Digital imaging and Communications in Medicine (DICOM), the blueprint to allow communication to flow seamlessly between an assortment of imaging modalities and other hospital information systems developed by various original equipment manufacturers (OEM), is designed to produce, store, display, process, send, retrieve, query, and print medical images.

DICOM is what allows an MRI scanner made by one manufacturer, a thermal imaging scanner made by another, and an ultrasound machine made yet by another to all interface with a Picture Archiving and Communication System (PACS).

This global information technology standard, developed in 1993 to advance communication of digital image information, aid the development of PACS, and allocate the construction of informational database to be queried by devices all across the world, allows hospitals worldwide to enjoy system interoperability and to manage the related workflow that comes with the standard’s relationship to PACS.

As advances in technology become more and more sophisticated, so does the advancement of DICOM. A multitude of technical and medical experts participate in updating evolving DICOM standards, forthcoming from committee member organizations, four to five times each year, ensuring effective compatibility with previous editions and the most advanced integration within radiology, cardiology, oncology, pathology, ophthalmology, breast imaging, neurology, surgery, pneumology, veterinary, dentistry, and radiotherapy.

“DICOM started out purely in radiology,” comments Don Van Syckle, President of DVS Consulting and former DICOM Working Group 6 Chairman – Lead Technical Committee, “but then once we realized that medical imaging is not just a radiology solution, we brought in many other specialties to join DICOM. One of the first things to do was to enhance the type of specialties that could use DICOM, and that was really the first piece.”

Mr. Don Van Syckle, DVS Consulting, LLC explains how DICOM started in radiology and then branched out...

Before DICOM reached out and embraced other areas of healthcare, during the pre-DICOM days, when the ACR (American College of Radiology) and NEMA (National Electrical Manufacturers Association) teamed together in 1983 to form the original ACR – NEMA standards format, Dr. Dean Bidgood, from the University of North Carolina Chapel Hill - Department of Radiology - Pediatric Section and a founding pioneer member of what we today call DICOM, remembers “the opportunity to make the first ACR - NEMA presentation to a meeting of the cardiology group who was looking at digitization in the coronary catheterization lab.”

Dr. Dean Bidgood, Clincial Associate Professor of Radiology, Pediatrics, University of North Carolina Chapel Hill explains the team contribution to starting and implementing DICOM in different therapeutic areas ...

After the presentation, talks quickly moved in establishing a group outside of ACR – NEMA, and under the auspices of the ANSI healthcare informatics standards planning panel, into a multispecialty consortium with whom I contacted, one by one, and encouraged and fortunately found quite willing to move forward alongside radiology. The consortium quickly saw the similarities, not always an easy sell in the beginning. “I remember one individual in particular said ‘you radiologists don't know anything about what we do’ but by the end of the day that person was nodding his head and saw the light, I guess,” Dr. Bidgood told MedicExchange.

We went from cardiology through dentistry and pathology, ophthalmology, a couple dozen different groups, even the medical and surgical veterinary groups. Dr. Bidgood described the development as a lot of fun and found the prospect to be one of the most exciting project ever worked on. "I am fulfilled to see that the work that many of us were trying to do, struggling, when it seemed almost like an imaginary job or an ivory tower waste of time to some 20 years ago,” Dr. Bidgood excitedly described.

Today, DICOM enjoys a robust template structure capable of receiving defined value sets for any platform or ‘–ology,’ however, DICOM’s more humble beginnings never would have or could have imagined what the future would hold.

“I think the people, working in the beginning, did not realize how hearty the marriage of message/template and content resources would go forward into areas like computer aided diagnosis which was certainly not on the radar screen when we were just trying to build hardware robust enough to move bits and pixels around in the early 90s,” recalls Dr. Dean Bidgood.

The beginning saw many talented and patient volunteers and academics, learning things throughout the process of building the standard for digital radiology, working on what was to become an unrelenting dream to provide any image, anytime, and anywhere. But the building process did not suffice to just develop a standardized image to be passed around and stored in a storage system and viewed on workstations.

“I didn't want my x-ray to be just a standalone system,” said Mr. Van Syckle. “I wanted the image to be integrated with information managed by radiology information systems (RIS), electronic patient records (EPR), and hospital information systems (HIS). I wanted not just the data from the modality but for the data to be integrated with the other information in the hospital.”

To accomplish facilitation, they had to define the specifications so that the different vendors could implement their piece of the integration and work together. They had to define actual data to say ‘what is an image?’

“We had to define things like ‘Okay, I need to work on patient files, so I need a work list of all the patients I need to work on at my workstation.’ I know that Jane Smith is scheduled for 8:30, so ‘what type of procedure do I need to perform for Jane, scheduled at 9:00?’ and so what we wanted to do was to integrate the work flow so that not only do we get the images out of the modality but we also tied it to the procedures that the hospital was requiring,” Mr. van Syckle told MedicExchange.

So what does the future hold for DICOM? Who knows, especially with how new ideas, initiatives, inspirations, and expansions of reality develop. One thing is certain – DICOM continues to evolve. New features still need to be addressed, like a recently added activity proposal to add cardiac stress test reports, for example or as Steve Munie, Chief Information Officer, Pinehurst Radiology, suggests, “CT scanners are producing so many images now, and in order to more effectively move these images across the network, we are looking at using a multi-frame DICOM object, still within the DICOM standard, but is just a new type of object that will allow a whole series of CT images placed into one DICOM object and move it more efficiently across the network. We will continue to see more and more features of the DICOM standard that help us achieve tighter and tighter integrations. I do not believe we will stop seeing new advances in DICOM. There are always change proposals and new ways of doing things.”

Mr. Steve Munie, Chief Information Officer, Pinehurst Radiology brings us to the very beginning and the future of DICOM ...

Stepping out of the Healthcare industry is a real possibility as well. Relating to the organization John Paganini, Senior Director of Product Management, at Guardian Technologies Intl., discloses “we have both a healthcare division and a homeland security division Recently, the homeland security area has adopted a DICOM standard they call DICOS - the ‘S’ standing for security. DICOM is emerging into not only other areas of healthcare as a de facto imaging standard but is also moving into other industries as well.”

In conclusion, DICOM, through years of growth and development, truly made PACS to be quite an incredible system. Whether taking initial images for diagnosis or taking images to insure correct positioning during radiation therapy stages, it is amazing to think that all these images stored in PACS, allow for physician collaboration departmentally, or even communication with a specialist half way across the globe. Furthermore, because most if not all modalities today are DICOM compliant, distributing and viewing any kind of medical image regardless of the origin is possible anywhere in the world. If, for example, a certain type of tumor is needed to be treated on certain equipment at a different hospital, a tumor contour along with other anatomical structures and contours can be imported onto those modalities for further treatment. Many patients also do not know that a patient can obtain these images from their doctor. The physician can provide a CD with these images in the DICOM format and the patient, if he so chooses, can send them to someone that they feel may help. Amazing what 21st century technology can do, no?

References

http://www.medicexchange.com/Who-s-Buying-What/worlds-first-website-for-patients-to-share-diagnostic-quality-medical-images.html

http://medical.nema.org/

http://www.imagingeconomics.com/issues/articles/2005-05_01.asp

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