DICOM and challenges it faces in the ever changing healthcare IT environment

In this writing I will explain the Digital Image Communications in Medicine (DICOM) standards. I will consider the current and proposed changes in informatics information infrastructure, the challenges they may have on DICOM standards and why.

DICOM is made up of a long list of standards. According to Merge Healthcare (n.d.), these standards are:

Conformance – These are statements written to allow a network administrator to plan or coordinate a network of DICOM applications.
Information Object Definitions and Service Class Specifications – This standard defines the types of services and information exchanged using DICOM.
Data Structures and Encoding & Data Dictionary – This is how commands and data should be encoded for interpretation.
Message Exchange – This is the standard by which two DICOM applications mutually agree upon the services they will perform over the network.
Network Communication Support for Message Exchange – How message will be exchanged using TCP/IP and OSI.
Common Media Storage Functions for Data Interchange – This is the DICOM model for storage of images on removable media.
Media Storage Application Profiles & Media Formats and Physical Media for Data Interchange – Specifications on physical storage media and details of the characteristics of various physical medium and media formats.
Grayscale Standard Display Function – Display function for display of grayscale images.
Security Profiles – Secure network transfers and secure media.
DICOM Content Mapping Resource – Defines templates and context groups used elsewhere in the standard.
Explanatory information – Consolidates informative information previously contained in other parts of the standard.
Web Access to DICOM Persistent Objects (WADO) – Specifies a web-based service for accessing and presenting DICOM persistent objects.

Proposed changes in the US health informatics infrastructure include the adoption of health information exchanges and this can present a problem with DICOM and multi-site use. According to Langer & Bartholmai (2011), one challenge of multi-site interoperability is “the magnitude of data produced by imaging systems and unstructured text reports.” They go on to say that this is because this giant amount of information “has made it very difficult to share results among sites until the wide availability of both broadband networks and universal protocols.” This is definitely and challenge to image transmission.

Another transmission challenge is the use of XML, which is utilized by HL7 V3.0. One example is caBIG, architecture (Langer & Bartholmai, 2011). Langer & Bartholmai mention that a “vast majority of PACS and imaging modalities will require intervening computers to broker the DICOM to caBIG translation.

Another challenge is storage. Steve Langer (2011) writes, “images from different vintage equipment will encompass different levels of the standard.” What this means is that there can be ambiguity in what data elements mean, based on time periods when it was created and the location of data elements if its not in a standard location (Langer, 2011).

There are several challenges that DICOM face. These deal with image transmission because of large data sets and lack of utilization between standards. Data storage can also be an issue because of legacy definitions.

References:

Langer, S. (2011 November 12). A Flexible Database Architecture for Mining DICOM Object: the DICOM Data Warehouse. Journal of Digital Imaging, 25, pp. 206-212. DOI: 10.1007/s10278-011-9434-6

Langer, S. & Bartholmai, B. (2011 February). Imaging Informatics: Challenges in Multi-site Imaging Trials. Journal of Digital Imaging, 24(1), pp. 151-159. DOI: 10.1007/s10278-010-9282-9

Merge Healthcare. (n.d.). The DICOM Standard. Retrieved from http://estore.merge.com/mergecom3/resources/dicom/java_doc/javadoc/doc-files/dicom_intro.html