If anything has become apparent this week at RSNA, it is that there is a sense of unease, even foreboding, among attendees of all stripes, from radiologists to IT and other executives, to consultants and vendors. While on a very superficial level, the halls at McCormick Place appear similar to past years, just below the surface, there is a sense of nervousness and anxiety everywhere.

It’s interesting to me that the RSNA folks are refusing to release daily counts, while promising some kind of attendee count within a couple of weeks. I’m guessing that if the actual attendance numbers are widely revealed and known, even more attendees will decide it’s not worth their while and might exit the exhibit halls early. As Scott Grier, CEO of the Sarasota, Fla.-based Preferred Healthcare Consulting, told me this morning, “I have not seen the final numbers, but from what people are telling me and what I’m observing, is that far fewer people are attending than in years.”

Grier, who has attended every single RSNA since its inception three decades ago, added, “While the traffic in the Lakeside building” (the eastern building in the three-building complex that is McCormick Place, here in downtown Chicago) has been good this year as it was last year, “You can go bowling down some of the aisles” in the western building (Halls A and B), “and you can get a taxi right away”—something unknown in recent years. “It’s evident,” he said, “That traffic overall is down.” What’s more, he added, “I’ve spoken with about 20 vendors who are my typical contacts” this week, and none of those vendors are at capacity in terms of needing additional help from outside consultants. Everyone, he said, seems to be waiting for the much-awaited ARRA-HITECH-related clinical IT spending to kick in.

More ominously, because radiology-related clinical computing was not explicitly mentioned in the initial communications around ARRA-HITECH, there is a great deal of confusion and frustration—not to mention exhibit-floor speculation—around just how image-related computing and communications might figure into any final meaningful-use language or mandates. Vendor executives have a very good point when they note (as many have been) that computing and communications around the image really are a significant component of the electronic health record. A source I met this morning with strong ties to the ONC told me that ONC leaders have taken note of the many comments and letters coming from the vendor and provider communities in this area. We’ll see what happens.

In the meantime, everyone involved in imaging and imaging computing may need to accept a “new normal” of lowered expectations in terms of business, reimbursement, everything. Is McCormick Place in December 2009 like New Year’s Eve in Vienna in 1913…??? I keep thinking of the brilliant 1981 book, A Nervous Splendour: Vienna 1888-89, by Frederic Morton; or of numerous British films I’ve seen set just before World War I. Is the RSNA world of the 1990s and first decade of this century about to slide into permanent decline? Or will this world make a relatively speedy comeback?

No one really knows, of course. Yet the air here is thick with anxiety and uncertainty. Stay tuned for RSNA 2010 to see how things (begin to) play out.

Department of Good Works

Meanwhile, here’s the most uplifting thing I’ve seen yet at RSNA this year. Merge Healthcare, in its booth, has allotted space to highlight a technology advance being created by a not-for-profit organization that aims to improve disease diagnosis in developing countries. According to the World Health Organization, two-thirds of the world’s population is without access to basic x-ray services (not to mention PET-CT et al). But the World Health Imaging, Telemedicine and Informatics Alliance (WHITIA) has unveiled Remi-d, a new product concept that provides for remotely operated x-ray capabilities to help developing countries with large incidences of HIV, tuberculosis, black lung, and other diseases. It is a self-contained digital x-ray device intended for use in areas such as sub-Saharan Africa, South and Central America, and Southeast Asia, where radiologists and rad techs are few and far between. Remi-d looks like a little voting booth or white closet, with three walls. The individual steps inside and is able to make use of directions conveyed remotely to them, to initiate a remote x-ray scan. What’s more, a radiologist or rad tech located anywhere in the world can guide the individual through the scanning process.

“When Remi-d’s development has been completed and the device has been approved, we hope to make a significant difference in the screening of diseases worldwide,” said Ivy Walker, CEO of WHITIA, in a press release.

Seeing this device, which is focused on the whole rest of the world outside the advanced industrialized nations, helped put a lot of what’s going on at McCormick Place into real perspective for me when I saw it this morning. Kudos to Merge Healthcare for supporting an organization like WHITIA and for showcasing their Remi-d device. For more information, go to www.whitia.org.