The Ultimate Guide of DICOM

If you ever went to a clinic for an MRI, CT, or any other medical imaging modalities, you have probably received something that looks like a picture of your in-depth body parts. Due to DICOM, you can see that picture, and doctors do not have to waste valuable time from their work trying to decode the medical images that machines generate.


What is DICOM

DICOM, or Digital Imaging and Communication in Medicine, is the standard file format that supports medical images generated by medical imaging machines, such as CT, X-RAY, MRI, SPECT, PET, and so on. 


The history of DICOM started in 1993 when after eight years of iterations, ACR (American College of Radiology) and NEMA (National Electronic Manufacturers Association) finally developed a standard file format that used local area networks like Ethernet. The file format was developed because it was very hard for anyone but manufacturers to decode the images.


To better understand DICOM, simply imagine taking a picture with your phone. Your camera lens acts like a medical imaging machine, and the image with the .jpg extension is the DICOM file.


The DICOM file exported is not just a picture of your body parts. It also has additional data in the header, such as institution name, patient data, and performed procedures or reports.


Even if they are something different, they are entirely complementary.


PACS, or Picture Archiving and Communication System, is a technology used to store and transfer medical files, such as DICOM files. Briefly, PACS is the server where DICOM files are kept after a patient is doing a medical imaging procedure. This technology allows your medical images or the whole medical file to be securely retrieved, sent, or used if needed. Coming back to the example above with the phone, you can view the phone's camera like a medical imaging machine, the "picture.jpg" like the DICOM file, and the phone like a PACS where your picture is saved and from where you can access it or send it.


PACS data could be stored cloud-based or on-premise. The key difference between them is that on-premise PACS uses a local storage solution where servers are connected directly to hard drives; contrariwise, cloud-based PACS uses an offsite, online method to store patient data. Patient data automatically flow into the cloud as they are being produced.


The big advantage of an on-premise PACS is that the owner has total ownership and control over data. On the other hand, cloud-based PACS offers remote access, improves the collaboration process, supports DICOM sharing in real-time, has a built-in disaster recovery, and could lower the cost of the clinic's infrastructure.



All mentioned above regarding DICOM and PACS will only be complete if we take into account a proper DICOM Viewer. A DICOM Viewer is a software application that enables clinicians to see DICOM files exported by machines (CT, X-ray, MRI,...). This software is available as a downloaded program (Desktop version) or online through a web browser (Web version). 


Coming back to our example, you may think of the camera as a medical imaging machine, a PACS as your smartphone's memory, the DICOM file as "image.jpg," and the DICOM Viewer as the app that allows you to see the picture.


An online version has the substantial advantage of saving doctors time by removing the requirement to install desktop DICOM reader programs on local PCs. It is useful for doctors who are on the go and away from their workstations and facilitates collaboration between multi-disciplinary specialties.



Diagnostic images constitute a tremendous amount of data circulating in healthcare. Healthcare data represents 30% of world data.

Medical data are often kept in qualitative reports, which do not let recovering the images of interest together with the related details. The clinical decision is usually based on information derived from several sources that may vary from the patient to the diagnostic systems but could not be stored appropriately and standardized.


The diagnostic procedure results are elaborated by the medical machines and kept in the DICOM file after the image formation procedure. Medical images and reports are usually safely stored in the local PACS and could be recalled by a doctor whenever ought. So, data retrieval is a decisive step for reporting the examination result, and identifying and giving the patient or other doctors the relevant representations. Numerous critical elements may be lost during the traditional workflow because of the lack of standardization, like using different formats.



The digitization of healthcare is making significant progress, but certain difficulties still exist. Information technology systems are overburdened in the healthcare business. Despite the obstacles, several of these technologies can work together to enhance healthcare. However, because of regulatory concerns and siloed data, healthcare professionals and personnel are still required to perform extensive manual labor.


Interoperability in healthcare helps solve various difficulties by decreasing the cost of healthcare and bringing together diverse sections of the system. This contributes to overall system quality improvement.


The essential benefits of interoperability are: improving patient care, keeping patient data safe, reducing medical errors, reducing costs, and enhancing productivity.


Privacy and Security

Privacy is one of the most debated problems in data collection, analysis, and interpretation since these operations and outcomes are now regarded as a new industry. Medical data can be used for a variety of valid secondary purposes, such as research or education, but patients must provide informed consent. Another example is the creation of decision support tools, which might be readily marketed if the outcomes of the digital toolkit are deemed appropriate. Furthermore, most personal data should be safely erased, even if some data or a connection to personal data must be retained in many circumstances.


The growing demand for predictive models, clinical decision support systems, and data analysis has created a scenario in which research demands frequently clash with privacy regulations. There is currently no widely acknowledged answer since the amount and kind of personal data sought by researchers vary on a case-by-case basis, and the choice of information to be preserved, updated, or deleted is determined by the aims and rules to be followed.


To address these issues, governments and organizations have created rules and regulations that combine privacy, data, and research aims. To that end, the following are some of the most often requested and utilized restrictions that must be followed when using data for research purposes:


  • HIPAA, 1996 Health Insurance Portability and Liability Act (HIPAA),


  • GDPR, the general data protection regulation (EU) 2016/679.



In the end, DICOM Standard is not just a simple in-depth image of our body, it comes with many responsibilities and things to consider when it is used in practice. Medical imaging is evolving to help patients and doctors understand more accurate diagnoses, reduce errors and facilitate multidisciplinary collaboration. Technology is growing day by day, and this will facilitate new discoveries and new updates to what we know today. 




About the author - Andra Bria

Andra Bria is a growth marketer at Medicai. She is interested in health equity, patient experience and care pathways. She believes in interoperability and collaboration for a more connected healthcare industry.