Digital Imaging and Communications in Medicine (DICOM)

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Chapter 13 DICOM and Teleradiology
pitals are still fighting with the same “last mile” problem, unable to efficiently
transmit their data anywhere beyond a couple of reading rooms.
It’s no wonder then that, while PACS were battling with those technical and
logistical problems, similar and somewhat lighter approaches were explored.
These approaches were easy to implement, often did not require any special or
expensive equipment, and, more importantly, could easily be done by the doctors
without relying on slow-moving administrative or technical resources.
In the early 1960s, a classic and widespread example of transmitting medical
data remotely was achieved by sending ECGs over phone lines (just like
Dr. Einthoven prescribed). It worked well even then. First, because ECGs were
much smaller in data size compared to digital images, thus matching the low
bandwidth of the phone lines. Second, even half a century ago, phone lines
were already in place, thus providing a ready-to-use infrastructure. Finally,
ECGs were conveniently transmitted in their original analog format, which
was very handy before the entire spectrum of data digitizing techniques had
been worked out.
Eventually, by the 1990s, these and similar experiments gave rise to a direction
called telemedicine, which was dealing with all possible ways of providing
clinical services remotely. The most typical features of telemedicine projects
would include:
1. Use of standard (often analog) networks and equipment to transfer data remotely:
ISDN (Integrated Services Digital Network), TCP/IP, analog lines.
2. Use of standard multimedia formats for clinical data: for example, converting
images to JPEGs, AVIs, or word-processing documents.
3. Use of standard teleconferencing software and hardware (online meetings,
Internet chat-like applications, Web cameras, and so on) for remote
consultations.
4. Lack of any serious PACS interface or DICOM support.
In brief, at that time the word “medicine” in “telemedicine” was reflecting only
a particular choice of data, but not the choice of tools. The same systems could
have been used for telematchmaking, telecooking, tele-practically-anythingelse.
In one respect, this generality made many telemedicine projects popular
and easy to use; no learning curves, no complex installations. Unfortunately,
the same generality that once contributed to the spread of telemedicine applications
has also become its main drawback and limitation. While telemedicine
systems proved to be important and efficient in areas such as remote education,
they never really made it to the heart of medical imaging: radiology (here
they were sarcastically nicknamed “talking heads” 38 ). The main reason for this
failure was the lack of sophistication and relevant, radiology-specific imaging
tools, which are crucial for remote image reading. When one of my colleagues,
an expert radiologist, was invited to consult on a remote patient over a video-
38 Referring to the videoconferencing style of such applications.