Can you say, ‘interoperability?’

I have been writing and talking about the importance of DICOM for medical imaging for some time now.

By Jeffrey B. Dalin, DDS, FACD, FAGD, FICD

I have been writing and talking about the importance of DICOM for medical imaging for some time now. In this column, I'd like to address some frequently asked questions on the subject.

Question: What is this DICOM thing all about?

Answer: DICOM is an acronym standing for Digital Imaging and COmmunications in Medicine. In essence, it is a series of worldwide software standards, approved by an international body, to help programmers create their medical-imaging products to meet common and universal specifications.

Question: What sorts of products are we talking about?

Answer: DICOM is particularly relevant for dentists wanting to purchase intraoral and extra-oral digital radiography systems.

Question: Do digital radiography systems talk to each other?

Answer: Two concepts need to be understood here. One is DICOM, and the other is "interoperability." They are not the same thing, although many people mistakenly think they are.

When two digital radiography systems are truly "interoperable," images taken with one system (and all of the associated tags of information

Question: What are the conceptual differences between DICOM and interoperability?

Answer: Manufacturers voluntarily produce what is known as a "DICOM conformance statement." They write it themselves and publish and freely circulate the document, typically on their Web site. Dentists are free to ask for a copy of it if they wish.

The purpose of the conformance statement is to help manufacturers and customers compare claims about imaging capabilities. No document exists that describes or substantiates manufacturer claims about interoperability. The only way to prove interoperability is to try out the systems on the same computer and see if they work together properly.

Question: How does DICOM conformance lead to interoperability?

Answer: Think of DICOM as the foundation on which interoperability is created. For example, if DEXIS creates a DICOM conformance statement and the folks at Planmeca want their system to be interoperable with the one from DEXIS, they first study the DEXIS conformance statement. Their next step will be to try to ensure that their own capabilities and conformance statement are compatible with DEXIS' capabilities and conformance statement.

Question: What is the ADA's role in all of this?

Answer: Two leading figures are working for the ADA on these matters. They are Allan Farman and Brent Dove. Both have been leading committees, task forces, or work groups on DICOM conformance and interoperability for some time. Increasingly, the two efforts are converging because it has become apparent that although DICOM and interoperability are separate concepts, they are sequentially linked to one another.

Question: Who are the leading manufacturers supporting this effort?

Answer: Ten manufacturers attended a meeting at the ADA offices in Chicago last November. Five of these companies demonstrated that their digital-radiography systems were both DICOM-conformant and interoperable with each other. These companies were DEXIS, Gendex (Dentsply), Instrumentarium, Planmeca, and Trophy.

Question: Does this mean that if I am using a digital radiography system from one of these five companies and a colleague is using a system from one of the other five companies that we can exchange and view each other's patient images?

Answer: In principle, yes. In practice, it may be a little more difficult task for anything other than viewing one or two images at a time. The effort to export an image in 0the DICOM format (the file would end in .dcm) via email, floppy disk, or some other method and the corresponding effort to import that file into the other system is possible. And, in fact, if a general practitioner were to refer a patient to an endodontic specialist, it might make a lot of sense. But exporting a full-mouth series in this manner might be more work than we would like.

Question: Is there anything else dentists should know when they research various digital radiography systems?

Answer: Here is my wish list:

• I want dentists to push manufacturers hard to develop DICOM conformance in their products and to provide assurance that their systems are interoperable with other leading systems.
• I want the interoperable systems to be simple and easy to use.
• I would like practice-management companies to help make interoperability work.
• I would like to see the ADA become the leader in making all of this a reality. Dentistry seems to lag behind other branches of medicine. We need the ADA to generate its own vision of the future and move swiftly and effectively to ensure that DICOM conformance and interoperability become the standard in dentistry.

Jeffrey B. Dalin, DDS, FACD, FAGD, FICD, practices general dentistry in St. Louis. He also is the editor of St. Louis Dentistry Magazine and spokesman and critical-issue-response-team chairman for the Greater St. Louis Dental Society. His address on the Internet is www.dfdasmiles.com. Contact him by email at jeff@dfdasmiles.com, by phone at (314) 567-5612, or by fax at (314) 567-9047.

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