FC9008 - DICOM

3.6 The DICOM Standard

• Initially DICOM was defined as a standard to transfer medical images. Through the years several new
functions have been added to DICOM.

• The DICOM books describe the DICOM standard. Due to the changes within DICOM the number of
books have increased and the books have become thicker. In principle a new set of books is published every
year. The DICOM books are available to download for free.

• To download the DICOM books go to the website: DICOM.nema.org. Click the hyperlink “The DICOM
standard”.

3.7 Everbody happy now?

The fact that there is a DICOM Standard does not mean that all problems are solved. However, the standard
has encouraged all manufacturers to use the same protocol which has resulted in an enormous step in
improved connectivity.

There is still room for interpretation, due to the complexity and flexibility. Some vendors use features that are
not defined by DICOM. So, company specific solutions are required.

4. How Does DICOM Communicate?

4.2 How does DICOM communicate

• DICOM is always a dialog between two systems. The system that initiates a communication is the
“Requestor”. The system that responds to the request is called the “Acceptor”. In general you can say that the
Requestor will take the SCU role, the Acceptor will take the SCP role. In general, because there are
exceptions.

What are these services? Let’s take the “car-rental-service”. Hertz has cars and provides the car-rental-
service. You need a car, so you want to use the car-rental-service. Hertz is the provider, and you are the user.
You can imagine that two “users” will not result in the actual rental of a car. The same is applicable in DICOM,
you need a SCU and a SCP for a DICOM communication to occur.

4.3 Initial negotiation phase

• When you need to interact with a computer on the network, you will need the IP-address of that
computer.

• Several programs and services are active on that computer. The question is now which service will
pick-up the information you are sending?

• The mechanism to address the correct program or service within the computer is using PORT numbers.
Programs and/or services may have either fixed or configurable port-numbers.

• To avoid that any computer in the network can interact with the medical systems, authentication is

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 FC9008 - DICOM
required. The trust can be very simple: the host name of the sender must be in the hosts files of the receiver.

• Another method is having authentication on DICOM level. In the initiation phase the SCU sends a
message containing “calling AET” and “called AET”.

When the calling AET is not known by the SCP, the connection will not be build up. When the called AET is
incorrect, the connection will also be refused.

• The requestor or SCU initiates the so-called “Association Negotiation“. In this negotiation the requestor
asks the acceptor if it can do the SOP classes it needs. For example: if the SCU wants to store MR images,
the SCP must be able to handle MR images. In DICOM terms this means that the SCP must support the MR
Image storage SOP Class.

• Also part of the negotiation process is the transfer syntax. The SCU offers all available possibilities it
can do, the SCP has to choose which will be used. For example: the SCU offers the possibilities ILE and ELE,
the SCP has chosen to use SCP.

4.4 Exchange data phase

The data exchange phase is about what you want to do. This can be storage of an image, or request for a
worklist, or a DICOM print job, etc. The SCU takes initiative, the SCP responds.

• When the exchange phase is completed, a request for closing the association is initiated by the SCU.
The SCP responds to the request by sending a kind of ‘OK’ message. Now the association can/will be closed.

4.5 SOP Classes

Storage of a MR image is not the same as storage of a CT or DX image. When storing an image lots of
modality specific parameters are stored with the pixel data as well. For each modality type that can store
images there is at least one “rules-set” that describes what information must be sent together with the pixel
data. The rule-set mentioned above is the SOP Class.

SOP is the abbreviation of “Service - Object Pair”. Service refers to what you want to do, example: store an
image. Object refers to the kind of image you want to store. (MR, CT, DX, etc).

Each SOP Class has an Unique Identifier (UID)

4.6 DICOM tags

• DICOM transmits the information using so-called DICOM Tags. Which DICOM tags must be
transmitted, is defined in the used SOP Class that is used. MR image store is not the same as CT image store.
The difference is in different DICOM tags that are stored: In the MR image store you will find MR parameters,
likewise in the CT image store you find CT parameters.

• The first part of the DICOM tag is the group number. Group numbers can be odd or even.

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 FC9008 - DICOM
• All even group numbers are described in the DICOM standard.

• Odd numbers, also known as “private DICOM tags”, are not described in the standard. Private DICOM
tags are used to make vendor specific solutions, that vendors mostly want to keep secret.

• The second part of the DICOM tag is the element number.

4.7 What you need

No audio.

5. DICOM - STORE

5.2 DICOM Store

DICOM is the abbreviation of "Digital Imaging and Communications in Medicine". As this name indicates, it is
about storage of pixels data and the corresponding meta data, in short: the medical image. Thus, it all started
with DICOM STORE!

5.3 Association Steps

DICOM communication can be compared with a telephone call. Let's look at the helpdesk example:

• Like in a normal telephone conversation you start with a greeting. Probably without realizing you have
checked a few things:

• Am I connected tot the right person?, and,

• Does the person understand me? The helpdesk might be in another country!
These first steps can be compared with the DICOM association negotiation.

• Then you tell the message you want to bring. The other side will respond
The message can be compared with the DICOM interaction.

• When the conversation is finished, you say goodbye.

In the DICOM communication this would be the Association release.

5.4 Association Negotiation

• DICOM started as a protocol to store images. An example of common used DICOM storage is from
Modality to PACS. As the picture shows, it is also possible to store data between Workstation and PACS.

• DICOM is not only about images, it is also possible to store special objects like presentation states. A

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CSIP Level 0: ATTENTION: THIS PAGE CONTAINS COPYRIGHTED MATERIALS THAT ARE CONFIDENTIAL AND/OR PROPRIETARY. ANY RELEASE OR DISTRIBUTION OF THIS MATERIAL, WITHOUT PERMISSION, IS A VIOLATION OF LAW.