pile-2 (CP-2). CP-2 began operation in March 1943 and was later buried at the same site, now known as the Site A/Plot M Disposal Site.

Significance and commemoration

The site of the first man-made self-sustaining nuclear fission reaction received designation as a National Historic Landmark on February 18, 1965. On October 15, 1966, which is the day that the National Historic Preservation Act of 1966 was enacted creating the National Register of Historic Places, it was added to that as well. The site was named a Chicago Landmark on October 27, 1971. A small graphite block from the pile is on display at the Museum of Science and Industry in Chicago, another can be seen at the Bradbury Science Museum in Los Alamos, NM. The old Stagg Field plot of land is currently home to the Regenstein Library at the University of Chicago. A Henry Moore sculpture, Nuclear Energy, in a small quadrangle commemorates the nuclear experiment.

As it turns out, several tiny slivers of the graphite, encased in lucite, were also given to friends of the University of Chicago (I assume that translates to big donors and such), and several have found their way to eBay.  A fellow Nuclear Aficionado found one a few years back:

This 25th Anniversary memento popped up on eBay not long ago and I paid dearly for it. However, there’s not much of this stuff left; all but a couple bars of this famously pure graphite went on to be incorporated in CP-2 and thereafter entombed in concrete under a nondescript field in Illinois. The eBay seller would only say “I do know that my grandfather worked on the building of the atomic bomb but other than that I don’t know much else.” I have a feeling that the human story could be interesting, but on account of the seller’s reluctance to share so much as her grandfather’s name and other “personal information,” there’s nothing more to say right now.

The momento is pictured above.

I had almost won one of these several years ago, but I was outbid at the last minute (darn snipers!) and I've been watching for one ever since. By some miracle, two of them came up for bid a few weeks ago, and I bid successfully on one identical to that pictured above.  The second actually sold for double the amount I paid, which I guess makes mine worth more as well.  It was slightly different, perhaps encased in lucite at a different point in time.

I'll never do anything historical, but at least I can own a piece of history.  What better way to start a new year than to hold a connection to the past in the palm of my hand?  No, it's not radioactive, and it doesn't glow in the dark.

Happy New Year, everyone!

The Doctor Dalai Facebook Page!

I owe an apology of sorts to my Facebook friends.  You see, Mrs. Dalai tried to get me hooked on Farmville a year ago, but I just don't seem to have the agricultural instinct.  She has definitely caught the bug, however, and runs my farm, her farm, and a farm for both dogs.  Thus, my Facebook feed is full of dozens and hundreds of inane entries of Farm-vile related crap, and I'm sure I've been defriended by more than one disgusted reader.

It finally occurred to me today to do something productive to solve this dilemma, and so I created the Doctor Dalai Page on Facebook.  It's not much more than a feed from this blog at the moment, but it does give me another outlet for commentary and other foolishness.

So, click "Like" below and become a fan!

New Years' Notes

The most wonderful part of being the Dalai Lama of PACS is, of course, the amazing people I have met.  PACS is a business for the best and brightest, and somehow they tolerate me, too. 

I received this note the other day, and I pass it on with all due humility:

Dalai,


I am enjoying a rare couple of days of business-free family time, visiting my sister and my mother. One of my sons is also visiting.

In just a couple of days, I have probably gone through my online routine several times. First, check the Dalai’s blog. Then, check the AuntMinnie forums. And so on.

It occurred to me that I should write and thank you for your contributions, blog-wise. Over the years, you have delighted me, confounded me, vexed me, irritated me, gotten me so mad that I have cursed you. You serve up a pretty wide range of tastes, none of them bland.

I am politically pretty far to the left, and I have these same reactions when I read the editorial pages of The Wall Street Journal. And guess what? I buy the Journal every time I have the time to read it, mostly when I fly.

So, to one of my favorite bloggers: Thank you, Dr. Dalai, for your contributions, and for the continuing delight (and other reactions) that you give me.

My best regards to you and Mrs. Dalai, and may 2011 shower abundant blessings on the Dalai clan.

All the best...

As I have said countless times, I never cease to be amazed that anyone even reads the drivel I post.  I'm left speechless.  If I've brightened the day of at least one reader, or at least made him or her think about something, then it's all worthwhile. 

Not to be lost in the melancholy of the moment, allow me to return to my more ascerbic self.

Email also brought me this unsolicited advertisement for a little PACS company that I won't name:

Hello Dr. Dalai,

Sorry you missed us at RSNA. If you really want something new and different please read. We can out perform Life Image in every way. We are looking for luminary accounts let me know if you have an interest.

It has been brought to my attention that a new and different way to see images from anywhere on any computer is needed. Even though most PACS vendors provide a physician portal the truth is most physicians will not use it for a variety of reasons. Hospitals also have a problem dealing with CD’s. It is time consuming to make them and they sometimes cannot be read even if a viewer is available. If this sounds familiar please review the alternative solution from XX. I would like to discuss how we can help resolve these problems so please respond to this email and let’s talk.

Do You Need An Alternative to Sending out CD/DVDs

Do You Need a Simple Easy Way For Your Referring Doctors To See Their Images And Reports

Do You Need A PACS But Don’t Have The Capital Funds or Personnel To Support It.

Now There Is A Way You Only Pay A One Time Use Fee Per Study.

No On Site Hardware or Software Needed, Just An Internet Connection.

Please Read Below:

PACS, RIS and Image Sharing Across Communities

The XX supports the same image interpretation and reporting as a state-of-the-art web-based PACS. In addition, it enables image communications over the Internet for on-the-fly referring physician reporting, remote consultations, trauma transfers and more—without any dedicated software or hardware requirements for remote users. As a result, it is a highly effective image communication hub for Regional Health Information Organizations (RHIOs) or entire unaffiliated medical communities, providing an important step towards universal access to healthcare information. With appropriate permissions, multiple users in disparate locations simultaneously may schedule a patient visit, check exam status, access any study, interpret an image and obtain a report.

Lightning Fast 3D/4D Remote Processing

At the same time, XX’s lightning fast 3D/4D processing overcomes the challenge of formatting and delivering interactive high volume 3D/4D reconstructed images over the Internet on-demand. XX, for example, displays the latest 4D 320-slice CT scan output comprising 6700 images (3.35GB data) in seconds, by contrast to hours using conventional PACS and 3D processing solutions. Sites with an existing PACS can seamlessly integrate this functionality into their systems, and any site can take advantage of new revenue channels for advanced visualization without incurring a capital expense.

Taking Advantage of Computer Game Technology

At the heart of XX’s unique capabilities are Graphics Processing Units (GPUs), the same technology that powers today’s advanced video gaming cards. These GPUs are made up of hundreds of small processors that handle information simultaneously, in contrast to the single central processing unit (CPU) of a typical PACS server.

“XX’s artificial intelligence algorithms running on GPU technology make XX servers thinking machines. They are capable of producing XX™ and adapted to handle the ever-increasing volumes of medical data—100 times more powerful than current PACS servers,” notes XX, president and founder of XX.

One-time Fee-Per Study

With XX, any site, whatever its size and budget, can enjoy the most advanced digital imaging workflow without system set up costs and only a reasonable one-time per-study fee. “Hardware and software capital expenses, IT staffing and physical workspace no longer are barriers to the most advanced digital imaging applications and integrated PACS/RIS workflow,” explained XX.

He notes that getting started is easy, whether XX is implemented as a first-time conversion to a digital imaging environment, a cost-effective replacement for an existing PACS, or an added advanced visualization processing engine.

The XX supports authenticated access, encrypted communication, data and access redundancy and unlimited storage for the highest level of data safety and security. XX cloud-based advanced clinical viewing software has been cleared as a diagnostic device by the FDA,

Sounds intriguing to a degree, although the talk of being "100 times more powerful than current PACS servers" seems a little over the top.  How do you measure the power of a PACS server?  Processor speed?  RAM?  Probably the most important factor is the communications network, which has little to do with the PACS server itself. 
Unfortunately, XX went on to post similar information as a comment on my recent lifeIMAGE article.  That's a no-no.

There are a lot of PACS systems out there.  Many die off from lack of funding, some scrape by in competition with the big players, sometimes buoyed by customers who can (or will) only pay for a bargain-basement product.  Doubtless there are some good ideas out there, and XX's line suggests that he might actually have some innovations buried in the hype.  But caveat vendor:  too much hype spoils your message, at least if you are approaching someone like me who actually has some inkling of what you are talking about.  I've found that the more smoke and mirrors involved in a showing or marketing a product, the more likely it is that said product isn't all that.

Words to the wise.  And by the way, don't spam.