Standards and System Integration in Digital Medicine

Abstract

If you are interested in the organization and management of PACS workflow, I suggest you read an excellent book by Dreyer et al. (2006). In this chapter, we will glance only at the DICOM-related standards that are supposed to make everything fit together. Why, even within DICOM, has product integration become such a big hassle? Let me answer this with a really simple question: If two DICOM products conform to the same parts (SOPs) of the DICOM standard, do they conform to each other? Do not rush to say “Yes”, as it would be a mistake. Well, theoretically, “Yes” is the right answer. Practically though, there is enough room for mistakes and incorrect assumptions in any DICOM product. Although DICOM is called a standard, it is really a guideline, a big fat 16-volume suggestion on how things should be if you and your vendors are nice enough to take the 16 volumes into consideration. If a DICOM vendor makes a mistake in its DICOM implementation – or claims false conformance, or understands something differently, or just does not care to follow DICOM at all – there will be no penalty and no blame. In fact, caught in this situation, most DICOM vendors would usually say something like “DICOM is too complex, it’s DICOM’s fault”. What DICOM really needs, in addition to any technical complexity, is a nice set of teeth to transform itself from a scapegoat into an industry authority. Before this happens, you as a customer will be responsible for making sense of standard implementation and integration, so read carefully. Oh, and by the way, there are other standards, too.