A Most Influential Online Extra

Posted By: Jane Kollmer

By now I'm sure many of you have seen this week's "Most Influential in Radiology" issue. We're very proud to present this year's list of people who are making things happen in radiology. Unfortunately, we were limited to a certain amount of space, so what we included in the print issue had to be kept on the shorter side.

But since we have this handy-dandy blog, I figured I would give you all a little "behind-the-scenes" scoop on one of the Most Influential honorees - Dr. J. Martin Pfaff, or "Marty," as he is more commonly known. With such a rich background in PACS, I felt like his story warranted further explanation on our Web site. His stories about the early days of PACS are truly entertaining. PACS has come a long way, it seems!

So, sit back, relax, and read about Marty Pfaff, who I had the pleasure of meeting in person at SIIM. At the end of this passage, be sure to follow the link to a Webcast featuring Marty so you can see him in action. On another note, I'll be going on vacation to sunny Florida for the next few days, so I leave the magazine in the able hands of the remaining staff.

J. Martin Pfaff, PhD, has a history which traces itself to the dawn of the PACS technology era. Dr. Pfaff completed his Stanford education and enrolled in the Medical Physics Graduate program at UCLA. He began his career in medical imaging at UCLA, where his position as a research scientist at Cedars-Sinai Medical Center helped forge his experience in image processing.

Dr. Pfaff developed early image processing techniques to determine the morphological characteristics of coronary arteries using early digital subtraction angiography systems. At that time, the power of the computers used was barely more than today's hand-held calculators. He recalls when ADAC provided their research department with the first IBM Gigabyte disk, a 4 foot cube with a startup protocol rivaling NASA's shuttle launch sequence! During this time, Dr. Pfaff formed his early friendships with other pioneers of medical imaging, and forged his passion for this field. Being one of the first to see the images from early MR phase-contrast pulse sequences and the clinical impact that Maximum Intensity Projection (MIP) image processing had on MR angiography inspired him to architect his early Rational Imaging PACS system.

Dr. Pfaff recalls that radiologists resisted PACS at first, complaining about reliability and the fact that digital reading was slower than film at that time. But, radiologists endured in the hopes of reducing film costs, improving service for the referral base and providing more personalized service. Dr. Pfaff has vivid memories of the early teleradiology systems, which were mere "cameras-on-a-stick" focused on a viewbox. This, combined with modem delivery of lossy, compressed, JPEG images, were largely only good for "wet" reads, and interpretation would have to wait until the following day. With improvements in computer technology, networks and software design, PACS evolved to dedicated reading stations, enterprise image distribution and workflow enabled systems.

In his Rational Imaging PACS, Dr. Pfaff pioneered many of the capabilities now available across the industry, including anatomic grouping, dynamic cross referencing, stacked image displays with mouse scroll, user-configurable hanging protocols, paper-film, key-image summaries and anatomic triangulation using a distributed architecture with image manager coordination. Early in Rational Imaging's development, Canon carried his product. "A sales representative at GE introduced me to an executive at Canon", remembers Pfaff, "Canon was trying to get UCLA to develop medical imaging using the Canon printer, and thus, the partnership began." At the time, Pfaff was working for Tower Imaging in Los Angeles, CA, developing teleradiology applications to help them cover remote hospitals. "The Canon printer was under-utilized at UCLA," recalls Dr. Pfaff, "with most of us using it to copy wedding pictures!"

This partnership helped Canon enter another vertical market; increase sales of high-end color printers and helped establish a customer base for its DX entry into the market. When Canon decided to exit the PACS industry, Dr. Pfaff continued his passion as an independent company, Intuitive Imaging Informatics, LLC. "This gave us direct contact with the customer base," Pfaff elaborates, "allowing us to provide the highest level of customer service." Though working in a smaller, independent company has its advantages, buying organizations for hospitals sometimes make it difficult for smaller companies to bid on technology.

The early days of PACS were fraught with obstacles; some not exactly necessary... "Our system went down during the night coverage three days a week, and we could never figure out why," Pfaff muses, "then, one night I stayed late, and discovered that the janitor would remove the power for the server to plug in his vacuum!" Even the early trade shows bring back memories. "At the first RSNA, there were less than 5 PACS companies involved," Pfaff reminisces, "today, 50% of the booths offer some sort of image display capability."

"It is very gratifying to watch and contribute to the evolution of Radiology practice over the years," says Pfaff. "Twenty years ago, radiologists worked in dark reading rooms, covering only the nearby community; they also had to cover all modalities, since specialization wasn't always economically feasible. Radiologists began using PACS to expand territories and cover remote facilities, leading to specialization and an increase in the quality of care." In a business where sites frequently change PACS vendors every 3 to 4 years, Pfaff is proud that he has customers that are celebrating their 15th consecutive year with his technology! Dr. Pfaff is happy that he played -- and continues to play -- an important role in PACS innovation and development.

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