Why Does The DICOM Standard Exist

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Why Does the DICOM Standard Contents

Exist? What is DICOM?
Semantic interoperability
May 15, 2020 David Giese SHARE ON Conclusion
Innolitic’s DICOM expertise
DICOM
The DICOM standard’s purpose is to facilitate interoperability between medical

We need help with DICOM!
imaging systems from different vendors. The standard defines a file format for
storing medical images, protocols so applications can exchange them, and a
conformance format so buyers can determine which systems can (hopefully)
interoperate. But perhaps most importantly, DICOM provides a standardized
model of reality. This information model is the foundation on which
interoperability is laid.
This article is the first in a series. If you are new to DICOM, we hope this series will
help you get started quickly. If you have used DICOM before, we hope it provides
some interesting new perspectives on the standard.
What is DICOM?
The DICOM standard document has a succinct presentation of its scope in
section 1.1:
“Digital Imaging and Communications in Medicine (DICOM) is the standard

for the communication and management of medical imaging information
and related data.
The DICOM Standard facilitates interoperability of medical imaging

equipment by specifying:”
• For network communications, a set of protocols to be followed by

devices claiming conformance to the Standard.
• The syntax and semantics of Commands and associated information
that can be exchanged using these protocols.
• For media communication, a set of media storage services to be
followed by devices claiming conformance to the Standard, as well as
a File Format and a medical directory structure to facilitate access to
the images and related information stored on interchange media.
• Information that must be supplied with an implementation for which
conformance to the Standard is claimed.
DICOM facilitates interoperability in two senses. First, it facilitates a technical

“syntactical” interoperability:
• whether you use big endian or little endian

• how to indicate data compression
• the order to send bits across the network
• a JSON format for an image with its meta data.
Developing software that follows these technical details precisely can be

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Beyond a purely technical interoperability, DICOM also facilitates a “semantic”
interoperability.
Semantic interoperability
By “semantic” interoperability we mean ensuring that vendors use and require
metadata in a consistent manner. Given the breadth of the medical imaging
field, you can imagine how challenging this is! How does DICOM do this?
DICOM facilitates semantic interoperability by providing a consistent model of

reality across vendors.
Here is a diagrammatic representation of the core part of DICOM’s model of

reality:
This shared model of reality facilitates interoperability, because without it,

different vendors would likely have subtly (or drastically) different models of
reality, making it difficult to interoperate.
For example, one vendor may not bother including a “Study” object in its model
of reality, and another vendor may require certain pieces of data that another
vendor omits. In both cases, integrating equipment and software from these two
different vendors would be more complicated, and in some cases impossible.
The fundamental problem is that reality is complicated!
It is difficult to model it accurately, and depending on your application, it may or

may not make sense to include certain details in your model. There is a tradeoff
between accuracy and simplicity.
In fact, DICOM itself recognizes that its model is not perfect.

“This information model is a simplification of the real world concepts and
activities of medical imaging; for acquisition modalities, a Study is
approximately equivalent to an ordered procedure, and a Series is
approximately equivalent to a performed data acquisition protocol
element. In other domains, such as Radiotherapy, the Study and Series are
less clearly related to real world entities or activities, but are still required for
consistency. This simplified model is sufficient for the pragmatic needs of
managing imaging and related data collected in routine practice.”
Thankfully, despite these simplifications, DICOM’s model is pretty good. And in

our opinion, it is much better to have one flawed model than dozens of flawed
models—one for each vendor!
Of course, DICOM doesn’t completely eliminate integration problems for a few

reasons:
1. Applications don’t properly implement the standard

2. Applications implement different versions of the standard
3. A lot of meta information is optional (so an application may choose not to
provide it)
4. The standard is ambiguous.
Once again, DICOM is aware enough to inform you of its own limitations in case
you couldn’t deduce it yourself:
“This Standard facilitates interoperability of systems claiming conformance

in a multi-vendor environment, but does not, by itself, guarantee
interoperability.”
Conclusion
The DICOM standard’s goal is to facilitate interoperability between medical
imaging systems from different vendors. It does this by standardizing technical
networking and storage implementation details, but perhaps more importantly
by providing a consistent model of reality.
In our next article, we will introduce you to some of the DICOM lingo and will give
you some guidelines for reading the DICOM standard more effectively.
Innolitic’s DICOM expertise

Innolitics has considerable experience with DICOM. In addition to developing
DICOM-conformant software for our clients, we have built several tools:
• Our DICOM Standard browser is used by 10,000s of developers and

radiologists around the world.
• Our DICOM standard parser extracts key information from the standard into
a JSON format, which can be used.
• Our dicom-numpy Python library simplifies the process of forming a 3D
numeric array from a set of DICOM files.
• Our PACSMAN Python library providers a high-level API for common PACS
communication operations. It also includes a file-system backend for use
during development.
DICOM Part 1 © NEMA. The DICOM Standard is under continuous maintenance,

and the current official version is available at http://dicom.nema.org/.
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Why Does the DICOM Standard Contents

The DICOM standard’s purpose is to facilitate interoperability between medical

“Digital Imaging and Communications in Medicine (DICOM) is the standard

The DICOM Standard facilitates interoperability of medical imaging

• For network communications, a set of protocols to be followed by

DICOM facilitates interoperability in two senses. First, it facilitates a technical

• whether you use big endian or little endian

Developing software that follows these technical details precisely can be

DICOM facilitates semantic interoperability by providing a consistent model of

Here is a diagrammatic representation of the core part of DICOM’s model of

This shared model of reality facilitates interoperability, because without it,

The fundamental problem is that reality is complicated!

It is difficult to model it accurately, and depending on your application, it may or

In fact, DICOM itself recognizes that its model is not perfect.

Thankfully, despite these simplifications, DICOM’s model is pretty good. And in

Of course, DICOM doesn’t completely eliminate integration problems for a few

1. Applications don’t properly implement the standard

“This Standard facilitates interoperability of systems claiming conformance

Innolitic’s DICOM expertise

• Our DICOM Standard browser is used by 10,000s of developers and

DICOM Part 1 © NEMA. The DICOM Standard is under continuous maintenance,

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Monthly Medtech Insider Insights

Services About Get In Touch

AI/ML Development Resources

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