DICOM Upadate: VA pushes vendors to support DICOM

VA pushes vendors to support DICOM

The Department of Veterans Affairs (VA) was one of the first PACS users to implement DICOM interfaces between commercial PACS, imaging modalities, and hospital/radiology information systems (the VA's own VistA system). Based on these early implementations, the VA learned that modality vendors often don't support the DICOM standard in a consistent manner, and in many cases, critical information needed to identify the patient may be missing or improperly encoded.

To rectify this problem, the VA in the fall of 1997 issued a set of DICOM compliance requirements for vendors seeking to sell imaging modality or PACS equipment to member hospitals. In this document, the agency defined a core subset of requirements for imaging modalities, consisting of required attributes for all objects that are exchanged and a list of DICOM services that must be complied with.

A final version of this document was issued on July 17, 1998, with the intention that every modality purchase by the VA would have to meet this standard beginning July 17, 1999. The document has also been endorsed by the Department of Defense as a guide for its own hospitals when purchasing modalities such as CT, MR, ultrasound, CR, and other digital acquisition systems.

Since the final version was completed, two key events have caused the VA and the DOD to review the specification again. First, the VA has decided to incorporate into the document the technical framework of the Integrating the Healthcare Enterprise (IHE) initiative developed by the RSNA and HIMSS (PNN 4/99). In addition, many vendors protested that they could not meet the requirements by the specified deadline. This became clear during a February vendor workshop hosted by the VA and a poll the agency subsequently conducted. Eleven modality vendors responding to the poll said that their MR scanners would support the DICOM modality worklist, a core requirement of the VA initiative, by July.

Compliance among other modalities is not as far along, however. Participating vendors reported that only 25% of nuclear medicine devices would support the modality worklist by July.

Across all imaging modalities, 66% of scanners will support the modality worklist by July. Only 37% of all vendors will support storage commitment--a service allowing a device to transfer responsibility for its images to a PACS--by January. Another requirement, modality-performed procedure step, which communicates how many images have been created (PNN 7/98), will be supported by only 30% of all vendors before the end of this year. In a bright spot, 85% of devices will provide critical fields, such as the accession number, by July.

The VA initiative has also had an impact outside of the government. The IHE team has reviewed the VA specifications for consistency with its technical framework document. In good news for vendors, the VA/DOD has relaxed some of the initial requirements to match the companies' expected availability schedule.

Increased activity in this field comes at a good time for modality firms. End users are becoming more educated about the importance of DICOM, and high levels of DICOM connectivity are becoming a requirement for purchase of modality equipment.

--Herman Oosterwijk, president, OTech Inc. (herman@otechimg.com)

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