OEM shift to DICOM begins with feelers between competitors

July 13, 1994

Vendors build network integration groups Initial strides are being taken by all major scanner OEMs to implementthe ACR-NEMA DICOM 3.0 network interface standard. The vendorsappear to be responding to a sea change in networking expectationsamong

Vendors build network integration groups

Initial strides are being taken by all major scanner OEMs to implementthe ACR-NEMA DICOM 3.0 network interface standard. The vendorsappear to be responding to a sea change in networking expectationsamong medical imaging users, according to one supplier of interfacetechnology to OEMs.

Scanner manufacturers are currently testing their attemptsat implementation of DICOM 3.0 against each other in order tofind applications that are compatible, said William C. Mortimore,president of network interface developer Merge Technologies ofMilwaukee. The DICOM 3.0 standard was ratified by the MedPACSsection of the National Electrical Manufacturers Association lastOctober (SCAN 11/17/93).

Many vendors have instituted network integration programs aspart of their service organizations, probably in response to perceivedcustomer demands, he said.

Increased efforts among scanner vendors to provide networkingcapabilities are probably tied to a call for productivity enhancementsfrom their customers and their customers' customers, Mortimoresaid.

"Radiology departments are service businesses. They havecustomers of all kinds, including managed care," he said."Their customers are demanding a lot from them. They seethat computer networking is one way to improve productivity andbetter manage information."

While DICOM 3.0 implementation proceeds, the standard itselfcontinues to congeal in detail and expand in breadth of applications.

"There will still be a couple of years required in understandinghow to interpret the standard and getting minor problems takencare of," Mortimore told SCAN. "However, the major manufacturershave allowed for flexibility in areas where there could be misinterpretation."

Flexibility is key when dealing with DICOM 3.0 since the thirdversion of the ACR-NEMA standard actually has less explanatorymaterial than was provided in the previous two versions, he said.Instead, details are developed through initial case-study experience.This ambiguity may prove to be a strength of the standard overtime as it is molded to fit real-world requirements.

"There are some areas (of the DICOM standard) where well-intentionedpeople could read the same thing and draw different conclusions,"Mortimore said. "But its robustness and changeability arewhat will allow the standard to growin medical imaging communications."

Merge's business will benefit from a continued fleshing outof the standard. The firm's Mergecom 3 product is a tool kit forvendors, enabling them to add new DICOM objects and other capabilitiesin a modular or dictionary fashion, rather than having to writebasic coding themselves.

Merge also provides network services of its own, as well asblack-box proprietary interfaces known as multivendor protocolconverters (MVPs). Demand for MVPs will likely remain healthyfor the time being, as most of the existing installed scannerbase is non-DICOM compatible.

Just the fact that DICOM has been launched may be its strongestcard in advancing the cause of medical imaging networks. The marketfor picture archiving and communications systems fizzled for yearsbecause users did not believe the time was right. Few sites wouldrisk expending the necessary dollars on proprietary networkingtechnology that might quickly become obsolete. Now, however, proprietaryinterfaces will live on in a DICOM world.

"One thing DICOM has done for us and the industry is makepeople believe that all this stuff could be interconnected,"said Dwight Simon, Merge vice president. "This was a stumblingblock. People didn't understand that it could be connected. Now,they believe and want to connect things that are old and willnever be DICOM -- and they are going to need bridge boxes."

Simon, as well as two other Merge employees, worked with theACR-NEMA standards group in developing the initial nine partsof DICOM. Next on the standards agenda are parts 10, 11 and 12,which deal with writing DICOM data to removable storage media,such as optical disk, he said.

Bringing others on board. Efforts are also under way to expandDICOM's modality reach, Simon said.

"Since the standard was passed, there has been a lot ofactivity from outside groups trying to get their objects definedso they can be part of the standard," he said. "Theyinclude ultrasound, endoscopy, cardiology and radiation therapy."

The application of DICOM 3.0 to ultrasound for use with removablemedia is progressing, he said. An ultrasound object may be availablefor ACR-NEMA voting by August.

An object for angiography use in cardiology, developed in conjunctionwith the American College of Cardiology, has already been releasedfor preliminary review prior to a formal vote, he said.

Standards convergence is under way internationally as well,Simon said. DICOM 3.0 has been tentatively accepted by the Europeansas the basis for their medical imaging standard. The Japaneseare farther behind, but they have begun translating DICOM, includingsome sections that have not yet been implemented in the U.S.

"The Japanese manufacturers are deciding what to do aboutit," Mortimore said. "DICOM is seen as something theyneed to deal with because of their sales in Europe and North America,not for the Japanese market. But it shapes a lot of their thinking."