Who moved my DICOM?

by Juan Martin Palomo DDS, MSD
palomo@case.edu

Most orthodontists associate the term “DICOM” with Cone Beam Computed Tomography (CBCT).  DICOM however represents much more than that.  DICOM, which stands for “Digital Imaging and Communications in Medicine,” is the international standard for all medical images and related information.  Any radiograph, 2D or 3D, as well as photographs and even text documents can be stored as DICOM files.  DICOM represents is a non-proprietary file format that can be accessed by any software regardless of the hardware and software used in the capture stage.  Think of it as the equivalent to a .jpg, .tif, or .pdf, with many extras. Most importantly, it replaces company-specific file formats making data accessible by anyone in the healthcare field.

Many of us have had to at some point in time change management software systems, or send information to referring or transfer offices.  This would be very simple if everybody involved used the same software or if all software read the same formats. When this is not the case complications may occur.  Software programs use their own proprietary file formats because 1) they have invested a lot of time and resources to make the files efficient, and 2) they want to protect their intellectual property.  This can be a shortcoming to the user if there is no option for exporting the data in a format that can be opened with other programs.  It is important for anybody buying clinical software (regardless if it comes with x-ray equipment or not) to make sure that not only can it read DICOM files, but that it is able to export data into that format too.

A DICOM file has multiple layers of information embedded within it.  A DICOM file contains the patient’s name, demographics, information about the capture system, the date, etc. So a DICOM file located on a computer hard drive is much better than an unlabeled radiograph or picture laying on the desk. It has all the identifying information embedded within it.  This is obvious when a DICOM file is opened and the patient’s personal information is quickly displayed.  Additionally, most DICOM viewers also use the data embedded within the file to assign the patient’s identity, helping avoid the mismanagement of images (i.e. placing the wrong image into a patient’s file).  If your current software does not read DICOM files, don’t worry.  There are plenty of DICOM readers free of charge that can be easily downloaded that will perform most necessary tasks.

Lastly, when archiving images, make sure to do so in the DICOM format because there is no guarantee that your specific software will be available forever.  I would further recommend that you go back to your previously archived files and see if they are in the DICOM format. Don’t be surprised if they are not!  Luckily most, if not all, dental and medical capture devices now provide a “save as DICOM” option. Just be aware that DICOM is not usually the default.

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