Jog-Shuttles vs. Joysticks, and Other Weird Ideas…

From the cyberworld back to the hardware world for a moment…

I have yet to get the Contour Jog-Shuttle Wheel (remember Darth Vader’s codpiece?) to work the way I would like with my PACS. Fortunately, it does work with my video editing software, so it isn’t a total loss.

I’ve been thinking about the problem of navigating a 3D dataset, which can be a dangerous and expensive thing (me thinking, that is). How is this done in real life? First, we have to find an analogous situation. Airplane pilots have to navigate their aircraft through three dimensions, though, in general, they had better be going forward, and they have to deal with gravity. Helicoptors don’t have to go forward, but the collective, the up-and-down control, adds complexity to this discussion. So, how about video games where one pilots a spaceship around, well, space, without regard to gravity? Most use some form of joystick navigation, though this might manifest as a limited D-pad on an X-Box or Game-Cube controller. The joystick was the one device Sherbondy did not test for his article.

An overwhelming number of joystick options are available. Take a look at the Saitek “Cyborg evo Force” pictured above. This joystick has lots of buttons as well as mini-joysticks mounted on it, and some of the buttons themselves even have switches. Our younger generation is being prepared for something, although I’m not sure we’re going to like it when it arrives. But I digress.

Seems to me that this is the way to pilot through the inner space of the body, and would be especially valuable with virtual colonoscopies. I haven’t, of course, worked out the logistics of this approach as yet, but one could use the main stick for navigating the slice you are in, be it axial, coronal, or sagittal, and one of the little mini-joysticks for diving up and down or in and out of the plane you are in at the moment.

My son has an old Sidewinder joystick, and since he has lost his computer priviledges for a week (forgot his homework or some other onerous offense), I’m going to confiscate the stick for my experiments. We’ll see how it goes.

Tool Time!Part I: Spine labeling

With apologies to Home Improvement…

I am starting a new series of blog-installments discussing various tools within PACS viewers. I’ll try to describe the versions of the tool I use, with my (biased) evaluations and suggestions for improvement. At least this gives me material for the forseable future!

Let’s start with the spine labeling tool. By the way, here is my stylized icon which I will be glad to sell to any interested PACS company for a really reasonable price:

Hands-down, my favorite incarnation of this tool comes from Amicas. This is the way it should be, simple, intuitive, quick, and effective. You click the button on the menu bar, and then point at the middle of S1 and click. Then you point to the middle of L5 and click…and so on until the spine is labeled. The magic of this is that 3D information within the DICOM header is utilized to deploy labels in the axial plane:

This whole process literally takes 5 seconds.

A drop-down menu gives several options with further control available from the labeling dialogue:

Now this is really neat: “Preferences” lets you set up a degree of automation. If the spine study is properly named(cervical, thoracic or lumbar), the labeling tool automatically starts at the level you choose. (This is actually an unusually deep level of adjustment access for Amicas tools, by the way, and the initial set-up will probably be adequate for the vast majority of users.)

The other systems we use either don’t have this tool at all, or have a such a poorly-designed version that using it would take 10 minutes; therefore, we don’t.

I don’t have any significant improvements to suggest for this tool; Amicas did it right. I would perhaps like to have the ability to change the font, or at least the size, of the labels. It would also be nice if they would propagate to the coronal projections as well if these are available. Finally, it would be really nice (but really difficult to accomplish) to have the labels appear within the embedded Voxar 3D window. I can dream, can’t I?

Tune in next time, when Heidi and Al get caught up in the magnification tool!

"Geek Squad" and The Dalai Manifesto On Expert Witnesses

Voice of Reason writes on

Sorry to get on a tirade but I just got handed a bill from the Geek Squad serviceman for a service call on my Gateway that I have had for 2 years now. I just had a service call last week where a piece was replaced that was worn out and my contract states that I get 1 service a year for free. Well the hard drive failed as they sometimes do, and I needed it repaired.Here comes the fun part, for a 50 gig hard drive I was charged $667.18. Yes that is correct over 600.00 for a hard drive I could get for less than 100.00. I was charged at a rate of $240.00 per hour to install it which took 3 hours and $325.00 for them to drive to my office which is less than 25 miles from there office here. I was told that all of these are the standard rates.
Well I asked the rep if I charged him 667.18 for a contrast injection would he be upset, he said of course he would, but he has no control over the pricing. As far as I’m concerned this is all horse shit, I’m sick of being charged $95.00/ hour for IT support while they sit at one of my computers and wait 30 minutes for a download to finish or for a program to scan my hard drive. Plus they charge me 1/2 the hourly rate for travel to my office.We (physicians) have been taking in the shorts for way too long and I for one am pissed off ( sorry about the language). I want to organize just like every other business in the free world. I would like to see them put all of us in jail for collusion. I have said it before but it is time to strike!!!!!!!!!!!!!Close the doors for 2-3 days don’t answer the phone, all of us go see our families take them fishing or go play golf, round on your hospital patients if you have them, but otherwise stop, Only by a massive shut down will anyone, inscos and gummit, see that we aren’t going to take this crap any longer.My prices just went up 50% and no more free work of any kind unless it is something I want to do, not what some patient or inscos think I have or should do!!!!!!!!!Sorry but I’m pissed!

Among other posters, Dalai responds:

Shoulda got a Dell with a 4 year service policy. Or learn to open the can of your computer and swap the drive yourself. 5 minute hardware procedure, 1 hour or so to reload the drive.
On the more serious medical front, I think in the end docs are their own worst enemies. How ’bout them expert witnesses? Without them, the lawyers are SOL. But Google the term “
medical expert witness” (I’ve made it easy by linking it for you), and you get 40,000+ sites that will connect you with a doc that will say the sun didn’t come up this morning if you pay him/her enough. My personal solution is to make it ILLEGAL to pay for such expert testimony beyond travel expenses and such. Some of these plaintiff whores make $5,000-$20,000 per case that goes to trial, so they have every motivation to drag your sorry backside into court, even if there is no case. This must stop. The tort-reform bills going through various state legislatures, and even Congress, are not dealing with this issue as strongly as they should.
For us imagers, the clinicians with their own scanners are presenting an interesting problem. They are generating more imaging business, and the more upstanding of them contract real rads to read their stuff, but their out-of-control self-referral is bringing down the house on ALL of us. This baby doesn’t want to go out with the bathwater. Then you have the ERs that order everything but a corpora-cavernosagram in the middle of the night (at least I haven’t had to do one yet), and want the answer yesterday, overtaxing the system at that end.
$700 for an hour of work to replace a hard-drive? Maybe I’ll join the Geek Squad….

I’ve been wanting to post something like this for a while, but just never got around to it. I’ve been sued twice, both for rediculous reasons. Don’t get me wrong: I make mistakes, as do all rads and even all doctors, and all human beings in general. However, the tort system in this country, especially with the contingency basis upon which many of these cases are pursued does nothing to correct mistakes, it simply pads lawyers’ pockets. In my first case, I and two of my colleagues were accused of missing a lesion on a mammogram that wasn’t there. The “expert” was a general radiologist that had been sued 7 times before himself. His deposition would have been funny if it wasn’t directed at ME. That case was dropped. The second case, which is awaiting summary judgement, accuses me and another rad of not seeing a chest tube on a radiograph that wasn’t there. I kid you not. It is one of those classic “shotgun” suits where every doc that had the bad fortune to get his or her name on the chart was sued, with no regard for level of involvement with the patient. Once I get summary judgement, I will seriously consider seeking sanctions for the litigating attorney. I think he was expecting all NINE of us docs to settle just to make him go away. He is in for a bit of a nasty surprise.

I am very serious about my solution to the “expert witness” problem. Look at it this way: if you can pay for testimony, then it can be bought. If I am called to testify, I refuse payment, and I require a subpoena. Therefore, I am there as a free-agent, not paid by anyone, and I can speak the truth. Period. Now, the standard answer an “expert” gives when asked on the stand how much he is being paid is something like, “(muffled thousand dollars) for the time I put into this case, but I am here to give my expert opinion and payment doesn’t change what I’m going to say.” Sorry, I don’t buy it.

Many professional societies are starting to sanction their members that grossly perjure themselves on the stand. That’s a start. However, the ONLY way, in my humble, simplistic opinion, to completely stop the abuse of (and by) the legal system is to decouple the testimony from payment. That is what I practice personally. I have had lawyers look at me like I have three heads when I tell them this, which maybe is indicative of how it impacts them.

I refer to this declaration of independence of testimony from reimbursement as the “Dalai Manifesto”. Outrageous? Yes, but I haven’t heard a better idea yet.

RSS Feeds and Fellow Bloggers

There has been a request for RSS feed for my humble blog by Anonymous (I wouldn’t admit interest either). I haven’t dabbled much in such things, but Blogger publishes the RSS feed as I plugged this into SharpReader, and it appears to work properly.

Docderwood has joined the league of Bloggers with his new blog NuclearVision. Check it out…it is very nicely done. Like me, Doc is a Nuclear Radiologist, double boarded in Radiology and Nucs. His blog is a lot more erudite than mine!

Stentor? Who’s That?

Take a look at the former Stentor website….It is now called the “Philips Global PACS Business Unit”, and barely refers to Stentor by name at all. The introductory paragraph says it all:

Introducing Philips iSite PACS

Philips iSiteĀ® PACS is the leading enterprise-wide medical image and information management system on the market today. iSiteĀ® PACS is an innovative image and information management system that delivers on-demand diagnostic-quality images over existing hospital networks, advanced radiology reading stations for radiologists, and “always online” long-term storage.

Sure sounds like Stentor to me. Now don’t get me wrong, I have the utmost respect for both companies, but the rapid transition feels a little like Orwellian doublethink. Oh well. Good luck to all Philips users, both the Sectrans and the Stentorians.

Hello, Freeman Health System!

I noticed a great deal of traffic today from the Freeman Health System of Joplin, Missouri. They seemed to be particularly interested in my ScImage posts. Freeman bought ScImage for Cardiology and Radiology PACS in 2003. Maybe their experience has been better than mine, and perhaps they got a good laugh out of my ranting. I hope so, anyway, for their sake.

ADDENDUM…I just couldn’t resist posting FHS’s response….

We enjoyed your rants about ScImage! Our favorite was “Dear ScImage.” Don’t know how many times i have had to walk our radiologists over the phone at night how to re-inistall picom client. One them asked in a huff one night….”now why do i have to keep doing this?!?” I do not know sir.We enjoy your site and will most certainly be keeping up with it!Take Care!