Dalai Embraces Agfa!

Sometimes being a pest can work to your advantage. I’ve been yowling for years about the various deficiencies in Agfa Impax 6. I am proud to tell you today that they have listened to my ranting, and plan to introduce Version 6.6.6, (which I affectionately call the Dalai Edition) which will solve most if not all of the difficulties we have had with Agfa. This product will supercede most of the other PACS GUI’s on the market.

Let me outline what V666 will do:

  1. No more “X-box” errors.
  2. Priors and reports from the earliest days of the archive will be accessible.
  3. Proper function of worklists, with indicators for studies available and already being read
  4. Elimination of possible double-reads due to poor study sequestering
  5. Built-in MPR, 3D, etc, with intuitive function of cursors.
  6. Instant on-line priors.
  7. No decompression artifacts.
  8. Functioning and intuitive hanging protocols.
  9. Intuitive tools, with elimination of mega pallette of crap no one uses
  10. Easy upgrade/patch installation.
  11. Elimination of “toggle” mentality.
  12. Others too numerous to list.

Yes, folks, today, Agfa is my new favorite PACS. They have listened to me, and fixed everything that was wrong with their old systems. V666, the Dalai Edition, will make a believer out of you as it has with me. Starting today, I will begin replacing all of my other systems.

Yes, take GREAT NOTICE of Today’s Date, because it’s the only time you will hear a statement of this magnitude!

Amicas Goes South

To Australia, that is. According to PR Newswire, Amicas just cut a deal with Healthinc of Sydney, Australia, for Amicas PACS.

Healthinc is a leading provider of digital medical imaging solutions and radiology information management in Australia. Established in 2002, Healthinc supports more than 350 sites throughout Australia with cutting edge technology and end-to-end solutions that are backed by quality service and support.

AMICAS will offer its acclaimed image management solutions to the Australian marketplace through an exclusive distribution partnership with Healthinc. The AMICAS solution suite will be tightly integrated with Healthinc’s market leading OCCAM RIS and fully supported locally by Healthinc’s experienced sales, marketing, services, and support teams.

. . .Healthinc will be distributing AMICAS PACS Version 6.0, which introduces the next generation of AMICAS PACS. Version 6.0 combines the intuitive, easy-to-use, Web-based design of previous versions of AMICAS PACS with major enhancements to the image viewing toolset. Complementing the industry leading, workload balancing RealTime Worklist(TM), Version 6.0 introduces the Halo Viewer(TM), which includes advances in functionality aimed at increasing radiologist productivity and designed to help improve the quality of reading.

Darn. The Aussies get V6 (for real, anyway) before I do!

This sounds like a rather major deal, although I’m not sure Healthinc plans to deploy Amicas to all 350 sites, and even then, with the web-based nature of the product, they might not have to buy 350 separate PACS. (Sorry, but I couldn’t keep that secret!)

By the way, the Amicas deal replaces none other than GE/Dynamic Imaging to form the new OCCAM PACS solution. From the Healthinc website news of November 2008:

Healthinc welcomes Dr Lynne Brothers and Womens Imaging Tasmania who have installed our OCCAM Centricity IW PACS solution.

Of course, I am ready, willing, and able to help out my Australian counterparts if Amicas wishes to send me down under. I’ll start packing my bags right away!

Yankees, Towels, and Surgeons on Planes

There is nothing harder than returning to work after a nice vacation. Somehow, I’ve managed to function adequately for the past couple of days since leaving the warm beaches of Costa Rica.

The last day at Paradisus was at once the worst and the best. We went to a little place called “Monkey Park” in the morning, hoping to feed some more Capuchins. Sadly, the descriptions were a little off, and “Monkey Park” turned out to be a sort of small zoo, with a few animals in cages. Still, this is a place of animal rescue, where some of the baby critters abandoned in the wild are saved and rehabilitated, so our visit did support a good cause.

Back at the hotel, we had the joyous experience of trying to find a lounge-chair by the pool. It seems there is a Yankee trick of going to the pool at 7AM, and placing your beach-towel on a chair. Magically, the spot becomes YOURS for the rest of the day, even if your gluteus maximus never graces the chair and the towel again. Heaven forbid someone should even move it slightly (we did and the Yankees came running, bellowing about THEIR chairs!) People, this is disgusting, piggish behaviour, and it is no wonder Americans aren’t well-liked. Don’t blame Bush for our bad reputation!

Fortunately, this chair-fight prompted a move to a quieter section by pool (the Paradisus pool is supposedly the largest in Central America), where we met a wonderful family from Iraq, now living in Canada. The mom was a physician, the dad a computer specialist. They told us some nasty tales of Saddam’s Iraq, stuff you won’t hear on the news. Did you know that last names were banned? Saddam’s new world order required that one take the first name of his father and grandfather as his “last name”, dumping traditional family names. Had you heard that Uday and Qusay Hussein made a regular practice of going to clubs to select the women they would rape that day? A few lucky women were able to escape out of the back doors. And there was more that we never hear from the mainstream media. As for Canadian health-care, well. . . Our new friends were absolutely incredulous that we in the States wanted to copy their system. “It doesn’t work!” The wait for an MRI is over 6 months, unless you have a spare $900C and can get to a big city such as Montreal, where there are a (very) few private outlets. There were numerous other examples. This isn’t the way to go, but no one will believe it until it’s too late.

Flying home the next day turned out to be a bit more of an adventure than I had anticipated. I had already seen the movie, so I was watching something old on my iPhone, blissfully oblivious to my sourroundings. About 45 minutes into the flight, there came the call we physicians, especially radiologists, all dread: “Is there a doctor, nurse, or P.A. on board? We have a medical emergency. . .” Hoping for the best, I pressed the call button to identify myself, and I was taken to the back of the aircraft. (Mrs. Dalai had to help me get untangled from my headphones.) Fortunately, another physician, a family practitioner, was right behind me, so I wasn’t totally on my own. We found one of the flight-attendants writhing in pain in the aft-most row, and we began working with what we had available.

The in-flight medical kits are well-stocked for heart-attack victims, with drugs and devices up to and including an automatic defibrilator. There were drugs for colds, too, but there was nothing in there for nausea or pain. I guess keeping morphine in the kits would attract the wrong kind of patient. Anyway, the FP and I could do little but take vitals, listen for bowel sounds, provide moral support, and just stand around looking stupid, and wishing we had a CT scanner available. (Even a pocket ultrasound would have been nice.) The crew gave us the option to divert the plane to Miami if we thought getting the patient to the hospital an hour sooner would make a difference. But since she had a soft abdomen and no fever (although we could detect no bowel sounds over the noise of the engines) we concluded her malady was probably not life-threatening. All the while, the crew had been in touch with a ground-based physician (or nurse or P.A.?) contracted by the airline to deal with this sort of thing when no docs come forward. The service independently came to the same conclusion, which probably made the folks in Flight Operations breath a sigh of relief.

Now, here’s the punch-line. After we, the radiologist and the FP, had been ministering to the poor girl for an hour, a well-dressed fellow sauntered back from First-Class, identified himself as a surgeon, and had a quick look. He got the history that she had had some sort of viral enteritis a year ago, and he was convinced that she had it again. He then told the other flight-attendants that the FP and I had it under control, and went back up to First. The FP and I looked at each other and said pretty much simultaneously, “Surgeons!”

We made it to Atlanta with no other mishaps, and the victim was able to walk off the plane to the ambulance. I don’t yet know how she is doing, but hopefully she will be back on duty very soon.

In 46 years of flying (I took my first plane-ride at age 4), this is only the second time I have heard (and heeded) the call. Maybe riding up there closer to Heaven helps out some. An on-board CT would have been nice, though. Maybe if lighter-than-air travel ever comes back in vogue, that might be possible. This being a PACS blog, it occurs to me that a small ultrasound unit could be included in the spartan medical kit. Even if there is no one on board who can interpret the images, they could easily be transmitted ground-side to someone who knows what they are doing. We have night-hawks, why not Sky-Hawks? I think I’ll look into it.

Dalai Down South

Mrs. Dalai and I realized that we wouldn’t have much vacation time with Dalai, Jr., this year. Since I have part of Spring Break week off, we decided to give the gang a bit of adventure, and head to Costa Rica for a few days.

We are staying at the all-inclusive Paradisus Playa Conchal, on the Guanacaste coast of Costa Rica. The property is beautiful, although there aren’t any rooms on the beach per se. There have been some significant service glitches, and while I’m glad we came, when we return to Costa Rica someday, we won’t come back to this hotel. In brief, the personell seem to be trained to say “no” before they actually look into whether or not they could grant a particular request. A slight change in attitude would turn this from a 6-level experience to a 9 or a 10. Oh well. Look for my report on TripAdvisor in a little while.
We’ve had some great times. Saturday, Mrs. D and Jr. went on a zip-line through the tree-tops. I got my harness on, and then my vertigo kicked in, and I bailed. But they enjoyed it!

Sunday, we took a drive to the Palo Verde National Park, for a trip down the river to feed the crocodiles and the Capucin (white-faced) monkeys.

This was quite a lesson in “sharing the wealth”. The crocs just loved the raw chicken our guide offered them, and would have taken more (and his hand) had it been offered. The monkeys were cute as can be, but overran the boat, grabbing all the pieces of banana we had, and then left a calling-card (carajo) in a seat. But it was still worth the trip to see the little guys.

Today, Jr. got to go scuba-diving for the first time. Mrs. D. and I stayed on the boat and fretted for the 30 minutes he was underwater, and out of our sight. What great parents we are!

Since this is a PACS blog, I do have to note the presence of an Agfa branch-office at the hotel:

Given all the joys going on back home, I’m wondering if they need a radiologist around here. . .


Henpecked Hornbill

Rhinoceros Hornbill, image courtesy of Wikipedia

Every so often, the local zoo needs some advanced imaging on one of its residents, and we are glad to help out.

It seems that our local pair of rhinoceros hornbills (see stock photo above) has not been living in wedded bliss. The male bird was young and inexperienced, and supposedly the female was upset over his not responding to her amorous advances. So, she pecked a hole in his beak to show her frustration. This was easily patched by the veterinarian, but our poor boy then started to have nasal discharge. I suppose that could be bad with a beak as prominent as pictured. Plain-films didn’t tell the story, so it’s off to the nearest CT!

Of course, Mr. B. Hornbill had to be anesthetized for the procedure:

Here is a clip of the volume-rendered images:

The sinuses were clear. There was a tiny calcific density which you can see somewhat centrally which might represent an osteoma, although I’m not sure birds get osteomas. Note the rather tiny brain. I guess it doesn’t take much horsepower to run a bird.

Perhaps my next revenue source could be pet-scans as opposed to PET scans. . .

Stockholders Object, Attempt To Halt Amicas/Emageon Marriage At Altar

Just when I thought there would be clear sailing for Emageon, some disgruntled investors felt the need to disrupt the apple-cart. From the Birmingham News:

Birmingham’s Emageon Inc. said Friday it has been sued by shareholders who say the software firm made a bad deal when it sold to a Massachusetts company last month.

The suit was filed in Suffolk County Superior Court in Massachusetts, Emageon said in a regulatory filing.

The company, which makes software used to automate medical billing and imaging, agreed to sell to Boston rival Amicas for $39 million, or $1.82 a share.

Emageon a few weeks earlier had collected a $9 million breakup fee from a New York-based firm that had agreed to buy it for $62 million, or $2.85 a share. That deal collapsed after the buyer couldn’t get financing from the Antigua bank of accused fraudster Allen Stanford.

The SEC Form 8-K filing notes:

On March 11, 2009, a putative shareholder class action lawsuit was filed against Emageon Inc. (the “Company”), the members of the Company’s Board of Directors (the “Company Board”) and AMICAS, Inc. (“AMICAS”) in the Superior Court Department, Suffolk County, Massachusetts. The action, styled Fishman v. Williamson, et al., alleges, among other things, that the members of the Company Board violated their fiduciary duties by failing to maximize value for the Company’s stockholders when negotiating and entering into the Agreement and Plan of Merger, dated February 23, 2009 (the “Merger Agreement”), among the Company, AMICAS and AMICAS Acquisition Corp. (“Purchaser”). The complaint also alleges that AMICAS aided and abetted those purported breaches. The plaintiff seeks, among other things, to enjoin the acquisition of the Company by Purchaser or, in the alternative, to rescind the acquisition should it occur before the lawsuit is resolved.

The Company believes that the allegations of the plaintiff’s complaint are entirely without merit, and the Company, the Company Board and AMICAS intend to vigorously defend this action. The parties do not expect this lawsuit to have an impact on the completion of the tender offer and merger contemplated by the Merger Agreement, however, even a meritless lawsuit may carry with it the potential to delay consummation of such transactions.

Frankly, in this day and age, the shareholders ought to be: a. Thrilled that they weren’t acquired by Bernie Madoff, Jr. and b. Even more thrilled that someone wants to buy their stock at all. But I guess hope and greed spring eternal. The “Fishman” in question hopefully wasn’t Elliot Fishman, M.D., who said in a Johns Hopkins meeting a year or so back that he used Emageon but had some problems with it. We’ll see. . .


A new SEC filing by AMICAS tells us:

On March 11, 2009, a putative shareholder class action lawsuit was filed against Emageon Inc., members of the Emageon Board of Directors and AMICAS, Inc. in the Superior Court Department, Suffolk County, Massachusetts. The action, styled Fishman v. Williamson, et al., alleged, among other things, that the members of the Emageon Board of Directors violated their fiduciary duties by failing to maximize value for Emageon’s shareholders when negotiating and entering into the Agreement and Plan of Merger dated as of February 23, 2009 among Emageon, AMICAS and a subsidiary of AMICAS. The complaint alleged that AMICAS aided and abetted those purported breaches. On March 16, 2009, this action was withdrawn by the plaintiff without prejudice.

I’ll bet they filed it with prejudice! This is how we keep lawyers busy, I guess. So, all systems go for merger!