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Document 2

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Pham Duc Quang
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FC9008 - DICOM

3.2 Abbreviation
DICOM is the abbreviation of Digital Imaging Communications in Medicine.
As you can see it is about Medical images. At least, this is how it started!

3.3 The initial goal of DICOM


The initial goal was to develop a standard for the transmission of medical images in digital format, to enable
users to: transmit images and associated information, from digital imaging equipment in a standard format, that
would be the same across multiple manufacturers.

3.4 History
• For many years images were made on film, because there was nothing else! The images were read
using a light box.

• The availability of medical images in digital format made it possible to change the way of working.
Images could be transmitted over a network to another destination, for example to ask another radiographer for
a second opinion.

• Network protocols were already defined, but not the way how the medical images would be transmitted
were not. The lack of a standard resulted in many company specific solutions, a nightmare for compatibility.

3.5 Versions
• ACR and NEMA joined forces and formed a standard committee in 1983. Their first standard,
ACR/NEMA 300, was released in 1985. Very soon after its release, it became clear that improvements were
needed. The text was not clear enough and there were internal contradictions, leading to different
interpretations.

• In 1988 the second version was released. This version gained greater acceptances among vendors.
The image transmission was specified as over a dedicated 50-pin DICOM cable.

• In 1992 the third version of the standard was released. Its name was then changed to DICOM. As this
was the third version, you will often read “DICOM 3”.

• The last “third” version, defined in 1992, is still the current version. However, this does not mean that
DICOM doesn’t change. Changes to the DICOM standard are continually requested. The change requests are
investigated by the DICOM board which validate or reject the change.

To guarantee backwards compatibility existing implementations remain available, changes or new features are
ADDED to the DICOM standard.

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FC9008 - DICOM
3.6 The DICOM Standard
• Initially DICOM was defined as a standard to transfer medical images. Through the years several new
functions have been added to DICOM.

• The DICOM books describe the DICOM standard. Due to the changes within DICOM the number of
books have increased and the books have become thicker. In principle a new set of books is published every
year. The DICOM books are available to download for free.

• To download the DICOM books go to the website: DICOM.nema.org. Click the hyperlink “The DICOM
standard”.

3.7 Everbody happy now?


The fact that there is a DICOM Standard does not mean that all problems are solved. However, the standard
has encouraged all manufacturers to use the same protocol which has resulted in an enormous step in
improved connectivity.

There is still room for interpretation, due to the complexity and flexibility. Some vendors use features that are
not defined by DICOM. So, company specific solutions are required.

4. How Does DICOM Communicate?

4.2 How does DICOM communicate


• DICOM is always a dialog between two systems. The system that initiates a communication is the
“Requestor”. The system that responds to the request is called the “Acceptor”. In general you can say that the
Requestor will take the SCU role, the Acceptor will take the SCP role. In general, because there are
exceptions.

What are these services? Let’s take the “car-rental-service”. Hertz has cars and provides the car-rental-
service. You need a car, so you want to use the car-rental-service. Hertz is the provider, and you are the user.
You can imagine that two “users” will not result in the actual rental of a car. The same is applicable in DICOM,
you need a SCU and a SCP for a DICOM communication to occur.

4.3 Initial negotiation phase


• When you need to interact with a computer on the network, you will need the IP-address of that
computer.

• Several programs and services are active on that computer. The question is now which service will
pick-up the information you are sending?

• The mechanism to address the correct program or service within the computer is using PORT numbers.
Programs and/or services may have either fixed or configurable port-numbers.

• To avoid that any computer in the network can interact with the medical systems, authentication is

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