Imaging Informatics Unplugged

What happens when a radiologist, a former hacker, and a cybersecurity leader live in the same person? You get Dr. Benoit Desjardins, and this conversation is one of the most eye-opening we've had on Imaging Informatics Unplugged. Benoit is a Professor of Radiology at the University of Montreal and the first Chief Medical Cybersecurity Officer in Canada at CHUM. He's a consultant for the FBI, a 2025 CEH Hall of Fame inductee, and a past NSA Codebreaker Challenge winner. If you manage a PACS, run an imaging department, or support radiology IT, hit play. This one will change how you think about your environment. Here's some of what we dig into. Benoit shares how a packed DEF CON room in 2017 pulled him back into hacking, and why he frames healthcare cybersecurity as a patient safety issue rather than an IT one. We talk about what really happens to care when imaging goes dark, including the loss of priors and delayed diagnoses. We also compare the US and Canadian approaches to ransomware, why paying a ransom is a risky bet, and how double extortion works when you have good backups.Then we get into the imaging-specific stuff. Benoit explains how he put PHP code into the 128-byte DICOM preamble and took over a test PACS, proving that an image can be part of your attack surface. We cover practical steps your PACS team can take on Monday morning: treat incoming DICOM as untrusted, validate and sanitize inputs, patch the apps that parse images, segment older infrastructure, and monitor for odd behavior. We also get honest about DICOM security, why encryption is often off by default, and the key management problem nobody wants to own.We wrap with what secure by design means for a province-wide PACS in Quebec, what it takes to train a true cyber physician, and Benoit's warning about AI-powered hacking tools and what hospitals should expect over the next six to eight months. It touches AI in radiology, enterprise imaging, VNA strategy, and vendor procurement along the way.If conversations like this make you want to go deeper on the fundamentals, check out the Imaging Informatics Primer course, the CIIP Foundations Program, and the hands-on DICOM Learning Lab at nagelsconsulting.com. They're built for people like you who live in PACS, DICOM, HL7 and Radiology IT every day.Learn more at nagelsconsulting.com#ImagingInformatics #PACS #DICOM #HealthcareIT #RadiologyIT #Cybersecurity #HealthcareCybersecurity #Ransomware #EnterpriseImaging #MedicalImaging #PatientSafety #RadiologyAI #InfoSec #SecureByDesign #CHUM

Dr. Les Folio has one of the most unusual resumes you'll hear on this show. Before he ever read a scan, he was a volunteer firefighter who got burned on his first field fire, a drummerwho hauled his gear around in a hearse, and an X-ray tech who got hooked watching a CT scanner run its first head scan back in 1977. He spent 20 years in the Air Force as a colonel, deploying to some of the busiest combat hospitals in Iraq and serving as a NASA liaison, before becoming a chest radiologist and imaging informatics section chief at the James A. Haley VA Hospital, a professor at USF Morsani College of Medicine, and a longtime board member of the Society for Imaging Informatics in Medicine. He's published more than 150 peer-reviewed papers and remains one of the most active mentors in theSIIM community. Les and Jason start with reading room ergonomics: research Les has led comparing radiologist workstation setups to aircraft cockpits and NASA mission control, and why four monitors, notthree, became the standard in so many reading rooms. From there they dig into a naming problem Les sees nearly every day, CT orders labeled “high resolution” that actually route patients to roughly six times the radiation of a standard low dose scan, and the SIIM hackathon team that tackled it when two competing groups, Rad Guide and Les's own VA team, merged instead of competing. They also cover PACS Man, the crowdsourced lesion-segmentation game that turned a SIIM showcase into aleaderboard-fueled frenzy, and what CIIP candidates consistently underestimate about the gap between passing the exam and being genuinely useful on the job. Les shares a story from a combat hospital in Iraq where point-of-care ultrasound caught a pneumothorax a chest X-ray would have missed, plus an update on SIIM's POCUS work group and the push to formalize POCUS manager roles. He closes with his radiology pre-processing course, which flips traditional shadowing on its head, and a preview of the space medicine work he's doing with NASA flight surgeon Jeff Jones. If PACS, DICOM, HL7, or enterprise imaging AI are part of your world, this one is worth the full listen. Jason also has an update from nagelsconsulting.com: the Imaging Informatics Primer course is a great startingpoint if you're new to the field, the CIIP Foundations material is built for anyone prepping for certification, and the hands-on DICOM Learning Lab gives you live, practical reps with the standard itself. Learn more at nagelsconsulting.com #ImagingInformatics #PACS #DICOM#HealthcareIT #RadiologyIT #CIIP #SIIM #POCUS #RadiologyAI #MedicalImaging#HealthIT #MedicalEducation #EnterpriseImaging #CombatRadiology 4. Hashtags

Quick one this week: no guest, just me and a question that's been rattling around my head for a while. Does Shazam actually hear the song it's identifying? Short answer: no, not even a little. And once you understand what it's actually doing instead, you won't look at your MRI scanner or your ultrasound machine the same way again.This is a solo lecture episode where I trace one piece of math, the Fast Fourier Transform, from a guy studying heat in the early 1800s, through Carl Gauss casually stumbling onto the same trick, to a 1965 breakthrough that made it fast enough to matter, and straight into the guts of how your MRI and Doppler ultrasound actually work.Here's the thread I pull on in this episode. Music is just air pressure moving over time, a messy waveform with no obvious structure. Shazam runs that waveform through the Fast Fourier Transform, or FFT, which breaks it apart into pure frequencies, the mathematical DNA of the sound. That's the whole trick behind catching a song in a loud room.Now swap out the song for a body. MRI doesn't collect an image the way a camera does. It collects raw frequency data in something called K space, and if you've ever looked at raw K space data, it looks like static, not anatomy. FFT is what turns that static into an actual image you can read clinically. No FFT, no MRI image, period.Doppler ultrasound works the same way from a different angle. It's looking at frequency shifts caused by moving blood, and FFT is what converts those shifts into velocity, direction, and flow, so you're watching physiology happen in real time instead of just staring at vessels.I also get into the history, because it's a fun one for anyone who likes the origin story behind the tools they use every day: Joseph Fourier's work on heat transfer in the early 1800s, Gauss quietly beating everyone to the punch, and the 1965 Cooley-Tukey algorithm that finally made this fast enough for real-time medical imaging, and eventually, for your phone in a grocery store.If you work anywhere near PACS, radiology IT, or imaging informatics, this is one of those under-the-hood concepts (DICOM, HL7, and enterprise imaging systems all sit downstream of it) that's worth actually understanding rather than just accepting as a black box.If you want to go deeper on the fundamentals behind the imaging tech you work with every day, that's exactly what we built at nagelsconsulting.com. The Imaging Informatics Primer course is a great starting point if you're looking to build a solid foundation, the CIIP Foundations material will help if you're working toward certification, and the hands-on DICOM Learning Lab lets you get in and actually work with the data instead of just reading about it.Learn more at nagelsconsulting.com#ImagingInformatics #FFT #FastFourierTransform #MRI #Ultrasound #DopplerUltrasound #RadiologyIT #MedicalImaging #HealthcareIT #EnterpriseImaging #PACS #DICOM #RadiologyAI #SignalProcessing #MedicalPhysics

Michael Rosenberg has spent the last decade obsessed with a problem most of healthcare IT would rather not think about: how do you get a medical image from one institution to another, safely and without a human babysitting every step? An industrial and systems engineer by training, Michael cofounded Medicom Technologies in 2015 out of North Carolina State University, and as CEO he and his team built the company around what they call Enterprise Imaging Interoperability. Their software now runs across every VA medical center in the country along with some of the nation's leading IDNs and academic medical centers. In this conversation, Jason sits down with Michael to dig into why some of the most well-intentioned efforts in image sharing, the ACR's Ditch the Disc campaign among them, never fully solved the problem, and what it will actually take to get there.They start by grading the ACR's Ditch the Disc initiative: strong on messaging, short on the policy and mandates needed to change workflow. From there, Michael explains why three-point patient matching (name, date of birth, and one other identifier) is still common in DICOM image exchange, and why he considers it unsafe. He walks through Medicom's FHIR-based approach for pulling additional demographics from the EHR before a match is made, and why the study instance UID deserves treatment as a universal identifier across systems.Jason and Michael also dig into what a national scale rollout looks like, drawing on Medicom's work across the VA network, and how that compares to centralized models already in place in Canada and parts of Europe. From there they cover patient-driven image sharing, including a surprisingly high adoption rate for patient upload tools, the privacy risks buried in supposedly de-identified imaging data, and what happens when interoperability moves beyond radiology into pathology, cardiology, and oncology, where the workflows barely resemble each other. They close with a look at where imaging regulation is headed, including proposed ONC certification requirements that could finally make interoperability mandatory rather than optional.If PACS, DICOM, HL7, VNA, or enterprise imaging AI are part of your world, this one's worth the full listen.Jason also has a quick update from nagelsconsulting.com: the Imaging Informatics Primer course is a great starting point if you're new to the field, the CIIP Foundations material is built for anyone prepping for certification, and the hands-on DICOM Learning Lab gives you live, practical reps with the standard itself.Learn more at nagelsconsulting.com#ImagingInformatics #PACS #DICOM #HealthcareIT #RadiologyIT #EnterpriseImaging #VNA #HL7 #RadiologyAI #MedicalImaging #Interoperability #PatientMatching #FHIR #HealthIT #DitchTheDisk5. Chapter List (Timestamps)Note: chapter times are offset by 1:23 to account for the intro script

Norman Young has spent 25 years building software at the intersection of imaging and medicine, but the story behind his work starts with his own diagnosis. In 1992, as a third-year engineering student at the University of Toronto, Norman was diagnosed with Hodgkin's lymphoma, an experience that reshaped the rest of his career. After working on eFilm, one of the first free PACS viewers, at University Health Network, he founded ClearCanvas in 2005, an open-source medical imaging platform still used by clinicians around the world. In 2021, the American College of Radiology recognized his work with their Global Humanitarian Award. Today Norman is building something new: CareChorus, a nonprofit aimed at helping patients and caregivers make sense of their own medical records.Jason and co-host Mohannad Hussain sit down with Norman to trace that whole arc. He explains why ClearCanvas went beyond free software into full open source, what it took to build a professional-grade PACS and RIS largely on his own before landing the hospital contract that got the company off the ground, and what it was like watching download counts climb from every continent, including, improbably, Antarctica. They also get into how AI coding tools like Claude Code and Codex are changing what a small team can ship, and why Norman still insists on reviewing every architectural decision even when the AI writes the first draft.The back half turns personal. Norman walks through the two stories, one about a friend's husband facing a serious diagnosis, the other about a colleague who passed away after struggling to get coordinated care, that led him to found CareChorus. He breaks down the four problems the platform is built to solve, from organizing scattered medical records to helping patients actually understand what their reports mean, and explains why he built it as a nonprofit with data that stays on the user's own device rather than in the cloud.If PACS, DICOM, open-source imaging informatics, or healthcare IT are part of your world, this conversation is worth the full listen.Jason also has an update from nagelsconsulting.com: the Imaging Informatics Primer course is a great starting point if you're new to the field, the CIIP Foundations material is built for anyone prepping for certification, and the hands-on DICOM Learning Lab gives you live, practical reps with the standard itself.Learn more at nagelsconsulting.com#ImagingInformatics #PACS #DICOM #HealthcareIT #RadiologyIT #OpenSource #EnterpriseImaging #HealthIT #MedicalImaging #PatientAdvocacy #AIinHealthcare #CIIP #DigitalHealth #HealthTech