Digital Imaging and Communications in Medicine (DICOM) is an industry standard facilitating the

processing and exchange of medical images in digital form. It is, in fact, a comprehensive set of
standards for handling, storing and transmitting information in medical imaging. The objectives of
DICOM standard are (NEMA, 2001):

1. To standardize of communication of digital image information, regardless of manufacturer of the

imaging equipment.

2. To facilitate the development and expansion of PACS that can interface with other systems of hospital
information.

3. To promote the creation of diagnostic information databases that can be accessed by a wide variety
of devices and users distributed geographically.

DICOM was developed by the American College of Radiology (ACR) and National Electrical
Manufacturers Association (NEMA), with inputs from various vendors, academia,industry groups, etc.
(ACR-NEMA, 1993). Computed tomography, nuclear medicine imaging,digital subtraction angiography,
and magnetic resonance imaging systems directly produce digital images as the data are computer
processed and are examples whose images can bedirectly converted to DICOM format (Ackerman and
Gitlin, 1992).

ACR and NEMA have formed alliances with pathology and cardiology groups to

extend the standard to other types of images and photographs, such as pathology slides,

photographs of clinical significance, microscopy images, endoscopy, angiography, blood

vessel and ultrasound images. The objective of development of DICOM standard is to

have a general standard so that it can be applied to the entire range of medical images

encountered in the healthcare field. This can enable avoidance of different standards for

various types of medical images facilitating storing and transmitting electronic patient

records that include images also.

DICOM facilitates integration of various items of hardware such as workstations,

servers, scanners and network hardware from several vendors into picture archiving and

communication system. The different machines supplied by various vendors now come

with DICOM conformance statements indicating the DICOM classes they are designed to

support. The adoption of DICOM has been widely accepted by medical facilities and the

applications are expanding fast. Figure 3.9 shows spectrum of applications of DICOM in
integrating medical imaging devices in telemedicine.

DICOM facilitates the image acquisition devices (digital x-ray machines, CT, MRI

scanners, etc.), diagnostic imaging workstations from different vendors, image archives

and hardcopy devices to be connected into a common imaging information infrastructure

which can be conveniently integrated with other information systems. These include Picture

Archiving and Communication System (PACS), Hospital Information System (HIS) and

Radiological Information System (RIS). Thus, the DICOM standard facilitates interoperability

of devices claiming conformance (Bedi, 2003). In particular:

• The DICOM standard addresses the semantics of commands and associated data.

For devices to interact, it provides standards on how devices are expected to

respond to commands and associated data, not just the information which is to be

transferred between various devices.

• The DICOM standard explicitly defines the conformance requirements for

implementing the standard. Therefore, a conformance statement must specify the

functions for which interoperability can be expected from another device.

• The DICOM standard does not require network interface units to operate in networked environment.

• The DICOM standard provides support for future a application as it is structured to accommodate the
introduction of new services.

Besides facilitating the transfer of images, the DICOM standard also includes transfer

of associated data and information relating to the patient, the health provider and the

device. The DICOM version 3.0 also facilitates transfer and interchange of waveforms

such as ECG, EEG, EMG, etc. DICOM files consist of a header with standardised as well

as free-form fields and a body of image data. The header contains the patient details such

as name, scan type, dimensions of the image, etc. A single DICOM file can contain one or

more images and/or animations, allowing storage of large volumes of information.

The DICOM standard covers the details of transfer of data on a variety of storage
media or across the network. It supports various kinds of media ranging from CD-ROM’s

to Magneto Optical Drives (MOD). For interchange of data using DICOM, it is preferable

to use the recommended networks specified in the standard. The network interface for

communicating between various systems is generally TCP/IP which facilitates transfer of

data from the data scanners, CT, MRI, etc. or between telemedicine systems.

In DICOM, grayscale images are 16 bits per pixel, and true colour images are 24 bits

per pixel plus 8 bits per pixel of intensity information.

DICOM is based on the Open System Interconnect (OSI) reference model, which

defines a 7-layer protocol. This is explained in Chapter 6. The DICOM standard version 3

consists of 20 parts. This modular design of the standard facilitates its periodic expansion

and updating without the necessity of republishing the entire standard.