As quick look at the current DICOM validation standings shows that there are a number of veterinary digital radiography vendors who have yet to pass their DICOM validation. Despite marketing statements to the contrary, they are selling products that are not DICOM compliant. The implications of a DICOM failure can be significant or minor depending on the cause of the failure. In order to make sense of all this a little understanding of DICOM is necessary. At the end of this discussion you get to feel some of the pain I felt at this years SHOWDOWN.
DICOM is a language. There are no police
DICOM is analogous to a language. There are no language police. Vendors can claim DICOM compliance just as any person can claim to speak any language. Errors in DICOM compliance lead to errors of interpretation just as errors in communication can be caused by people whose language abilities are not up to par. An analogy is in order to explain all of this DICOM stuff. I would like to introduce you to two of my colleagues.
Lord Simon Batwing is an old school Brit who still breaks out the tailcoats he wore in his days at Eton College. He speaks the kings English and the marmite and tea in his stomach begins to turn when he hears anything other than proper King’s English.
Irwin Goldstein is an Israeli meatpacker and former Mossad agent who recently moved to the United States. His English is poor but he is great to travel with. You want him on your side when visiting a third world country. Nobody messes with him. Nobody.
Irwin, Lord Batwing, and I recently traveled to India. I was walking behind the two of them as we approached Assi Ghat in Varanasi and Lord Batwing started ranting and raving that he cannot understand a word that Irwin is saying and that he would prefer to listen to an Indian schoolboy talk because they have better English skills than my buddy Irwin. This is not unexpected but can generally can piece together most of what Irwin says and for the most part do not have a problem talking with him. Unfortunately, sometimes I misunderstand what he is saying and other times I agree with Lord Batwing as I have no idea what he is saying. In once case, Irwin was trying to tell me that during a war, he had prostatitis but said that he had prostitutes. It always seemed odd that the Israeli army brought prostitutes to war but that is what I thought he said.
This stupid analogy is really pretty close to what happens with DICOM failures. In this analogy, Lord Batwing is 100% compliant. He can communicate with any other system that is DICOM compliant and there will never ever be any errors in interpretation or communication. This is the way most computers work. If there is one character or one number out of place or out of line – you get a communication failure and the computer throws an error. If all vendors were 100% DICOM compliant we would have no communication errors.
In this analogy, my approach to things is akin to what some digital vendors do. They allow for some degree of DICOM error. Some even build workarounds so they can communicate with systems they know are not compliant. Most of the time this works out OK but errors in communication are still common when communicating with non-compliant systems.
Poor old Irwin is analogous to a system that failed their DICOM validation. If he tries to communicate with some people (such as Lord Batwing) there will be a total breakdown of communication. If he tries to communicate with some people such as me, in some cases things will work out OK but in other cases, there will be errors.
Getting back to the original question that so many vets ask me, “what does it mean to me if my vendor fails the DICOM validation?’ you can now see that the answer to that question will depend on 1) how bad they failed the validation and 2) what system is trying to open the images from your vendor.
In some cases, the validation failure is minimal and you wont have issues unless sending to the most precise systems. In other cases, the failure will be so large that no system will open the images. In other cases, the vadliation failure will be intermediate and the images will open in some systems and not others.
What can be said for sure, is that if the vendor passes the DICOM validation, every other system out there should be able to communicate with that system without error.
Now you get to feel my pain and see how important this DICOM stuff really is.
During the Veterinary Digital Radiography SHOWDOWN and DICOM validation, vendors generate digital radiography images that are distributed to veterinarians on a DVD that contains a DICOM viewer. The issue I ran into this year was that I tried 4 different DICOM viewers and none of them could open all of the SHOWDOWN images. This is because we had a number of vendors fail the DICOM validation. The viewers simply rejected their images. I was finally able to find a viewer that opened the images so the SHOWDOWN was saved. (Woohoo!)
Nonetheless, you can see that if you buy a system that is not 100% DICOM compliant you run the risk of radiologists or specialty hospitals being able to open your images. This is a real issue that every veterinarian must consider when purchasing a digital radiography system.
Your pain may be delayed a bit but you will feel the pain
I have had vets tell me that teleradiology is not important to them and they rarely refer cases so they do not care about DICOM. I agree with them. In their situation, DICOM is not important for the time being. However, this practice will catch up with them sooner or later.
Remember, a digital radiography purchase is a 5-7 year purchase. You WILL have to replace your system or your software in the not too distant future. We are already seeing veterinarians trying to upgrade or change systems and they are not able to move their old images into the new system because the new system cannot open these images. That situation can only be described as “no bueno.”
Bottom line: Please do yourself a favor and avoid future pain by only purchasing systems that are DICOM compliant. A running validation of the veterinary digital systems and image repository can be found here . If your vendor is not listed, please have them contact us and we will work with them to perform the validation test and fix errors if any are identified.
Please feel free to comment on this article over on our Facebook page.
