The PACSman Pontificates: Reflections on SIIM 2022

By Michael J. Cannavo, contributing writer

June 20, 2022 -- I have been involved in medical imaging for almost 40 years now. While people talk about the late Samuel Dwyer, PhD, and his contributions to the Society for Imaging Informatics in Medicine (SIIM), I recall sitting on my back porch at my house in Maitland, FL, back in the early 1980s, getting Sam's sage advice on how to start my fledgling PACS consulting business.

Mike Cannavo
The PACSman, Mike Cannavo.

He also gave my then fiancé and me advice on marriage that I wish I had listened to more closely. He loved imaging almost as much as he did his wife Mary Lou. He called her at the same time each night when he was out of town as well. That was classic Sam.

He also advised me to join an organization I had never heard of back then called the Society for Computer Applications in Radiology (SCAR) -- now known as SIIM. So how has SIIM evolved from its humble beginnings? There are many good people and companies who are a part of SIIM, but I would love to see a few improvements made to the annual meeting to enhance its value for attendees.

Onsite attendance at the annual show is closer to what one would expect at a smaller show like the annual AHRA or Radiology Business Managers Association (RBMA) meetings than a technology-focused organization like SIIM. Better than half of SIIM attendees support PACS either as PACS systems administrators or other support personnel.

Although these are key influencers for PACS-related decisions, they are not the decision-makers. Still, it only takes one strong influencer or decision-maker to make a favorable decision to buy an exhibitor's PACS to justify the cost of exhibiting. Artificial intelligence (AI) is different. Radiologists need to see AI to make a decision on which AI solution is best for them, so the RSNA might be a better venue for that, perhaps supplemented by an AI course or two from SIIM.

Expo Hall

I thought I knew most of the vendors in the marketplace but there were over a dozen companies at the SIIM meeting in Orlando that I had never heard of before. Those were companies outside "Startup Street" as well, which had me singing that famous Rolling Stones song of a similar name for days. The smaller venue does provide an opportunity for more one-on-one dialog than you could get from a larger show like the RSNA meeting or the Healthcare Information Management Systems (HIMSS) conference, so that is a plus as well.

Over 50% of attendees were from universities or corporate environments as well, not your regional community hospitals that make up the lion's share of PACS/enterprise imaging system purchases. In fairness, though, many corporate entities have been gobbling up smaller community hospitals like PACMan eating anything on the screen while trying to avoid the ghosts. But still ...

Education is a big focus of SIIM, and the number of educational presentations and topics were impressive. While many had the potential to educate, the format of having several panelists share a fairly small block of time didn't seem to work as well as one or even two presenters might have. Admittedly, I only sat in on a few presentations, but that was enough to get a feel for the format being used. Areas I would like to have seen covered would have been cloud-native vs. cloud-enabled systems, what makes AI algorithms different (in nontechnical terms), and a host of other areas presented in plain English.

Many attendees were there scoping out the marketplace for a replacement PACS/enterprise imaging system. I chatted with several about what they hoped to find. Many had an idea of what they wanted but almost everything they wanted to find out could just have easily been handled remotely.

The process still being used -- request for information (RFI), request for proposal (RFP), vendor evaluation, and selection -- hasn't changed in over a decade. This significantly extends the decision-making process and provides the end user with little added value, if any, with the consultant they may employ being the only one who benefits. I haven't used that process in over a decade, saving clients time and money and often getting superior results.

Although some facilities have added workflow-related information to the vendor assessment process, this was far from universal. It reminded me why so many second marriages fail. It is the classic definition of insanity: doing the same thing over and over again and expecting the outcome to be different. Although, you may luck out and find a better vendor partner, even if you haven't changed.

AI presence

I was surprised there were not more AI vendors present, especially some of the larger players. This could be due to the fact that there are so many upcoming shows to attend including the European Congress of Radiology in July, causing vendors to pick and choose where to exhibit. There were about a dozen or so AI vendors represented, plus the major PACS/enterprise imaging system vendors displaying integrated AI offerings.

It was enough to get a flavor for the marketplace but not enough to go back and report about more than a single vendor or two they may be interested in. Only one vendor promoted eligibility for current procedural terminology (CPT) codes, which is key to reimbursement from a return investment (ROI) standpoint and with it, greater acceptance of the technology.

Although reimbursement today is voluntary on the part of the payors with a Category III code assignment, the fact that a CPT code even exists is a huge leap forward. CPT codes are forever and have a much longer duration than other programs that provide payment on a year-to-year basis. Once the CPT code goes from a Category III (no assigned relative value unit [RVU]); the payor determines payment or not) to a Category I (fixed associated payment amount) reimbursement is automatic and the value proposition can then be demonstrated. This process should take a few years at best, though.

OTech acquisition

SIIM has done a few good things recently including its recent acquisition of the PACS, DICOM, and HL7 training assets from OTech at the end of last year. OTech started PACS administration certification well before SIIM began offering the PACS Administrators Registry and Certification Association (PARCA) certification. There were significant differences between the two programs, and now that they are unified, I hope a lot of the benefits OTech's program offered will be retained by SIIM.

Hopefully attendees got out of SIIM 2022 what they came for. Sam summarized married life like I would about the show: you get out of it what you put into it. From an educational standpoint, SIIM does a fairly good job and gets kudos for that. That said, it can and definitely should be a two-day show, not three.

In addition, some format changes need to be made to many of the presentations and there needs to be a bigger distinction between the virtual show and onsite to justify the cost differential, even though the networking aspect can't be overlooked. In the end, it's all about cost-to-value, just like it is when looking at PACS, AI, or any of the technologies being promoted.

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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