Tornadoes Happen Here

The South has experienced more tornadoes in the past few days than ever seen before. I’m waiting for someone to blame global-warming-climate-change, but hopefully the dirt-worshipers will keep that opinion to themselves out of respect for those injured. An unprecedented 280+ people were killed in this unholy battering from Mother Nature, and thousands more were injured or lost their worldly possessions.

I would urge you to donate to the Red Cross, or whatever agency you prefer. There is tremendous need, right now.

My heart goes out to those who were caught in these horrific storms. I had the joy of riding out a tornado in Omaha in 1975, and it remains the most frightening experience of my life. Below is an artist’s rendering of the storm, that coincidentally depicts the funnel roughly one minute before it hit the building I was in at the time, Temple Israel Synagogue. The steeple of the church across the street is visible to the left of the image; the church was hit as well, but the steeple remained standing. (Image courtesy shayden.com)

Here is an aerial view of the Temple (to the right) and the adjacent Playhouse Theater after the storm (image courtesy noaa.gov):

I got a few scratches, and a few of the other kids got cut up a little, but we were otherwise OK. “Only” three people died in this terrible storm.

We tend to forget just how powerful these natural events can be, but trust me, the view from the middle of a tornado is pretty awe-inspiring. That is if you happen to be looking and not kissing your ass goodbye as I was…

Seriously, be generous to the Red Cross or the charity of your choice in this time of need. Tell ’em Dalai sent you, and when they stop laughing, give. From the heart.

ADDENDUM

Sometimes I hate to be right.  Here’s a dirt-worshiper’s comment on the storms:

Storms Kill Over 250 Americans In States Represented By Climate Pollution Deniers
Today, news agencies are still tallying reports of deaths from the most devastating storm system in the United States in decades:

Dozens of massive tornadoes tore a town-flattening streak across the South, killing at least 250 people in six states and forcing rescuers to carry some survivors out on makeshift stretchers of splintered debris. Two of Alabama’s major cities were among the places devastated by the deadliest twister outbreak in nearly 40 years.

 “Given that global warming is unequivocal,” climate scientist Kevin Trenberth cautioned the American Meteorological Society in January of this year, “the null hypothesis should be that all weather events are affected by global warming rather than the inane statements along the lines of ‘of course we cannot attribute any particular weather event to global warming.’”

The congressional delegations of these states — Alabama, Tennessee, Mississippi, Georgia, Virginia, and Kentucky — overwhelmingly voted to reject the science that polluting the climate is dangerous. They are deliberately ignoring the warnings from scientists.

So “ignoring” the proclamations from the dirt-worshipers’ High Priests of Gaia brought about tornadoes that killed 300 people, eh?  Talk about supreme arrogance….I just can’t wait to see what they’ll come up with next.

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Read ‘Em And Weep

I’m a little leery of Klas results on occasion.  The surveys are not quite scientific, and commentary is occasionally several versions behind on any particular product.  Still, Klas is about the only compiled source of such information, and it cannot be ignored.

Klas just published the latest Ambulatory RIS/PACS review.  I’ve seen it, but I don’t want to violate copyright laws by reproducing it here.  But I’ll share a few results:

Number 1 out of 18, with a score of 88.9….Intelerad IntelePACS.
Number 13 out of 18, with a score of 79.8….Merge/AMICAS PACS.
Number 17 out of 18, with a score of 73.6….ScImage PicomEnterprise.
Number 18 out of 18, with a score of 64.6….Agfa IMPAX.

Now I realize this is for the ambulatory space, which not Agfa’s strongest market.  But…

Listen to the customers.  They are saying something, although it isn’t always clear just what that might be.

Toshiba Acquires Another Advanced Visualization Company

It’s deja vu all over again. I reported back in 2008 that Toshiba had purchased Barco’s Advanced Visualization Imaging System (AVIS), which used to be Voxar, Ltd. Today, we have this report:

Toshiba Medical Systems and Vital Images have signed a definitive agreement for Toshiba to purchase Vital Images’ stock for a total of $273 million, putting the cap on a decade-long partnership between the two companies.

Under the agreement, which is expected to close by the second or third quarter of 2011, a Toshiba subsidiary will acquire all outstanding shares of Vital Images’ stock at $18.75 per share. The merger has been unanimously approved by the boards of directors of both companies, Tustin, Calif.-based Toshiba said.

Minneapolis-based Vital Images, which develops advanced visualization software and other health IT products, has relied heavily on a partnership with Toshiba over the last ten years.
“After a decade-long successful partnership spanning more than 50 countries, [Toshiba] is taking the partnership to the next level. We have enormous respect for Vital Images’ products, pipeline and people, and look forward to working with their highly skilled team to enhance clinical value for patients throughout the world,” saidSatoshi Tsunakawa, CEO of Toshiba Medical Systems.

Michael Carrel, CEO of Vital Images, expressed enthusiasm over the deal, saying “This transaction means we can now accelerate our global presence with the strength and backing of [Toshiba].”

The $18.75 share price Toshiba agreed to pay for Vital Images represents a 39 percent premium over the volume-weighted average of the company’s 30-day stock, Toshiba reported.

The bid follows Toshiba’s 2009 purchase of Barco’s advanced visualization business, which resulted in the formation of Toshiba Medical Visualization Systems Europe.

I guess TeraRecon and Visage will be next, eh?

My dealings with Vital have not been spectacular over the years, as I reported a while back. Hopefully, Toshiba can make good use of its Advanced Acquisitions.

Hat tip to 23 Skidoo.

Dalai’s Rules, II

Since my last post on the topic, I’ve acquired more classroom-sized slide rules.  At this point, I’ve got a reasonable sample of most of the brands and variations of these things.  There are really only two or three that I need to have a really complete collection.  But as you can see, I’m running out of wall space.  My ultimate plan is to donate the entire collection to my alma mater, if they have enough wall-space.  At least my old engineering school will know what a slide rule is…

And The Answer Is….BGO!!!

I tried and tried to confirm which crystals are being used in GE’s new PET/CT, the Kia Optima PET/CT 560, but GE just wouldn’t answer my emails.

Fortunately, I have friends in high places. I posed the question to MedGadget, wherein we find another review of the Optima. Somehow, their email was answered, and here is the response:

You can tell him/her we chose the BGO crystal as it delivers a proven track record of speed and performance and is optimized for oncology imaging especially for Fluorine-based tracers.

I don’t like to parse words, but this basically says that “we’ve used it before and we’re using it again.” And the energies of the other PET tracers all peak at 511 KeV, standard for positron/electron annihilation. So what’s this about being best for F-18? (As we will see below, F-18 might be best for a machine with BGO crystals, but not vice versa.) If BGO is the end-all to end-all, why not mention it in the extensive Optima product brochure? If BGO is the best choice, pat yourselves on the back for making it.

Personally, I’m not buying any of this. Literally or figuratively. As I mentioned in the initial post, this is a deal-breaker, not that I have the funding to buy a new PET/CT in the immediate future.

I think we can assume that the rationale behind the decision not to go with LYSO as used in the Discovery 690 was cost. BGO is cheaper, and adequate (barely) for the job. (Ummm, by the way, did GE ever actually make any 690’s? Did they sell any? Reports from the field appreciated…)

As I’ve said again and again, LSO beats BGO hands down for positron imaging.

AuntMinnie has a great reference paper on PET fundamentals.  Therein, we find this passage (emphasis mine):

Bismuth germinate oxide (BGO) crystals are generally used in conventional PET imaging systems. BGO crystals have a high stopping power (high efficiency), high spatial resolution, and are 50% more efficient than thallium-doped sodium iodide — NaI (Tl) — crystals. Most crystals are 3-6 mm thick and they are not hydrophilic. The detection efficiency for 25 mm BGO crystal is approximately 80% [31]. The spatial resolution approaches 5 mm, which nears the theoretical limit of resolution. The disadvantages of BGO crystals are that they have a much lower light output (15% of NaI (Tl) crystals), long photofluorescent decay times (decay constant of 300 ns which limits count rates/coincidence timing resolution [31]), and poorer energy resolution than sodium-iodide crystals. Energy resolution of BGO is normally worse than 20-25% in FWHM at 511 keV. A typical energy window for a BGO scanner is 300-350 keV to 650 keV [18]. This poor energy resolution makes it difficult to remove scattered events by energy discrimination. Therefore, lead-tungsten septa are interposed between detector rings to reduce interplane scatter [18]. The coincidence time window is normally set for 10-20 ns. The inferior time resolution causes larger accidental detections and greater dead times. BGO detectors are best suited for imaging isotopes with long half-lives such as F-18 and C-11.

Lutetium Oxyorthosilicate (LSO) crystals offer the best combination of properties for PET imaging [2]. LSO has a higher effective Z (number of protons per atom) and density compared to BGO which results in an equal or higher detection efficiency [3,31]. It has very good energy resolution (about 12% [21]- with a typical energy window set to 425-650 keV), a short decay constant for good coincidence timing (a decay constant of 40 ns and coincidence time window of 4.5 ns), and higher light output (five fold more light compared to BGO crystals [31]) [2]. The coincidence time window is set to 4.5 ns. These characteristics enable image formation is less time when LSO crystals are used [31]. The crystal is rugged and nonhygroscopic.

BGO versus LSO detector: The images below were acquired in 2D mode with a scan time of 5 min/bed emission and 3 min/bed transmission. The upper row of images were acquired on a BGO camera system and the lower row of images were acquired on a ECAT Accel LSO PET camera system. The data was reconstructed using normalized attenuation weighted OS-EM reconstruction. Image courtesy of Northern California PET Imaging Center, Sactamento, CA and CTI, The Power Behind PET.

‘Nuff said.  The great Crystal Caper is solved at last.  Many thanks to MedGadget!

Advancing The Cloud

I’ve been a TeraRecon fan for quite a while now. Sadly, I’m not a customer as yet, since we cannot convince our administration to cough up come up with the cash in these hard economic times.

But TeraRecon has recently provided a very economical alternative. How does FREE sound? Yes, for the time being, you can have the power of TeraRecon at no charge.

In a recent article in ImagingEconomics.com, TR president Robert Taylor, PhD, outlines the problem many of us out in the boonies face when trying to implement (or justify) advanced imaging:

Advanced visualization—for all of its benefits—also comes with its challenges, said Robert Taylor, PhD, president and CEO of TeraRecon, who outlines the challenges in this way: it is expensive (you have to have enough volume to justify investment in a complete system); it is an IT deployment (you need an IT department to deploy and manage it); and it is confined to your organization (if you need to reach outside your organization to share or collaborate, it can get complicated).

In order to respond to these challenges, the company announced iNtuition CLOUD late last year. With this new solution in place, new customers can have their iNtuition UNLIMITED licenses hosted within the company’s cloud solution. To date, more than 400 users have signed up for evaluation accounts, which were offered free of charge to professional attendees at RSNA ’10 and continue to be available at www.terarecon.com/cloud.

I’m one of those 400 users, and I can vouch for its functionality. Maybe it isn’t quite as seamless as having an in-house installation, but iNtuition CLOUD does work, and it works very well. For all intent and purpose, you have a full iNtuition product at your disposal via the Internet, I mean Cloud.

On the client side, iNtuition CLOUD functions as a browser link, according to the company. After logging in, the user can start to work with their studies. On the server side, when a user connects and logs in to their account, the cloud establishes a secure link to an appropriate server from the company’s global network that has the user’s data and is located in a geographically appropriate location.

To be fair, I haven’t tried it out on the iPhone or iPad, but I see no reason why it won’t work on these devices, as the image above suggests.

Naturally, there are a few areas where one must convince the IT folks and lawyers that this is a kosher approach:

Taylor concedes that one of the biggest challenges is that health care providers have to get comfortable with the legal, regulatory, and security aspects of putting patient data into the cloud and entrusting it to a third party like TeraRecon. He’s aware that legal and regulatory departments within health care facilities will need to develop the right contractual and policy frameworks that will allow them to use iNtuition CLOUD and still comply with HIPAA, HITECH, and all of the other applicable obligations. The company’s immediate goal is to get health care facilities talking about the possibilities related to iNtuition CLOUD.

Hey, if you can’t trust TeraRecon, who can you trust? Stated differently, if you can trust certain larGE companies, you can certainly trust TeraRecon.

Dr. Taylor concludes:

“2011 will be the year that iNtuition CLOUD ‘arrives’ in a very meaningful way as a part of the advanced visualization landscape.”

It has definitely arrived. Anyone looking into advanced visualization should certainly check out iNtuition CLOUD. Having the power of TeraRecon for free is like having Hanukkah in July.

ADDENDUM

Dr. Taylor sent some comments on this post:

The article references 400 users but we’re actually past 1000 now and just made a PR about it. You can find a link to the PR at the top of the press releases column on the right of our homepage: www.terarecon.com

iNtuition Cloud is working out really well, and some surprising ways. We are starting to commercialize it now, with several heavy evaluators turning into paying customers, even at their own request – people need a contract in place to use the service formally, I suppose.
But in addition to this, we have found Cloud to be very helpful for our prospective customers to user in a “try before you buy” mode. We used to feel that if we didn’t provide a carefully controlled demo with a specialist there in person, we couldn’t do our product justice and we may leave a sub-optimal impression, but with Cloud, people are trying it, digging in, figuring things out, asking us questions, and getting a sense of comfort that our solution will work for them, without any major issues. It’s very exciting.

I would say that in 2011 so far, I can point to several significant purchases that were driven by Cloud evaluations. One was an extremely famous cancer center that wanted to first make sure we could load their data and perform the specific measurements they needed, and another was a major radiology group that wanted to see how the system could work for their distributed group of interpreting physicians, before jumping in to buy a tool to enable them to offer wider interpretation services, including brain perfusion, cardiac, EVAR, etc.

In some cases, people try the Cloud and buy the Cloud. In others, they try the Cloud and then buy a system. In a couple of cases, we have even sold “Private Clouds” where the customer buys a set of the equipment we use to operate the Cloud, and then sets it up in their own datacenter and operates and controls it for their staff only (e.g. radiologists working from a wide range of remote locations needing access from a browser).

We have also been adding features, like automatic anonymized, compressed DICOM routing to the cloud, relay back to the site of derived results, and PACS integration, so you can launch the Cloud client from a supported PACS system (instead of needing a local client installed).

It’s definitely picking up speed and we’re having a lot of fun with this!