EXPERIENCE IMPLEMENTING A DICOM-3.0 MULTIVENDOR TELERADIOLOGY NETWORK

Objective: The ISIS Center at Georgetown University received a grant f rom the U.S. Army to act as systems integrator for a project to design , develop, and implement a commercial off-the-shelf teleradiology syst em to support the U.S. troops in Bosnia-Herzegovina. The goal of the p roject was to minimize troop movement while providing primary diagnosi s to military personnel. This paper focuses on Digital Imaging Communi cations in Medicine (DICOM) 3.0 related issues that arose from this ty pe of teleradiology implementation. The objective is to show that usin g the DICOM standard provides a good starting point for systems integr ation but is not a plug-and-play operation. Methods: Systems were purc hased that were based on the DICOM 3.0 standard. The modalities implem ented in this effort were computed radiography (CR), computed tomograp hy (CT), film digitization (FD), and ultrasonography (US). Dry laser p rinting and multiple-display workstations were critical components of this network. The modalities and output devices were integrated using the DICOM 3.0 standard. All image acquisition from the modalities is d irectly to a workstation. The workstation distributes the images to ot her local and remote workstations, to the dry laser printer, and to ot her vendors' workstations using the DICOM 3.0 standard. All systems we re integrated and tested prior to deployment or purchase. Local and wi de area networking were also tested prior to implementation of the dep loyable radiology network. Results: The results of the integration of the multivendor network were positive. Eventually, all vendors' system s did communicate. Software configuration and operational changes were made to many systems in order to facilitate this communication. Often , software fixes or patches were provided by a vendor to modify their DICOM 3.0 implementation to allow better communications with another v endor's system. All systems were commercially available, and any modif ications or changes provided became part of the vendor's commercially available package. Conclusion: Seven DICOM interfaces were implemented for this project, and none was achieved without modification of confi guration files, changes or patches in vendor software, or operational changes. Some of the problems encountered included missing or ignored required data elements, padding of data values, unique study identifie rs (UID), and the use of application entity titles. The difficulties w ith multivendor connectivity lie in the understanding and interpretati on of standards such as DICOM 3.0. The success of this network proves that these problems can be overcome and a clinically successful networ k implemented utilizing multiple vendors' systems.