Nova-Spam!

Message to NovaRad, a small PACS company with a somewhat lesser known product:

STOP SPAMMING MY BLOG!

I’ve received two comments on generic posts with not very cleverly disguised links to NovaRad’s NovaPACS.

If you are resorting to this bottom-feeder approach to advertising, you guys must be having some significant problems. You just earned the DON’T BUY designation from yours truly. Of course, your customers probably don’t read my blog anyway….

Give ‘Till It Hurts!

As a public service to my readers, I wish to extend the fine opportunity offered by the PRESIDENT OF THE UNITED STATES, Barack Hussein Obama, to forgo giving gifts to friends and loved ones, and divert the funds to the President’s reelection campaign, where they will do much more good.  You may use this link.

Register with Obama 2012

Got a special milestone or event coming up?

Instead of another gift card you’ll forget to use, ask your friends and family for something that will go a little further: a donation to Obama for America. Register your next celebration—whether it’s a birthday, bar or bat mitzvah, wedding, or anniversary—with the Obama campaign. It’s a great way to show your support for a cause that’s important to you on your big day.

Just log in or sign up to build and customize your page—and congratulations!

Let’s review…THE PRESIDENT OF THE UNITED STATES is asking you to ask your friends to donate to his reelection campaign instead of giving you stuff. How noble. How patriotic. How…well, come up with your own epithet.

Personally, I think this goes way over the line. THE PRESIDENT OF THE UNITED STATES is pandering to newlyweds, 13 year-olds, birthday babies, for money to boost his campaign coffers past $1 BILLION, so he can stay in office four more years (at least). I can’t think of any other candidate for PRESIDENT OF THE UNITED STATES who has appealed to CHILDREN for money. The man is asking for kids to give up their birthday presents for Heaven’s sake! Perhaps all the Bar Mitzvah’s are supposed to include a prayer for reelection? I’ve got a good prayer, borrowed from “Fiddler on the Roof”:  May God Bless and Keep Mr. Obama….FAR AWAY FROM US!!!!

So, what’s next from THE PRESIDENT OF THE UNITED STATES? Oh, I’ve got it!

SKIP A MEAL FOR BARACK!

“Michelle says the nation is too fat, so stop putting your money where your mouth is, and put it in my hands!”

How about this:

DRIVE BARACK TO VICTORY!

“You know you don’t need to take that big gas-guzzling SUV out today. Save the cash and send it to me so I can run over the opposition! Or better yet, sell the darn thing and send me the proceeds!”

And finally:

HELP BARACK WIPE OUT THE GOP!

“If you overweight folks cut down on the intake with my SKIP A MEAL FOR BARACK program, you won’t be needing as much toilet paper. Instead of buying that extra roll of Charmin, send me the cash, so I can wipe Washington clean!:”

Personally, I just want to vomit. This is the most sickening performance by a politician I’ve ever seen. Can’t wait until November…

Too Big Not To Fail?

Our Agfa IMPAX 6.5 failed for over three hours this past weekend, and that’s not the first time that’s happened. This sent the three hospitals it services into complete pandemonium, as you might expect. At the moment, there is no hardware disaster recovery option. Hopefully, this will be implemented…eventually.

Fortunately, I was not on call when this little disaster occurred, but I certainly heard about it. To this point, we don’t know quite what went wrong, but bouncing the servers seemed to fix it.

I guess we should be quite grateful, as the IMPAX installation in Western Australia continues to misbehave. I’ve received no word from Agfa as to why they think this might be happening, nor when it will be fixed Personally, I would hesitate to buy anything new until I knew the answers to these questions.

I have to contrast the IMPAX experience with our other hospital (and our group-owned system) that uses AMICAS Merge PACS. Merge (I still have some trouble with the concept) is a simpler product, using Windows Server and SQL databases instead of the supposedly more robust Oracle and Unix boxes galore. But it is much more stable. We’ve had perhaps two or three hours total unplanned downtime in the past 8 years.

PACS is not rocket science. It is simply a database of images and associated text. But the images are rather large, and have MEDICAL stamped on them, and thus has grown the culture of complex, expensive, and cantankerous big iron systems.

Most of the next generation of PACS are not a whole lot more than web-servers and associated databases. In this manner, they are robust, (relatively) simple, and while not quite bullet-proof, they have fewer points of failure, and are more easily maintained.

Could it be that the legacy designs are so complex that there is no way to avoid failure? I have to wonder…

Too Big Not To Fail?

Our Agfa IMPAX 6.5 failed for over three hours this past weekend, and that’s not the first time that’s happened. This sent the three hospitals it services into complete pandemonium, as you might expect. At the moment, there is no hardware disaster recovery option. Hopefully, this will be implemented…eventually.

Fortunately, I was not on call when this little disaster occurred, but I certainly heard about it. To this point, we don’t know quite what went wrong, but bouncing the servers seemed to fix it.

I guess we should be quite grateful, as the IMPAX installation in Western Australia continues to misbehave. I’ve received no word from Agfa as to why they think this might be happening, nor when it will be fixed Personally, I would hesitate to buy anything new until I knew the answers to these questions.

I have to contrast the IMPAX experience with our other hospital (and our group-owned system) that uses AMICAS Merge PACS. Merge (I still have some trouble with the concept) is a simpler product, using Windows Server and SQL databases instead of the supposedly more robust Oracle and Unix boxes galore. But it is much more stable. We’ve had perhaps two or three hours total unplanned downtime in the past 8 years.

PACS is not rocket science. It is simply a database of images and associated text. But the images are rather large, and have MEDICAL stamped on them, and thus has grown the culture of complex, expensive, and cantankerous big iron systems.

Most of the next generation of PACS are not a whole lot more than web-servers and associated databases. In this manner, they are robust, (relatively) simple, and while not quite bullet-proof, they have fewer points of failure, and are more easily maintained.

Could it be that the legacy designs are so complex that there is no way to avoid failure? I have to wonder…

Thank You For Funding Imaging Advantage

You may remember the string of articles published here on DoctorDalai.com concerning Imaging Advantage.

In brief, Imaging Advantage insinuates itself between radiologists and hospital administrations, promising the latter huge benefits and screwing the former. Think Enron and the energy market, and you have the idea. IA’s most famous take-over and subsequent flop in Toledo is well documented here and elsewhere.

The model is one only a doctor-hating administrator could love. IA claims that they are usually able to successfully hire on the group they are displacing from the hospital, and ultimately that group loses a good chunk of its salary, which goes back to IA, and probably is kicked back in some subtle form to the hospital. Administrators seem to be buying into the platitudes, as IA claims “hospitals and partners across 14 states.”

Since I’ve declared my love for capitalism on numerous occasions, the Socialists out there are probably just drooling (more than usual) over the opportunity to point out that IA represents the “free” market in action, so how could I possibly object? Basically, this is anything but a free market scenario. C-Suite types, who make these decisions, are NOT the end-consumer of my product. They are choosing IA and their ilk in theory to “improve care” which somehow never seems to happen. Perhaps they think they will save some money on those horribly expensive rads, although how this happens when most hospitals don’t directly pay rads is a mystery to me. My personal theory is that these interlopers take over the interpretive revenue stream from the rads, and somehow promise, maybe surreptitiously, to return some of that to the hospitals. No, this is about as much of a free market operation as the collection of protection money.

But only greedy capitalistic administrators would fall for this greedy capitalistic scheme? Wrong, borscht-breath. Your very own United States of America is buying into the inflated egos of Mr. Hashim and company. I assume our pal Naseer still runs this thing…the IA website isn’t very informative these days.

Read this and weep:

Health Care Innovation Awards: Illinois

Notes and Disclaimers: 
  • Projects shown may also be operating in other states (see the Geographic Reach)
  • Descriptions and project data (e.g. gross savings estimates, population served, etc.) are 3 year estimates provided by each organization and are based on budget submissions required by the Health Care Innovation Awards application process.
  • While all projects are expected to produce cost savings beyond the 3 year grant award, some may not achieve net cost savings until after the initial 3-year period due to start-up-costs, change in care patterns and intervention effect on health status.

IMAGING ADVANTAGE LLC    

Project Title: “The right exam, at the right time, read by the right radiologist”
Geographic Reach: Illinois
Funding Amount: $5,977,805
Estimated 3-Year Savings: $14,935,320
Summary: Imaging Advantage LLC, in partnership with Vanguard Health Systems and other hospital systems in the Chicago metropolitan area, is receiving an award to re-engineer the end-to-end workflow process for hospital-based imaging services, including by leveraging technology to integrate immediate consultations with radiologists and other decision-support tools into the “front-end” of the patient-care continuum, where imaging exams are ordered and critical care decisions are made. A key objective of the program will be to reduce duplicative and/or clinically unnecessary advanced imaging exams. The program also will (1) deploy a unique disruptive innovation — RealTime QA® — which applies “double-blind” interpretations to high-difficulty exams in advance of patient treatment, (2) eliminate preliminary (or “wet”) reads after-hours and (3) materially improve exam turn-around times.  As a result, the program will reduce inappropriate advanced imaging utilization, improve quality assurance and, ultimately, improve patient safety and experience. A 30% decrease in CT use and decreased utilization of other imaging modalities is expected. CMS will also be evaluating planned centers in Detroit, San Antonio, and Boston.
Over a three-year period, Imaging Advantage LLC will train 495 workers in health care-related jobs. The new workforce will include clinical staff as well as IT development and operational staff.

Yes, folks, that would be about SIX MILLION DOLLARS out of YOUR pocket and mine, to fund this “experiment”. There’s a sucker born every minute, and most go to work for the government or become hospital administrators, it seems.

IA is doing nothing more than slapping a few buzz-words on its anything-but-clever “Real Time QA“, labeling it a cost saving measure, (which is like wrapping a turd in fancy paper) and selling it to the morons civil servants at CMS.

Imaging Advantage is committed to advancing patient care and optimizing radiology services healthcare by introducing our RealTime QA Program. Imaging Advantage is the first in the healthcare industry to create a program specifically designed to address issues and resolve discrepancies while the patient is still present in the hospital, clinic or imaging center.

How it Works
Using our double blind parallel reading and review process, targeted high-risk cases are selected and interpreted simultaneously by two radiologists. If the results differ materially, the interpreting physicians review and resolve discrepancies, and correct any reported results prior to the patient being discharged. Simply put, higher quality of patient care is provided if discrepancies are resolved prior to the patient leaving the facility.

Why it’s Important
Catching mistakes before they are made, our RealTime QA Program adds value to healthcare facilities by:

–Reducing errors in high-risk exams lowering malpractice claim potential
–Reducing the need for patient call-back or report addenda
–Improving operational efficiency

Anyone who buys into this should be committed, in my humble opinion. What is a “targeted high-risk case”? Where are the most errors made? Probably mammo, but I don’t see them applying this in that venue. How many of these double reads will be forced on the already overworked and underpaid rads? And I suppose cutting imaging utilization is the primary goal of a company that makes money from imaging utilization? Sure it is. Actually, utilization was cut at the IA flagship in Toledo, according to one of the displaced rads there, as clinicians took their business elsewhere.

If you aren’t happy about your tax dollars supporting this, let your Congressman know. As an aside, and this is my PERSONAL OPINION, not reflective of anyone or anything else…any rad who signs on with IA had better have one incredible collection of extenuating circumstances which forced him to do so…otherwise don’t ever come to me looking for work. Favorable consideration will be given, however, to those displaced by this operation.

New GE Optima NM/CT640 SPECT/CT Scanner Gets 32 MPG!!!

GE has announced another SPECT/CT scanner, the Optima NM/CT640:

Optima NM/CT640 offers brilliant CT image quality enabled by high speed 1 second CT rotation minimizing motion artifacts while keeping dose and ownership costs low.

Miami, Fla June 11, 2012— At the Society of Nuclear Medicine this year, GE Healthcare is introducing the latest addition to its Nuclear Medicine 600 series with a new performance SPECT/CT system—the Optima* NM/CT 640 — that offers nuclear medicine physicians the optimal balance of image quality, patient dose efficiency and low total cost of ownership.

Based on the innovative 600 series SPECT technology found in the Discovery* NM630, this system integrates the latest generation general purpose camera with a newly developed 4 slice CT designed for hybrid rather than standalone CT use. The CT, available in 2.5mm and 5mm slice thicknesses to optimize dose and resolution required for particular procedures, offers clinicians confidence with routinely low CT dose at 1-2 mSv for a 40cm abdomen CT scan.

The Optima NM/CT 640 can be fully upgraded on location from a Discovery NM630 SPECT only system, and may be upgraded in the future to a 16 slice Discovery* NM/CT 670, expanding not only its clinical capability, but offering the potential for research use. This upgradeability helps protect clinicians’ and healthcare providers’ investments as the needs of their department evolve.

With its small footprint (5.7m x 3.6m) the Optima NM/CT 640 requires minimal renovation and installation costs. With the benefit of optimized CT power, shielding and control room requirements are often eliminated; saving as much as $100,000 compared to higher CT powered systems…

“Building off of our extensive experience in SPECT/CT, the advances we’ve made to our Infinia Hawkeye 4 platform and incorporating the SPECT technology of our Discovery NM630 camera, we’re striving to give our customers unsurpassed diagnostic confidence,” added Hermony.

GE Healthcare believes in nuclear medicine as a powerful diagnostic tool that is efficient, precise and sophisticated and we’re dedicated to harnessing its power. We have a strong vision for the future and with continued investment in technology advancements like the Optima NM/CT 640 and breakthroughs like CZT. In the end it’s a commitment from a global company that’s dedicated to solving big challenges everywhere – all for the benefit of clinicians and their patients.

*Trademark of General Electric Company

†Shorter acquisition times and dose reduction capabilities are possible with Optima NM/CT 640 system only when used in combination with the relevant features offered on the Xeleris 3 processing and review workstation.

Good stuff.

However…I’m a little worried about the diagnostic quality of the “newly developed 4-slice CT”, and given the mention of CZT, I’m assuming this is an attempt to create a nicer Hawkeye, with better SPECT, and maybe, possibly a bit better CT acquisition. Otherwise, why emphasize the ability to upgrade to the 670, which has “real” CT capability? Apparently, GE sees a market for the more limited version that doesn’t need shielding, and continues to offer the “low dose” enticement in trade for lesser image quality. We’ll know when the spec sheet becomes available.

In the meantime, anecdotal reports from the one owner in the neighborhood of the NM/CT 670 has been less than enthusiastic. As in “why didn’t we get the Siemens?”

But what I would really like to know is this: How much did GE pay Kia for the rights to the name “Optima”? What? Kia doesn’t even know about it? Uh oh…

The Case Of The Vanishing Vibrating Underwear (And iPad…)

Radiologists are no more immune to weird behavior than anyone else. However, it is probably not terribly wise to call attention to yourself when indulging in such. I won’t source this, and the names have been redacted, but you can easily Google a snippet of the text if you just have to know more…

A hotel guest told police he was missing two iPads and his vibrating panties after an encounter with a woman in his room.

Dr. X told police he had purchased the items on Tuesday.

Later that day, Dr. X met a woman and invited her to his room.

Dr. X believes the items were still in his room after he took the woman back to her room at another hotel at around 9 p.m.

Wednesday morning, Dr. X left his room at 7:30 a.m. When he came back that night at around 6:30 p.m., he realized the iPads and panties were missing from an open piece of luggage in his room.

The front desk told Dr. X the only access to his room during the time he was gone was by housekeeping at 12:30 p.m.

Dr. X told police he believes that either the woman he met or hotel housekeeping is responsible for the theft.

He told police the woman he brought to his room still had a key.

An officer asked the front desk for the door log for room 405, but the employee who has access to the logs had left and would not return until June 7 at 9 a.m.

Police are still investigating the theft.

Dr. X, who shall remain nameless, turns out to be an interventional radiologist working for one of the BIG radiology corporations, being put up in said hotel. Not that it’s pertinent, but Dr. X trained in a nation in the Middle East that is not Israel. I am unfamiliar with the customs in that particular wooded nation relating to reporting of missing items of a personal nature.

You filthy-minded perverts out there, otherwise known as readers of DoctorDalai.com, are almost certainly jumping to the wrong conclusion. Clearly, Dr. X was in the process of an incredible breakthrough in interventional radiology, using the oscillating lingerie as a tactile feedback device during cases. I haven’t quite worked out all the details for this yet, but I’m guessing he had modified the electronics in the panties with a WiFi access point for open communication with deep signal penetration, perhaps with an adcock ad hoc architecture.  The two iPads were then made to interface with the lacy drawers (although perhaps he preferred burlap). If I were doing this, I would use some sort of very sensitive probe at the tip of my catheter which could transmit sensations back to the first iPad, which might then map its trajectory. If the catheter bumps and grinds up against the smooth lining of the vessel wall, a sensory cascade might then be triggered causing the vibrating unmentionables to, well, vibrate, thus warning the operator of an impending state of no return. I’m would assume the woman in the article was a technologist or engineer helping Dr. X to perform a wet-run of the prototype device, perhaps helping him guide his catheter.

Or maybe they were both just watching His and Her porn on the iPads.

Anyway, nice to know that the BIG radiology companies deliver rads of such immense quality. Yes indeed.