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Medical Image Management: DICOM Images Sharing Process

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5 minutes, 29 seconds read

For modern healthcare organizations, extending better patient care across the service continuum involves new challenges that surround sharing information over a distributed network. Effectively sharing patient information remains a challenge. However, the inability to access these records in a time-sensitive manner results in re-imaging and re-testing the patients. It affects both — ‘time-to-treatment’ and the bottom line. Effective medical image management thus becomes crucial for every digital healthcare enterprise. 

The release process for medical images is altogether complicated — brimming with security related-risks. Images (such as X-Ray Scans, MRI scans, PET scans, etc.) are created and released across several departments and systems while being purposefully kept ‘out-of-reach’ from a host of unauthorized users.

Training & controls on release policies and procedures require ‘health information management’ expertise. It’s because image Handling (electronically) can become susceptible to data corruption, complex accessibility/sharing issues and high-security risks. All of these raise potential red flags for health information management (HIM) professionals.

So how does Medical Image sharing work in this environment? What, if any — are the safeguards surrounding the ‘release’ process?

Medical Image Management: Sharing DICOM Images across healthcare enterprises

Before we go further, let’s delve into the term ‘Medical Imaging’. According to the WHO, the technique embodies different imaging modalities and processes to image the human body (creating visual representations) for diagnostic and treatment purposes. — making it crucial for improving public health initiatives across all population groups.

First, the image is captured using a medical imaging device (routine imaging techniques like ultrasound, MRI, etc.). Then it is necessary to archive and store the images for future use and further processing. Unlike regular images (.png, .jpeg), medical images use DICOM format for storage. DICOM is Digital Imaging and Communication in Medicine standard. The medical practitioner responsible for acquiring and interpreting such medical images is a ‘Radiologist’. And the system they rely on for storing electronic image data is ‘PACS’ (Picture Archiving and Communication System).

If a healthcare organization or an outside consultant (physician, clinician) needs access to an individual patient’s medical images, then the access and retrieval will have to go through PACS. Typically, a Radiologist has authority to control and operate PACS.

Here is a simple process diagram of a medical imaging system —

medical imaging system process diagram

A Typical HIPAA-compliant Medical Imaging Management System places a request (for a specific file) to ‘PACS’ via an intermediary system known as ‘Edge Server’. The sole purpose of the Edge Server is to function as a request-node so that other hospitals or physicians can contact the particular radiologist (who possesses the images stored in PACS) and place a request to access a copy of the file in question.

[Related: Modern Medical Enterprises Absolutely Need Test Automation. Here’s Why.]

Medical image sharing use cases

Critical use cases arise for medical image sharing involving support for:

  • Remote image viewing (out of network)
  • Specialist consults
  • Telehealth (examples such as teleburn, telestroke)
  • Trauma transfers
  • Ambulatory image review

Typically, PACS store digital medical images locally for retrieval. A PACS consists of four major components: 

  1. The imaging modalities such as X-ray plain film (PF), CT and MRI 
  2. a secure network for the transmission of patient information
  3. workstations for interpreting and reviewing images
  4. archives for the storage and retrieval of images and reports. 

To communicate with the PACS server we use DICOM messages that are similar to DICOM image ‘headers”, but with different attributes. The Edge Server manages several functions that allow users to sort through hundreds of thousands of large-volume data and retrieve a specific file from a database either stored in ‘PACS’ or on the ‘MIMS’.

Each of the three highlighted sections (see diagram) can perform various functions, while communication is defined through specific rules and standards that are legally enforced and universally followed.

DICOM medical image sharing via PACS and MIMS

Through the ‘Edge Server’, we can access images stored in PACS. The ‘Management Services’ operation is the first and foremost feature. It means that a user can control & maintain the complete functionality of the server through this. Using ‘Remote Authentication’, users can obtain centralized authorization and authentication to request files from PACS. Please note, Remote Authentication is a networking protocol operating by way of specific ports.

To verify basic DICOM connectivity to the server — i.e, to check if the server is live or not, a C-Echo message is sent to ping the server, after which it will wait for its response. Once identifying the server as live, a user can perform querying and retrieval-based operations. Next, the user can begin the process of requesting DICOM images from the Medical Image Management System — known as ‘Ingestion’. DICOM Ingestion involves pre-assigned IP and port addresses (default ports are 2104-2111).

Basic DICOM Operations

Client: First, it’s important to check the location of the specific image(s) on a particular server. For this, a query-based C-FIND operation sends a request to the server. The user establishes a network connection to the PACS server and prepares a C-FIND request message (which is a list of DICOM attributes). The user then fills in the C-FIND request message with ‘keys’ that match. (E.g. to query for a patient ID, the user fills the patient ID attribute with the patient’s ID.) Then, the C-FIND request message is sent to the server.

Server: The server reverts a list of C-FIND response messages. Each of these messages contain a list of DICOM attributes with values for each match. It then initiates C-MOVE request using the DICOM network protocol to retrieve images from the PACS server. 

One can retrieve images at the Study, Series or Image (instance) level. The C-MOVE request specifies where the retrieved instances should be sent (using separate C-STORE messages). The C-STORE operation, also known as DICOM Push simply pushes (sends) the images to the PACS server (or P2P — Push to PACS). 

C-STORE message implements the DICOM storage service. The SCU sends a C-STORE-RQ (request) message to the server, which includes the actual dataset to transfer. The server answers by returning a C-STORE-RSP (response) message to the user, communicating success or failure of the storage request.

DICOM Images Benefits

Using DICOM images, health management professionals, physicians, and radiologists can utilize secure protocols in handling confidential medical image data. It extends the ability to view such images discreetly and instantly; avoiding duplication costs; and reducing unnecessary radiation exposure to patients.

Medical Image Sharing furthers the “Health 2.0” initiative by being able to instantly and electronically exchange medical information between physicians, as well as with patients — improving communication within the industry.

[Related: How AI is innovating healthcare sector?]

About the author: Rijin Raj is a Senior Software Engineer-QA at Mantra Labs, Bangalore. He is a seasoned tester and backbone of the organization with non-compromising attention to details.



What is the DICOM Image format?

DICOM stands for — Digital Imaging and Communication. It is a medical standard for sharing a patient’s MRI, X-ray, and other image files over the internet.

How are DICOM Images stored?

Unlike regular images (png, jpg, etc.) DICOM is a secure format for storing confidential medical images. Usually, PACS (Picture Archiving and Communication System) and MIMS (Medical Image Management System) are used to store DICOM Images.

What is DICOM used for?

DICOM is used for securely storing and retrieving confidential images in distributed networks (internet).

Why is DICOM important?

Using DICOM images, health management professionals, physicians, and radiologists can securely handle confidential medical image data.


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MantraTalks Podcast with Parag Sharma: Delivering Digital-first Health Experiences for Patient Care in the New Normal

6 minutes read

The healthcare industry took the brunt of the Covid-19 pandemic from the very beginning. It was, and still is, a humongous task for hospitals to deal with the rising number of COVID patients as well as handling the regular consults. 

To delve deeper into the state of healthcare in the COVID times, we interviewed Parag Sharma, CEO, Mantra Labs Pvt Ltd. Parag shares his insights on how technology can help in delivering digital-first health experiences for patient care in the New Normal.

Parag is a product enthusiast and tinkerer at heart and has been at the forefront of developing innovative products especially in the field of AI. He also holds over ten years of experience working in the services line and has been instrumental in launching several startups in the Internet & Mobile space. His rich domain expertise and innovative leadership have helped Mantra climb to the top 100 innovative InsurTechs in the World – selected by FinTech Global. 

Catch the interview:  

Connect with Parag- LinkedIn

COVID-19 and Its impact on Healthcare Organizations

Considering the COVID situation, according to you how has COVID-19 impacted the IT & service operations among healthcare organizations?

Parag:  Since the onset of COVID-19, the healthcare sector has been deeply impacted. Institutions are facing a serious crunch in manpower. IT support systems which were usually manned and managed by a large team of IT professionals are not available in the same strength. Resource allocation’ is one of the biggest concerns due to physical and mental exhaustion of the healthcare workforce. 

Hospitals are facing issues such as operational disruption due to staff quarantine, supply-chain delays and sudden decline in patient footfalls, difficulty in sustaining fixed costs, etc. People are not comfortable getting out of the safety confinements of their homes due to the rising risk of getting infected with the virus. Hospitals will have to reassess their future strategy and budgets in light of the uncertain economic situation.

Preparing for the Future

What can hospitals do to ensure the continuity of their customer-facing operations in the wake of a second Pandemic wave?

Parag: There are many things that hospitals can do to manage themselves in this hour of crisis. Being more digital than what they are would be one step forward for all of them. They can bring their IT systems to the cloud so that the person can access data and manage their work remotely. They can enable their patients to book appointments and enquire about services through apps and chatbots which won’t require them to call the reception or come to the hospital. These are some of the services which hospitals can provide to their customers with minimum physical contact. 

Related: Manipal Hospital’s move to a self-service healthcare mobile application

Hospitals can extend Telehealth services to their patients. Recently, telehealth has proved to be useful especially when there is asymmetry between the number of patients and healthcare providers. I think it will be very useful for healthcare institutions to deploy telehealth solutions to provide medical facilities to people who have so far been outside the benefits of healthcare.

New Expectations in Health Experiences

Is consumer behavior defined by the ‘new normal’ going to change the way we access healthcare from this point on?

Parag: Yes, people will expect a completely different way to access healthcare services from now on. Hospitals should gear-up and rise to this occasion. The pandemic has also provided a new opportunity to adopt a completely different approach in the way healthcare is delivered. They always felt that medical care cannot be provided remotely but now this is happening and people are appreciating remote healthcare services. Hospitals and healthcare institutions are convinced that telehealth and remote care will be more successful soon.

Technology in Healthcare can Bridge Operational Gaps

What are the operational challenges, as far as digital capabilities go, that hospitals are facing currently? And, what steps must they take to bridge these gaps?

Parag: Operational challenges are not just digital challenges. But a lot of these challenges can be addressed with technology. For example, Electronic Health Records which hospitals manage within the premises can be moved to the cloud so that the person can access these records on the cloud itself and need not come to the hospital. 

Related: Medical Image Management: DICOM Images Sharing Process

Secondly, if you deploy telehealth and telemedicine solutions, irrespective of where your patients are or doctors are, hospitals can deliver the required care to its patients. You can even extend your diagnostics services to your patients by giving them an application through which they can seamlessly book appointments for consults, diagnostics, or pathological services and resolve their queries, etc. Simply by giving a seamless interface either through bots or applications can go a long way in providing better health experiences to the customers.

Role of Chatbots in Superior Customer Experiences

According to you, what role does chatbots powered by Artificial Intelligence have in the Healthcare CX landscape?

Parag: Chatbots are the simplest example of the implementation of AI-based technology in healthcare. There are a lot of things which bots can do simplistically. For example, if a patient wants to book an appointment with the doctors, instead of going through a complex web applications and interfaces, what if I can simply write “I want to book an appointment with the doctor Dr. XYZ at 4 pm” and the bot can figure out in case the time slot is available with that particular doctor, it will confirm the appointment followed by a payment process if the payment has to be made upfront. 

Apart from this, you can extend your bots to provide e-consultations where doctors can do remote consultations via audio and video features of a chatbot. So there is a huge scope for bots beyond answering routine queries by customers or booking appointments. It does not stop just there. You can extend chatbot functionalities to support functions such as admin, HR, finance, and business process efficiency so that they can provide better services to their customers.

Related: Healthcare Chatbots: Innovative, Efficient, and Low-cost Care

Chatbot Use Cases in Healthcare

Could you tell us some possible bot use cases for delivering better customer experiences to digital health users?

Parag: Apart from booking appointments and resolving customer queries, these bots can conduct remote consultations, internal processes, health symptom checker, out-patient video consultation, second opinion consultation, ordering medicines, psychological counseling & mental wellness, scenario-based risk advice, Heroism Recognition for employees, etc. Also, it can be further extended to help patients enquire about health insurance related queries, and all the interactions between insurance companies and hospitals can be provided to the patient. 

Related: Healthcare & Hospitals Use Cases | Digital Health

The Road Ahead

COVID-19 has forced hospitals to revise patient support strategy with limited operational staff that is bringing every day a new challenge. A way out is to heavily rely on digital innovation.

In India we have a disparity between the no. of healthcare providers and care seekers. Without technology, I don’t think there is any way healthcare institutions will be able to scale to a level where they can provide meaningful services to such a large number of people. Hospitals can invest in setting up an information exchange; making the process as seamless as possible; and removing all possible inefficiencies from the supply chain through technology.

Future growth for hospitals will come from digital technology because patients will opt more for digital platforms. And it is up to hospitals to catch up with the pace at which modern technology is developing. We, at Mantra Labs, have achieved several use cases including hospitals/diagnostic centers that are able to deliver superior health experiences.


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