DICOM standards in dentistry

Larry Emmott, DDS

The dental profession is racing toward an electronic digital future. Will it be an integrated, smoothly functioning future with seamless electronic transfer of information, or will it be a frustrating nightmare, where information can be lost or, worse yet, your sophisticated computer system will crash?

In order to ensure the preferred integrated future, industry standards are necessary. One such standard, which will have a significant impact on dentistry is Dicom (digital communication in medicine). This international standard was developed years ago for medical cat-scan types of systems. It has grown to include digital X-rays (dx), visible light (vl) images, and more. The ADA, through the informatics council, and Dr. Brent Dove have been very influential in the development of the parts of the standard important to dentistry.

Dicom is important to dentistry for several reasons. First, Dicom-conformant systems will allow you to transfer digital images, such as X-rays and patient photos, to colleagues, specialists, universities, or third parties, even if they are using different software running on a different platform such as Windows or Macintosh. Conformance also will ensure that the digital document is accurate and secure for proper diagnosis or legal documentation. Finally, what will be most significant to the majority of dentists is intercompatibility between systems.

There is a famous story of a traveler riding the back roads in a Jeep. The ruts and rocks keep getting bigger. Finally dropping into a deep valley, the ruts grew even bigger. Beside the road, a carefully hand-written sign proclaimed, "Choose your rut with care, you will be in it for the next 43 miles."

The same idea applies to digital image systems. If the digital radiography system or the digital image management system you choose is not Dicom-conformant, carefully consider your choice. You will be stuck with it for a long time. It is not possible to accurately transfer digital images with attached data from one system to another in bulk unless they conform to a shared standard.

The Dicom standard is very complete and vendors may comply with all or part of the standard. However, a requirement of compliance is preparation of a conformance statement. If a company or product is truly Dicom-conformant, it must have a conformance statement. When shopping for a digital image product, either X-rays, or visible light, ask the vendor if they are Dicom-conformant and also ask to see the conformance statement.

If a vendor is not yet conformant, be sure to ask: What plans do you have to comply in the future? How will your current system be upgraded to conformance? What will the conformance upgrade cost?

Most new technology markets begin with vendors attempting to control market share with proprietary systems (as we see now with digital X-rays). Then, as the market matures, vendors are forced to create standards. The most successful companies are those which are the most compatible. This pattern is easily seen in the development of personal computers or even VCRs.

We will see continued change in digital images and filmless X-rays over the next several years. Buying now will put you ahead of the technology curve. However, early buyers face some risks as well. If the system you choose does not conform to standards, or the developer goes out of business, you could be Betamaxed. One safeguard against this possibility is to be sure that any system you purchase is Dicom-conformant.

The future is coming and it will be amazing!

Dr. Larry Emmott is a practicing general dentist in Phoenix, Ariz. He also is an entertaining, award-winning professional speaker. He has addressed hundreds of professional groups. He is a featured speaker at the Las Vegas Institute, is a member of AADPA. He will be a speaker at Cosmetic Dentistry 2000. He has written many articles for national magazines on dentistry, computer use, and management. He produces a monthly newsletter on management and computer use in the dental office. He has developed and maintains an Internet Web site at www.drlarryemmott.com; his e-mail address is [email protected].