The PACSman’s opinionated view from RSNA 2002

CHICAGO - PACS has evolved to the point where the earth-shattering advances are long gone. At this week's RSNA meeting, most of the changes being shown can largely be considered evolutionary in terms of features and functionality.

Such changes include porting to the Microsoft Windows 2000 platform to allow tri-screen displays (dual monochrome, single color), advanced software integration (MIPs, MPR, and 3-D), and other features of a similar ilk. There were a few significant advances in both computed radiography (CR) speed and cost, and the integration of document scanning into PACS, but little else really jumped out as a show-stopping highlight.

Everywhere you go, vendors talk of integration, yet few vendors really understand all it takes to make this integration work. “Seamless” radiology information system (RIS) integration is the buzzword this year, yet it was only “seamless” with the latest version of one particular vendor’s software. I especially loved one vendor’s pitch about their seamless integration that failed to take into consideration that the RIS software upgrade required to make this happen costs $400,000 –- about five times what a “non-seamless” integration would have cost. Minor detail.

Integration with other clinical systems, notably cardiology PACS and electronic medical records, is also being extensively shown and discussed, although few vendors can actually show where integration in a SAN (storage area network) environment has been performed. This has been a major hot button for chief information officers and information technology directors nationwide.

There is very high interest in computer-aided detection, with a number of companies jumping on the mammography CAD bandwagon, and new applications for both chest and CT CAD applications being shown as well.

Three-dimensional viewing is also in great demand, shown as both stand-alone 3-D products and integrated into almost every PACS vendor’s workstation.

“E to E” disease is rampant on the exhibit floor, with too many vendors trying to be everything to everyone. Considering many of these vendors didn’t even do one thing well, they must figure they have nothing to lose by doing everything mediocre instead.

I was amazed at how many OEM suppliers are no longer content to enjoy their piece of the pie but instead want it all. So many have chosen to directly compete with their OEM partners that it boggles the mind. In a year or so, when they run out of money forgetting about PACS’ abysmally long sales cycle (18 months to two years on average) and get purchased by these same OEM partners for 10 cents on the dollar, they will play Monday morning quarterback, wondering what went wrong.

The 2002 RSNA PACSman Awards

The “Sales Professional” of the Year Award -- To the company that sent a blanket e-mail to me and 5,000 of their closest friends the Friday before the show, addressed to “Dear Human Resources or Sales” containing only four sentence fragments and more grammatical errors than you can shake a stick it. No wonder why there are so many warm bodies on the street.

The “You Can Dress ‘Em Up” Award -- To the individuals who tried to start the Civil War again by requesting “Rocky Top” be played by classically trained violinists at one vendor’s cocktail party Sunday night. This, of course, was followed by a request for “My Old Kentucky Home,” which was followed by “New York New York.” I left before the bullets started flying.

The “Alicia Silverstone” Award -- The star of the movie “Clueless” would love this company, which has bought, chewed up and spit out more PACS companies than Madonna has had boyfriends. They really do need to start thinking outside the box.

The “Apollo 13” Award -- To yet another unnamed company, which in the wake of watching its market leadership position erode as fast as the value of Enron stock, has at least stated, “Houston, we have a problem” and has had the intestinal fortitude to not only acknowledge that they’ve screwed up but to outline a plan of recovery as well. I wish them well.

“The Price is Right” Award -- To the company offering 1 terabyte of turnkey RAID for under $7,000 and promoting 500 GB S-AIT (super advanced intelligent tape). Just four months ago I was writing how great it was that 1 TB of RAID could be had for less than $25,000 and how AIT-3 at 100 GB each would provide such an incredible value. What ever happened to Moore’s law and my 12-month grace period?

The “Dragnet” Award -- To several vendors that offered the exact same product under a totally different name hoping people can’t tell from one year to the next by touting a “different marketing philosophy” or other corporate gobbledygook. I thought names were only changed to protect the innocent?

The “Rube Goldberg” Award -- To an unnamed company whose single-plate reader CR prototype was promoted as state-of-the-art technology, yet was about as big as the old IBM Univac computers. Guess they haven’t heard about nanotechnologies and the decades-old trend that smaller is better.

The “You’re Gonna Make A Liar Outta Me Yet” Award -- To the big iron vendor that's been totally dispelling the myth that big companies don’t listen to their customers, can’t offer state-of-the-art technology, can’t be price-competitive, and don’t need to play Fred Astaire dancing around answers. If you guys don’t stop doing what you’ve been doing over the past year, you’re going to set a standard of excellence that no one else can follow and become the industry leader, so stop it right now.

The “Elton John ‘I’m Still Standin’ ” Award -- To e-Med of Lexington, MA, for defying the odds as the longest independent PACS vendor in the market -- over a decade on its own.

The “Gloria Estefan ‘Coming Out of the Dark’” Award -- To San Diego-based DR Systems for using 50-inch plasma screens to demonstrate its PACS products. Unlike years past where people had to be herded like cattle into covered enclosures to see a demo, this year people could see the product sitting down or even by walking in the aisles. Personal aside to the company -- if you have no need for those gorgeous displays after the show my address is....

The “Little Engine That Might” Award -- To Springfield, Missouri-based Health Care Manufacturing for presenting a full digital radiography room (chest bucky and table) including a custom-designed x-ray generator for under $100,000 complete. If the 13-year-old manufacturing firm is successful in delivering systems at this price point as they say they will by mid-2003, the biggest barrier to DR adoption –- price – will evaporate and the paradigm shift from analog to digital will be complete.

The “Aretha Franklin” Award - To Konica, which after many years of trying finally may get the R-E-S-P-E-C-T that it deserves with its Xpress CR product. The product combines price and performance to present a solid challenge to Fuji, Agfa, and Kodak in the moderate-throughput CR product tier.

The “Holy Moses” Award -- To Philips, Stentor, RADIN, and others who demonstrated integrated images on tablet PCs, showing that tablets aren’t just for the Ten Commandments any more.

The “Loaves and Fishes” Award -- To software developer Amicas, which last year had a booth one-quarter the size and with one-tenth the employees and this year seems to have grown more than a guy with a prescription for Enzymyte natural male enhancement pills.

The “R.J. Reynolds Blowin’ Smoke” Award -- To all the vendors that announced in print and showed products that won’t be ready for commercial delivery for at least six months but somehow neglected to let RSNA attendees know this, reaffirming that the acronym RSNA also stands for Real System Not Available. Someone needs to tell them that selling futures should be reserved for pork bellies, orange juice, and oil.

The “Pop Tarts” Award -- To CD and DVD burner provider Sorna, for calling its CD burner the FilmX Toaster. This is probably one of the hottest and most cost-effective products at the show, with incredible applications offering CDs as an option to film at less than $1 per disk. The cost includes a sleeve, labeling, and an integrated DICOM viewer burned into each disk that puts many more expensive diagnostic workstations to shame.

The “If It Ain’t Broke, Don’t Fix It” Award -- To video display systems provider Planar for having the common sense and presence of mind not to mess up a good thing when it bought Dome Imaging Systems, keeping the company almost as it was before the buyout.

The “Cleopatra” Award -- To those who walked the RSNA show floor looking at no fewer than 400 different PACS options and deciding to wait until next year, “when the market more fully matures.” The Queen of De Nile lives on.

The “Genghis Khan” Award -- To film-scanner provider Vidar Systems, which in two short years has managed to become an integral part of over 95% of the PACS vendors solutions.

The “I’m Sure We Can Make It Better” Award -- To all the Goliaths who bought, sought out and purchased young, innovative PACS vendors and then injected their own corporate culture and six layers of management trying to make what already worked perfectly even better and in the process totally screwing up a good thing.

Agent Mulder was right. The truth is out there for those who dig deep enough. Just don’t fall into the hole.

By Michael J. Cannavo contributing writer
December 4, 2002

Copyright © 2002

Editor’s Note: Michael J. Cannavo is a leading PACS consultant and has authored over 250 articles on PACS technology in the past 15 years. This is his second year as’s resident cynic covering PACS technology.

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

Comments about this column can be made as a posting on AuntMinnie’s PACS Digital Community Discussion Groups or by contacting the author directly via e-mail at [email protected].

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