Saturday, March 1, 2008

Escape from Paper Mountain

In the days of yore (about 5 years ago in internet years), radiologists interpreted physical films. Many of these films were large (14" x 17") , were stored in large paper envelopes, and were theoretically stored in a film library, which occupied a large chunk of every radiology department. This theoretical ideal was approached only in film libraries run by file room gnomes as fanatical as those in Gringott's Wizarding Bank. In practice, most of these libraries operated in a state of barely controlled chaos, with film folders squirreled away in doctor's offices and locker rooms throughout the medical center.

Life in the medical imaging world is much better now. In the past 5 years, a large fraction of medical imaging has gone completely digital. The images are acquired digitally and stored digitally, usually in an online digital film library called a PACS (picture achiving and communication system). File room gnomes have largely been supplanted by an equally fanatical group of IT gnomes, who keep the PACS and radiology workstations up and running.

Moving to a PACS system has solved so many of our old film-based system that most of us would never go back. Images are stored centrally where many folks can view them simultaneously. Search and retrieval of images is usually a piece of cake -- most decent PACS systems automatically find and open an appropriate comparison image right next to a new exam.

Now that this major part of my life has been enhanced by going digital, I've eager to find ways of upgrading other parts of it. Even though my office is no longer dominated by stacks of films, it continues to be crowded by paper. My file cabinets, desktop, and yes, even my floor are filled with journals, manuscripts, forms, letters, research data, receipts and lots of other crap. This paper glacier even extends an arm into my home. It was therefore with great interest that I ran across an article on the 43 Folders personal productivity site called Palimpsest: the guide to a (mostly) paperless life, by Ryan Norbauer.

This article echoed a lot of my own feelings on the tradeoffs between paper and digital:
Paper also lacks a number of the affordances of its digital counterparts: pen and paper don't offer very good full-text search, for one thing—and the spell check is even worse. But as a medium for encouraging unbounded creative thinking and planning, nothing quite beats a hunk of the old papyrus.
Another great quote:
... the key is to recognize that paper is all about process, whereas digital media are all about information and retrieval.
Bold words, but just how does one convert mounds of paper into some useful digital form? For me, so far, the answer has been the phenomenal ScanSnap S510M, by Fujitsu. This little jewel lets me drop a stack of papers into its built-in automatic document feeder, hit one button, and then ignore it while it converts the stack into a PDF file at up to 36 pages / minute in duplex mode. The ScanSnap scans both sides simultaneously in color, at an optical resolution up to 600 dpi. The scanner comes with a full copy of ABBYY FineReader, which converts the PDF's into searchable PDF's. This latter feature is the final clincher for me. In this context, searchable means that one can search for a particular word within the scanned PDF. For me, this works either while viewing a single PDF or while searching my hard drive via Spotlight.

Since the ScanSnap scans both sides of a document simultaneously, clippings often include unwanted material as part of the PDF. However, it's very easy to use Apple's awesome Preview or Adobe's Acrobat to rearrange or remove pages. A full copy of Acrobat comes bundled with the ScanSnap, by the way.

This might be a good place to mention that the ScanSnap S510M is a Mac-only device. However, Fujitsu makes a version for Windows-based PC's as well, called the ScanSnap S510. As far as I can tell, these devices are otherwise identical, other than their colors (white = Mac; black = Windows). Read into this color scheme what you will.

One last nicety: either of these devices have a footprint small enough to sit on a small corner of my desk (less than the size of a standard US piece of paper). The ScanSnap also folds up, making it easy to carry to a new location.

One final bit of the roadmap out of Paper Hell is finding the right place to store the stuff. At the moment, I've been using the iDisk on my .Mac account. After scanning in a file, I drop it onto some meaningfully-named folder on my iDisk icon, which causes the file to be synchronized automatically with Apple's servers. Files on my iDisk are then available to me at other locations and other computers from across the net, but are not accessible to the public.

Another alternative for offline storage is Amazon's new S3 web service. S3 stands for Simple Storage Service, and Amazon currently charges 15 cents / GB-month of storage used. About this, Norbauer says:
I use JungleDisk to automatically back up my "inbox" and "Archive" folders to S3 each night (not to mention iTunes and iPhoto.) Now it actually seems more dangerous to keep a single physical copy of a document than to have digital copies on my hard drive and redundantly backed up to S3. You can read here all about the baroque lengths Amazon goes to in order to safeguard your data on S3.
Both Norbauer and Gordon Meyer, of the O'Reilly Network MacDevCenter, give a number of practical tips about how they set up a personal workflow with the ScanSnap. Meyer also describes the programs he uses to wrangle his growing herd of 1,000+ PDF files, such as DevonThink Pro Office, Skim and PDFPen.

Soooooo.... how is all of this working out for me so far?

Thus far I've scanned in 218 files, which are currently backed up offsite on my iDisk account. Each file probably runs an average of 5 pages, so I'm already up to the 1,000+ page mark myself. This includes all sorts of receipts, manuals for home appliances, and lots of other papers I'd like to be able to easily find again.

This process has also been very useful in managing my son's increasing homework loads. After scanning in an assignment, a copy is e-mailed to his teachers and then stored in the iDisk archive. Another pending project -- using the ScanSnap to digitize and store a lot of his early school artwork that is currently in bulging boxes around the basement.

Finally, the ScanSnap has turned out to be a great alternative to fax for us. The ScanSnap scans faster than our home fax machine, and allows us to e-mail things out in one large PDF via our home high-speed internet connection. This also saves having to tie up the home phone line while a large stack of papers oozes slowly out of the house at fax modem speed.

I initially got a ScanSnap for home use. However, it quickly became so useful to me that I soon bought another one for my desk at work. I've still got several metric tons of paper to go, but for the first time in a very long while, I feel like I've got options other than a bulldozer and a landfill for dealing with them.


Greg said...

Would like to communicate wit you backchannel on a radiology-related issue. Please send me your email.

The Samurai Radiologist said...

@ greg: You can reach me at:

samurai (no space between these words) radiologist (little at sign here) gmail (dot) com