Digital Imaging and Communications in Medicine (DICOM)

Last revised by Raymond Chieng on 10 Aug 2023

Digital Imaging and Communications in Medicine (DICOM) is a worldwide standard for the storage and transmission of medical imaging. The standard therefore defines both a file format and a networking protocol. The standard also has some specifications in terms of file storage on some types of media e.g. compact discs. It has been developed with input from members of the DICOM standards committee, with representation from both manufacturers and users (including American College of Radiology (ACR), Radiological Society of North America (RSNA), and European Society of Radiology (ESR), as well as societies representing other users e.g. cardiologists) 1.

A formal protocol (such as DICOM) defines the way that devices talk with one another and store their program data.  The aim of using the published DICOM standard is to ensure that devices made by different companies speak the same language and can, therefore, operate together within the same hospital environment.

As well as the core imaging information (pixel data which may be encoded in different ways), DICOM files usually include a large amount of additional data relevant to the study and patient. Although some security features are part of the DICOM standard, the standard also has some notable vulnerabilities in terms of cybersecurity 3. Patient identifying information in DICOM files is included in the header tags but also can be included in other parts of the files 5 e.g. ultrasounds often have a patient name or number as part of the images.

A DICOM file is made up of several parts, namely: preamble, prefix, header, and image pixel intensity data. The header stores the patient's information, acquisition parameters during the study, image dimensions, matrix sizes, and color spaces. The header is separted from the pixel intensity data by an attribute "7FE0". The pixel intensity data is stored in series of "1"s and "0"s which can be decoded into an image by using the information from the header 6.

DICOM is used together with Health Level 7 (HL 7) standard to exchange textual data among Hospital Information System (HIS), Radiology Information System (RIS), and Picture Archiving and Communication System (PACS) 7.

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