eRAD Snags "Pryor" Agfa President

The world of Radiology is pretty small, and the world of PACS is even smaller. Thus, the same people (and the same personalities for that matter) seem to reappear in different venues.

I first met Bob Pryor at RSNA 2003, and I remember his mea culpa for Agfa’s performance quite well. “We dropped the ball,” he stated, “but we’re going to pick it up and run with it.” And so they did. As you well know, the Impax 6 purchase that was prompted by this admission has been anything but trouble-free, but Agfa has been very willing to work with us, and certainly hasn’t thrown a certain blogger to the wolves over negative posts.

Mr. Pryor retired from Agfa recently, and now, he has a new spot:

Image Medical Corporation, parent of eRAD Inc., an industry leader in workflow solutions through its native Web-based RIS/PACS and Diagnostic Imaging Information Management Systems, announced today that Robert S. Pryor has been appointed to Image Medical’s Board of Directors. Pryor had recently served as President of Agfa Healthcare, Americas with responsibility for Agfa’s Imaging and Informatics business throughout the Americas. He had previously held executive positions at Sterling Diagnostic Imaging and in E.I. Dupont’s medical businesses. Roy W. Miller, Image Medical Board member and CEO of eRAD Inc. stated: “Bob Pryor is an outstanding individual with a tremendous business acumen and an extensive knowledge of the diagnostic imaging industry. We are delighted to have him join us in a position of such strategic importance.”

I would imagine that a smaller company like eRAD presents some different challenges and rewards than a big conglomerate like Agfa. I’m sure this new relationship will be beneficial to all involved.

Dalai’s Workstation Salvation!

I love Radiology, or at least I used to before the governmental bureaucracy and other joys of modern medicine crept into the field. Still, I can’t see myself doing anything else, except perhaps for retiring, and that ain’t happening any time soon. One major problem with the field, however, is that it does not encourage physical activity. With the advent of PACS, we don’t even have to lift a film-jacket, and as my group employs P.A.’s, I don’t even have to lift my carcass out of my chair to sling barium much these days.

These circumstances help radiologists fit right in with the rest of the population:

Obesity is a major health epidemic in the United States. It is estimated that more than two-thirds of the population is overweight and one-third obese. Both of these numbers have significantly increased over the past 25 years. Obesity increases the risk for many diseases, including hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, and some cancers.

But apparently not the heartbreak of psoriasis, at least.

Jeff L. Fidler, M.D., and colleagues at the Mayo (rather ironic since were talking about overfed, obese radiologists) decided to investigate ways to help our profession with this problem, which they also note to be sedentary, and their work is presented in this month’s JACR.

Fidler, et. al., note that

. . . even small repeated movements throughout the day can lead to increased caloric expenditure by a process termed nonexercise activity thermogenesis. In one study, the mean increase in energy expenditure for walking and working over sitting was 119 +/- 25 kcal/h. It was estimated that the incorporation of walking and working 2 to 3 hours per day could lead to weight loss of 20 to 30 kg/yr (44-66 lb/yr) if eating is not correspondingly increased. In addition, other studies have shown that cerebral blood flow, oxygen extraction, and brain metabolism may be increased with exercise and activity.

So what’s a radiologist to do? Walk on a treadmill while working? You betcha!

Potentially, these or otherdevices could be incorporated with image interpretation workstations, allowing radiologists to review imageswhile increasing their background activity. However, such a device has not been studied in this setting to determine if there is a negative impact on the detection of abnormalities. The purpose of this study was to evaluate the feasibility of a walk-and-work image interpretation workstation for computed tomographic (CT) image interpretation and to assess interpretation accuracy. If it can be shown that accuracy is maintained, this device could be implemented in clinical practice, allowing increased caloric expenditure and subsequent improvement in overall health for radiologists.

So, this is what they did:

A worktable was constructed that could be adjusted from a height of 38 to 52 in above the treadmill track using a hydraulic device. Thus, it could be adapted to accommodate the different heights of the radiologists (5 ft 9 in and 6 ft 1 in) in this study. This height range would be suitable for individual heights of 5 ft 7 in to 6 ft 10 in but could be revised for other heights. Because of the configuration of the table, the front support and control panel for the treadmill was not attached, and the treadmill control panel was mounted on the wall adjacent to the treadmill. The tabletop size was 4 ft wide by 2 ft 10 in deep. This allowed placement of a 2 monitor workstation, keyboard, fan, and dictating machine while still leaving ample room for note taking. The desktop was designed to have an overhang of 10 in. This allowed ample space for legs to extend forward without making contact with the support during a low rate of walking. The total cost for the worktable construction was approximately $1,500. A commercial-grade treadmill (C954i; Precor Inc., Woodinville, Washington) was used (Figures 1 and 2). The cost of the treadmill was $3,000. The retrospective review was performed in a remote location, and a computer with electronic medical record access, electronic dictating machine, and telephone were not present. Reviewers wore tennis shoes while walking on the treadmill.

The cost of the tennis shoes was not given. The researchers then interpreted 10 cases whilst walking on the treadmill at 1 mile per hour. Average interpretation time under these conditions was 9.2 minutes, a little longer than we usually spend on a case. The results are surprising:

As the study was developed, the main concern was that the use of the treadmill would cause the investigators to miss a significant number of findings because of the associated motion. It was surprising to discover that a significant number of findings were detected while on the treadmill that were not mentioned on the initial interpretations. Many (60%) were very subtle findings, and 13% likely would rarely be seen. Although it is intriguing to think that the walking technique may have led to this increased detection by increasing blood flow and alertness, there are several other issues that may have accounted for this.

Why did they have to go and spoil it? The other factors involve the fact that the images were evaluated twice, only 10 cases were read at a time, and the bloody phone wasn’t ringing off the hook during the interpretation. Then, there is the Hawthorne effect which says we perform tasks better in response to a change in environment. Sounds like we ought to at least move offices every hour or so.

The bottom line is that it is feasible to read from PACS whilst exercising, and your accuracy might even improve. This is wonderful news, of course. However, the researchers were probably in good shape and had good coordination. Get me up there on the treadmill, give me a tough case, and I’m likely to go George Jetson within 30 seconds.

Citrix Comes To iPhone (Finally)

With a hat-tip to HIStalk, here is some good news from InfoWorld for those of us with iPhones and Citrix at the office:

By the first half of 2009, Citrix will make its XenDesktop and XenApp client and server software for remote access to Windows applications available for the iPhone. “We expect to have it sooner rather than later,” said Chris Fleck, vice president of Solutions Development at Citrix. Fleck said the company is addressing an “unbelievable market demand” for such a product. Requests have become the number-one topic of discussion on its blog site.

“Your entire XP or Vista desktop and all your apps are available in that virtual desktop with all the inherent security and manageability that is currently available on remote desktops now,” said Fleck.
Similar Citrix technology is available for Windows Mobile devices and devices running the Symbian operating system.

However, in the case of the iPhone, Citrix has tweaked the XenApp and XenDesktop technology so that it can leverage the unique features and capabilities of iPhone, such as touch gestures, pinch and pull, zoom, and pan.
“What it does makes applications that were designed for a full-screen desktop usable on small form factor,” noted Fleck.

According to Fleck it will make available the entire world of a half-million Windows applications.

From Citrix, here is how it’s going to work (I recommend you turn down the volume on the accompanying music):

This is actually very good news. Right now, I can easily sign reports from my iPhone on our EmpiricSystems Encompass RIS, because it is HTML-based, and easily accessed via Web. However, there has been no way to access the Citrix-based Cerner system (at another hospital) without at least a laptop. Now I can do it from the field. And, since said hospital has set up a Citrix based virtual desktop, I may finally have iPhone access to our various PACS installations. Time will tell just how well that will work on the small screen and with relatively limited bandwidth, not to mention the overhead imposed by Citrix. Still, it is a major step toward portability.

I have had the iPhone for several months now. I haven’t written a review as yet, and I probably won’t, as many others have done a very good job of that. Suffice it to say, I love the thing, glitches and all, and couldn’t live without it. Score another one for Apple.

Dalai Goes To A Gun and Knife Show

A friend invited me to join him at the local Gun and Knife Show, and out of curiosity and boredom, I agreed. This is an event held several times per year at the Shrine Temple, sort of an odd place for a collection of weapons. But it has a large auditorium and every available nook and cranny was filled with armament, military surplus, and books on the topic.

This is definately a cultural experience, highly recommended for those who are interested in weapons as well as people-watching. There were quite a few people to watch, everything from doctors (me and a few others I knew) to vets proudly sporting caps detailing their service, to people of all backgrounds, rallying around the common interests of bearing arms. While there were no signs or posters to this effect, there was a lot of talk in the aisles about rumours of coming gun restrictions. I can promise you that Americans will not take lightly to anything getting between them and their guns.

I managed to leave with my wallet intact, but I was very taken with this little jewel from Taurus:

From the Taurus website:

The “Taurus Judge® ” is so named because of the number of judges who carry it into the courtroom for their protection. Capable of chambering both .410 2-1/2″ shotshell and .45 Colt Ammunition, this amazing combo gun is ideal for short distances – where most altercations occur, or longer distances with the .45 Colt ammo. We have finely tuned the rifling to spread the shot pattern at close quarters or to guide the .45 cal. bullet to the target. Fully customized with fixed rear sights, fiber optic front sights and Taurus Ribber Grips®, the “Taurus Judge” is one decision-maker that lays down the law.

I was really intrigued with the possibility of using miniature shotgun-shells in a pistol. Kind of like a Swiss Army Pistol, yes? My friend bought a Smith and Wesson .22, “just for fooling around.” I plan to be somewhere else when he “fools around” with it.

Have A Nuclear Christmas

This could well be us in a few years…

As found in the Timmins Press, it seems that the Timmins and District Hospital in Timmins, Ontario, Canada, is in need of a new gamma camera for the John P. Larche Medical Imaging and Cardiopulmonary Department. Around here, when I need a new camera, I lobby administration with numerous letters, emails, and other tactics that don’t seem to work well anymore. But in Timmins, an appeal to the public seems to do the trick.

This Friday, the hospital will mail 55,000 letters, hoping to raise money for the new scanner. The “Christmas Card Campaign” has raised $622,017 (Canadian, of course) since they started it in 1996, and last year it brought in $48,138. They might need a little more for a decent Nucs camera, though, so I hope everyone will consider contributing to this worthy cause. Please visit for further information as to where you should send your donation. I’m sure $US would be accepted.