Digital Imaging and Communications in Medicine (DICOM)

3.2 DICOM, DICOM-Compatible, DICOM-Ready? 13
All current, medical image-acquisition devices are digital, which does not
necessarily mean that they inherently provide DICOM functionality. Device
manufacturers can implement their own proprietary protocols for digital image
acquisition, storage, and display. Those manufacturer-dependent protocols
will suffice to operate the device as a stand-alone unit, or connected to the
other units from the same manufacturer. Thus, for the manufacturers, the use
of their proprietary protocols involves the issues of convenience and marketing.
Convenience because the manufacturers can do anything they want to implement
the device functionality internally – they are not limited by any standard
or any particular requirement; marketing because proprietary standards make
you dependent on your manufacturer – you simply cannot connect to another
manufacturer’s equipment or software.
This might sound like just another conspiracy theory, but pragmatically,
any proprietary format inevitably segments the medical device market. This
will be discussed in more detail at the end of this book (see Chap. 12).
The bottom line is that in many cases, you must explicitly purchase DI-
COM functionality as an option (in addition to the DICOM device purchase
itself). If you do not purchase the DICOM functionality option, you end up
with what some manufacturers label as a “DICOM-Ready” device, a device that
could have been running DICOM, if you had paid for its DICOM functionality
option.
Another way of looking at this problem is to realize that, in its very essence,
DICOM is a device-interfacing standard. It connects the devices externally, but
it is not meant to drive them internally. DICOM provides a standard for device
output (which also ensures that various devices can be connected to each
other). When you purchase a DICOM option, you pay for this conversion, you
pay for uniformity, and you pay for the ability to export device data in DICOM
format.
If you are serious about your medical imaging workflow, all DICOM options
on your manufacturer’s price list should be treated as mandatory.
What should you do if any of these options are missing? Heed these words
of wisdom: despite the urgency and possible sense of guilt, never attempt to
fix this problem yourself. If you have a DICOM-Ready device that is lacking
DICOM options, the only way to remedy the problem is to contact the device
manufacturer. Resolving all DICOM issues with the manufacturer should become
your standard approach under any circumstance. Not only does it deliver
the best functional solution (even if you have to pay for it), but it also preserves
the device warranty and ensures that no harm will be done to the unit.
A similar DICOM-compatibility problem can arise with an old imaging
unit. As we will see in Chap. 4, the DICOM standard has been around for a
long time and has evolved considerably. As DICOM devices age, they need to
be updated with current DICOM software from their manufacturers. In general,
this is the same approach but with one new catch: the original device
manu facturers might not exist anymore. If this is the situation, you will more
likely have one of the following remedies: