Imaging Informatics Unplugged

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

What happens when a remote Arctic community with zero medical radiation technologists needs a chest x-ray — and the nearest one is a plane ride away? In this special crossover episode with SIIMCast, Jason and Mohannad sit down with Greg Toffner, a PhD researcher training local Inuit community members across 25 Nunavut communities to become Basic Radiological Technicians (BRTs). Greg breaks down the concept of task shifting, how it’s reshaping radiology IT access in one of the most geographically isolated regions on earth, and what six years of hands-on curriculum design, mobile x-ray equipment, and government policy work have taught him about building a sustainable imaging informatics workforce from the ground up.You’ll hear real numbers on health disparities in the North, how a 60-procedure competency framework turns a health center janitor into a trusted member of the care team, and where AI might eventually fit into enterprise imaging and radiology workflows in low-resource settings. It’s a conversation about access, dignity, and what imaging informatics looks like when PACS, DICOM, and specialist radiologists aren’t around the corner.If you’re building your own credential in imaging informatics, check out the CIIP Foundations Program at nagelsconsulting.com, and keep an eye out for our upcoming DICOM training program featuring hands-on, live imaging learning labs: Learn more at nagelsconsulting.comKey Topics Covered• What “task shifting” means and how it’s applied to solve radiology workforce shortages in remote Arctic communities• Life inside Nunavut’s 25 flying communities — the geography, climate, and health disparities driving the program (life expectancy, respiratory disease, and smoking rates)• How Greg’s team built a simplified radiology curriculum for learners with no formal healthcare background• The three-phase, hands-on training model — from image critique to a 60-procedure competency audit• Why government policy recognition, not just curriculum quality, is what makes a task-shifted role sustainable• Early findings from Greg’s PhD research: pride, community trust, and the ripple effects on local health outcomes• Where the program is headed next — expanded scope into lab work and ECGs, and where AI might fit inhealthcare IT, medical imaging, radiology technology, healthcare interoperability, PACS administration, DICOM standard, HL7 integration, radiology informatics, imaging workflows, vendor neutral archive, enterprise imaging, radiology AI, medical imaging data, PACS migration, rural health access