The Belated RSNA PACS Post IV: A LarGE Surprise...

The Merge booth bordered on the edge of GE-Town, which I believe was somewhat smaller this year as compared to RSNAs of the past. In fact, there was a LOT of unused territory on the exhibit floor, cordoned off with the standard blue curtains. I would guess there was at least 1/8 of the floor unused, which is unusual, but probably indicative of bad times to come.

Anyway, my friends at Merge told me that there was a big to-do at the GE booth before I got there, that Mr. Immelt himself had been present, that something Really BIG must be happening. Given the presence of Herr Großen Kopf over at Siemens, I figured I'd missed Immelt, but I decided to wander over to GE-land anyway.

Turning my badge around so my name wouldn't show (yes, badges this year were printed on both sides, but I stuck my class tickets in the holder, covering the demographics on the back), I marched right in to the PACS area, noting nearby the big display about GE's new quiet MRI. Having been in a GE MRI (we own two), I can vouch for the need to silence them a bit, and apparently GE has made great strides in this regard. There was also an announcement for a hybrid PET/CT/MRI, which is really just a PET/CT and MRI image merger. Cheaper than bolting all three gantries together I suppose, although not as interesting.

To me, the biG Excitement came in the PACS booth. Here, we find the new GE Universal PACS viewer, and this represents a HUGE departure from the status quo. I didn't have time for a proper demo, but with a few minutes exposure, I was quite impressed. Suffice it to say, GE FINALLY gets it, or at least some of it, and offeres a unified, web-based PACS viewer that integrates the AW platform's visualization ans well as automation. Did I mention that it is web-based? And that it isn't Centricity IW, the late, great product from the late, great Dynamic Imaging?

In my brief demo, the following features were emphasized:

1. This is a web-based ActiveX client.
2. There is a zero-footprint version for clinicians, and mobile access, with considerable functionality
3. Native MIP and MPR
4. Timeline display
5. Relevant Priors based on body-part
6. Auto-open cine's 
7. Multimodality fusion (which I think they said was drag-and-drop)
8. Smart Reading protocols, which learn your preferences as you go.

GE literature adds:

1. Intelligent productivity tools, including smart hanging protocols; 
2. Advanced Visualization applications, including oncology; powered by AW
3. Breast Imaging Workflow, including screening and diagnostic capabilities; 
4. A common, streamlined, ergonomic user interface; and 
5. Access anywhere the Internet is available — web based, zero footprint and web client access.

To flesh out my report, I'll direct you to the pertinent GE site. Here's an introductory video from that link:

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Also, here's the full text (sorry) from GEs press release:

CHICAGO – NOVEMBER 26, 12 – With this week’s introduction of Universal Viewer, GE Healthcare aims to put clinical insight within reach to help radiologists and referring physicians deliver patient results efficiently. Universal Viewer brings together advanced visualization, intelligent productivity tools, and multimodality workflow for oncology and breast imaging all within one intuitive workspace that can be accessed anywhere, anytime. It works with Centricity* PACS, Centricity PACS-IW, and Centricity Clinical Archive.

A recent GE-sponsored study conducted by ACR Image Metrix, a subsidiary of the American College of Radiology, showed up to 2.5 hours in a radiologist’s day wasted because of workflow inefficiency. As healthcare rapidly evolves to a more patient-centric, collaborative, and outcomes-focused model, customers need to integrate information across different systems to help make patient diagnosis and treatment more efficient. Rather than creating complexity with multiple logins, tools that behave differently, and separate workstations, Universal Viewer has the potential to provide 5% productivity improvement. It has a unified user interface with a single look and feel that is easy to learn and able to adapt to radiologists’ preferences, automating exam setup. Referring physicians can access the viewer from anywhere and patients can get from the exam to their results in less time.

Centricity PACS and Centricity PACS-IW users will find a new dimension of clinical intelligence as they explore Universal Viewer. It enables seamless workflow with pre- and post-processing. Advanced clinical applications, powered by AW, are embedded to enable oncology quantification, auto bone removal, vessel analysis, and registration. In an industry “first,” Universal Viewer also includes integrated mammography tools for screening and diagnostics, with the ability to display images across a breadth of modalities, support CAD markers and IHE profiles, and connect with reporting systems.

“This is really fantastic,’” said Dr. James Whitfill, Chief Medical Informatics Officer of Southwest Diagnostic Imaging in Scottsdale, Ariz. “When we bring all of this together and provide what I think we’re all asking for, it’s really going to be an exciting step forward.”

For radiologists who want a next generation viewer that requires less manual setup to read exams, Universal Viewer has the potential to reduce mouse clicks by 70%[1]. It has a “smart reading protocols” feature developed in GE’s Global Research Center that essentially digitizes radiologists’ sequencing preferences on the fly as though it were hanging physical film across a lightbox. It introduces case-based reasoning techniques, including machine learning algorithms, image analytics, and text mining for automating exam setup.

“Adopting new applications means change for providers, but minimizing change by keeping workflows consistent can help to reduce the impact and lost productivity associated with the change. Machine learning features are a great way to digitize workflows without long, costly implementation projects and extensive application customization,” said Judy Hanover of IDC, a leading analyst firm, “Radiologists will appreciate being able to work in a digital environment without having to abandon their familiar customs.”

A zero footprint (ZFP) exam viewer intended to deliver non-diagnostic, review only capabilities provides clinicians with easy, enterprise-wide access to images and reports through connectivity with an EMR or GE Healthcare’s Centricity Clinical Archive. The ZFP has the added advantages of a zero installation with no download of any software to the user’s device. It also does not require administrative rights required to access.

Jan De Witte, President and Chief Executive Officer of GE Healthcare IT and Performance Solutions said, “This is an enormous step on a path to our future, a future of intensifying imaging investment and innovation. Customers have told us that systems have become too complex and interoperability needs improvement. This takes away time they could be reading exams and delivering patient results. We invite radiologists everywhere to join us and view our proposed solution, Universal Viewer. We invite them to tell us what they think and, most of all, to stand by to see the future of imaging IT delivered to their desktops.”

To emphasize..."Customers have told us that systems have become too complex and interoperability needs improvement." GEeee...WHAT HAVE I BEEN SAYING FOR THE PAST SEVEN YEARS ON THIS BLOG????? It's nice that GE finally chose to listen to their customers, at least those who actually use their product, and not those who told them Centricity web was something to be proud of.

To be fair, Siemens' plaza.via takes a similar approach, but for better or worse it uses the syngo platform. AMICAS/Merge and others have been doing this sort of thing for quite a while, too. It's just phenomenal that GE has finally taken this route.

I need more hands-on time with Universal to give you much more feedback. Hopefully, GE will see fit to upgrade our horrendous Centricity 3.x installation with the new software. Please? Pretty Please? Well, I can dream, can't I?

The Belated RSNA PACS Post III: Agfa

When I was in school, and then in residency, I used to define the best professors those who could tell me I was full of it and make me like it.

I don't think I would make a very good professor, but Agfa is a true class-act on this score. I've whined rather mercilessly about some of their approaches with which I don't agree, and I've mentioned some problems with certain installations in the Eastern/Southern Hemisphere periodically. Still, the people at Agfa have been incredibly friendly and amicable toward me, trying hard to at least listen to my rants and do what they can do within whatever restraints they operate under. 

I spent but a few moments at the Agfa booth, devoting much of the time to the latest version of Agility, or IMPAX 7 as I like to call it. I'm under NDA not to talk about it, but I CAN tell you that it will be much more powerful and intuitive than good ol' IMPAX 6. 

In the meantime, IMPAX 6.5.3, the latest release, will have improved background caching, and boasts various clinical app suites for advanced imaging, from basic MPR and 3D to PET/CT fusion.

The Agfa booth hosted a little company called Real Time Medical, which offered a workflow engine that would unite disparate PACS, RIS, speech recognition, etc., under one wrapper. From their website:

Real Time Medical develops vendor-neutral context-aware workflow management software solutions for diagnostic imaging organizations (DIOs).

In introducing diagnostic imaging to context-awareness in workflow management, we offer breakthrough methodologies to automate and optimize the way workloads and workflows are managed in DIOs, with an eye to drive more value out of their existing PACS/RIS investments and confidently prepare themselves for a rapidly changing future.

Our software products, under the umbrella platform DiaShare™, concentrate on the areas of workflow management and enterprise productivity (WORKFLOW) and quality assurance (QUALITY). Both are seamlessly vendor-neutral because of our elegant connectivity, integration and interoperability engine (OPEN)....

DiaShare™ WORKFLOW removes concerns regarding physical locations, traditional IT infrastructure and existing RIS/PACS infrastructure, and answers the question: how can your system’s workload be optimally managed according to contextual parameters you set, and can easily change as environmental conditions change.

The DiaShare platform does require the use of their particular worklist, but it's a good start. I'd like to see all this done in the background, i.e., I want to see the worklists of all my connected PACS show up within IMPAX, or Merge, or whatever, in a manner transparent to where I'm sitting. We're almost there, I think.

Apparently our funding for upgrading to the next version of Agfa is limited, so I may have to rely on outside reports to let you know how well it works. Agility has been deployed in beta in a few sites around the world, and I think one here in the States. I offered our services, but then thought better of it, given how stubborn our guys can be sometimes...

The Belated RSNA 2012 PACS Post II: Merge

Being a happy Merge customer, one of my most important visits on the exhibit floor is to their big orange booth. Sadly, the orange Tesla is no longer on exhibit, although I'm told it is still part of the Merge fleet, and might possibly be available to be taken for a spin by the best Merge customers. I'm not sure I qualify for that, and besides, I wouldn't even think of driving in Chicago in a $100,000 vehicle.

You may remember the pre-RSNA Merge teasers:

And indeed, there was a big orange box in the middle of the booth:

That's me with an unidentified member of Merge who was trying to conduct business on her cellphone but was forced to pose with me by certain photo-shy Merge folks. (You know who you are!!)

What's inside the box is "Clear", literally!  The box itself a dramatization/simulation of Merge-Clear, a new quick and easy ordering system allowing imaging centers to "stay in the loop" and hopefully increase their referrals. The clinician gets online, even using iPhone/iPad, (I think Android is supported as well) or whatever to post the order, and the appropriately registered patient can get online and schedule the exam at the place of his/her choice, (of course those imaging centers registered with Merge.com have the chance to advertise WiFi or child-care, or free drinks, etc., and the lucky patient can even preregister or fill out paperwork on an iPad.) The ordering doc can then view the report on the iPhone whilst on the golf-course, illustrated by a very nice set of clubs at the far end of the box. Some very interesting metrics and data-mining can be found within Clear, such as ways to see how many patients your center is losing because you don't have child-care, and so on.

Merge has established a partnership with SureScripts to create a portal into most EMR's:

Merge Healthcare Incorporated (NASDAQ: MRGE), a leading provider of clinical systems and innovations that seek to transform healthcare, will connect its extensive imaging network with the Surescripts Network for Clinical Interoperability. This connectivity will allow hospitals and imaging centers to electronically deliver imaging reports to care provider organizations through EHRs on the Surescripts Network. In addition to electronically receiving the report through their EHR, ordering physicians will be able to access and view images securely from the Merge Honeycomb™ cloud-based solution. Sharing results and images is immediately valuable and will become increasingly critical as EHR vendors work to certify their systems and organizations look to attest to Meaningful Use (MU) Stage 2.

"With the majority of physician groups and hospitals now having an EHR in place, these organizations want to receive results electronically to increase efficiency and avoid errors, however connecting to hundreds of certified EHRs is expensive, custom work," said Jeff Surges, CEO of Merge Healthcare. “With Surescripts delivering connectivity solutions that improve the delivery of vital clinical care information between care providers/organizations, and Merge offering premium imaging content, we can help hospitals and imaging centers improve efficiency, reduce costs and most importantly, strengthen care collaboration among referring physicians by delivering radiology reports and image links directly into the physician’s EHR.”

As usual, it's all about who you know, eh? Merge itself knows a lot of folks, claiming to have managed 82 million of the 370 million annual ambulatory imaging procedures in the US. (This does not include ePhlegm, by the way.) That's quite a footprint in the ambulatory space.

In other news, Honeycomb, the cloud image repository, is up to 3.9 million images in its first five months of operation.

iConnect, the access and sharing system with Facebook style interface, is also now iconnected to SureScripts as well, providing image access to the EMR, and it includes server-side rendering, requiring another server, but able to handle default JPEG2000 or DICOM images, even on my beloved Retina displays. (It won't work with a virtual server as we have been assembling for our PACS upgrade.) If more power is required, iConnect can launch the Halo PACS viewer.

There were a few incremental changes to AMICAS Merge PACS 6.5, with more powerful credentialing, determining who can read what, and the creation of a temporary worklist via the search function. Ortho tools were added in 6.4 as were multiple teaching files.

Perhaps the most important comment I can make about Merge is that while it isn't AMICAS, its stewardship of the software has been exemplary, providing good service, and growing the product nicely, even in this age of cutbacks. I anticipate this to continue, sale or no sale (and NO ONE mentioned anything about a sale, by the way...)

The Belated, Limited RSNA 2012 PACS Post I: lifeIMAGE and HealthFortis

My sincerest apologies to my readers, some of whom have nicely pointed out that I've been lax in my Post-RSNA posts. In years past, I've been very diligent about posting my RSNA observations immediately, never letting even a day go by without putting something down on virtual paper for my loyal fans, all three of you. I guess this is what happens when I violate the rules set out by Dr. Bruce Hillman in a recent JACR editorial: "The key to a happy career is being low enough on the totem pole to escape notice. Even better is to be so far down the hierarchy as to be beneath contempt."

But like the kid with the dog-chewed homework, I've got several excuses.

First, when you go to RSNA with wife and family, your time must be devoted to...wife and family. Instead of hanging around McCormick with my laptop as the sun set on Chicago, pounding away at a pithy post, I was compelled to high-tail it back to the hotel to meet up with the boss. Yes, it's Mrs. Dalai's fault, but PLEASE don't tell her I said so!

Second, I've been battling a light case of the flu. No, I haven't taken the confirmatory test, but the pharmacist at Rite-Aide, whom I trust more than most physicians, tells me she's seen a lot of this among those of us who took the flu vaccine. Those who didn't have the shot are getting REALLY sick. But I'm doing better.

Third, in anticipation of changing tax laws, especially those concerning non-cash contributions and deductions, I've been going through the house and donating everything not nailed down. (The dogs have been hiding under the bed.) A collection of 300 Beanie Babies (remember those damnable things?) went to our local Children's Hospital. My collection of every transistorized version of Zenith Trans-Oceanic shortwave radios, 30 miniature transistor radios, and 7 Minox spy-cameras and dozens of accessories all went to our State Museum. And finally, and most painfully, my beloved collection of 19 huge classroom-sized slide rules and 70 more normal-sized and projection slide rules went to MIT. And let me tell you, sending a bunch of 8-foot long objects to Massachusetts is not an easy task.  Watch for the Dalai Memorial Slide-Rule exhibit at the MIT Museum sometime in the next year or so.

Finally, not so much in anticipation of any change in the law, but more in reaction to our neighbor's house being burglarized at high noon last week, I bought a gun and started to learn how to use it. For those who are interested in such things, it is a Heckler and Koch P7M8 with Robar NP3 coating.

This is an old model, no longer made by H&K, which was designed for the German police. It has no safety per se; to cock the weapon, one squeezes the handle. Without the squeeze, the gun cannot fire, PERIOD, making it one of the safest firearms out there. I went to the local firing range, and with a lesson (having not fired a gun in 30 years) I shot 50 rounds with fairly good accuracy:

I'm not a huge gun advocate, but I think it is self-evident that had someone at the Sandy Hook School in Connecticut been armed, 26 innocent children and their protectors would more likely be alive today. And that's all I'm going to say about that. (Don't even bother to comment.)

Right. Let's get on to business.

From my earliest, infantile postings, I've been bemoaning the problem of the "portable patient," the fellow whose imaging studies are spread about the land like a virus. My friends at lifeIMAGE, including CEO Hamid Tabatabaie many other wise folks from the old AMICAS days, continue to lead the charge in solving this particular bane of my existence. There has certainly been progress in digitizing even the smaller hospitals, but the free-standing PACS therein create what lifeIMAGE terms "information silos".  A new (well, evolutionary, anyway) service called Connections™eases the communication between these silos, the patients whose information they contain, and the medical personnel that staff them.

lifeIMAGE Connections employs simple and social workflow to connect people in real-time to send or receive imaging information. Physicians, patients and imaging service providers can connect to sources of imaging data on CDs, remote PACS networks, scanners or electronic health records. This will drive better, less expensive patient care by preventing unnecessary imaging exams, and will also foster a new level of collaboration on imaging that will escalate the value and scope of radiology in healthcare delivery.

Accountable Imaging™ is a commitment to bridge silos of medical imaging information to avoid unnecessary exams, delays in care and medical errors. lifeIMAGE Connections facilitates the seamless exchange of studies between institutions, physicians and patients anywhere, supporting radiology practices that pledge to be accountable.

For those whose path will force them into an Accountable Care Organization (ACO):

In the coming year, Connections will evolve to support new models of provider collaboration. To help hospitals involved in ACOs meet quality and cost containment goals, lifeIMAGE will provide imaging duplication detection through integration with clinical decision support and EMR applications. This will connect physicians who are part of at-risk models to relevant prior imaging, no matter where it is stored. lifeIMAGE is demonstrating its early integration with HealthFortis, a leading decision support system, at RSNA.

lifeIMAGE had at RSNA-time approximately 300,000,000 images under management. Not bad. Clearly, the market agrees that their solution works: customer list reads like a Who's Who of radiology:

Yes, there are other ways to skin the silos, so to speak, and many PACS companies tout them. But I firmly believe lifeIMAGE has solved this problem in the most vendor-neutral and HIPAA compliant manner possible. I have but one regret: I'm not yet a customer. But I'm working on it!

On a tangential issue, I got to hear as well about the continued evolution of HealthFortis, mentioned above and described in one my RSNA 2011 posts. Kang Wang, another of the software geniuses (and I do not use that term flippantly) has taken the approach to CPOE that would never occur to a megalithic company:  BE the piece of paper the surgeons and clinicians really want! Never slow down the docs, but add decision support to the format they already know. The interface is simple, intuitive, EMR integrated, cloud based, it actually works. Initial placements have demonstrated that compliance with the system increases rapidly with use, with fewer and fewer incorrect orders. While the average "decision support" software simply second-guesses the user, HealthFortis HELPS select the recommended procedure, following a search and display algorithm reminiscent of Google.  Appropriateness of radiological procedure selections are graded by the ACR Appropriateness Criteria, with 9 for the best and 1 for the worst choices given the particular setting.

Sitting on the periphery of the CPOE committee of one of our hospitals which is trying to rework 20-year-old MediTech software, and hearing the shrieks of pain and agony from the other which is trying to make Cerner user-friendly, I can tell you first hand that Kang's approach is light-years ahead of the old-fashioned ways.

lifeIMAGE and HealthFortis have, through simple interfaces and effective software, solved some of the most troublesome problems we face in the "Information Tsunami". I urge you to have a look for yourself.

Teaser...

I know RSNA was last week, and I've been bad about posting my observations. This is what happens when I you bring your wife to RSNA and your kid lives in the vicinity...instead of staying up late writing blog posts, you go out to dinner and generally have a good time in Chicago.  On top of this, I had a bunch of things to accomplish when I got home. Please stand by for some interesting PACS revelations from Merge, Agfa, lifeIMAGE, and (gasp) GE!

Dalai in RSNA "Wonderland"

For the second year in a row, AuntMinnie.com has allowed me the privilege of substituting my foolish ravings for Mike Cannavo's far more thoughtful and educational RSNA articles. Below you will find my final draft, which was altered slightly by the AuntMinnie editors to be a bit more politically correct. The officially published version can be found here. 

Dalai in RSNA Wonderland

or

Dalai in Vendorland

Chapter 1: Down The Scanner Bore

Dalai was very tired that morning; tired of sitting at his PACS station and getting slammed beyond belief. Twice, he had peeped over to his partner’s stations, but they were lost in conversation, leaving the long list of exams for Dalai.

Suddenly there appeared out of nowhere none other than The One and Only PACSMan, wearing a white T-shirt and with eyes bloodshot. “Goombah!  I’m late for my scan!” he muttered. Dalai was not generally prone to hallucination, and it later occurred to him that the white-clad PACSMan should not have actually been there in the reading room at that time. But Dalai followed PACSMan's mad dash out of the door to the reading room, down the hall, and into the MRI enclosure. The PACSMan popped into the MRI bore, and disappeared. In another moment, Dalai followed, not stopping to think just how foolish this action might be.

The journey down the bore was slow and rather odd. It was quite dark, but here and there could be seen glowing jars of radium, and chest x-rays on old-style viewboxes. Where would this end? Perhaps Dalai would exit another MRI in China, or New Zealand, or maybe in the clinicians’ .05T device across the street. What would Mrs. Dalai think? Probably that Dalai had gone to hike the Appalachian Trail, or was otherwise misbehaving.

With no warning, Dalai found himself sprawled on the floor of the Grand Concourse of McCormick Place, having narrowly missed a delegation of sonographers from Japan standing by the Starbucks counter. He spotted the white-shirted PACSMan bouncing down the Concourse, headed for the Technical Exhibits.

Dalai tried to follow but was stopped by the guards. “Badge, Please” they croaked. All Dalai had was his radiation monitor badge, but clearly this wasn’t what was needed. Behind him appeared a pedestal with a large red button labelled “Scan Me!” Dalai pressed it, and a warm glow enveloped him, and his tiny radiation monitor had grown into a proper RSNA blue-edged ID . “Only vendors ‘till 10, Doc!” cried the guards. Another pedestal and “Scan Me” button appeared. Dalai pressed this as well. He felt a tingle up his leg, and his badge turned Exhibitor brown. “You may pass!” said the guards, nodding toward the entrance.

CHAPTER 2: The Rat Race

Dalai wandered into the thick of the Exhibit Hall, and soon encountered a cluster of rather odd-looking black-suited men, milling about the various technical displays in more or less circular fashion.

“Whatever are you doing?” asked Dalai timidly.

“Why my good man, we are running the Imaging Sales Rat Race!” said the first of the gentlemen. “It serves no purpose, we end up where we began, but we look busy and everyone gets a prize. Did you bring one for all of us?”

“Um..well, I only have my iPhone,” mumbled Dalai.

“Hand it over. We’ll use it to place orders for all of our modalities, and everyone wins!”

The dark-suited man grabbed for Dalai’s phone. “Patience! First, we must....” Dalai cried.

“Yes, Dalai! Patients First! The patients deserve the best of the scanners, which you cheap doctors seem loath to provide!”

“I didn’t mean it that way! It’s Administration’s fault! They HATE spending money and salesmen too! And they want to comply with the Laws, known and unknown! But of course for me, Patients come First! Don’t be so easily offended!”

And with that, the odd men got up and resumed their circular trek.

Chapter 3: The PACSMan Gets a Little Bill

The white-clad PACSMan reappeared, rounding a corner behind a huge display of bone-containing plastic phantoms. He looked straight at Dalai, and howled: “My Bill! My Bill! this is outrageous! $5,725 to look in my head? I’ll have someone bumped off, I will! Get going buddy, right now! Leave the scan, bring the cannolli!"

“He thinks I’m his personal radiologist,” Dalai thought to himself. “Patients First”, yes, but really...

Another pedestal arose with another button labeled “Scan Me!” Dalai pushed it, and this time felt a migrating itch travel from head to toe. His badge turned green, the RSNA color of important people who are not physicians.

As he was unable, and, by virtue of the new badge unqualified, to fix the PACSMan’s Bill, Dalai was able to escape to the next booth.

Chapter 4: Advice from Aunt Minnie

Dalai’s flight took him to a booth containing several plush leather motorized massage chairs. In the last was seated a little old lady, smoking a Cuban cigar.

“Who are YOU?” she cackled.

“I’m not quite sure anymore,” said Dalai rather hesitantly. “I was once a radiologist, but I seem to have become a number of other things. I started out trying to care for Patients First, but now I seem to have to please everyone! I have to fix Bills and such. I’m not sure I even remember what FEGNOMASHIC stands for.”

“Repeat it for me, Sonny!”

“OK, if you insist...Fibrous Dispepsia, Elusive Granuloma, Generic.....”

“Wrong! Wrong from beginning to end!” She puffed the cigar for a moment. “So if you don’t know who you are, why do you think you are a radiologist? Why can’t you go with whatever you are now? Like they say, if it looks like your Aunt Minnie, sounds like your Aunt Minnie, it’s your Aunt Minnie. That’s me, Dalai!” And she cackled some more.

“By the way, Sonny, if you push that button behind you, you’ll turn into something else entirely, since you don’t know who you are anyway. Neither looking or sounding like a duck, eh? Push it and get outta here!”

Dalai looked and there was yet another pedestal and red button, although it lacked the “scan me” label. He pushed it, experienced a transient rash across his torso, and his badge turned red for a non-member physician.

Chapter 5: Cheshire CAT-Scanner

The next booth over was the home of the Cheshire CAT-Scanner. Dalai walked up to the massive device, which had a huge display panel on top.

“What shall I do, dear Scanner?”

“It depends on what you wish to accomplish,” scrolled across the display.

“I don’t care much at this point. I just want to scan gently, and put my Patients First.”

“Then it doesn’t matter much where you go on the exhibit floor...they all do the same thing. Except for this!”

And with that, the Scanner faded from view, with only the flashing alphanumeric display still visible.

“You’ve come to an area of unreality, of madness. The real world doesn’t work this way, Dalai, and now you’re mad too. You must be, or you wouldn’t have come here.”

“And you know I’m mad how?”

The scanner faded back into solidity. “Look at me. I can scan the entire volume of a patient in 0.066 seconds, and rather than irradiate the patient, I draw radioactivity FROM the body. They patient leaves my gantry with less dose than when he arrived. Yes? Since you believe every bit of the hype you see around you when you come to the exhibit floor, you are therefore mad. Now do you wish to play footsie with the King and Queen today?”

“I don’t think I would,” demurred Dalai.

“Too bad,” said the Cheshire CAT-Scanner silently...you’re booked for One in the Afternoon at the Palace. But you need to have a bit of a chat with the Vendors first.” And with that, the scanner vanished from the booth. A new pedestal appeared in its place, with the familiar “Scan Me” button. Dalai shrugged, and pressed it.

Chapter 6: The Mad Vendor’s Cappuccino Party

With a sudden, brief attack of GERD, and the conversion of his badge back to blue, the color of full members of RSNA, Dalai walked down to a very large booth, finding a lovely Danish Modern dining room table and chairs placed directly in front of a huge brass espresso machine. Several dark-suited types were scattered about the table, with one wearing a meatball-splotched tie.

“Have some cappuccino, Dalai,” said one of the diners.

“But we’re out of cappuccino!” said another.

“Hey Dalai,” said the man with the tie, “How do you qualify for Meaningful Use?”

“I believe I can guess that,” responded Dalai.

“Do you mean that you think you can find out the answer to it?” said another dark-suit.

“Exactly so,” said Dalai. “It’s simple, really, isn’t it? But wait...what’s Meaningful Use anyway?”

“You mean you don’t know?” cried the Mad Vendor. “Darn. Neither do we. But that won’t stop us from trying to sell it to you!” And the dark-suited men began to bicker amongst themselves, telling stories of customers that got away.

Dalai got up and left the table, ultimately exiting the madness of McCormick altogether, and wandered south.

Chapter 7: Nothing's Cricket in Hyde Park

After walking quite a distance, Dalai found himself in a quaint, tree-lined neighborhood, with one house that stood out, clearly a palace. The King and Queen themselves were inside, sitting on matching thrones. They were incredibly angry, calling out, “Off with your revenue! Decapitate your capitation!” Sprawled before the thrones were a dozen other radiologists, just as confused as Dalai by the whole proceeding.

“Patients First!” bellowed the King. “You tried to steal the revenue! Call the witnesses!”

The Mad Vendor approached the dais. “I tried to get them to participate in Meaningful Use! But they wouldn’t buy my wares. I’m a poor man, your Majesty, and a very poor salesman.”

“And a very poor speaker. But you tried to put Patients First. Stand down.”

“But your Majesty, I’m already on the floor as it is!”

“Then SIT down!”

The assembled courtiers snickered in delight.

“Call Dalai to the stand!”

Dalai approached with hesitation, but then stood straight though with head bowed.

“What do YOU know of this business?” asked the King, and the Queen nodded, sure of what was to come.

“Why, nothing, your Majesty. I’ve always tried to put Patients First, but to no avail. With the coming cuts and payment shifts, we radiologists can’t serve them as we once did. And no one knows how radiologists might participate in Meaningful Use!”

“Matters not,” said the King. “If they cannot transmit Patient Data to Us, they are not worthy. Haven’t they signed the Meaningful Use Attestation?”

“No, your Majesty.”

“Aha! All of you must have meant some mischief, or else you’d have signed your names like honest men! Off with their revenue! Decapitate their capitation!”

Chapter 8: Back Home

Dalai sat up with a start, and looked around at his reading room, to which he had returned from his rather bad daydream. His colleagues were still locked in conversation, and the list had grown to gargantuan proportions. He picked up the microphone, put it down again, got up, and walked out of the hospital. The other rads eventually discovered his absence, after receiving several frantic calls from the Emergency Department inquiring after reports. They realized what had happened, although Dalai’s trip to Vendorland and Hyde Park could never be known to them. Still, they longed for the simple life when Patients really did come First.

The End

The Siemens RSNA Press Conference ...and some thoughts on IT

For the third year running, Siemens has somehow acquired the idea that I'm a true journalist, a member of the press, and invited me to their annual RSNA Press Conference. In return, I'll report to you what was said.

Presiding over the conference was Dr. Hermann Requardt, (PhD in Physics!) CEO of Siemens Healthcare, with Dr. Gregory Sorensen, (Neuroradiologist) CEO of Siemens Healthcare North America, in the supporting role. 

Dr. Requardt blended optimism with realism, noting that the healthcare market continues to expand, although we must continue to temper this with cost containment and determine ways to achieve the balance. The US was (and probably will continue to be) the lead market in this business, the target market most receptive to innovation. However, the European market is flattening, and the Far East is ramping up healthcare spending. But, "if you can't pay your physicians, you can't buy new MRI's," says Dr. Requardt, and that's certainly true. Even so, Siemens orders were stable from 2011 to 2012, with revenue and profit increasing slightly.

Probably stung by the barbs thrown at healthcare spending, especially directed at imaging, Siemens acknowledges a dramatic need for efficiency, and doesn't want to be seen as part of the problem, but rather the solution, "which is innovation," according to Dr. R. One somewhat surprising part of the solution: less expensive, entry-level, "good enough" scanners manufactured in China by Siemens are being sold world-wide, and actually moving quite well here in the good old US of A. (Dr. Sorensen later said that HALF of these "good enough" scanners are sold to the US, and conversely, their high-end machines sell well…in China.)

Siemens grasps that the mountain of data thrown at radiologists is nothing short of disruptive, terming it a "Data Tsunami". The solution is to be found within IT, which becomes the enabler for productivity.

Siemens is making the best of the Accountable Care movement, viewing it as a US-driven movement from "what's wrong with the patient" to "what's going to help the patient," assuming that outcome-optimized medicine will be based on knowledge.

Dr. Sorensen then gave a brief overview of Siemens' past, present, and future. It turns out that Siemens is the largest and oldest company in the world, dabbling in everything from power plants to power Doppler ultrasound, yielding a background of durability and long-term outlook. He revealed this year's Breakthrough Innovations:

• The First Wireless Ultrasound probe, allowing for cordless scanning, say in the operating room. You can see Dr. Sorensen holding the probe above. 
• Their new full-field mammography offering will have the lowest available dose, 30% lower than the competition. 
• New Angio suite. 
• Interpretation software for AmyVid, Lilly's new amyloid PET agent. Apparently, the interpreting physician will be blinded as to patient history for this scan. (Not that we get one anyway)
• Siemens will soon offer the "highest performance" 3T MR, the Prisma. 

For the future, Dr. Sorensen notes that 20-40% of US healthcare is wasted, often because we pursue diagnostic dead-ends. "The value of knowing is paramount, and the worst treatment is the treatment you didn't need."

Siemens optimistically (can you say wishful thinking?) believes ObamaCare will sharpen the US market, though they think we will still stay in the lead. To this end, they must improve upon their value-based product, with the hope that demand for high-end products will continue.

The team lastly traced the cyclic nature of health care spending with respect to the growth and contraction of any particular national economy: “From Underinvestment to Cost Cutting.” We’re clearly beyond the fat years, and into the last stage. And it seems that there is usually a time-lag between recovery of an economy, and recovery of the health care industry. I’m not holding my breath on that one.

I want to revisit the point about IT being the solution, the enabler of healthcare. (I'm assuming they don't know some of MY IT people, although I realize that isn't what Dr. Requardt meant.)

The sentiment was also reflected by Paul Chang, M.D., in his Eugene P. Pendergrass New Horizons Lecture, "Meaningful IT Innovation to Support the Radiology Value Proposition."  (Note that the information on lectures to follow is from the RSNA Daily Bulletin.) PACS, according to Dr. Chang, is a "commodity-level service". To really show the value we rads provide, we need IT. First, IT provides advanced workflow to help quality in radiology, and help all the clinicians get their needed information as well. Rads used to collaborate with clinicians daily, looking over the old-style films. PACS has done away with that to a considerable extent. We need to follow the examples of the new social media, says Dr. Chang, like Facebook and Twitter, which leverage the technology of the Web to share content and collaborate virtually. We need to improve how we mine data from our reports and the EHR in general, an area where we are woefully behind. And, we need to demonstrate our value directly to the patients, using IT to connect to them as well as to the clinicians. "We have to become irreplaceable and add measurable, demonstrable, and differentiable value to our clinical colleagues in this aligned environment," said Chang. "We have to be perceived as irreplaceable in this aligned model and have to provide evidence ... and demonstrate to that aligned enterprise that we truly add value," Chang said. "In other words, we need to be a differentiable value innovator."

Next, let's consider the contributions of Dr. Keith Dreyer, who gave another New Horizons Lecture, "The Future of Imaging Informatics: Meaningful Use and Beyond". The development of PACS and so forth was driven, said Dr. Dreyer, by the imaging necessities under the soon-to-be historical fee-for-service payment system that incentivizes volume while being neutral on value, with a focus on maximizing productivity and volume and reducing the cost of doing business. Since the US Government wants to lower costs, we are now steered toward bundled payments and accountable care organizations that "shift risk from the payers to the providers...and even to us..."  Meaningful Use arose from the need to monitor this transition. "Radiologists need to adapt, not only for incentives, but because this is where the future of healthcare is headed. Previously, technology was driven toward improving productivity while reducing costs, but in the new model, the push is to improve the quality of care, access and safety, with the assumption that those improvements will reduce costs."

"At the expense of some productivity, we're going see a dramatic increase in quality that will be measurable by metrics that we'll be required to measure but also an increase in relevance," said Dreyer.

"They really haven't been optimized for performance metrics such as quality, safety, access, and outcomes," he said.

If radiologists were incentivized by outcomes, they would likely want, for example, to open up a chat session with referring clinicians who have questions on a difficult case they recently read to guide them through it. If the motive was patients first, they might wish to have a system that extended that chat functionality to patients, Dreyer said.

Meaningful Use ". . . provides a fertile ground for innovation in radiology access, communication, and utilization..."

We should add the opening statements of Dr. George Bisset III, RSNA president, as quoted on AuntMnnie.com:

"What I mean is owning our patients' problems," he said. "I mean being more fully invested in them, thinking of them as 'our' patients as much as anybody's -- owning their fears and their frustrations; owning their need for clear, understandable information; and owning their health behaviors and capacity to make good health-related decisions. I believe it's time to redefine what we mean by patient care, viewing it not so much as a product we deliver but as a virtue we live and breathe as we go about our daily duties."

Bisset sees the current healthcare chaos as a "golden opportunity." The changing environment of value-driven healthcare is an opportunity to address radiologists' invisibility. He advised paying attention to small details -- even relatively routine exams such as mammograms or chest radiographs may be alarming for some patients. Spend a little time in the waiting room and ask patients what can be done to improve the experience, he added.

To create a patient-centered practice it boils down to four principles, according to Bisset:

1. Dignity and respect: Healthcare practitioners should listen and honor patient and family perspective and choices.
2. Information sharing: Healthcare practitioners should communicate and share accurate, complete, timely, and unbiased information with patients and families in ways that are affirming and useful.
3. Participation: Patients and families should be encouraged and supported in participating in care and decision-making at whatever level they choose.
4. Collaboration: Patients and families should be included as partners on an institution-wide basis. Healthcare leaders should collaborate with patients and families in policy and program development, implementation, and evaluation. They should also collaborate in healthcare facility design, their professional education, and in the delivery of care.

Well, then. From the luminaries of radiology, you have a relatively bright vision for the future, thanks to IT, and an attitude (marketing?) shift that portrays us as more caring than the clinicians themselves. I hope they're right, of course. But here's where I go off the rails. Since I'm NOT a radiology superstar, or even a dwarf star, I can have a contrary opinion, and no one will notice. And so, contrary I shall be.

I won't quite say that we are seeing the death-throes of radiology, because I think we will always have something to add. WE have become the master diagnosticians, and are often called upon to solve problems before the patient even gets off the gantry. We DO provide value, we DO deliver quality. Of this I am certain. Could we do better? Yes, of course. Of the the viewpoints presented, I'm frankly most in line with Siemens, who wishes to provide IT solutions which will truly help us improve what we do. And to make money in the process. This is what capitalists do, and those who do so the best are those who are flexible and provide what is needed at the proper time. Siemens IT products are quite advanced, and worthy competitors in the world market. (Yes, we chose TeraRecon over syngo.via, but the latter has HUGE potential which I think will be realized in the next few years.)

I have nothing but the highest respect, even awe, for Drs. Dreyer, Bissett, and Chang, and again, I hope their optimistic vision is correct. However, I'm feeling much less certain. Basically, they are saying that first, we need to use IT to comply with the new laws and new paradigms, "quality" metrics and otherwise, brought to us by ObamaCare, and secondly, that we need to do a better job of selling ourselves, and we should use IT tools to make this happen. Frankly, these are not, or should not be, fundamental changes. We should already be communicating to our clinicians, we should already be using advanced visualization and other accoutrements to improve our reads. But...there are HUGE pitfalls awaiting us, and thinking that IT will save us is perhaps naive. I'm very wary, for example, of the ACO concept, where we will be placed in the dichotomous positions of gate-keeper to prevent excess scans, and whipping boy when we DO advise against a scan some clinician (or patient for that matter) thinks he needs. Having a direct Facebook-style connection to our patients sounds good and right, until a patient latches on to us and is incapable of understanding what we are trying to tell them, and becomes belligerent  (Been there, done that, by the way.) Dr. Bissett's comments are well-taken, but for the most part are things we should be doing already, with the possible exception in my little mind of the ultra-high level of communication to the patients, especially of troubling results.

How do we measure our contribution to the patient's outcome, relative to the treatment they receive? Could we provide more quality? No doubt. Many scans could be read better, and we would like to make fewer errors.  But all I'm seeing here are ways to seek out and punish those responsible for "bad outcomes". Incentive to improve? Maybe. But certainly no mechanism is provided. Well, I'll take that back. With the pressure to produce removed, we can perhaps just read one or two studies per day, and we damn well better get those right. Oh. That won't fly either, will it?

As an iconoclast, I'm seeing these measures as being reactive to the new governmental restrictions, and not proactive. We are trying desperately to prove our value, when it's continuously proven every minute of every hour of every day. Radiology isn't going away, but reimbursements are going to plummet, and all of the electronic arm-waving and attempts to add even more value to what we do isn't going to change that. At best, those who play this game better than others will be more likely to be enslaved purchased by their hospitals, soon to be the only game in town, to the exclusion of predatory entrepreneurial groups who can micromanage and tailor their minions to produce whatever metric is desired at that moment.

Innovation is life in this business, as with many others. I'm certainly not rejecting the concept, and I do embrace IT (the technology, not the personell) as our path forward. However, I fear that none of this will change how we are perceived by the government and by our colleagues. At 3AM, the ER docs know quite well how valuable we are, but we will always be the folks with the expensive toys that (in the delusions of many) overspent the healthcare dollar and backed the entire field into the corner in which we now find ourselves. All the computers and all the IT men can't put our reputations together again. Sorry.

Attention NovaRad: PLEASE STOP SPAMMING MY BLOG!!

YET ANOTHER Blog Spam message from someone at NovaRad in the last hour:

Megan Billard has left a new comment on your post "Practice SafeCT": 
Thank you so much for this great information. As I was looking on the internet for more information on PACS systems I found your site and I don't think there's anything better I could have found. Thank you so much for being clear and concise in the information you share. This really is a great blog. 

And of course, the PACS system link goes to....NovaRad!

If you have to resort to this bottom-feeder tactics like spamming blogs that few people read, your product must REALLY be lacking.

This doesn't even reach the level of an RSNA Naughty Bit.

Practice SafeCT

Axial scan, 0.6 mm slice thickness, acquired with a LightSpeed VCTTM by GE Healthcare and displayed in a Soft Tissue window of W=60; C=40. SafeCT processed image on right.

Image courtesy medicvision.com 

This entry, by the way, does NOT qualify as a Naughty Bit. In fact, it's about something rather impressive.

Last year, we were quite involved in selecting an advanced visualization system. We were at one time under the impression that one of the products under consideration was going to deliver a added bonus: Dose Reduction! But sadly, this turned out not to be the case. Please read this Old Post for details. As you know, we went with TeraRecon, although it has yet to be installed. Good things come to those who wait.

In the meantime, we have been fortunate enough to afford to replace several of our CT's with the latest and greatest from Philips, which have quite advanced dose reduction built into their hardware or software. But what of the old scanners we can't yet replace? If a patient is so unlucky as to be scanned when the low slice slicers are the only thing available, do they deserve a higher dose of radiation? Now, I think I need to mention that one scan on the higher dose machines might theoretically carry a greater risk of something, but really, the excess dose is probably not all that dangerous. Still, we treat radiation with respect, and try to reduce the cumulative dose by limiting the dose of each individual event. Alas, we cannot go back and retrofit the old but serviceable scanners with the new dose reduction technology.

Or can we?

I don't know off hand if Atlantis Worldwide contacted us, or if our physicist found them. Atlantis deals mainly in used equipment, an honorable and difficult task. But they are the US representatives of an Israeli company called MedicVision, the creators of the product in question. I've had the joy of a WebX demo, and today, the chance to speak to some of the scientists behind a new approach, SafeCT. To be brutally honest, when I first heard of it, I thought it was nothing but bullsh*t. After much more exposure, I think I was full of bullsh*t, and SafeCT might well be the answer for many in our position.

So what is it? What it is NOT is a simple filter. What it is NOT is a hardware solution. It IS a software solution, utilizing a "novel" non-linear three-dimensional post-processing iterative image reconstruction algorithm that increases SNR and allows CT radiation dose reduction. From the MedicVision website:

Medic Vision’s SafeCT is based on proprietary patented iterative volumetric algorithms technology for Signal-to-Noise Ratio (SNR) enhancement of CT studies acquired over a wide range of exposure parameters on conventional CT scanners. SafeCT is compatible with all major CT platforms and PACS systems. It can serve multiple CT scanners simultaneously via their DICOM network. SafeCT has been in clinical operation at leading medical centers and private radiology practices in the Unites States, serving thousands of patients. SafeCT is FDA-cleared for distribution in the USA.
Excellent Image Quality

• Reduced image noise
• Improved visualization of anatomical detail
• Preserves the look and feel of images the site is accustomed to. 

High End-User Value

• Add-on product compatible with any CT scanner
• Eliminates the need for costly scanner upgrades or replacement 
• A single SafeCT simultaneously serves multiple CT scanners from different vendors and models, providing a solution for the entire department.
• Rapid processing—no impact on image reconstruction time at the CT console
• Unchanged clinical workflow—seamless to both technologist and radiologist
• Scalable product capable of accommodating future scanner additions.  

The website has links to dozens of papers which validate the stuff. However, I looked at a bunch of pictures which were truly worth a thousand words. If everything is as it seems, the technique enhances noisy images and reveals pathology, EVEN ON IMAGES SCANNED WITH REDUCED PARAMETERS. In other words, pump in less radiation for the scan, and use SafeCT to rescue the image, and maybe even get a better image than you would have otherwise. (They compare favorably to GE's ASIR for example.) MedicVision suggests that we could routinely cut the doses by 50%, and with more experience and experimentation, possibly to an even greater degree.

I was worried that dropping the dose and impairing the image would lose data and detail. As near I can tell, SafeCT does just the opposite. The processed images seem quite diagnostic, with lesions clearly detailed that were essentially invisible or at least not well-demonstrated prior to their digital massage. In fact, the algorithm works in part, I was told, by edge-detection, incorporated within iterative reconstruction, thus detecting lesions in a way. I suggested to the inventors that they parlay this into a CAD display, lighting up the detected anomalies in red, for example. I'll take a 5% royalty on that one.

SafeCT works by placing a processing box between the modality and the PACS, rather like any other advanced imaging processor. It's a little pricey, but in the right setting, it may be well worth the cost.

This is a product worthy of your attention.  Have a look!

Siemens Hat Einen Sehr Großen Kopf

Welcome to RSNA 2012! I shall be serving as your intrepid reporter from the floor, acquainting you with whatever takes my fancy, and that could well stray into the strange and perverse. We'll call this section Dalai's RSNA Naughty Bits.

Many of the BIG Players (but not the LarGEst) have their booths in the old Lakeside building, with Siemens dominating in floorspace and sheer volume of offerings. As an ad for Amyvid, the new Alzheimer's imaging agent, Siemens presents a very large head of an older gentleman, complete with animatronic features, and a screen embedded in the back. The clip doesn't show the animatronic activity quite so well, but the old guy is eerily life-like.

When Siemens gets a Big Head, they do it right.

Stay tuned for more from the frigid wastelands of Chicago!

Agfa IMPAX RSNA Preview

I think I see some Dalai-esque influence here...

Full coverage from the RSNA floor to follow!

Golden Dalai!

So THIS Is Why I Missed That Lesion...

From Health Imaging:

GE Healthcare has issued a notice to users of its Centricity PACS alerting them that images could be lost when transferring between two or more Centricity PACS systems.

The potential safety issue is related to the Centricity to Centricity (C2C) exam transfer module and affects Centricity PACS versions 3.X, 4.X and higher.

“When another process in the destination server attempts to access the same object or table, the transfer process of a particular image may be terminated,” read GE’s advisory. “Once terminated, the transfer service skips the image being sent, and continues to send the next image in the exam. The loss of an image could result in a mis-diagnosis.”

GE recommended the sending user verify the number of images to be sent with the recipient as users may not notice when an image is skipped during transfer.

The company also said it will provide a patch to 3.2.X and 4.0 systems to address the issue.

Actually, this sounds like a rather isolated problem, but if you have the indicated software, get it patched ASAP!!

OK, Maybe Merge IS For Sale?

You'll remember the flurry of posts a few months ago about Merge maybe being for sale, prompted by apparent inquiries of potential suitors. We were assured at the time that this was simply all financial due diligence and no sale was pending.

Perhaps that wasn't quite the case. Reuters reports, via Chicago Business, that five possible buyers are quite interested in this non-sale:

Merge Healthcare Inc., a Chicago-based provider of medical-imaging software that is exploring a sale, has attracted interest from at least five private-equity firms, Reuters reports, citing people familiar with the matter.

Chicago-based companies Thoma Bravo LLC and GTCR LLC are among the buyout firms that have met with the company's management and are considering submitting offers this month, the sources told Reuters.

The other companies are Francisco Partners of San Francisco, and Welsh Carson Anderson & Stowe and Avista Capital Partners, both of New York, according to Reuters.

Merge's chairman, Michael Ferro, is also the company's largest shareholder, controlling a more than 31 percent stake through various ventures, including Merrick RIS Inc.

In September, Merge said the company had appointed New York-based investment bank Allen & Co. LLC to evaluate strategic alternatives, including a possible sale.

But Merrick RIS will also earn a fee if the company is sold.

If the sale price is more than $1 billion, Merrick RIS will receive a 2 percent “success fee,” according to filings with the Securities and Exchange Commission. If the sale price is less than $1 billion, the success fee drops to 1 percent.

In February, Merge increased Merrick's fee if the deal exceeds $1 billion, the SEC filings show. Previously, Merrick would have earned a flat 1 percent, regardless of the size of the deal.

Mr. Ferro is also chairman and CEO of Chicago-based investment firm Merrick Ventures LLC, which is affiliated with Merrick RIS. In December, Mr. Ferro led a group of investors to buy Sun-Times Media Holdings LLC, which includes the flagship Chicago Sun-Times.

Last week, Merge reported a third-quarter net loss per diluted share of 4 cents, four times the loss it posted in the third quarter of 2011. Net sales totaled $60.4 million for the three months ended Sept. 30, up 0.5 percent, from $60.1 million during the same period in 2011.

Merge Healthcare, Thoma Bravo, GTCR and Avista declined to comment, while representatives of Welsh Carson Anderson & Stowe and Francisco Partners did not immediately respond to a request for comment.

Merge's stock price closed at $3.07 today, down 54.6 percent, from a year-high on Feb. 28 of $6.76 a share.

$20 Million for Merrick if the price tops $1 Billion, eh? Not a bad payout.

It would be poetic justice of a sort if Thoma Bravo ends up with Merge. Bravo had signed an agreement with AMICAS in 2009 (see Here and Here), only to have the offer dislodged by Merge. The AMICAS stock went for $6/share, at that time, although I'm not financially savvy enough to figure out what percentage of Merge that now involves, so I'm not sure if Thoma would end up with a bargain or not.

I can say that Merge has been a far better master of AMICAS than I anticipated, and I'm actually worried about how things might fare under a new owner.

IF Merge is sold, though, I have two requests to the new powers-that-be:

1. Keep as much of the team intact as possible, and hire back any of the folks from the prior incarnation of AMICAS that will deign to join up.
2. PLEASE change the name of the PACS back to AMICAS. That would make me really, really happy. With all due respect to Merge, "Merge PACS" just doesn't sound right...

(Hat-tip to Spidey...)

DICOM Style!

Tonight of all nights, I need a little project to take my mind off of current events, and I'm going to enlist your help to create it.

I'm not going to tell you exactly what I'm up to, although students of popular culture will figure it out quickly. With lots of luck and hard work, I'll have it done by RSNA; that might be a bit ambitious, so don't be disappointed if it's not complete by then.

Oh, yes...how do you participate? It's easy. Use your cell-phone as a video camera, or use a REAL video camera (or a real camera in video-mode) and film, I mean video yourself saying the following:

"Oppan DICOM Style!"

If you would, say the words crisply and with vigor, look happy, or intense, or whatever.

I'm not sure how many responses I will get on this, but I'll use as many as possible. If you don't want to do this yourself, find someone else in your enterprise or company who is willing to take one for the team, I mean participate in this fun exercise. CEO's (anyone know Jeff Immelt?), PACS luminaries (David Clunie, Mike Cannavo, Bernie Huang), and other Big Names in the business are particularly encouraged to join in.

Please send your clips to:  doctordalai(at)gmail.com.

Thanks for your indulgence.

Disney Buys Lucasfilm, Lucas Lowers Tax Burden

Cartoon by Robert Arail

May the Force be with you...and a few million shares of Disney stock wouldn't hurt either...

And by the way (from NewsWatch)...

That Lucas struck a deal in 2012 may be no accident, either, advisers say. Long-term capital gains tax from the sale of assets held more than one year are taxed at a rate of 15% for investors in the 25% income-tax bracket or above (Lucas’s level), and zero for investors in the 10% or 15% bracket. Those rates are set to jump to 20% and 10%, respectively in January. “He probably wanted to take advantage of the lower rate on long-term capital gain while it’s certain,” says Bill Smith, managing director at CBIZ MHM, a national accounting and professional services provider.

I wonder what the tax rates are on Tatooine?

"Something Big! Something New!"

I have it on good authority that Merge Healthcare will be announcing "Something Big! Something New!" at RSNA. No, I have absolutely no idea what it might be. However, here are some possibilities, borne of my own perverted imagination:

• Acquisitions?
• Merge buys Agfa--Certainly Big, but not particularly New
• GE buys Merge--Let us hope this is not the case
• Allscripts buys Merge--long predicted by people in the know, but...
• Products?
• Meaningful-Use-Ready EHR
• Mating of AMICAS Merge PACS and Honeycomb for a true Cloud-PACS solution
• Off-The-Wall
• Michael Ferro switches from Tesla Roadster to Fiskar Karma and invites me for a ride down Michigan Avenue although I have to man the extension cord.

Stay tuned...

ADDENDUM...

From the latest Merge email:

The next revolution in imaging is coming...RSNA 2012. Booth 4845.Radiology is moving at the speed of life. Technology is evolving. You have clouds, viewers, portals, HIEs and more to address. Regulations like Meaningful Use (MU), HIPAA, ICD-10 and others keep pressing forward. And, the industry itself is changing with consolidation of imaging centers, emergence of ACOs and more.At RSNA 2012, we invite you to take a peek inside the new Merge box. In booth 4845, we'll be previewing the next generation of imaging — an innovative closed-loop imaging solution that will benefit radiologists, physicians and patients.We'll also be showcasing:

• How Merge can help you meet Meaningful Use (MU) now and prepare for the increased thresholds in MU Stage 2

• Why an end-to-end radiology solution offers greater ROI than mixing point products

• How to optimize your combination of onsite and cloud storage for maximum efficiency and benefit

• And much, much more!

Interested? Be the first in line. Sign up today for a Merge Innovation Tour and book a demo!

HMMMMMM...."an innovative closed-loop imaging solution that will benefit radiologists, physicians and patients..."  I'm thinking I'm fairly close on the "Cloud PACS" prediction. I'll still accept a ride in the Tesla, or Karma, or Maybach...