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DICOM and DICOM BrowsersThe digital imaging and communications in medicine (DICOM) standard was created by the National Electrical Manufacturers' Association (NEMA) in order to improve compatibility and workflow efficiency between imaging systems, medical devices, and other information systems used in a hospital environment. This has become the principal standard for the communication of medical images and is now implemented by virtually all medical imaging equipment manufacturers.Image files that conform to the DICOM standards are commonly referred to as DICOM-format images. The basic difference between a DICOM image and an image in other formats like JPEG, TIFF, or GIF is that the DICOM image contains a ‘header’ with information (such as patient demographics, machine, scan parameters, and a host of other non-image data) in addition to the image data. Thus it is possible to identify the origin of the image, the patient, data acquisition parameters of the study and so on, even if a single image is analyzed in isolation. The adoption of DICOM standards by medical imaging equipment vendors has helped in effective cross-machine communications and made possible integration of imaging equipment from different manufacturers.Although DICOM is the accepted standard for the storage and networking of medical images, the image is encoded in a format that cannot readily be viewed on an average personal computer (PC).
Viewing these images outside the radiology network still requires printing of the images on hardcopy films. With the fall in prices of hardware and peripheral devices, computers with high-end hardware specifications are available at affordable prices.
To view DICOM images on PCs, dedicated DICOM browsers are needed. Though these softwares are available from several vendors, they are expensive and beyond the reach of the average radiologist.Several freely downloadable DICOM browsers, which can be easily integrated into a radiologist's practice, are available via the Internet.– This article describes the applications of a few DICOM browsers in clinical radiology and imaging research and evaluates their merits and demerits in common radiology applications (Appendix 1).
DICOM browsers for basic viewing of DICOM imagesThe simplest and most intuitive application of DICOM browsers is to view images on stand-alone systems that are not a part of a radiology network. Most equipment manufacturers offer the option of archiving imaging data on compact discs (CDs) which can be transported, stored, and reviewed easily. Though a proprietary DICOM viewer is written into the CD along with the image data, it is often limited in its functionality.
Using a DICOM browser of one's own choice permits the use of a set of tools suited to one's needs, irrespective of the source of the imaging data. It must be remembered that most freely downloadable software is intended for educational purposes and is not custom built for medical diagnosis or commercial purposes.Most browsers in this category provide basic image-processing functions, such as the ability to adjust image contrast and brightness, to magnify, to perform measurements (distances, angles, areas, pixel values, etc.), to change image orientation, and the ability to annotate. Studies containing a time series of image data need a ‘cine’ viewer with the ability to change the frame rate. Another useful tool is the ability to simultaneously load and compare two sets of images (available with Jivex dv viewer and Sante DICOM viewer); this is usually necessary when looking for enhancement on post-contrast studies and to check for response to therapy. The ability to view the localizer/scout view, along with a specific image, is a feature of Sante DICOM and Jivex dv viewers as well.
Free DICOM softwareWeb addressFree/limitsDICOM queryThumbnail viewDisplay layoutFlip/rotationInvert b/wLinear measureAngle measureCine viewerCompare viewScout localizer supportSoftware requiredAdditional features3D-Doctor Viewer v 4.0.070803FreeNoNo1 × 1NoNoNoNoYesNoNoNoneFull version is an advanced 3D visualization and processing toolCarDiCon v 1.53BFreeNoYes1 × 1NoNoNoNoYesYesNoNonePrimarily a browser for angiographic studiesDCM ViewFreeNoYes1 × 1 to all-in-oneNoNoNoNoNoNoNoNoneNo installation. Small programDCM Vista v 3.2FreeYes and data import functionYes1 × 1 to 4 × 5YesYesYesNoYesNoNoNoneNo installation.
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Small programDicomlight v 5.4FreeNoNo1 × 1 to 4 × 5NoYesNoNoNoNoNoNoneNo installation. Small programDICOM Scope v 3.5.1FreeNoNo1 × 1YesYesYesYesNoNoNoJavaOffers structured reportingImRead DICOM ViewerFreeNoNo1 × 1YesNoNoNoNoNoNoTomovisionCan open only five images at a timeNoNo1 × 1NoNoNoNoYesNoNo.
DICOM browsers useful for teachingOf late, more and more departments are beginning to use electronic media for teaching. Free DICOM SoftwareWeb addressInput formatThumbnail viewDisplay layoutFlip/rotateInvert b/wText annotationsMeasurementsCine viewerExport FormatsAnnotations OffAdditional software requiredAdditional featuresRadfiler DICOM for PowerPointDICOMNo1 × 1NoNoNoNoNoNoNoMicrosoft PowerPointProvides DICOM functionality within a presentationDicomLitev1.01DICOMNo1 × 1NoNoNoNoNoTIFFNoNoneNo installation. An earlier publication has described the integration of DICOM viewer functions into Microsoft PowerPoint presentations by the installation of ActiveX components and add-ins. A freely available software - Iconotech - is now available to help compile a database of teaching files, incorporating patient demographic information, clinical details, imaging findings, diagnosis, as well as bibliographic references, along with DICOM images. Presentation as teaching cases as well as in the form of quizzes, is enabled in this software.It must always be remembered that when an image is being stored for teaching purposes or for publication, it is essential to hide the demographic information on the image. In most browsers it is possible to turn annotations off while the image is being exported into a different format, to maintain patient confidentiality. Some browsers also have the ability to alter certain tags in the DICOM header so as to introduce information into the image to help in organizing the teaching file.
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DICOM browsers for mini-PACS serversA direct extension of the capabilities of a DICOM browser would be the ability to access, store and retrieve, transmit, display, and process images that were generated by DICOM-compatible equipment. Softwares in this category range from simple solutions called mini-PACS to extremely complex systems that interact with the hospital information system/radiology information system (HIS/RIS), electronic medical record systems, and web servers. Essential features of such softwares include the ability to access DICOM data available on a local or network drive and to search for DICOM data within hard disks, folders, and CDs, using patient name, study number, study date, or other queries. Examples of software available on the web that can be used for such applications include CharuaPACS, Dicomscope, KPACS, Tudor DICOM Viewer, and Sante DICOM Viewer.The setting up of such a system and its integration with the imaging equipment usually requires the help of a network administrator. Such software can also be of use for arranging viewing stations for monitoring imaging studies from the radiologist's office, for printing images using DICOM printers or paper printers, and for teleradiology. DICOM Browsers for Research ApplicationsAnonymization of the DICOM header is of vital importance in medical research, where the identity of the patient and the participating institution needs to be removed from the DICOM header.
There are several software programs that can be used for extraction and analysis of structural and functional imaging data. These programs have been developed for applications such as image segmentation, registration with atlases, contour generation, texture analysis, computer-aided diagnosis, volumetric studies, and relaxometric studies. As some of these programs are designed to run on image data in non-DICOM formats (such as Analyze and NIFTI), DICOM data needs to be converted using applications such as MRIcro. A review on freely downloadable software for offline analysis of structural and functional neuroimaging data can be found in a future issue of this journal. Free DICOM SoftwareWeb addressFree/limitsInput formatDICOM queryView DICOM InfoEdit DICOM InfoAnonymizeExport functionDICOM Browser FP ImageFreeDICOMNoYesNoYesJPEGDicomWorks v 1.3.5FreeDICOMYesYesNoYesJPEG, AVIMEDISPv 1.0.2FreeDICOMYesYesNoYesJPEG, TIFF, BMP, PNG, AVIMRIcro v 1.4FreeDICOM and other formatsYesYesNoYesConversion into a wide variety of medical image formats for functional analysisSame DICOM Viewer 6 (Demo mode)Unlimited time with watermarks and options disabledDICOM and DICOMDIRYesYesNoYesWatermarked JPEG, TIFF, BMP, PNG, HTML, AVI. Appendix 1: Testing Methodology of Free DICOM Browsers.For the preparation of this article, software for viewing and processing DICOM image data, that can be downloaded free of cost, was evaluated on a notebook computer with a 1.73 GHz Intel Centrino processor, 1GB RAM, and Microsoft Windows XP Professional operating system.As on 25 Oct 2007, most browsers were available as a simple download link, while a few required online registrations to unlock certain features.
All programs were simple to install. A few programs required the installation of additional software (such as Java Runtime Environment) that is available on the web.Softwares that require compilation before use, handle proprietary and non-DICOM medical image formats, and run on other operating systems have been excluded from the review.All softwares were evaluated independently by an experienced radiologist and a trainee radiologist for features such as ease of installation, range of tools available, and the relative ease of operation. Though some browsers were able to process non-DICOM image formats as well as proprietary image formats, these capabilities were ignored for the purpose of this review.Though every attempt has been made to keep the information about these browsers accurate and up-to-date, variations in host computer specifications and periodic software updates may cause inconsistent browser functionality. Readers are urged to study the relevant up-to-date documentation regarding these browsers.