Digital Imaging and Communications in Medicine
DICOM was initiated by the American College of Radiology and the National Electrical Manufacturers' Association. Since 1996, DICOM has expanded its scope from radiology and cardiology imaging to include visible light imaging (e.g., pathology, endoscopy, ophthalmology), imaging-related therapy (radiation therapy), reporting about findings, and information exchange at the boundary between imaging systems and information systems. DICOM has become the de facto imaging standard for medicine.
It is a detailed specification that describes a way to format and exchange images (as in sending images, printing, query/retrieval, and media storage) and associated information, such as the text describing the image. The DICOM standard applies to the operation of the interface that transfers data in and out of an imaging device (media devices and computer network connections that address the communication and storage of images). Dissimilar imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), nuclear medicine, ultrasound, x-ray, digitized film, video capture (eg. slit lamp imaging, ultrasound, color fundus imaging, fluorescein & ICG retinal angiography) and other camera systems require a DICOM interface to communicate with each other. Obviously, imaging falls squarely in the path of the EMR and how it is defined affects how vendors develop systems to store images. The DICOM standard has been implemented for a number of medical products already, and it is supported by industry and professional societies in the United States, as well as internationally.
It is important to understand that one of the major goals of DICOM is to enable interoperability. Interfacing, in the sense of the mechanical and electronic connection of equipment, is difficult, but even this is not sufficient for operation to be transparent to the user. As an example, consider one person making a telephone call to a stranger to ask about fixing an automobile engine. At a low level, communication involves dialing the correct phone number. This establishes a link between the two people. But, if the two people do not speak the same language, they will not be able to communicate. Even if both speak the same language, if their understanding of car engines is vastly different, they will not be able to communicate about the task at hand (fixing the engine). Successful communication requires not only that the individuals have the correct telephone number (network address) and establish a telephone connection, but that they agree on the language to speak and that they negotiate the level at which they have a common understanding (the presentation context). In this telephone example, the task of interfacing could be thought of as the making of the telephone connection and establishing that the connection is to the right destination. For interoperation to occur, that is, for the two telephone parties to communicate and comprehend their tasks, an understanding of the data and its context is necessary. DICOM provides the tools for this in the form of the negotiation capability and the object-oriented design. The former allows understanding of capabilities, and the latter of context. Using DICOM does not guarantee interoperability, but it does make it easier for users and manufacturers to achieve.
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