The 2006 PACSman Awards: Of Chiclets and cappuccino

Nov 28, 2006

CHICAGO - RSNA 2006 was the year of Chiclets and cappuccino -- both were given out freely in the hopes of attracting people to see déjà vu technology. I'll admit I haven't had a Chiclet in over a decade, when I was assaulted by 6-year-old Mexican kids selling them straight from the cruise ship docks. Cappuccino wires me in the worst way (and there is nothing worse than a wired PACSman), so neither really appealed to me at all. I avoided both. I should have avoided many of the booths as well.

To be fair, there are a few things at RSNA 2006 that stand out, but these aren't really technological advancements per se despite an astounding number of first-time exhibitors. Storage costs continue to drop dramatically, with a terabyte of data storage now offered for less than $4,000 ($35,000 for more than 10 TB, about five years' worth of data archiving for the average mid-sized community hospital).

Digital radiography (DR) prices have also tumbled due to the influx of foreign-manufactured plates coming into the market, with three DR vendors offering 14 x 17-inch plates for less than $40,000. While the plate itself is not a full DR system, the availability of low-cost receptors will no doubt drive the cost of DR down by more than half, and bring DR a lot closer to the realm of affordability for those currently using computed radiography (CR) as an entry to the world of digital x-rays instead of the significantly more expensive DR.

Unfortunately, this may also hurt the DR vendors trying to recover their R&D costs by undermining margins in a market that is just beginning to take off, but that's medical imaging.

The number of teleradiology service providers at this year's show is staggering, with at least a threefold increase in vendors offering their services over prior RSNA conferences. What's also amazing is that we are seeing many non-U.S. entries into the market segment as well -- and all with no real licensing body overseeing the explosive growth of this industry. The American College of Radiology (ACR), the U.S. Food and Drug Administration (FDA), or others MUST get involved in this market and establish a framework that all need to follow from a licensing and credentialing perspective on down.

Leading up to the show, there was lots of talk about integrated RIS/PACS solutions, as well as enterprise-wide software encompassing electronic medical record (EMR) systems, computerized patient records, etc., but very few companies that took a proactive stance in actually demonstrating this.

It is good to see smaller independent companies such as Aspyra, SoftMedical, and others join the ranks of the majors in the IHE (Integrating the Healthcare Enterprise) demonstrations, but unfortunately not nearly enough people saw the demos and poster sessions due to the demands of trying to take in all the show floor had to offer. That was a shame, because there have been some awesome poster sessions this year as well.

One of the most frustrating things about the show this year, and something I have written about for over a decade, is that vendors STILL have not learned how to KISS -- Keep It Simple, Stupid. They talk in technical lingo that is way over the heads of most RSNA attendees, many of whom consider technological advancements as adding more bells and whistles that rarely get used.

As I look at the plethora of workstations with drop-down menus on top of menus, I'm reminded of the Jitterbug cell phone for senior citizens -- big buttons, maybe 10 programmed numbers, and that's it. How can they get $150 (just three easy payments of just $49.95) for something so basic? Basic sells.

My phone does things I don't even know it does, and often on its own without my prompting either (or at least knowledgeable prompting). If I need it to do something, I have a built-in tech department in the form of my 13- and 15-year-old sons, Matt and Nick. They are always saying, "Let me show you, Dad," and my answer is always the same: "Don't bother me with the birthin' pains, just show me the baby," which leads them to roll their eyes.

Radiologists want simple. Radiologists need simple. My good friend Dr. Sam Friedman (the Dalai Lama of PACS on AuntMinnie.com's PACS Forum) is a Star Trek aficionado, but has told me time and again he doesn't want his radiologist's workstation to look like the bridge on the Enterprise. It's time to listen and keep it basic, keep it simple, and use complex technology to make radiology simple instead of simple technology to make radiology complex. We have what we need -- now we just have to figure out what to do with it.

Okay, on to the 2006 PACSman Awards:

The "Green Eggs and Ham" Award
To the major modality vendor whose marketing department must have read too much Dr. Seuss before designing its booth. Unfortunately, the green booth color was about the only thing new that the company offered, at least in the PACS arena.

The "Situs Inversus" Award
To the same modality manufacturer that, by inverting the x-ray image, displayed a green heart on the wrong side of the body. I'm sure the official explanation will be that they wanted to see if radiologists were really paying attention or that it was a real patient with dextrocardia, but we all know the truth.

The "Me, Myself, and I" Award
To the company that quoted one of its users with something less than the King's English, stating, "I have used a lot of PACS myself and this is the easiest." Using "I" and "myself" in the same sentence is redundant, so if you are going to quote a customer at least make sure they look good.

Combine one of the übercomfy vibrating chairs found in the South Hall with a two-screen monitor on an articulated arm and you have the "Marriage Made in Heaven" Award.

The "Whip It" Award
To the major modality vendor that had young women decked out in white jumpsuits, reminiscent of 1970's Devo videos minus the flowerpot headpieces. I saw a couple changing the oil in a Beemer and Mercedes, leading me to believe if you can't make money selling PACS you make money however you can.

The "Kunta Kinte" Award
To the writer who wrote that radiologists "will be a service commodity to be bought, sold, and traded" in the subheading of an article in Tuesday's "RSNA Daily Bulletin," addressing the new RSNA president's address, interestingly titled "Strengthening Professionalism." I've heard about getting back to our roots, but that is going a bit far.

The "Scotch and Soda" Award
To the major modality vendor whose Expert Bar concept was intriguing, but whose execution left a lot to be desired. All that was missing was a tip jar.

The "Amen and Alleluia" award
To the vendor that in describing its offering of DR choices instead described their company, as well, "Because you don't do things exactly like everyone else." What do I hear bid?

The "Donna Summer" Award
To Disc O Tech. Nuff said.

The "Away in a Manger" Award
To our host sponsor who had more people than rooms for the first time in the 20-plus years I've been coming to Chicago. When the Best Western wants $667 a night, something is seriously wrong.

The "If You Can't Say Something Nice" Award
To the archive provider whose promotional material focused on offering a reprint of its competitor's product being "ditched."

The "We Know the Problem Well" Award
To the staffing solutions company whose booth when I went by twice was … empty.

The "South Shall Rise Again" Award
To the modality manufacturer whose digital mammography product was called DXSI, known to us Southerners as Dixie, regardless of what y'all call it.

Random thoughts: Why do vendor marketing departments still insist on putting stethoscopes on radiologists? What do the radiologists always look so ^&*%$ happy? What is the correlation between sumo wrestlers and preowned medical equipment? Why is it that you can pay more than $400 a night for a hotel room but still have to hold the toilet seat up when not sitting down?

And this year's top PACSman Award goes to:

The "Bend Over and Say 'Ahhh'" Award
To the company that developed Prosty the Spokesgland, a Ren and Stimpy-like cartoon character designed to bring attention to the need for prostate imaging. The company has developed a full line of humorous and enlightening educational products that discuss prostate cancer diagnosis. Its cause is great, yet I can't help but think of how many times we've been asked to bend over year after year at the RSNA show without even getting so much as a clean bill of health.

By Michael J. Cannavo
AuntMinnie.com contributing writer
November 29, 2006

Michael J. Cannavo is a leading PACS consultant and has authored nearly 300 articles on PACS technology in the past 15 years. He can be reached via e-mail at [email protected].

The comments and observations expressed herein do not necessarily reflect the opinions of AuntMinnie.com, nor should they be construed as an endorsement or admonishment of any particular vendor, analyst, industry consultant, or consulting group. Rather, they should be taken as the personal observations of a guy who has, by his own account, been in this industry way too long.

Part XII: Exploring PACS Secrets -- PACS and marriage, August 15, 2006

Part XI: Exploring PACS Secrets -- Stop the insanity, May 29, 2006

Part X: Exploring PACS Secrets -- Excuses, excuses, May 19, 2006

Part IX: Exploring PACS Secrets -- How to fix DICOM, April 20, 2006