The 2021 PACSman Awards: The Jack in the Box show

2019 02 13 21 09 9034 Cannavo Mike 2019 400

I live by the Ninth Beatitude: "Blessed are they who expect nothing for they shall not be disappointed." They don't teach you that one in the Bible or in Catholic school either; it's only learned through the school of hard knocks.

The PACSman, Mike Cannavo.The PACSman, Mike Cannavo.

I came to RSNA 2021 unexpectedly this year, thanks to a benefactor who apparently felt the radiology world needed the PACSman Awards. So as hard as it was to come, I just couldn't say no.

Although I came with no expectations, I have to say this was probably the best RSNA ever. It was like the Jack in the Box popping out; you kind of expect it but don't know just when it will happen. The lower attendance actually allowed for companies to present to those who were serious about implementing technology sooner than later.

Registration took all of five minutes, if that. The Healthcare Information and Management Systems Society (HIMSS) should take a page from the RSNA playbook. Wearing a mask all the time really sucked, but that's a Chicago requirement, not an RSNA one. Considering we have the COVID-19 variant of the week out there, I guess it's better to be safe than sorry.

You never know actual attendance, only who registered to come, but actual attendance was down nearly two-thirds from 2019. That was still good, though, and it helped keep hotel rates down to a more manageable level -- nearly half that of 2019. There were about 500 exhibitors registered, but I stopped counting empty booth spaces at 40. Most were 10 x 10 booths, though, so it was still worth the trip.

Many vendors, especially the majors, seemed to not get the message about scaling back their personnel, however. Most big booths had at least two to three times the number of people needed, and most were on their cell phones or chatting with fellow employees. In one major OEM's booth, I walked around the enterprise imaging area for almost 15 minutes -- wearing a press badge no less -- without a single person asking if they could help. It was an illuminating moment for me for sure.

The number of first-time exhibitors, at 70 or so, was staggering given the dynamics surrounding the show, and most did OK overall. Again, their messaging could have used tweaking, but I could say that for just about everyone.

While great in theory, over half of the vendors claimed to have some form of artificial intelligence (AI), including nearly all the major companies. That said, you really needed to dig deeper to understand what they meant by AI versus the industry's common understanding of AI.

Yes, there are standards for AI, but there still isn't a uniform descriptor of what medical imaging AI is other than what is in the mind of some company's marketing department. Yes, AI can help with improving signal-to-noise ratios and even with adapting hanging protocols, but that is not what most people are looking for when they look at AI.

Pragmatically, most hanging protocols are also like Ronco's Showtime Rotisserie and BBQ; set it and forget it. If a radiologist wants to change them for whatever reason, they usually can rely on their PACS administrator to do that. It doesn't take or need an algorithm.

"Real AI" was out there, although anyone who says it is a developed marketplace is sadly mistaken. Fewer than a dozen vendors have more than 20 paying customers using their algorithms, even though they might claim to have 200. Alliances are being formed between several AI vendors who have decided to partner up after realizing the movie dialogue cliché, "this town ain't big enough for two of us," or in the case of radiology AI, the 200+ of them.

Interestingly, even though there were only a few AI consolidators preshow, almost everyone now claims they can interface with every AI vendor at any time. Details were nonexistent to sketchy at best, though, leading me to recall one of the best RSNA marketing slogans ever from 20+ years past, back when Dome Imaging had buttons that said "Dome -- We can do that." One AI vendor at RSNA 2021 even claimed to have completed validation testing against 30 algorithms, yet only had two commercially available.

PACS, vendor-neutral archives (VNA), and enterprise imaging systems (EIS) were all displayed on the exhibit floor, with VNAs making a resurgence of sorts. But with a few exceptions, most of the excitement around PACS/EIS primarily involved upgrades for those using their existing products.

Turning the handle on the box, here are the 2021 PACSMan Awards:

The Lion Sleeps Tonight Award

To the multibillion dollar company that's used by many already for cloud storage but spells imaging in their 10 x 10 booth "imagining." Imaginine that.

The Kenny Rogers Award

To the company that named their product after a great song that Kenny sang. No one else in the booth could tell me what their product name meant -- "I guess it's something that marketing made up" was the most popular answer -- so I just have to hope she doesn't take her lover to town anytime soon.

The Donald Award

To the company that chose to "democratize data-driven medicine, together." No doubt Rep. Nancy Pelosi was behind the company because there was no one looking to republicanize anything here.

The Fred Astaire Award

To the company that wouldn't give me a straight answer on their pricing model -- not pricing, just the model. When asked, "Do you do enterprise licensing, per workstation, or per use," their answer was always "We do what is best for the customer." Trying to get clarification every way known to man, I still got the same answer. I expected nothing less from a company that charged customers to use software to take images from their proprietary format to an industry-standard one.

The Sensuous Chair Award

This company just left me shaking my head at the incredibly thinly veiled, highly suggestive ad for a product that has a name close to an old Steve Winwood song. Where is HR when you need them? Probably finding a way to exclude my resume due to my age or other factors.

The Mamma Mia Award

To the company who seemed to imply they reached out to provide breast imaging to underserved women yet showed a close up of one woman with a gold embossed tooth and gold and diamond-studded nose piercings and another just with a gold nose ring -- poorer no doubt. I wonder if they were wearing Jordan's too.

The Jumanji Award

With wild boar, alligator, and fish -- all presented whole before being carved and served, this company took the prize for the most-unique-far-from-boring-postshow party ever. The intimacy of the crowd where most everyone knew everyone made it even better as well.

The Semantics Award

To the company that said the U.S. Food and Drug Administration (FDA) approved their product. The FDA doesn't approve products; they clear them to be marketed, but that's it. I knew what they meant, as did most of the people looking, but the FDA will not be amused. The only thing worse would be saying that the FDA endorsed them. No wait, did I miss that one? LOL.

The Semantics Award Part II

What is it with marketing? Using words like liberated, infused, orchestrated, and -- my all-time favorite from a single company on a single story -- index, cohort, extract, curate, pseudonymize, and traceability. Now what is it that you do again?

The FJB Award

Given the conservative nature of most radiologists, I was surprised not to see a single "Let's Go Brandon" mask on the floor. I am apolitical and, frankly, could care less, but it's fun to see those who aren't sharing their thoughts in various ways. Most were probably sitting in on the "Is $5 million enough to retire on or should $10 million be my floor" presentation.

The "Just One More Thing ..." Award

To the company whose name made me think back to the old TV show of the same name that ran from the 1970s to 1990s. I'm not that old (cough, cough) but I did read about it on the internet.

And the winner of the 2021 PACSMan Award is ...

The company whose tagline not only mimics their company name but also hits the nail on the head when it comes to RSNA -- "People Can Tell When You Imagine." There is so much imagining going on in the imagining marketplace.

I've been coming to the RSNA show for 30 years and the imaginations keep getting deeper. I'm not sure if this year's PACSMan Award is my swan song or not; finding a nonconsulting gig hasn't been easy, but only time will tell. If it is, though, know the Grateful Dead had it down pat when they sang in the song "Truckin."

"Sometimes the light's all shinin' on me. Other times, I can barely see. Lately, it occurs to me. What a long, strange trip it's been."

As my son would say, peace out.

Michael J. Cannavo is known industry-wide as the PACSman. After several decades as an independent PACS consultant, he worked as both a strategic accounts manager and solutions architect with two major PACS vendors. He has now made it back safely from the dark side and is sharing his observations.

His healthcare consulting services for end users include PACS optimization services, system upgrade and proposal reviews, contract reviews, and other areas. The PACSman is also working with imaging and IT vendors developing market-focused messaging as well as sales training programs. He can be reached at or by phone at 407-359-0191.

The comments and observations expressed are those of the author and do not necessarily reflect the opinions of

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