DICOM standard tackles small clinic setting

The DICOM standard is spreading beyond radiology into other medical specialties. Now it may boost fields like dentistry into the lead in digitizing smaller healthcare enterprises.

Digital solutions that fit large hospitals are not necessarily the best for small clinics, such as those found throughout the field of dentistry. DICOM is flexible enough, however, to accommodate both the large and the small, according to Dr. Allan G. Farman, a professor of radiology and imaging sciences at the University of Louisville School of Dentistry.

Farman documented the advantages of DICOM in dentistry in a report published in the November 2004 issue of the Journal of Digital Imaging.

DICOM had little relevance to dentistry until a high enough proportion of dentists invested in digital imaging equipment instead of relying on traditional analog silver halide film for radiography, Farman said.

Unlike the relatively closed system of a traditional hospital, most of the 160,000 dentists in the U.S. work in the world of small business, where solutions need to be highly cost-effective.

"In the medical hospital, one is dealing with large sophisticated departments loaded with many expensive devices. In dentistry, however, one is dealing with a large number of disparate clinics with much more basic radiographic equipment," Farman said. "Dentistry is a leader, along with ophthalmology, in applying DICOM to the small clinic environment."

Because dentists often need to transmit radiographs for second opinions, specialist referral, forensic identification, and third-party approvals and claims, an imaging standard would ensure that important diagnostic information could be transferred between practitioners as well as between systems within a single practice.

Dentistry and DICOM have a solid history. The American Dental Association was a founding member of the expanded DICOM standard committee that evolved from American College of Radiology and National Electrical Manufacturers Association roots.

Dr. Brent Dove, a dentist, chaired Working Group 2, which developed the standard for radiography transmission radiography. The standard actually includes a special section for dental intra-oral radiography, according to Farman.

"The ADA resolved four years ago to promote DICOM as the core for interoperability of dental digital image interoperability," he said.

Farman chairs Working Group 12.1, tasked with bringing this process forward, and cochairs Working Group 22 (Dentistry), which was formed in 2003 to develop correction packages and new DICOM supplements related specifically to dentistry.