Monday, December 1, 2014

Lovely whether on the first day of RSNA 2014

It's that time of the year. I'm in Chicago again. Luckily, this year the whether is welcoming. We had a lovely two days and only this afternoon the temperatures are starting to drop. Tomorrow it's going to be below zero and hopefully it will get better during the rest of the week.
RSNA is a great opportunity to meet with colleagues and customers and see what's new and where things are going to. Apart from Big Data which is the number one interest right now, The two hot topics this year seems to be Image Sharing and Dose Recording and Monitoring (which I hope to cover on a future post). On the imaging side, I think the focal point is on Ultrasound technology that brings to the table its best up-side, no radiation damages! So Ultrasound has to evolve to the point where more and more anatomies and pathologies can be imaged with this great device. And it defiantly going that way. We're seeing giant steps in breast ultrasound imaging and many other fields will follow as hardware and software will evolve and mature. There's also the question of price and how it affects this technology. Ultrasound device is by 10's, 100's and 1000's less expensive to purchase and to operate compared with CT and MRI.

Image Sharing. Of course it links directly with big data which will also wait for a future post. As an ex-enterpuneer in this field with XRFiles, I'm always curious to see how the business model is built. One of the issues we had with XRFiles, apart from the misfortunate fact that we failed to raise money on it for various miserable reasons, was that patients don't want to see their images or any other medical data unless they really have to.

We found out the hard way that unless patients were extremely ill, I mean almost dying, they didn't want to know anything more about their health other than what they absolutly have to know and that didn't include looking at their X-Ray or CT images. X-Rays and CT's and Ultrasounds mean nothing for patients because they usually can't read it so they can't understand what they are looking at. That's what doctors are for, to read it for them. Patients want to sit face to face with their doctor or at the minimum read a report. This was one of the reasons back then that our business model that was based on consumers paying for our service was completely wrong.
This was in 2009 and since then a lot has changed. Patients still don't want to see their images but on the technology side, internet technology and cloud computing services are accessible and easy to integrate with and good HTML5 viewers based on great JavaScript code are on the shelves for very competitive prices.
Businesswise, nobody expect today patients to directly pay for their images shared and their EHR maintained. It becomes clear that Image Sharing is a must have just like DICOM was 20 years ago. If you want to sell a PACS to medium-large healthcare enterprise, today you have to offer built in Image Sharing capabilities.
The issue right now is how you do this. On one hand there's IHE XDS-I. On the other hand there are Imaging and Heath information Data Banks. There's still not one standard that takes over all the others and its interesting to see how it will evolve. IHE is peaching XDS for almost a decade but its still not the gold standard. This says something about XDS.
Regardless of what standard will take over on the image sharing, there's steel seems to be a gap on the usability side between zero footprint Web Viewers and stand alone local DICOM image viewers. This gap is natural but I think it can be bridged and up to now I haven't seen the one zero footprint HTML5 DICOM viewer that gives the same or even close to user experience that a standalone DICOM viewer does. Such product is at the top of my wish list for this RSNA and I haven't found it yet. Until than, for my company, H.R.Z., we will continue developing our DICOMIZER and add more stand alone, multi-modality DICOM viewer features to it, and relay on file sharing technologies available and reliable today, such as for example google drive and Dropbox and Amazon and many others, in combination with encryption and patient health confidentiality measures, to get the data to us as DICOM files on the local computer so it can be displayed properly. Once you have the original images on your local computer, you can work on them efficiently.

p.s. If you're also visiting RSNA and would like to meet please drop me a note on my email (it's roni@ ... our domain


  1. Hi,

    Are you there this year (2015)?

    1. No. This year I skipped RSNA. Apparently many others did the same.