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| View at the exhibit "floor" |
There are two types of
people, those who hate the RSNA Annual Meeting and those who love it. Most
“haters” despise the weather, the cab drivers, the expensive food, the long
lines, and the running back and forth from meeting to meeting while trying to
text to the next appointment that you are running late (assuming there is still
juice left in your cell phone and there are not too many people using their
phones simultaneously overloading the network). I count myself in the category of
a love/hate relationship: despite the negatives there are always new things to
see, and new people to meet, if not just in the bus to the conference, then
while waiting in line. In any case, here is my third and final installment of
this year’s review of what’s new and what’s old, concentrating on what’s old.
What’s old:
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| PACS is "old news" |
1.
PACS is old news: PACS systems are
mature. Even the catch-phrases were rehashed, from uni-viewer to VNA, cloud to
zero-footprint, workflow to image enabling. The good news is that there are
still new entrant
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| Data entry, not in RIS but in CPOE |
2.
The stand-alone Radiology Information
System (RIS) is dead: RIS systems have traditionally provided ordering,
scheduling, modality worklists, report distribution and operational support.
Several of these functions are taken over by other systems: Computerized Physician
Order Entry (CPOE) systems are used as part of the EMR or as a physician
portal, reports are uploaded directly into the EMR, modality work lists are
provided by the PACS, which has a direct HL7 interface, and many users opt for
a RIS module as part of the HIS or EMR. In addition, many smaller imaging
centers forgo the RIS totally and only have a practice management system and
interface their PACS system directly to their ADT system, again relying on the
worklist provided by their (mini-) PACS. Anyone who is considering upgrading
their PACS and/or implementing an EMR might want to have a close look at their
RIS and determine if they should be keeping it.
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| Hawaii or an X-ray room? |
3.
It is all about the ambiance: The
master of ambiance is obviously Philips, with its long-term presence in the
consumer electronics and lighting business. But there are other (smaller) vendors
that are starting to provide innovative solutions to reduce patient anxiety and
claustrophobia. If you think that this is just “window dressing,” I suggest you
wait until you have a MRI or CT done yourself and stare at the naked ceilings
which are often the drop-down office type stained with brown condensation marks
from sweating air-conditioning vents. If adults feel somewhat anxious you can
imagine how youngsters might feel. I have seen a lot of hospitals and most
children’s institutions do a pretty good job, but those are exceptions.
Hopefully more institutions are paying attention to their ambiance as it has
been proven to makes a difference and have an impact on the healing process.
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| One beam, multiple image sources |
4.
Operating theatre integration: Last
year there were demonstrations of “video over IP” whereby multiple imaging
sources could be “mashed” to a single screen. This is now pretty much a given
for any cath lab or OR where image and other information such as waveforms from
different sources are being integrated. A surgeon can see real-time
measurements, while a laparoscopic or endoscopic camera can view the actual
pathology while looking at a previous exam, or images from different
modalities. There is a significant after-market to upgrade your old multiple
monitor systems.
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| Hawking gadgets |
5.
Ultrasound massage: I missed the
massage chairs this year, as well as the ladies with the skin cream, and the
booth selling a small handy-cam to be used as a Christmas gift. The only
“off-side” product I could find was an ultrasound massager, for a conference
special of only $175 (online it is listed for $250). I should have been smart
and tweeted it right from the show and take orders on my PayPal account with a
25 percent markup, which might have paid for my dinner. Oh well, next year I’ll
be better prepared.
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| Wireless at the bedsite |
6.
Wireless: Wireless has penetrated the
display imaging chain to show image and provide access to an EMR, browsing the
web for teaching file cases, and showing an imaging study to patients. In
addition to the wireless display, much of digital X-ray acquisition has become
wireless. No need for a digital radiology plate to be connected to a cable
anymore, as information is transferred to a review monitor within seconds for a
technologist to be reviewed and sent to a physician.
7.
Image sharing: RSNA was showing off
the image sharing initiative again at a dedicated booth and even at a so-called
“town-meeting” (when did RSNA get into politics?) that allowed participants to
present their experiences. It is touted as a
pilot project, funded by the National Institute for Biomedical Imaging and
Bioengineering (NIBIB) and administered by RSNA. And a pilot project it is, as
its scale is surprisingly small, comprised of 5 major sites that are
participating and the number of participants is less than 10,000. One would
think that people are starting to get tired of importing and exporting images
on CD’s and carrying them around with all the related risks of losing them, not
being able to read them because of “rogue” CD generators, etc. I bet that it
will be shown again next year, hopefully with reports of more participating
institutions and patients signing up. One would think that for $10 million
dollars+, which is the size of the grant awarded to RSNA, there would be more
people interested in participating. |
| Small CT for training |
8.
Educational CT scanner: I have to
admit that I have a weakness for everything related to CT’s as I started my
early medical career writing software for one of the first Philips CT scanners
built (Tomoscan 300). Therefore, I found this product very interesting, it is
based on optical scanning but has the same technology as if one would use X-ray
as a source. There is even a complete set of exercises to go with it so any
teaching institution can just take it and include it in their training program.
Very cool.
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| Smart phones becoming medical devices |
9.
Yes, there is an app for that: There
are a plethora of medical applications out there for everything ranging from
taking your pulse to eventually measuring your glucose level. I wouldn’t be
surprised if in one of the next trade shows someone will have come up with a wireless
ultrasound probe talking back to an oversized phone (“phablet”), which by the
way can also post images on facebook and pull down any comparisons from a
Health Information Exchange. The FDA is actually getting rather concerned with
the lack of oversight and has recently published a ruling on the use of these
devices for medical applications. In the meantime, most of these apps are used
for accessing data for decision support and accessing Google images. I had
firsthand experience when my physician, after looking at my ultrasound did a
simple search of images with similar cases as a comparison using Google image
searches. I am sure this category of applications is going to explode and
provide tools that were unheard of a few years back and even today.
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| Xmas in Chicago at the Magnificent Mile |
10. The Magnificent mile:
Last but not least, nothing beats walking the “golden mile” at night. And
although not inexpensive, there is good food to be found and it is fun to walk
at least a mile. It was somewhat cold,
so me, being unprepared had to run into a local Walgreens and get a hat (we
don’t carry or wear those in Texas). It seems as if the number of designer
stores have increased, which makes shopping definitely out of my price range,
but people-watching and having a good dinner is always a joy and by the time it
gets too cold, I’ll take a cab back to the hotel.
Well, that was RSNA
2013: smaller, uneventful, except for a
few incremental product improvements, mostly “old news,” but fun as always. At
least I still enjoy it even if it is already my 30th year (I think
they should give ribbons for that as well). See you at RSNA 2014, and if you
won’t be able to attend, you can enjoy my write-up and taste (and feel the
cold) of a little bit of Chicago!
