The PACSman's opinionated view from RSNA 2003

"She's running at full power now, Cap'tin. If I give 'er any more, we may lose our shields."

"I hear ya, Scotty. Full speed ahead, Mr. Sulu. Plot a course for AlphaBetaGammaZulu 3. Warp speed."

CHICAGO - There were more references to the word "enterprise" this year than in any 10 episodes of Star Trek combined. Still, having spent the past few days reviewing vendor approaches to the healthcare enterprise market, I can hear the immortal words of Dr Spock: "Beam me up, Scotty; there is no intelligent life here at all."

RSNA 2003 was the year of the Uni-PACS -- a mind-meld of one PACS morphing into the next with little delineation between systems outside of price. Web-based (or Web-enabled) thin-client solutions reigned, but approaches to sales of PACS varied widely.

That said, here are the 2003 PACSman awards:

The New Math Award -- To all the companies that have used their No. 1 KLAS report to tout their z,1 ranking, then mysteriously removed all references to KLAS when they got ranked again a few months later and dropped several positions. You just gotta love an industry when there can be four number ones in a single year, and where companies doing $200 million in PACS sales are evaluated side-by-side against those doing 1/100th that volume.

The Money Pit Award -- To one of the leading PACS vendors that finally, after nearly a year's delay, is shipping the software release promised at RSNA 2002 as a first-quarter 2003 deliverable. When asked when the next software release would be forthcoming they replied, "Two weeks."

The White Knight Award -- To Intuitive Imaging Informatics, for accepting responsibility for supporting the 250+ existing PACS installations from the unnamed Japanese vendor that has spent the past eight months dancing around its unconfirmed yet undeniable exit from the PACS business.

The Master and Commander Award -- To the software company that had an exclusive relationship with a major PACS vendor that served them well for nearly a decade, yet has now begun to sell its software through other companies and also directly into the orthopedic market as well. I'm reminded of Russell Crowe's toast made in the movie Master and Commander -- "To our wives and lovers -- may they never meet!"

The New Math II Award -- To the Hawaiian company that showed an extraordinarily complex PACS design encompassing 10 servers, 41 modality interfaces, and 141 review workstations for an Asian hospital with 921 beds. Interestingly enough, the hospital only generates 180,000 procedures (about 25% of what one would expect for a hospital this size) and radiologists there read the studies on just two diagnostic workstations (or on 37 workstations, depending on how you interpreted their diagram) Either way, none of the math added up.

The Up Against the Wall Award -- To RSNA show officials who tried to enforce having only their "official" lanyard worn by meeting attendees, then realized there were more unofficial lanyards than official ones being worn and that enforcement was impossible. Luckily there was no enforcement by the "bag police" this year.

The Gillette Mach Three Award -- To the film vendor that failed to realize that, when you blow up a guy's face to 6 x 8-foot proportions, the fact that he hasn't had a clean shave will be very noticeable. Ever heard of digital retouching?

The New Math III Award -- To the PACS vendor that offered a "free" PACS with the purchase of every $100,000 CR solution. The "free" package consisted about $3,000 worth of hardware, Web server software, five nonconcurrent software licenses, and a single tape backup. No mention was made about the cost to connect to the modalities, installation, training, etc., but I doubt it was free.

The Fish Called Wanda Award -- To the monitor manufacturer that demonstrated its monitor resolution by showing fish x-rays. "Yup, she's got a bad case of the scales all right."

The Bill Clinton "I Inhaled and Enjoyed It" Award -- To the companies that paid absolutely ridiculous sums of money for PACS firms as an investment in their future, yet have no one in the organization who can explain why the investment was made.

The Most Pleased to Invite You to Special Event Award -- To the California company that calls itself "one of the leaders in the PACS industry" yet couldn't spend $100 to get a good English translation for its party invitation. Most bad move.

The Bill Nye the Science Guy Award -- To the cryogen provider that showed me how they make perfume by freeze-drying flowers at -320° F and why my hot dogs get freezer burn while theirs stay frozen forever. The demo may have had very little to do with radiology per se, but then again neither did their "Air Band" videotape either, which earned them the "Grateful Dead Wannabe" award. Glad to see creativity is still alive and well somewhere at RSNA.

The Paul Simon "You Can Call Me Al" Award -- To the modality vendor that got cute and gave its latest product a short, memorable first name. I flew up on United Airline's Ted to see Tim and in the elevator happened to run into Bob and Carol (and Alice -- Ted was already here).

The Dumb and Dumber Award -- To the companies using variations of "smart," "intelligent," "bright," etc. in their name or product. It's not the machine that makes you smart -- last time I checked, it was the user.

And last, but certainly not least ...

The Bruce Almighty Award -- To the PACS industry vendor that is getting better in controlling its superior attitude but, unlike Bruce, just can't give back the role of God to Him ... yet.

By Michael J. Cannavo contributing writer
December 4, 2003

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 fourth 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.

Mr. Cannavo can be reached via e-mail at [email protected].

Related Reading

The PACSman's opinionated view from RSNA 2002, December 4, 2002

Stop me if you've heard this one about PACS, November 29, 2001

RSNA 2000: The PACSman Awards, November 30, 2000

Copyright © 2003

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