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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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Enhancing digital patient experience with healthcare chatbots

5 minutes read

Chatbots are fast emerging at the forefront of user engagement across industries. In 2021, healthcare is undoubtedly being touted as one of the most important industries due to the noticeable surge in demand amid the pandemic and its subsequent waves. The Global Healthcare Chatbots Market is expected to exceed over US$ 314.63 Million by 2024 at a CAGR of 20.58%.

Chatbots are being seen as those with high potential to revolutionize healthcare. They act as the perfect support system to agents on the floor by providing the first-step resolution to the customer, in terms of understanding intent and need, boost efficiency, and also improve the accuracy of symptom detection and ailment identification, preventive care, feedback procedures, claim filing and processing and more.

At the outset of the COVID-19 pandemic, digital tools in healthcare, most commonly chatbots, rose to the forefront of healthcare solutions. Providence St. Joseph Health, Mass General Brigham, Care Health Insurance (formerly Religare), and several other notable names built and rolled out artificial intelligence-based chatbots to help with diagnostics at the first stage before a human-human virtual contact, especially while differentiating between possible COVID-19 cases and other ailments. The CDC also hosts an AI-driven chatbot on its website to help screen for coronavirus infections. Similarly, the World Health Organization (WHO) partnered with a messaging app named Ratuken Viber, to develop an interactive chatbot for accurate information about COVID-19 in multiple languages. This allowed WHO to reach up to 1 billion people located anywhere in the world, at any time of the day, in their respective native languages.

For Care Health Insurance, Mantra Labs deployed their Conversational AI Chatbot with AR-based virtual support, called Hitee, trained to converse in multiple languages. This led to 10X interactions over the previous basic chatbot; 5X more conversions through Vanilla Web Experience; Drop-in Customer Queries over Voice Support by 20% among other benefits.

Artificial Intelligence’s role in the healthcare industry has been growing strength by strength over the years. According to the global tech market advisory firm ABI Research, AI spending in the healthcare and pharmaceutical industries is expected to increase from $463 million in 2019 to more than $2 billion over the next 5 years, healthtechmagazine.net has reported. 

Speaking of key features available on a healthcare chatbot, Anonymity; Monitoring; Personalization; collecting Physical vitals (including oxygenation, heart rhythm, body temperature) via mobile sensors; monitoring patient behavior via facial recognition; Real-time interaction; and Scalability, feature top of the list. 

However, while covering the wide gamut of a healthcare bot’s capabilities, it is trained on the following factors to come in handy on a business or human-need basis. Read on: 

Remote, Virtual Consults 

Chatbots were seen surging exponentially in the year 2016, however, the year 2020 and onwards brought back the possibility of adding on to healthcare bot capabilities as people continued to stay home amid the COVID-19 pandemic and subsequent lockdowns. Chatbots work as the frontline customer support for Quick Symptom Assessment where the intent is understood and a patient’s queries are answered, including connection with an agent for follow-up service, Booking an Appointment with doctors, and more. 

Mental Health Therapy

Even though anxiety, depression, and other mental health-related disorders and their subsequent awareness have been the talk around the world, even before the pandemic hit, the pandemic year, once again could be attributed to increased use of bots to seek support or a conversation to work through their anxiety and more amid trying times. The popular apps, Woebot and Wysa, both gained popularity and recognition during the previous months as a go-to Wellness Advisor. 

An AI Wellness Advisor can also take the form of a chatbot that sends regular reminders on meal and water consumption timings, nutrition charts including requisite consultation with nutritionists, lifestyle advice, and more. 

Patient Health Monitoring via wearables 

Wearable technologies like wearable heart monitors, Bluetooth-enabled scales, glucose monitors, skin patches, shoes, belts, or maternity care trackers promise to redefine assessment of health behaviors in a non-invasive manner and helps acquire, transmit, process, and store patient data, thereby making it a breeze for clinicians to retrieve it as and when they need it.

Remote patient monitoring devices also enable patients to share updates on their vitals and their environment from the convenience and comfort of home, a feature that’s gained higher popularity amid the pandemic.

A healthcare chatbot for healthcare has the capability to check existing insurance coverage, help file claims and track the status of claims. 

What’s in store for the future of chatbots in Healthcare? 

The three main areas where healthcare chatbots can be particularly useful include timely health diagnostics, patient engagement outside medical facilities, and mental health care. 

According to Gartner, conversational AI will supersede cloud and mobile as the most important imperative for the next ten years. 

“For AI to succeed in healthcare over the long-term, consumer comfort and confidence should be front and center. Leveraging AI behind the scenes or in supporting roles could collectively ease us into understanding its value without risking alienation,” reads a May 2021 Forbes article titled, The Doctor Is In: Three Predictions For The Future Of AI In Healthcare. 


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