An Analysis of DICOM and Its Use for Image Management and Communication in Store-and-Forward Telehealth (pp. 33-54)
Authors: (Liam Caffery, Centre for Online Health, The University of Queensland, Australia)
Abstract: DICOM is an international information technology standard used for the encoding and communication of digital medical images. DICOM was originally developed for radiology and is considered a key determinant in the success of teleradiology. There is an increasing move and policy consensus to use DICOM as the standard image management and communication protocol for all medical images including images acquired for the purpose of store-and-forward telehealth services. Standardized image management would allow the efficient integration of all imaging into a patient’s electronic medical records and also allow a single Picture Archiving and Communication (PACS) to be used across an enterprise.
In this chapter the actual or intended application of DICOM for image management in store-and forward telehealth was investigated. It was found that DICOM allows alternative image encoding by acquisition modalities. These encodings include: Secondary Capture, Visible Light and Ophthalmic Photography. Different metadata in the DICOM header of these DICOM files is the predominant differences between encodings.
Ophthalmic imaging would appear to be the most mature non-radiological applications of DICOM and the Ophthalmic Photography IODs and related Service Object Pair (SOP) classes are intended for use with ophthalmic imaging systems, for example, microscopes, ophthalmoscope, fundus camera, slit lamp imaging systems and external cameras. These information objects contain rich patient, clinical, examination, and equipment metadata. Visible Light IODs (and related SOP classes) are intended for use with endoscopes, colposcopes and digital cameras. Hence, it would be suitable for use in teledermatology, telecolposcopy, telewoundcare, teleotolaryngology and numerous other clinical specialty services that use a simple digital camera to obtain clinical images. The inclusion of Secondary Capture support by acquisition modalities would appear to be only for interoperability with devices that do not support either Ophthalmic Photography or Visible Light SOP classes.
The wide spread use of DICOM Modality Worklist to improve workflow management in a telehealth imaging network was observed during this investigation. Similarly, the wide spread support of image communication services like electronic image storage from acquisition device to PACS was also seen. However, compliance of these network services is not mandatory and the device’s DICOM conformance statement should be used to identify what information objects and network services are actually provided by a device.
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