DICOM relay over the cloud

  • Luís A. Bastião SilvaEmail author
  • Carlos Costa
  • José Luis Oliveira
Review Article



Healthcare institutions worldwide have adopted picture archiving and communication system (PACS) for enterprise access to images, relying on Digital Imaging Communication in Medicine (DICOM) standards for data exchange. However, communication over a wider domain of independent medical institutions is not well standardized. A DICOM-compliant bridge was developed for extending and sharing DICOM services across healthcare institutions without requiring complex network setups or dedicated communication channels.


A set of DICOM routers interconnected through a public cloud infrastructure was implemented to support medical image exchange among institutions. Despite the advantages of cloud computing, new challenges were encountered regarding data privacy, particularly when medical data are transmitted over different domains. To address this issue, a solution was introduced by creating a ciphered data channel between the entities sharing DICOM services.


Two main DICOM services were implemented in the bridge: Storage and Query/Retrieve. The performance measures demonstrated it is quite simple to exchange information and processes between several institutions. The solution can be integrated with any currently installed PACS-DICOM infrastructure. This method works transparently with well-known cloud service providers.


Cloud computing was introduced to augment enterprise PACS by providing standard medical imaging services across different institutions, offering communication privacy and enabling creation of wider PACS scenarios with suitable technical solutions.


PACS DICOM Medical imaging Telemedicine Teleradiology Cloud computing 


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  1. 1.
    Huang HK (2004) PACS and imaging informatics: basic principles and applications. Wiley & Blackwell, HobokenCrossRefGoogle Scholar
  2. 2.
    DICOM-P18 (2009) Digital imaging and communications in medicine (DICOM), Part 18: Web Access to DICOM Persistent Objects (WADO). National Electrical Manufacturers AssociationGoogle Scholar
  3. 3.
    Rimal B, Choi E (2009) A Conceptual approach for taxonomical spectrum of cloud computing. Ubiquitous information technologies & applications. In: ICUT ’09—proceedings of the 4th international conference Fukuoka, pp 1–6Google Scholar
  4. 4.
    Rosenthal A, Mork P, Li MH, Stanford J, Koester D, Reynolds P (2010) Cloud computing: a new business paradigm for biomedical information sharing. J Biomed Inform 43(2): 342–353PubMedCrossRefGoogle Scholar
  5. 5.
    Huang HK (2010) PACS and imaging informatics: basic principles and applications. 2nd edn. New Jersey, Wiley & Blackwell, HobokenGoogle Scholar
  6. 6.
    Vaquero LM, Rodero-Merino L, Caceres J, Lindner M (2008) A break in the clouds: towards a cloud definition. ACM SIGCOMM Comput Commun Rev 39(1): 50–55CrossRefGoogle Scholar
  7. 7.
    Ribeiro LS, Bastião L, Costa C, Oliveira JL (2010) EMAIL-P2P GATEWAY to distributed medical imaging repositories. In: HealthInf. Valencia: SpainGoogle Scholar
  8. 8.
    Hajjat M, Sun X, Sung Y-WE, Maltz D, Rao S, Sripanidkulchai K, Tawarmalani M (2010) Cloudward bound: planning for beneficial migration of enterprise applications to the cloud. SIGCOMM Comput Commun Rev 40(4): 243–254CrossRefGoogle Scholar
  9. 9.
    Amazon Simple Storage Service. Available in: June 2011
  10. 10.
    Google App Engine (GAE). in: June 2011
  11. 11.
    Windows Azure Platform. Available in: June 2011
  12. 12.
    Weisser G, Engelmann U, Ruggiero S, Runa A, Schr^ter A, Baur S, Walz M (2007) Teleradiology applications with DICOM-e-mail. Eur Radiol 17(5): 1331–1340PubMedCrossRefGoogle Scholar
  13. 13.
    Hernandez JA, Acuna CJ, de Castro MV, Marcos E, López M, Malpica N (2007) Web-PACS for multicenter clinical trials. Inf Technol Biomed IEEE Trans 11(1): 87–93CrossRefGoogle Scholar
  14. 14.
    Yang C, Chen C, Yang M (2010) Implementation of a medical image file accessing system in co-allocation data grids. Future Gener Comput Sys 26(8): 1127–1140CrossRefGoogle Scholar
  15. 15.
    Sharma A, Pan T, Cambazoglu BB, Gurcan M, Kurc T, Saltz J (2009) VirtualPACS–a federating gateway to access remote image data resources over the grid. J Digit Imaging 22(1): 1–10PubMedCrossRefGoogle Scholar
  16. 16.
    Liu BJ, Zhou MZ, Documet J (2005) Utilizing data grid architecture for the backup and recovery of clinical image data. Comput Med Imaging Graph 29(2–3): 95–102PubMedCrossRefGoogle Scholar
  17. 17.
    Huang H, Zhang A, Liu B, Zhou Z, Documet J, King N, Chan L (2005) Data grid for large-scale medical image archive and analysis. ACM, New York, NY, USA pp 1005–1013Google Scholar
  18. 18.
    Chen C, Wang W (2010) Implementation of a medical image file accessing system on cloud computing. In: Computational science and engineering (CSE). Hong Kong, ChinaGoogle Scholar
  19. 19.
    (IHE) ItHE: Cross-Enterprise Document Sharing for Imaging (XDS-I)Google Scholar
  20. 20.
    Ribeiro LS, Costa C, Oliveira JL (2011) Current trends in archiving and transmission of medical images, medical imaging. In: Erondu OJ (ed) In tech. ISBN 978-953-307-774-1Google Scholar
  21. 21.
    Zhang J, Zhang K, Yang Y, Sun J, Ling T, Wang G, Ling Y, Peng D (2011) Grid-based implementation of XDS-I as part of image-enabled EHR for regional healthcare in Shanghai. Int J Comput Assist Radiol Surg 6(2): 273–284PubMedCrossRefGoogle Scholar
  22. 22.
    DICOM-P7 (2009) Digital Imaging and Communications in Medicine (DICOM), Part 7: message exchange. National Electrical Manufacturers AssociationGoogle Scholar
  23. 23.
    Pianykh OS (2008) Digital imaging and communications in medicine (DICOM): a practical introduction and survival guide. Springer, BerlinGoogle Scholar
  24. 24.
    Osirix DICOM Viewer. Available in: 2011
  25. 25.
    Ratib O, Rosset A (2006) Open-source software in medical imaging: development of OsiriX. Int J Comput Assist Radiol Surg 1(4): 187–196CrossRefGoogle Scholar
  26. 26.
    DCMTK Available in: (2011)
  27. 27.
    Conquest DICOM Software. in: June 2011
  28. 28.
    PubNub. Available in: June 2011
  29. 29.
    Costa C, Ferreira C, Bastião L, Ribeiro L, Silva A, Oliveira J (2010) Dicoogle-an Open Source Peer-to-Peer PACS. J Digit Imaging 24(5): 848–856CrossRefGoogle Scholar
  30. 30.
    Ribeiro LS, Costa C, Oliveira JL. A proxy of DICOM services. In: SPIE Medical Imaging. Diego, CA, USA, 76280LGoogle Scholar
  31. 31.
    Marcus DS, Olsen TR, Ramaratnam M, Buckner RL (2007) The extensible neuroimaging archive toolkit. Neuroinformatics 5(1): 11–33PubMedGoogle Scholar

Copyright information

© CARS 2012

Authors and Affiliations

  • Luís A. Bastião Silva
    • 1
    Email author
  • Carlos Costa
    • 1
  • José Luis Oliveira
    • 1
  1. 1.Universidade de Aveiro—DETI/IEETAAveiroPortugal

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