The Best Month Ever For DoctorDalai.com!

January 2008 isn’t quite over yet, but already we’ve passed the 4,000 visit mark for the month, a new record. OK, I know most popular websites have this much traffic every second or two, but to me, it’s impressive. As always, many thanks for reading my kinder and gentler blog. I’ve been hearing through the grapevine that some of you miss the old down-and-dirty approach. Well, I wish I could oblige you, but I think you know why I had to tone it down a bit. Maybe I’ll take it up a notch or two in the future, so keep your dial tuned to this station!

The Ultimate Radiology Keyboard?

As reported in PACS World, “a blog for Radiology network administrators”, there is a brand new take on keyboards that would work wonderfully for PACS.

From the Art. Lebedev Studio comes the modestly named Optimus Maximus keyboard. It is rather pricey at $462.27 US, but for this you get something rather wonderful:

Each key is a stand-alone display that shows the function currently assigned to it.

Optimus’s customizable layout allows convenient use of any language—Cyrillic, Ancient Greek, Georgian, Arabic, Quenya, hiragana, etc.—as well as of any other character sets: notes, numerals, special symbols, HTML codes, math functions and so on to infinity.

If this doesn’t make the idea clear, try the Optimus demo. There are some other versions coming or already here, such as the Optimus mini three:

Optimus mini three is an auxiliary keyboard-informer with OLED technology. The three keys can display static or animated images. Optimus mini three keyboard can be used as a toolbar, a remote control, an indicator or an RSS reader.

Functionality

Optimus mini three keys display information associated or independent of the running program. For example, you can be watching a film on your computer, while the keyboard displays a weather forecast, exchange rates or mail notifications.

Optimus mini three works in sync with the regular keyboard and is so configured that its current layout changes as you press the modifier keys (Ctrl, Shift, Alt, and their combinations).

This is really, really a phenomenal development. The author of PACSworld mentions the following applications to PACS:

For instance on a work list screen there may be some icons displayed on the keyboard indicating things like:

  • Move patient
  • Delete Patient
  • Edit Patient
  • etc.

But when the Radiologist is in Viewing mode there may be buttons that display icons for:

  • Next slice
  • previous slice
  • render 3D
  • annotation
  • exit viewer
  • etc.

The implementation of such a keyboard could mean a much shorter training period as the radiologists will have all the relevant buttons displayed to them directly on their keyboards.Now all that radiology needs is a standard set of icons that is universal to all PACS systems and the learning curve between systems will be much shorter!

This is almost like something out of Star Trek, where the LCARS (Library Computer Access and Retreival System) control panels supposedly are state-dependent and change with the current situation:

PACS is the perfect environment for such a display. But until we get to SickBay on the Enterprise, the Optimus may be a pretty good second best.

What A Difference A Year Makes

The MD Buyline reports (http://www.mdbuyline.com/) are rather pricey reviews of medical hardware and software, generally not available to those of us too cheap or too poor to buy them. Fortunately, Dynamic Imaging, rightly proud of its Number One status, has made these reports available for the past few years. Now, of course, DI’s product has a different name, but we won’t talk about that. Here are some exerpts from the 2008 report, and the 2007 version. I’ll leave it to my astute readers to spot the differences. (Hint…look at the First Place and Last Place entries for both years.) Congrats to all my friends at DI!

2007:
Vendor Composite

2008:
Vendor Composite

Agfa’s Pryor Retires, Stone Takes Over

As reported within the last few days, Bob Pryor has stepped down from the helm of Agfa HealthCare Americas, part of Agfa- Gevaert of Mortsel, Belgium. Details are pretty sparse, but apparently Mr. Pryor has chosen to retire. I can find no reference to his departure on the Agfa website itself as of tonight, 1/26/08, but I do expect one shortly. Barry Stone, currently COO, will step up to the plate. According to Healthcare Informatics, “Pryor joined Agfa with the Sterling Diagnostic Imaging acquisition in 1999. Pryor leaves behind a 34-year career in the healthcare field.”

Well, OK, maybe it’s time after all. (This coming from someone with a retirement count-down clock on his blog!)

I had the chance to meet Mr. Pryor at RSNA in 2003, when we were looking for a replacement to our elderly Impax 3.5, and Agfa was near the bottom of our list for various reasons. He told us that “Agfa had dropped the ball, but that they were ready to pick it up and run with it.” After our other choices more or less eliminated themselves, we had the chance to find out how true this claim might prove. You’ve read the saga that followed in my earlier posts.

Good luck to Mr. Stone in his new position, and of course to Mr. Pryor in his new endeavours.

French X-Ray Patients Recalled…Trouble in Oui Oui Land

A scary little piece from Reuters:

LILLE, France (Reuters) – The French health service is recalling thousands of patients who might have been wrongly diagnosed or infected at five substandard radiology clinics, the Health Ministry said in a statement.

Health experts said it was the largest such recall in France, adding the case had revealed severe failings in the health system.

Authorities closed the five clinics in the north of France last December after discovering a string of serious problems. “Inspections showed major malfunctions, notably with regard to record-keeping and personnel qualification, and with respect to the rules of hygiene and equipment safety procedures,” the ministry said in a statement.

Authorities will ask most of the 7,000 patients in question to be re-examined, ministry spokeswoman Geraldine Dalban-Moreynas said.
“The vast majority are patients who may have falsely received a clean bill of health after undergoing a mammogram or chest X-ray,” she said.
But an undisclosed number of patients also ran the risk of infection following examinations with instruments that were not sterilised. French media said some of the patients might have contracted AIDS or hepatitis as a result of the sloppy care.

Wednesday’s case followed a series of scandals last year over malfunctioning radiation machines used to treat brain cancer patients in a number of French hospitals.

France regularly tops international rankings for the effectiveness of its health care system, although some analysts say it is unsustainable given the country’s ageing population, and will need more private investment to survive.

(Reporting by Pierre Savary and Brian Rohan; editing by Crispian Balmer)

Oops… This is what can happen with socialized medicine, my friends, and it isn’t pretty. Is this a typical situation? Let us hope not, for the sake of the French patients. You really have to love the part about “more private investment” being required. That means the French will have to start charging for health care after all. The best things in life may be free, but they might well cut your life short.

ADDENDUM

I have received a number of comments from French readers, who are not pleased with my characterization of their system. I have to agree that my post above is a little acerbic, but if you read it carefully, I did state that I hoped this was not a typical situation. I will take the word of my readers who live in France that it is not typical at all. Still, how could a situation like this occur under the umbrella of the French system? “B” says that the radiology practices in question were closed immediately, and were “private practices”. Well, with the number of reexaminations and so forth, I don’t think they were closed “immediately” but rather after the problem festered for quite a while. But I guess it is a good thing that the problem was eventually dealt with at all. I would love to know if a private clinic over there has the same degree of autonomy as such a facility here.

For the record, I do not think the American system is perfect. Far from it. However, there are those here that see socialized medicine as a panacea, and that is not accurate either. Here is yet another tale of a glitch in another socialized system:

Glitch held up X-ray results

Patients’ health may have been compromised

Michelle Lang, Calgary Herald,Published: Thursday, January 24, 2008

Patient care may have been compromised after a computer glitch at Calgary hospitals delayed the transmission of as many as 40,000 radiology reports such as mammograms to local doctors’ offices last year, health officials said.

The Calgary Health Region revealed Wednesday that problems with software responsible for faxing radiology results began in May 2007 and continued until late July, when the region notified nearly 2,000 physicians about the delayed reports.

The health authority, which is still investigating the incident, said it’s possible patients were adversely impacted, although they didn’t know of any cases. Physicians said the worst-case scenario would be a delayed diagnosis of a disease such as cancer, where timely treatment might stop the illness from spreading.

“It’s one of those technical glitches that occurs in a system and it’s really unfortunate because it has the potential to impact patient care,” CHR spokesman Mark Kastner said in an interview Wednesday.

Kastner said any patients whose reports may have been delayed would have since received the correct information from their physician, noting doctors’ offices have now had the reports for several months.

Opposition parties called the situation a “mess,” adding the CHR should have announced the problem last summer.

“There may have been a lot of people delayed in getting treatment for cancer and other life-threatening issues,” said Laurie Blakeman, the Alberta Liberals’ health critic. “People were probably failed.”

The CHR’s fax problems come more than two years after another computer glitch at the health body where physicians viewed incorrect lab test results for 2,000 Calgarians during a two-month period. No patients were harmed during that mix-up.

In this latest instance, the fax problem related to radiology reports from imaging tests such as X-rays or CT scans, which are performed to help doctors diagnose a wide range of conditions. CHR officials say a configuration problem with the software responsible for faxing radiology results from its hospitals and clinics to doctors offices likely began last May.

Doctors offices that receive radiology reports by mail or courier were not affected.

In June, the CHR noticed it was receiving an unusual number of calls from physicians saying they didn’t receive faxed results from radiology exams.

It wasn’t until July 20 that the CHR identified the problem and sent a letter explaining the issue to the 1,750 Calgary doctors who had opted for faxed radiology reports. CHR then re-faxed the reports to physicians.
The region’s diagnostic imaging department, however, later became concerned that they may not have sent all the radiology reports to all physicians’ offices.

Finally, in September, the CHR faxed out 40,000 radiology reports to Calgary physicians as a precaution, sending results from all radiology exams done during that period, although it isn’t clear how many of those didn’t make it to doctors’ offices.

The health authority said it has fixed the computer problem and is still reviewing its response to the situation.

mlang@theherald.canwest.com

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CalgaryHerald.com

Is this the fault of Canada’s socialized system? The politicians want to make it sound that way. Nice to know political spin is a universal phenomenon. I do know that if a report doesn’t make it out to one of our clinicians around here, there is Hell to pay within 24 hours. Take it for what it’s worth, folks.

Daxor BVA-100: Turn Up The (Blood) Volume


No doubt some of you have performed blood volume analysis in the past, or at least had to learn how it was done. Remember the good old days, when we labelled red cells with chromium (Cr-51) and the plasma with I-125 albumin, then we had to do painstaking measurements with well-counters, and lots of hand-calculations? That’s probably why the test was so expensive, and why it was rarely ordered.

Enter Daxor and the BVA-100, pictured here:

This takes most of the work (and guesswork) out of the test. Basically, the old method has been streamlined and simplified, but philosphically the method is similar. The basic principle involves dilution. If I have a bucket of water of unknown volume, and I dump a gram of sugar (or a microcurie of I-131) into it, I can then take a 1 cc sample of the water, and determine how much sugar (or I-131) is in that sample, and then work my way back to the original volume. If the sample contains 1 mg of sugar, I know that the volume must be 1 cc water x (1 gram sugar/1mg sugar) = 1000 cc water! Simple algebra, right? In the old days, we used this method to determine both plasma volume with I-125 labelled albumin, and red-cell mass with Cr-51. Graphically, think of it like this:

Daxor’s method is a little easier from the user’s standpoint:

The BVA-100 is a semi-automated blood volume analyzer. The instrument is used in conjunction with a single-use injection kit consisting of a precisely measured standard and matching injectate (of I-131 labelled human serum albumin). The injectate is packaged in a patented flow chamber designed to ensure 99.8%+ delivery. The kit improves accuracy and eliminates the many time-consuming and difficult steps required for on-site standard preparation.

The BVA-100 utilizes five separate sampling points taken at regular intervals starting approximately 12 minutes after injection. In effect, each sample measurement is a separate, single-point blood volume determination. The BVA-100 computes the transudation time for the tracer and calculates the true zero point blood volume with an accuracy of approximately +/- 2.5%. The BVA-100 provides interim blood volume results while the samples are being measured; preliminary data is available within 30 minutes and may be used to guide decisions in emergency situations.

Daxor’s stroke of genius for me is the elimination of the direct labelling of the red cells, as well as plasma. Rather, a portion of the blood sample is reserved for hematocrit determination, and that ratio of red cells to plasma is then applied to the rest of the figures, i.e., the plasma volume. Simplistically, if the hematocrit is 50%, and the plasma volume is 2,000 ml, then the red cell volume has to be 2,000 ml as well. (The volume of white cells is negligible.)

The system goes even further, normalizing the readings to the patient’s height and weight (and incidentally providing a reading of how far above or below average the patient might be.)

We all remember using blood volumes to document Polycythemia, an overabundance of red cells. As it turns out, blood volume measurement can be applied to a number of other situation such as:

    1. Acute blood loss during surgery or trauma
    2. Hypertension
    3. Syncope
    4. Orthostatic hypotension
    5. Congestive heart failure
    6. Septic shock and hypovolemia
    7. Anemia in cancer patients or HIV positive patients on chemotherapy Renal or kidney failure
    8. Preoperative screening for low blood volume
    9. Chronic fatigue syndrome

Have a look at this brief slide presentation from Daxor:

We purchased a BVA-100 over a year ago, and I am very pleased with the results. I am very slowly getting the word out to the clinicians as to just how much we can help them with this test, and they are actually starting to believe me! Fortunately, as the system uses I-131, it requires a nuclear license, and cannot be placed in the clinicians’ offices. Sorry about that.