Implementation of the DICOM standard in a heterogeneous environment: incompatibility or interoperability?

Purpose: The DICOM standard, introduced in 1993, is now established in many of today's image modalities. Experiences with DICOM implementations and re quirements for future developments are described. Methods: First a brief summary of the development of the DICOM standard is given. Based on general observations, different problems with installation, programming and maintenance are outlined. Results: The standard consists of mandatory and optional information models and functionalities to enable the use and development of a broad spectrum of applications. But the available options lead to specific applications no t compatible with the basic idea of the standard. Discussion: For functional communication distinct DICOM services are necess ary. This includes DICOM Basic Worklist, Storage Commitment and Performed P rocedure Step. A constructive way to achieve interoperability through volun tary arrangements between manufacturers and users will be shown.