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Deploying a Picture Archiving and Communications System: Issues to Consider

By Stuart C. Gardner

In the years since its introduction, the Digital Imaging and Communications in Medicine (DICOM) 3.0 standard has been improved, and it continually shows signs of progress. The DICOM Committee has accomplished a tremendous amount and deserves much credit. As an industry, however, radiology must subscribe to its shortcomings. Equipment vendors do not incorporate functionality until driven to do so by end users, and end users do not take the time to learn what DICOM really is so that they can demand more DICOM functionality of their purchases.

Therefore, it is important to understand what DICOM really means:

• DICOM conformant means conforming with any part of the DICOM standard;
• DICOM compliant means conforming with all of the DICOM standard, with the definition of all being subject to multiple interpretations; and
• DICOM compatible means capable of being upgraded to work with DICOM.

There has been significant progress in DICOM awareness but, as an industry, radiology still has far to go. This is true both on the vendor side (where DICOM 3.0 compliance is concerned) and on the institutional side, where a better understanding of DICOM requirements is needed. Purchasing practices for imaging equipment today are in severe need of review. Too many institutions depend on one person to review equipment-purchasing decisions. Given the function and performance requirements of imaging equipment, representatives of at least the radiology, Biomedical/clinical engineering, and information services departments should review all imaging-equipment purchases. Minimum criteria for purchases should defined by the institution and adopted as purchasing policy.

In determining such criteria, institutions should consider the DICOM and networking capabilities of each device that will be acquired. DICOM requirements should be the domain of the clinical/biomedical engineering and radiology departments.