Finally! DICOM images with Viewer. ;o)

I emailed the Rep yesterday from TigerView™ and asked if he has spoken to Dr. East. He said "No". He called twice and emailed once.


I then called Dr. East's office and gave them the Rep's name and number again.


Today I received an email from the Rep stating that the files were all set at Dr. East's office. He was able to work remotely through his computer to a PC in Dr. East's office and got it done himself.


The receptionist gave him access. (I'm sure this was done with Dr. East's permission.) But they had no CD to burn my xrays on.I would have to bring them one.

I went in with a CD today and had them burn the files for me WITH the Viewer. YAY!!!  (Incidentally, I saw Dr. East as I was waiting for the receptionist to burn the CD and he said nothing to me. I said "Hello Dr. East" and he smiled briefly.) He hates me now I'm sure. ;-(

I tested the CD on a PC and VOILA! I sent the files to Dr. West immediately. Now he will be able to measure and know exactly what we are dealing with when I see him soon. I'm curious to know if Dr. West feels I am a candidate for the one-stage surgery! I'm excited!!! 


Tootles!

Thanks for following! ;-)

Sometimes You Have to Take the Bull by the Horns ;-)

© www.freewebs.com - © DNC

OK. So I got myself to a PC and popped in the CD given to me by the hospital where I got my mammogram done. It was very easy to go in, get the image to display via the Dicom Viewer, and use the tools to make measurements. So at least I have proof of what I suspected and am asking for from Dr. East.

Wait to you hear the latest. ;-)

After figuring to leave things as they were, (accepting that Dr. East truly knows nothing about DICOM)... it really bothered me to then hear that the program he has, TigerView, can actually output what I'm asking for.

So I went onto the TigerView website and submitted an inquiry in their contact page. Asking for the steps on how to produce DICOM images from their software. Someone emailed me back right away, asking me for personal info to better help me. The info they wanted was based on them thinking I was a customer who had the program. I replied with a simple reason why I was asking and my phone number.

A day later I was called by a Rep from TigerView who asked me what I needed exactly. He understood and asked for Dr. East's name and location. He then seemed to be able to pull up Dr. East's account. He told me that he would "activate the module" needed free-of-charge so that this request could be facilitated for me. YAY!!! (This leads me to believe that Dr. East, in order to be able to provide any further request of this kind for his patients, would have to pay for the use of this particular module.... what an education I'm getting ;o)

The Rep said he would be contacting Dr. East to walk him through it.

I thanked him greatly and told him that I in no way wanted to upset Dr. East, but really needed this. The Rep called Dr. East and left a message on Friday. No response. I then gave him Dr. East's email address because Dr. East seems to answer very quickly via his Blackberry. An email was sent out on Monday to Dr. East stating the reason for the contact and I was CCd. It's now Tuesday. Let's see if Dr. East truly meant it when he said he really wanted to get me what I needed.

Tootles! ;-)

My Education on DICOM (xray format you should know!)

© DNC -
www.brachymetatarsia.blogspot.com

Yesterday was a back-and-forth-day with both Dr. West and Dr. East. (This is actually the short version... Many emails. ;o)

I sent a third request to Dr. East via email asking for my xrays in the DICOM format. (Having to pay for such an expensive visit with him and then having to pay for another set with another doctor just didn't make sense.) Part of my email: "...It is normal and legal practice for xrays to be provided on CD as DICOM images along with the "reading" software. Not TigerView, but with the PC AutoPlay DICOM Viewer....."

He called me back within 20min. He was not rude, but seemed confused. He expressed not knowing what I was asking for. He barely let me get a word in, going on about his confusion. I had to actually ask him to give me a moment.

The result of his call?
He's only able to provide: TIF, JPG, either of those placed in a MS Word doc, or a paper printout. I thanked him, but expressed 1. I could do all that myself, and 2. It was not what I needed.

He asked, "what are you trying to do?!" I repeated what I had said before: "I want any hospital/physician to be able to make measurements."

He said he had never heard of DICOM..... blah blah. Also stating, "Most podiatrist don't even do DIGITAL xrays as we do." I left it at that and thanked him (for nothing).

I contacted Dr. West via email with the following:

• While I have an upcoming appointment with him in two weeks, I was still trying to get the xrays from Dr. East.
• I informed him of the unfruitful results with Dr. East.
• Researching I discovered 2 things
    1. I can save out a TIF into DICOM format (.dcm) with
        Adobe Photoshop
    2. There are free DICOM Viewers he can download
        online to then view them.

       (FYI: a Dicom VIEWER is sort of like Adobe Acrobat
       READER. The acrobat program cost something but
       the READER does not.)

• I sent him two .dcm files
• I sent him a link to a free PC downloadable DICOM Viewer (I had tried this myself on my Mac and was able to view the DICOM files in the Mac version of a Free DICOM Viewer.)

He got back to me very quickly (meaning he probably did not download the viewer and try it at that time.) He informed me however that:

"You can convert the TIFFs to Dicom via Photoshop, but the original file must have the proper registry. Therefore your file will not work accurately and can't be used for surgical planning. By the way, TigerView does produce DICOM images." cosmeticfootsurgery.com 

I had already been thinking about my call with Dr. East and decided to give him the benefit of the doubt, that he really was unfamiliar with the whole DICOM thing. Even though based on Wikipedia, it seems like a standard thing 'now-a-days'.

I thought that I should send Dr. East all the info I had gathered on this so he could be informed and ready for other clients who may request the same. I mean, if it's something his fellow physicians know about, perhaps he should too. (Seems strange to me. His website really gives you the impression that they have "state-of-the-art" equipment, yet he doesn't know about the DICOM format or its practice.)

leepodiatry.com

But now Dr. West was telling my that TigerView (The program Dr. East uses) is able to save out files in DICOM format!! Uhg.

© DNC -
www.brachymetatarsia.blogspot.com

I was still waiting for Dr. East to reply to a request for my left-foot xray without his red markings on it, when I sent him another email informing him that TigerView can be saved out the files as .dcm format!

I asked that he do this and I sent along with it:

1. a TigerView toturial/ statement pdf I found online about how to do this. (pg7?)

(I wasn't going to just take Dr. Wests' word for it. I looked it up.)

2. A link to a webpage mentioning DICOM and TigerView in the same breath

I received an email from his office stating:

"At the moment we are unable to process your request. As our prior conversation, here is your left-foot image as a jpg. Thank you."

I'm not naive, I'm inclined to believe this email was sent by one of the receptionist from Dr. East's office. They know how to save to jpg and email I'm sure. He had called me before from his cell, so I'm sure he was off-site at the time.

I can only hope that he'll look into my request further and be pleasantly surprised that he could do it all along.??  It would be great if this would happen in two weeks before I leave. If he never replies back then he knew all along or is not inclined to be in-the-know?

In any case I've done all I can at this point. What will be— will be. ;-)


One last thing, I did notice that Dr. West's office as a whole stays out of things. They kept quiet and never told me about the difficulty I'd have finding a local doctor to take xrays (yet they knew I would); while I explained all the difficulties in getting the xrays in a format they wanted, they really never went out of their way to help me get them from Dr. East. I will say, my emails were never completely ignored, in time they did answer them all at this point.


But I guess I was hoping that maybe they'd write something out to help me ask for them properly (I did request this)— in the right medical verbiage or something. Or maybe go the extra mile and call Dr. East to get what they needed. But they never did that. They stay out of it. You have to fend for yourself.

Here are some things for you.

You and your image records

TigerView and DICOM

I'm pooped! ;-)

Education on Xrays

© www.localwin.com

So I've been waiting for Dr. West to send me some information which would lead me to take another set of xrays. (In the meantime, I received an invoice from my insurance company. They will pay half of the bill for the 1st set of xrays from Dr. East's office. I will have to pay over $300 out of pocket! That means the visit and first meeting at Dr. East was about $700!) I would probably not mind this so much if Dr. East were to give me the proper files I could send to Dr. West. But he has refused stating he can't provide what I need.

This is against the law by the way. A patient, by law, has the rights to their records. You may have to fill out a request form, pay a small handling fee, but they are yours by law. Dr. East has basically given me my xrays but in a format no other doctor can use to measure to make diagnoses, etc.

My research taught me about the files being needed in a specific format. (After all I've been through I am very disappointed with Dr. West and his assistant, that through several emails of stating my difficulties, not once did they give me the proper format name for the files they needed. I had to research and learn myself.)

Fortunately, (I think ;-) I just had a mammogram and decided I would ask for copies of my xrays to see what they would provide. (A sort of test to see how hard this would be.) I had to fill out a request form. On it they asked what they would be used for. I wrote that I wanted to be able to take them to any other physician as well as for my own records. I waited about a week and a half, but they did provide a CD.

© DNC -
www.brachymetatarsia.blogspot.com

The files are in the format that my research indicated they should be. Something having to do with DICOM. (I'm on a Mac. DICOM is mostly used on PCs. I will test the CD tomorrow on a PC and let you know how it turns out.)

Anyway, as fate would have it, I have to make a short unrelated, impromptu trip out West! So of course I called Dr. West and set up an appointment to have him take another set of xrays. Terrible that I have to pay another bill on this. I'm inclined to try and contact Dr. East one more time and mentioning the actual format names I've learned and maybe say that I've spoken legally to some organization to see if he would then release the xrays in the format any other Doctor can use?

I feel if I do, he would claim he never got the email, or make me wait a terribly long time for them. But I'll stay positive and be thankful that in two week I'll be face to face with Dr. West and hopefully make up for lost time with Dr. East.

Oh and remember, this all hinges on my job. Being granted the many weeks to work off-site.... across the country? My company is going through some changes and I really don't want to be out of sight. But if all works well outside of that, I think I'll take the risk of being out of eye site. I work a bit from home already anyway for their pilot testing.

To say the least, I'm very excited. ;-)

NOTE: Aiming to provide all the details of the process may put out a gray tone, but please don't think that. (Giving all the detail I can will allow you to anticipate some possible things and hopefully avoid them if you can in your own corrective journey.) Anything worth doing will come with red-tape and with things that don't go your way. ;-)

But I'm happy about this as a whole! 

Dr. West, Dr. East, and my Xrays

© www.stoneybrookvets.com

It took over a week to find out that Dr. West's office received my package. Anyway the issue now is that he can not accept the hi-rez TIFF files from Dr. East for my xrays. They stated that he needs the digital files along with the program (software) that will allow him to measure bones, etc. (A phone consultation can not be done until he has the proper xrays. OY.)

I had suspected this was going to be an issue because I had read this specification in Dr. West's package he emailed to me several weeks ago. ;-(

I called Dr. East's office and they stated they could not supply software that they had paid for. (TigerView) So I related this to Dr. West's office. Then they explained that they never expected the TigerView software. I asked how this has been handled in the past with non-local clients. "Surely I can not be the first to be going through this difficulty." His assistant, (we'll call her Brenda), told me that it isn't the easiest thing, but that she has received CDs with the xray files without the software, yet when opened they are still able to make measurements. I asked her to tell me what format those files have been in, she was unable to say for sure. Uhg.

So I'm a bit stuck. Dr. West needs to be able to make measurements to determine if I am a candidate for the one-stage Brachy surgery. He offered me another option to get xrays he can measure. (To protect parties, I will keep this solution to myself.) While it's wonderful to have another option to manage Dr. East's uncooperative manner, it means more time I have to wait to get a second set of xrays done. Not.

I had hoped to have had my consultation with Dr. West by now. Oh well.

As you may recall Dr. East's first reaction to seeing my foot was that I may be a candidate for the one-step method. Then after measuring the xrays he said I was not. His measurement was 1.2 centimeters. He stated I had just missed the candidacy. (He also seemed to mention that if I still wanted the one-stage it would mean the short metatarsal would not be the same length as it appears on my unaffected right foot.

Dr. West's informational package states that he can perform the one-stage method up to 20mm (2 centimeters!) So there seems to be a conflict to me in what each of them considers to be the cut-off mark for candidacy.** But this is my pure speculation at this point. I will not know for sure until Dr. West is able to have xrays he can actually measure. (Dr. West can not make medical determinations based on another doctor's measurements/practice— and I don't want him to either.)

**I wanted to point out that Dr. East uses a cadaver bone while Dr. West says he harvests the bone needed from the patients own heel. I'm not sure if this is the reason for the difference in measurement-candidacy between both practitioners.??

Bye for now! ;o)