The PACSMan Pontificates: RSNA 2022 -- Should I stay or should I go?

2022 03 16 18 31 6806 Cannavo Michael 20220316184646

In nearly 40 years of being in medical imaging, I have missed attending the annual RSNA meeting just four times. Twice was when I worked for vendors, once when I was just too sick, and one other time I'm sure I had a good reason but can't recall why.

Michael J. Cannavo.Michael J. Cannavo.

I love the RSNA. It's a great organization and puts on a great show. I have also shared so many laughs and smiles at the meeting and sadly a few tears as well. Fifteen years ago, I got a call on Monday afternoon of the show that I needed to get home, as my 84-year-old dad had taken a turn for the worse. Sadly, he passed away a few days later.

And over 30 years ago, I had to choose between going to the show or visiting my mom, who was in the last stages of lung cancer. Since I flew up every week to be with her for months before, I chose to go to the show. She died the following week.

So while bittersweet, the laughs I shared with my closest friends at, a few vendors, and others overshadowed the losses I encountered. There is something about chatting over a few beers and sharing stories that will never ever make it into print about companies and people that always made the journey worthwhile.

So why go to the RSNA? If I were buying an imaging modality, I unquestionably would be there. There is too much to see and learn that only in-person demos can show you.


But PACS/enterprise imaging systems (EIS) and even artificial intelligence (AI)? If you have already done the due diligence, you may learn one or two tidbits that are new about one of the vendors that were evaluated. You may even run across a new vendor you were unaware of who had something interesting. But is it a game changer? Rarely, if ever.

If I am just starting out looking at PACS/EIS and wanted a very broad market overview or wanted to learn more about a specific vendor's AI product, then the RSNA meeting is unquestionably the place to be. Realistically, though, most of those coming to RSNA already know the vendor or a short list of companies they want to see and use their time in a vendor's booth as a confirmation tool that they are making the right decision.

Many have also already done web demos and maybe even site visits prior to coming to the show. The web demos might not be able to provide you with a demonstration of the processing speed that the workstations at the show possess or some of the advanced processing features offered. But not much beyond that.

RSNA also isn't the best venue for getting a demo when three other people crash your demo asking questions that don't apply to your site. In the limited time you are often allotted for a show demo you need to be able to focus on what you want to see.

I used to love to go to talk to engineers because they were completely unfiltered and would lay out the product's five-year roadmap for you if asked -- and often even if you didn't. Their excitement of getting away was just too much for many of them. Sadly, with cutbacks on who attends and who doesn't you rarely see a development engineer any more.

Catching your attention

On occasion, you also might find something that catches your attention in ways it was never initially intended. A peripherals vendor who has been at RSNA almost as long as I have sent me their RSNA press kit. At first, I was ho hum and almost tossed it aside until an infection-control product caught my eye.

Now normally I wouldn't think twice about infection control at a radiology show. The point about saving three minutes or more per case with automated cleaning versus manual cleaning got my attention. In a market in which saving radiologists seconds makes a huge difference, saving minutes is a literal lifetime. And when you convert those saved minutes to additional study potential, the numbers can be huge, so they will be looked at more closely for sure.

For the most part, though, most PACS demos are like listening to Ethel Merman singing, "Anything you can do, I can do better," with one-upmanship seen everywhere even if the benefits offered don't apply to your site. It's all a matter of how you look at things. Comparing apples to apples is always of paramount importance but sometimes you need to look outside the box to see how technology can best be applied to solve problems.

A lot to see

Seeing all the AI offerings can take up the entire show and then some. With over 200 algorithms having received U.S. Food and Drug Administration (FDA) clearance, you may get to see one out of three, if even that. With few exceptions, most of the 60 or so vendors exhibiting also have deep-enough pockets to afford to exhibit, while others hope at best to get an OEM agreement or reseller or partnership that gets the word out.

There are some very good AI applications from many companies you have heard of and several you haven't. Understand that the cost to compete in this market is very high. How high? A $5 million investment is the absolute minimum needed for an AI company to be even remotely competitive and $15 million is a good starting point to be taken seriously. Several of the companies from East Asia are also underwritten by their countries and have the resources needed to compete without any financial concerns.

There are exceptions, though, like the breast ultrasound AI company that managed to get reimbursement for clients on a budget that is a fraction of what the larger companies have to work with. But they are the exception, not the rule. With AI, though, it often boils down to money. That's why you see so much in print about the "bigger" companies, while the smaller vendors with more spartan budgets operate with so much less and rarely get the press coverage they deserve.

Jump starting the market

Everyone seems to want to see AI succeed, which is why so much attention is being given to helping the AI market jump-start itself. The New Technology Add-On Program (NTAP) was initiated a few years back. Yet, while getting a lot of press, it benefited less than a handful of vendors. Payments of up to $1,040 per use for stroke protocols helped the companies that got this benefit to grow exponentially.

Now the U.S. Centers for Medicare and Medicaid Services (CMS) is offering payment of between $600 and $800 for AI that assists with lung cancer prediction. I am all for anything that helps this market develop and am not begrudging vendors or end users who got money from using AI, but you have to ask at what cost and to whom.

If a Lung CT scan receives Medicare reimbursement at just under $112, how can AI software add $500 or $600 in value to the final payment for lung cancer prediction? Have studies shown it is that good or valuable? More importantly, are the payments being made uniformly available to all the dozen or so players in the lung CT AI market? Those are some of the questions that need to be asked.

Everyone assumed with NTAP what was good for one company would be applied to all. Sadly, that was not the case. With AI, you also need to understand what is being promoted by the company, how that promotion is perceived by CMS and insurers, and what it will take to show a return on investment (ROI). Yes, the technical aspects of the algorithm are important -- even crucial -- but if you can't justify the expense or show an ROI the reality is you may want to look more closely at other options.

Virtual benefits

Virtual RSNA evolved from the years when COVID prevented onsite meetings. The first year left a lot to be desired, but it has evolved and become much better since then. If you can go to the show in person, then by all means go. But if not, virtual will -- or at least should -- provide you with better information than looking at a vendor website alone.

There are several websites that give you information that is untainted by fluff, but so many are poor at best and abysmal at worst. I could cite example after example but that would take up an entire article. I just love the puffery, though. "We helped develop the DICOM standard." That's interesting. While technically correct, as the term "DICOM" wasn't adopted until the early 1990s, the standard actually was conceived and implemented on a limited scale almost a decade earlier by six vendors.

Before it became known as the DICOM standard, the American College of Radiology - National Electrical Manufacturers Association (ACR-NEMA) standard was initially advanced via the U.S. military's large-scale deployment known as Medical Diagnostic Imaging Support (MDIS). I know, as I was there back then. Interestingly, this vendor must have played a role behind the scenes as their involvement is nowhere to be found except on their own webpage. The same vendor also claims to have also completed over 1,000 projects as of a decade ago, yet this is their very first RSNA meeting.

I've heard of having a low profile, but ... Intrigued, I talked with people at the company, and they seem to have solid products and solutions, but you have to ask, do they really need the puffery? Ascertaining what's real and what's not is one of the challenges you deal with when looking at websites alone.

Stay or go?

As the rock band The Clash once sang, "Should I stay or should I go?" If you go, then go with a specific agenda with specific vendors. Try your very best to schedule demos before or after show hours if possible so others don't interfere with you. Or have the company have someone running interference with those who try and piggyback on your demo and pull you in directions you really don't want to go in.

The financial and time investment in going to the show is significant and frankly it needs to show some form of ROI. As I am not a member of the "Is $5 million enough to retire with or should $10 million be the minimum" club, the decision for me was as much financial as any other, with costs more than doubling from last year. I'm sure a GoFundMe account wouldn't have helped me much either; it seems everyone wants to pick my brain and show me their latest and greatest (yawn) as long as there is no financial investment needed on their part.

So, this year, I'm content staying home, reading press releases, perusing websites, chatting with company reps, and doing the RSNA virtually. Heck, I might even do a virtual PACSMan awards, too, although absolutely nothing beats some of the stuff I find from being on the floor of the show. That and getting together in person with my friends are what I'll miss most.

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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