The Digital Imaging and Communications in Medicine (DICOM) standard is a network protocol that has been used for years for handling, storing, printing and transmit medical images. One could say that is the the reason for the boom in medical imaging and subsequent improvements in diagnosis. I can confidently say that companies like 5C have an opportunity to innovate only because DICOM is in place.
A Brief History
DICOM was initially developed by the National Electrical Manufacturers Association (NEMA) and the American College of Radiology (ACR) in 1985. Initially, it was very extremely difficult for everyone except the manufacturers of MRI and CAT devices to decode the image generated by the machines, and this was the primary reason for making the DICOM standard protocol. In 1988 the second version was released and the first large-scale deployment of the technology was made in 1992 by the US Army and Air Force. Soon after in 1993, the latest version was released and officially named as “DICOM”.
Technical background of DICOM
Think of DICOM like any other network protocol: DICOM carries a “Payload”, which is the data that it wants to transmit. This data is the image that is represented in a series of 0s and 1s. This data has “headers” which contain meta-data about the patient, and other information regarding where the data has to go.
The DICOM protocol is compatible with Transmission Control Protocol and Internet Protocol (TCP/IP). This enables DICOM application entities to communicate over the Internet. DICOM standard support five general applications.
- Network Image Management
- Network image interpretation management
- Network print management
- Imaging procedure management
- Off-line storage media management
Network Image Management: It supports two general services: push and pull. In push mode, one device sends images to another device over a network. Whereas in pull mode, it receives the selected images
Network Image Interpretation Management: It provides services such as network image interpretation object and a corresponding interpretation storage service.
Network print management: It enables image acquisition devices and workstations to share a printer on a DICOM network similar to the way that personal computers share a networked laser printer or in simple words, The DICOM print service is used to send images to a DICOM printer to print film.
Imaging procedure management: This component provides comprehensive imaging procedure management capability. Essentially, this provides 2 related services: Modality Work List (MWL) which creates a worklist of all the scans that have to be done, including the patient information for each scan, and Modality Performed Procedure Step (MPPS) which helps in mapping each step of the patient - when the patient is ready for the scan, when the patient comes in for the scan, when the patien’s images are acquired etc. MPPS helps in closing the loop between PACS, HIS and HMIS.
Off-line Storage Media Management: DICOM Off-line Storage Media Management enables users to manually exchange DICOM files on removable storage media.
DICOM’s Impact
DICOM is used extensively for medical imaging in hospitals. It is used in the processes of diagnosing and treating patients, tracking patient outcomes, Tele-radiology to transmit radiological patient images, such as X-ray, CT, and MRI. The success of DICOM cannot be underestimated: it has shown the path for medical devices to associate with one another, and has given medical imaging an opportunity to be a part of the haloed Electronic Medical Record.
The DICOM standard is constantly being polished: it is constantly improving in terms of hardware interfacing, image display, etc. And because of its ease of integration and continuous evolution this communication standard has over the years achieved a nearly universal level of acceptance among vendors of radiological equipment.
In the decades since that first committee sat down, DICOM has become the foundation of image exchange, so much so that it is often referred to as DICOM image exchange. 5C salutes DICOM and are most grateful for its versatility, that allows us to focus on innovation and build great products.