Images on CDs Should Be in DICOM Format

Several times a day I get requests to look at outside images. The protocol at my institution is to have the front desk upload the study into our PACS and then have the radiologist review the images directly with the referring physician or compare it with a study performed at my institution. It is not uncommon that the front desk comes over to me with the CD stating that the CD does not contain DICOM images and cannot be uploaded into our PACS.   

I ultimately end up placing the CD into my laptop computer and view the study with the viewer provided on the CD. As there are several DICOM viewers on the market, most of my time is spent trying to figure out how to use the proprietary DICOM viewer. After several minutes of frustration, I finally begin to review the study. 

The underlying issue has been discussed in many research papers including a 2011 article from Radiology “Outside Imaging in Emergency Department Transfer Patients” which demonstrated that CD import to PACS was successful in 78 percent of the cohort and was unsuccessful in 22 percent, mainly owing to non-DICOM format. The study also stated that there were several originating institutions that routinely provided non-DICOM–format CDs containing images in proprietary formats with embedded image viewers.

An editorial in Radiographics in 2009 “Medical Imaging and Data Sharing: Are We There Yet?” also commented on this stating that “CDs have been plagued by several problems that collectively can be summarized as a lack of vendor compliance with standards.” The article goes on to say that “although a media profile for medical imaging was developed and disseminated to vendors by the cooperative work of the IHE (Integrating the Healthcare Enterprise) initiative, there is substantial variability in vendor implementation. Some imaging data written to portable media are encoded in proprietary formats instead of the DICOM (Digital Imaging and Communications in Medicine) standard. More substantial problems have been encountered with the design of the embedded image viewer, which must be used to view or ‘consume’ the data on the CD or DVD. Frequently, the image viewers are cumbersome to use, painfully slow, or completely inoperable.”

A 2011 article from Journal of American College of Radiology “Policies and Procedures for Reviewing Medical Images From Portable Media: Survey of Radiology Departments” also stated that “concerted efforts to improve the interoperability of DICOM on portable media have been undertaken, though several vendors persist in generating CDs in non-DICOM format that requires proprietary software to import. “

The field of radiology should have a concerted effort to fix this issue. We should create a standard format for all CDs containing medical images to include DICOM images. Although hospital and radiology facilities are shifting to the cloud for transferring radiology images, the use of CDs to transfer radiology images is still prevalent and will be for the near future.

CMS and the FDA should create a policy that all patient CDs containing medical images must be in a DICOM format.  This not only will make the radiologist’s task of looking over the images easier but will potentially reduce unnecessary subsequent diagnostic studies ultimately leading to decreasing health care costs.

Have you experienced this issue?