Moldy Business

You may recall from my older post, “Mold and Morality,” that I had several “mold remediators” come to my house to check out our mold problem that proved to be essentially non-existent. One of these operations wanted me to pay $125 for the honor of having been inspected by one of their “trained professionals”, who declared our house “contaminated”.

I sent this letter in response:

I sent an email outlining my thoughts on this to your assistant, but apparently she did not forward it to you.

While I was not present when you or your agent inspected my house, my wife relayed to me that she was told repeatedly that the house was “contaminated”. This prompted me to have the house tested by the same service used by our hospitals here in (our little town), at considerable cost to me. You may contact my attorney for these results, but suffice it to say that the living quarters of the home were found to be completely free of mold. There was a minimal amount of mold in the crawlspace, an amount that our inspector stated was less than or equal to virtually any other home in our area.

While researching this situation, I came across this video from KNBC (, and it was eerily remniscent of the entire experience with (your company).

With this in mind, I will respectfully request that you withdraw the inspection fee, and we will part with no hard feelings. If this is not acceptable, we can continue further discussion with the Better Business Bureau serving as arbitrator.


Dr. Dalai

Of course, this did not make the owner of the company very happy. He replied:

As to your email transmission:

Having checked her emails, (the secretary) did not receive any emails from you to forward to anybody.

Your wife was told the crawl space was contaminated – that’s where the inspection took place, based on Mrs. Dalai’s request.

Please furnish me the name of your attorney; I will be glad to ask him for the results – of course, you will have to release him to do so.

I am happy your living quarters are free of mold – your crawl space is not. If you would like some good information on mold in crawl spaces please visit our website and click on Mold Facts; then click on About Crawl Spaces (Read More).

There is not a minimal amount of mold in your crawl space – in fact some areas require either a dry ice blasting or baking soda blasting to remove the mold. Please view the attachment for pictures of your crawl space.

With all these added inspections at great cost to you, what is the problem with paying us the agreed upon amount of $125.00 to visually inspect the crawl space?

I refused to look at the video you bring up simply because I know it will infuriate me. I would expect better from an M.D. but apparently your aim is to bully and intimidate. Please look at the attached testimony of (another MD who liked the service).

I have hard feelings – (our) technicians are professionals – let’s have the discussion with the Better Business Bureau.

You owe this company $125.00 and I will turn it over for collection.

Neither one of us needed to waste this time.

Mr. X
Mold Company.

Well, I’m so sorry he took it that way. My final response to all of this was:

Mr. (President):

Apparently my email to (your assistant) ended up in her spam folder, which I suppose is appropriate.

The bottom line to our discussion is this: my wife, who is not a scientist, was told repeatedly by your agent that the HOUSE was contaminated, and that a $10,000 course of remediation was necessary to fix this. Note that he used the word HOUSE, and not simply crawlspace. That is a significantly different level of abnormality, as I’m sure you will agree. Based on our independent report, I’m certain we can also agree that the living quarters are free of mold. As to the crawlspace, our inspector did note small amounts of mold, which he stated were no greater than any other house in the area would reveal upon similar inspection. I’m sure you don’t wish to imply that absolutely every home in (our small town) is contaminated and in need of your services.

I’m sorry you feel the video clip would upset you, Mr. (President), as that is not my goal. A consumer-minded vendor would be interested to know how his agents are coming across to his customers. The video provides a very good example of how one should NOT conduct themselves in this particular business. And I’m sorry your feelings are hurt by all of this. I have no doubt that your techs are professionals, and I assume they have all been trained by (Big Cleaning Franchiser) methods since the establishment of your franchise in 2006. That is beside the point.

I am quite happy for Dr. (customer)’s positive outcome. His letter shows that he did have contamination in the living quarters of his house. I do not.

Please refrain from threats of collection agencies. I am respectfully disputing this charge, given the fact that your agent repeatedly declared the house contaminated, and followed this with a hard-sell pitch for your services. Independent testing later proves that the level of “contamination” was significantly overstated, as the living quarters are not involved. In this circumstance, use of a collection agency would be considered harassment. Beyond this, your comment concerning my profession is uncalled for in this setting, and is basically harassing as well. I am not attempting to bully or intimidate you or anyone else. A third party reading this communication would suggest just the opposite.

I certainly agree that neither one of us needed to waste valuable time on this. If you wish to have the BBB involved in this matter, I will certainly be glad to forward this communication thread to them.

By the way, your company is listed as a member of the National Organization of Remediators and Mold Inspectors, or NORMI. Their Regulations page,, states explicitly:

§100.107. Conflict of Interest and Disclosure Requirement.

(a) Conflict of interest.

(1) A licensee shall not perform both mold inspection and mold remediation on the same project.

I think that’s all that needs to be said in this matter.

Dalai, M.D.

I have yet to hear back from the gentleman. Perhaps that is indeed all that needs to be said. Caveat emptor, as usual.

OsiriX Involved in 3-Way….Fusion, that is

Image courtesy of

A long time ago, I posted a piece about a better way to link old and new CT’s together. My thought was to mark at least two, and preferably more, landmarks on each study and have the computer morph the old study to match the new one.

Well, this product hasn’t quite appeared as yet, but OsiriX has come up with something rather similar that allows the fusion of PET, CT, and MRI studies. As reported in AuntMinnie:

Using several pairs of reference points located in the area of interest, the OsiriX 3D application correlates anatomic landmarks from the CT element of the PET/CT scan (or SPECT image) with those of the MR scan. With these markers established — a greater number of points may be selected for greater accuracy — the program allows the user to realign the CT image with the MR image “in a matter of seconds,” consequentially also combining the PET/MR information accurately, Ratib (Osman Ratib, chair of radiology and head of nuclear medicine at the University Hospital of Geneva) explained.

“Once you’ve done that, you can use the registration tool to create a new set of images that are perfectly aligned, and which you can manipulate and play with,” he said. “It provides convenient and fast visualization and navigation capabilities across a large number of multimodality images, and, of course, it is free and runs on off-the-shelf software.”

Why is this fusion a good thing?

“PET shows the extent of metabolically active tissue in tumors, while MR shows the tissue alterations and the spatial distribution of surrounding organs. Unfortunately, very often MR does not show the exact extent of tumors due to surrounding inflammatory reactions and edema. Therefore, image fusion of PET and MR is expected to provide significant information that is not obvious from the two modalities presented separately; this can increase the accuracy and therefore confidence in diagnosis,” Ratib added.

“A three-way registration tool can provide clinicians and nonradiologists with a convenient way to review and localize focal abnormalities. That they can now interact and ‘navigate’ through these image sets rather than just rely on static prints provided by radiologists is a real improvement in clinical practice,” Ratib concluded.

One minor problem for some of us: This program only runs on Macintoshs. I guess I’ll break down and buy one sooner or later.

The Story According To GE

Our local GE rep and an applications specialist came to visit today. They ran me through a demo of the GE AW 4.4 Volume Share, especially as it will be used with our nascient Coronary CT arteriography (CCTA) program. While 4.4 retains some of the quirks of the earlier versions, it does show some very significant improvements, with some very nice implementations of automation. The images presented were spectacular, having come from a GE VCT 64 slice scanner. They did process a scan from another company’s scanner, and the vascular detection center-line placement didn’t go quite as smoothly, but it was relatively easy to tweak it into complacency.

At the moment, there is a limited remote control option. This allows three limited simultaneous access sessions, and one “virtual AW” session, which gives full control of the AW, but only if no one is using the workstation itself. Late this year, there may be a TeraRecon-style client-server product, but there are no details as yet.

The conversation turned to the Hawkeye, the SPECT/(limited)CT device. The nuclear rep wasn’t along for the ride today, but he did want me to know that diagnostic CT images from our 64-slice VCT could be grafted onto a Hawkeye study. Which sort of defeats the usefulness having a CT in your SPECT camera beyond attenuation-correction only. I related our pending purchase of the Symbia, but I did reassure them that when GE comes out with a diagnostic CT version, we would certainly consider it.

At this point, our rep began a rather surprising discussion, the GE side of my little unpleasantness from four months ago. It seems that there had been considerable internal pressure to get to the bottom of the episode, and it turns out to be rather more complicated than I would have thought. This was probably a rather difficult conversation for our rep, and I am very impressed with him for coming forward, and I am grateful to finally hear something from GE on the topic.

The problem originated with my post comparing the 2D/3D GE Discovery PET/CT with BGO crystals to the 3D Siemens Biograph 16 with LSO crystals. Frankly, it was one of my most carefully written and researched pieces, and I was quite proud of it. I evaluated the various technologies, both of which I actually use daily, and came to the following conclusions:

I’ll give you the punchline first, and then we’ll go into the boring discussion of what’s behind it. My educated, although still subjective, opinion is that the Biograph produces better images. Sorry, GE, but Siemens gives us images with less noise which are overall more pleasing and easier to read, again, in my opinion. . .

. . .What I do know is that the images from the Biograph are better, at least to me, than those from the Discovery. That’s my story, and I’m sticking to it. . .

You might ask, “Will the Discovery fail to demonstrate something that the Biograph would show?” Now that’s one question I can’t honestly answer, and it’s probably the most important of all. Time will tell on that one. But you can bet it will become obvious eventually.

Apparently, a competitor (which one is obvious) used this material in sales, which is their privilege, and I can’t say that bothers me particularly. Assuming that I was quoted correctly, and from what I’ve heard, they either handed out copies, or gave out my URL. I would certainly like to hear from any of you who received this material.

But somehow, word got back to GE that I had declared the Discovery’s images “non-diagnostic”. That is simply not true. The quote above is a direct clip from the offending post, which is now off-line. Nowhere do I say that GE’s scanner is non-diagnostic, and if I felt that way, I wouldn’t, I couldn’t, read from their machine. The patients come first, you know.

Supposedly, when someone like me “declares” that a machine is non-diagnostic, the manufacturer must file dozens of papers with the FDA to show that the claim is false. So, our rep went to the clinic that owns the Discovery to see what was the matter. The techs told him that there was no problem (and I remember them asking me why he would think there was), but in the process, this whole situation was mentioned to others. Supposedly, that is all that happened. You all know the rest of the story as it progressed from there.

Our rep had heard about the discomfort this had caused me and expressed sincere regret. Apology accepted, and I’m happy to let bygones be bygones. What was told to me when I was called on the carpet for my blog-posts placed more blame on GE than they deserve, based on today’s disclosure.

As I said at the time, this whole episode demonstrates the desperate need for better communication. Had GE approached me immediately, we could have put the whole problem to rest then and there. As it stands, everyone involved had an unnecessary trip through the ringer. The thread spawned by these unfortunate events disclosed a huge current of anti-GE sentiment, which I found quite surprising and very, very sad.

Let’s all take this lesson to heart and proceed forward. In this day and age, it is critical for vendors to hear what their customers have to say. Maybe today’s sale will be lost, but tomorrow’s might be saved. And, let’s all do a better job of listening to each other. I am very approachable, and I would like to think reasonable as well. Talk to me. Don’t wait until a situation blows up in our faces to say what should have been said.

Time Is Money

I love watches, especially those with lots of dials and buttons. I own only one really nice watch, which tells the time, of course, and also has a stopwatch, moon-phase, and perpetual calendar that will work until 2499. (Of course, there is a little enameled metal insert that my great-great-great (etc) grandson will have to have placed by a jeweler in the year 2299 to make that last 200 years. I’ve promised this watch to my son as an heirloom when he reaches the age of 40, the age at which I bought it for myself. So, at that point, quite a few years from now, I’ll be needing something new.

Pictured above is the Patek Philippe 5002-J Sky Moon Tourbillon, which should be adequate for the purpose. From the Patek website:

The Sky Moon Tourbillon Ref. 5002 is the most complicated wristwatch ever produced by Patek Philippe and also the workshop’s first double-face wristwatch. Its movement consists of 686 parts, some of which are microscopically small.

Technical Specifications


  • Minute repeater with tourbillon escapement
  • Chime with two “cathedral“ gongs activated by a slide piece in the case
  • Front side:
  • Perpetual calendar with retrograde date hand
  • Hours and minutes of mean solar time
  • Day, month, leap year by hands
  • Moon age
  • Crown at 4 o’clock: setting of the time and winding
  • Opaline-white dial with embossed Calatrava cross motif, gold applied Roman numerals
  • 9 hands
  • Reverse side:
  • Sidereal time, skychart, phase and orbit of the moon
  • Crown at 8 o’clock (24-hour scale): correction of sky/moon indications
    Case is humidity and dust protected only (not water resistant)
  • Case diameter: 42.8 mm


  • Thickness: 12.61 mm
  • Diameter: 38.00 mm
  • Case diameter: 42.80 mm
  • Number of jewels: 55
  • Power reserve: min 38 max 48 hours
  • Balance-wheel: Gyromax
  • Geneva Seal Hallmark

Yes, it has a star chart on the back! But I guess you have to take it off to see that. Oh, well, nothing’s perfect. And it’s not even waterproof!

I should probably start saving my pennies now. The list price is approximately $2 Million, but savvy shopper that I am, I found it here for only $1.4 Million. I do hope they take American Express. Think of all the Frequent Flyer Miles I’ll get!

Ah, it’s nice to dream about such things once in a while. The kind of wealth it would take to own one of these things is absolutely mind-boggling. I would frankly never buy one, even if I were so blessed as to be able to afford one, but it sure would be nice to actually see one someday.

Follow The Yellow Brick Road…The Centricity Upgrade Path

There has been a lot of rumour and innuendo concerning just where GE is going with its latest acquisition, Dynamic Imaging, and their IntegradWeb PACS. The discussion is further accentuated by mention of a Linux server upgrade to Centricity that will cost Heaven-knows how much.

I had the chance to speak with some very nice GE people who helped clarify all of this, at least to a significant extent. Some of it begins to make sense…

First off, as a site with Centricity 2.x and old Sun servers, we are, as they say, SOL. This is now an end-of-life product, a situation which GE blames on Sun for abandoning the hardware itself. So, to go to Centricity 3.x (presently 3.03 with 3.04 in the wings) we must replace the back-end with the new, flashy Linux server. I don’t know off-hand what actual hardware this encompases, but the new server is supposed to be the lynchpin of GE’s new IT-style approach to PACS and all things digital. Supposedly it is a more “robust” hub for connectivity of various things like Pathology and Cardiology images. How much will this cost? Well. . .we’re not totally sure, but probably less than $200,000, but likely more than but closer to $100,000. It could have been worse, folks.

As it turns out, the Linux server has been a part of the plan for the last three years, and there are already 1500 of them out there.
I have speculated that 3.x is the end of the line for Centricity, but officially, that is not the case. Supposedly, there is a 4.x in the planning stages. GE is not yet ready to pull the plug on our old friend.

There is a laundry list of improvements that differentiate Centricity PACS 3.x from 2.x. These include:

  1. Consistent Presentation of Images (CPI), part of the IHE profile
  2. GSPS (Gray-Scale Presentation State)
  3. Unreject Images
  4. Hiding Images
  5. Color Export
  6. Go to Image
  7. ROI Annotation (for multiple images)
  8. Modality-defined left and middle mouse button assignments
  9. DICOM Send-now sends GSPS and Key Image Notes
  10. Keyboard Shortcuts (see this link)
  11. Unlimited Status Changes
  12. Voice Commands–Allows the user to control the PACS application and to dictate annotations and notes
  13. Confidential Patients
  14. STAT prioritization
  15. PGP-Presentation of Grouped Procedures
  16. Voice Clips

These upgrades apply to the main thick client, called the RA1000. A few will be ported over to the Centricity Web client as well.

These additions add some interesting fuctionality (I’m intrigued with the voice-control thing, although if it works as well as the voice-controlled navigation in my car, it won’t be worth the disk-space it sits on.) There is now the option of integrating the Advantage Workstation into a viewport of the PACS. This is done entirely in software on the PACS workstation, with no client-server setup. The fundamentals of the viewer remain the same, however, and in particular, the worklist is still pretty primitive, and creating hanging-protocols, or DDP’s, is still rather painful.

Now here is where things get interesting. We all know that GE bought the IDX company and thus acquired its RIS. (Of course, this led to the “old” GE RIS going EOL, but that’s another tale.) Centricity’s new RIS is as displayed is called the RIS-IC (maybe IC stands for IDX-created?) and in the implementation shown to me, it really takes the place of the worklist, and the text or demographic page. As a worklist, it does a reasonably good job, showing what’s stat, what’s locked by someone else, what’s directed to you in particular, etc. It is very, VERY configurable. It isn’t an Amicas RealTime Worklist, of course, but it is a huge step up for Centricity.

And how much more for the RIS-IC? Well. . . my understanding is that it will be included with the purchase of the Centricity 3.0 Linux server. Maybe I missed something. . .

A very interesting aside about the IDX RIS is the integration of speech recognition. Actually, I don’t think you can get it right now, because GE/IDX has apparently had its share of problems with the Nuance engines. They are moving toward using something called M*Modal which does something called “speech understanding” rather than speech recognition, and requires no training. I’ll believe it when I see it, but I’d like to see it!

Now that you’ve suffered through the other drivel, it’s time to reap your reward, the UPGRADE PATH! There are actually several options to be available, and I don’t know how much more each will cost. But here they are:

  1. Don’t do anything, stick with Centricity 2.x and scour junkyards for Sun server parts.
  2. Immediate migration to IntegradWeb, or IW as they like to call it. Basically, this would be the same as buying the “old” Dynamic Imaging product would have been six months ago, except it now has a green GE on it. While the images will migrate, the annotations and what not won’t. Not a great choice.
  3. Buy the Linux upgrade, and round about November or December of this year, buy an IW to replace the Centricity Web for outside access. Yes, folks, this means that IW will be implemented as a web-appendage, a server grafted onto the Centricity 3.x database. If that bothers anyone. By mid-2009, remote dictation will be added to the IW, allowing one to actually use it for interpretation. I didn’t ask the question, but I have to wonder if this means that one won’t be able to click a study as dictated and have this propagate back to the PACS itself until this change occurs.
  4. In late 2009, the IW will be available as an alternative GUI for Centricity 3.x

As the relationship with DI progresses, the two cultures will start to mix, and the designers from both camps will sit down together to create the next generation of GUI’s. At the risk of offending my friends at GE (there might still be one, you know!), I have to hope that the offspring of this marriage favors IW more than Centricity. A lot more.

I’ll keep you posted on where we go with all this.

Get Into The Top 100!

Healthcare 100 -

While it isn’t quite David Letterman’s Top 10 list, my blog has made it to the list of “The World’s Top Blogs on Health and Medicine”. As of this time, it is number 305, although the widget to the left places it in the 500’s. Hey, I’m happy to be on the list at all!
You can help me move up the list, if you are so inclined. Here’s how they create the ranks:

Ranks are based on a combination of four sources:

Google PageRank (0 to 10) – Google PageRank is a link analysis algorithm that interprets Web links and assigns a numerical weighting (0 to 10) to each site. High-quality sites receive a higher PageRank.

Bloglines Subscribers (1 to 20) – Bloglines displays the number of subscribers for each blog’s feed. Each blog is assigned a Bloglines value from 1 to 20 based on subscriber ranges – e.g., more than 20, more than 30, etc. The more subscribers, the higher the Bloglines value.

Technorati Authority Ranking (1 to 30) – Technorati’s authority ranking shows the number of unique blogs that have linked to a particular blog over the past six months. The more link sources referencing your blog, the higher the Technorati ranking. Similar to a blog’s Bloglines value, a blog’s Technorati value is determined based on ranges (e.g., top 10,000, top 20,000, etc.), and each range is assigned a number (1 to 30) that is part of the algorithm. Points (1 to 10) – To add a little spice to the Healthcare 100 rankings, we add our own subjective ranking of each blog based on the quality of content and frequency of updates.

All four metrics are added to determine each blog’s total score. In the case of ties, the suborder is determined by points. If points are the same, Technorati authority ranking points are compared, followed by Bloglines subscriber points, and finally Google PageRank points.

Rankings are automated and updated frequently, with the date of the most recent update posted under the Healthcare 100 heading.

OK, folks! Link away! Subscribe to the feed! Make #1!!! (OK, #100 wouldn’t be so bad….)

GE’s Stock Plummets! (But It’s Not MY Fault!!!)

Jeffrey Inmelt, President of GE
Image courtesy of

No matter what you might think, I’m really not happy about this, since I’m a GE stock-holder. It seems that GE posted rather weak earnings, and its stock price plunged 12.8% today, dragging the Dow itself down 256 points. From the Wall Street Journal:

The conglomerate has significant presence overseas and was thought to be somewhat resilient to a slowdown in the U.S. economy, but it posted earnings well below analysts’ expectations, a near unheard-of outcome for a company renowned for posting profits at or above Wall Street forecasts. GE also cut its 2008 earnings outlook.

The decline in GE shares was the worst in percentage terms since the 1987 market crash. The drop erased about $47 billion in market capitalization.

Mike Thompson, research director at Thomson Financial, which tracks earnings data, called GE’s report “startling,” underscoring both the seriousness of the economy’s problems and the extent to which analysts’ profit expectations remain far too rosy.

WAH! $47 BILLION! Up in smoke, just like that. Ah, what I could have done with $47 Billion. Or $47 million, for that matter. C’mon, guys, let’s pick up the pieces and get back to work. GE has a larger GNP than many small countries, so I’m sure they will survive this painful episode. Let it be known that I’m at GE’s beck and call should they need whatever help and advice I can muster. reports that GE Healthcare didn’t do so well, either:

A lackluster U.S. economy and continued regulatory shipping restrictions on its surgical supplies business adversely affected revenues and profits at GE Healthcare in the first quarter of 2008. For the period (end-March 31), revenues for the Chalfont St. Giles, U.K.-based vendor dipped slightly to $3.88 billion, compared with $3.89 billion in the first quarter of 2007. Profit decreased to $528 million, compared with $637 million in the same quarter a year ago.

In its first-quarter financial report, parent company General Electric of Stamford, CT, noted that GE Healthcare was “impacted by a difficult U.S. environment” and cited the ongoing suspension of C-arm deliveries from its GE OEC Medical Systems unit as part of a consent decree with the U.S. Food and Drug Administration.

$500 million profit doesn’t sound so bad to me, but everything is relative, I guess.

A foundering GE means a foundering U.S. economy, and that is serious trouble for all of us. This is not good. Not at all. And I’m not kidding about that.