What is DICOM | PACS & VNA Fundamentals

Summary

This video delves into the DICOM standard for medical imaging, its integration with PACS (Picture Archiving Communication Systems), and the evolution towards VNA (Vendor Neutral Archive). It traces the history from X-ray film to digital radiography, explaining how DICOM files and protocols facilitate image transfer and storage. The video also discusses the shift from physical to digital annotations and the challenges of a VNA in handling diverse medical imaging data, including non-DICOM formats.

Takeaways

• 📚 The video discusses the DICOM standard used in medical imaging and its relation to PACS (Picture Archiving Communication Systems) and VNA (Vendor Neutral Archive).
• 🏥 Historically, X-rays were printed on films and processed in dark rooms, but now they are transferred digitally to radiologist's monitors in DICOM format.
• 🏅 Notable figures like William Rankin, Marie Curie, Pierre Curie, and Henri Becquerel contributed significantly to the field of radiation and medical imaging.
• 🔖 In traditional methods, X-ray films were organized with patient demographics in physical folders, following a hanging protocol for easy review by radiologists.
• 📈 The advent of digital technology has made the process of medical imaging completely digital, with images and patient data combined into DICOM files for easy transfer and storage.
• 🖼️ DICOM files are not just images; they include patient metadata, referred to as DICOM tags, which are crucial for organizing and retrieving medical images.
• 💾 PACS is a digital solution that has replaced the traditional film-based workflow in radiology departments, allowing for the storage, transfer, and viewing of medical images.
• 📊 VNA is an extension of PACS, aiming to be a single solution for storing, transmitting, and viewing all types of medical images across different departments and vendors.
• 🔍 Radiologists can now make digital annotations on images, which are stored within the PACS as part of the DICOM file, enhancing the review process.
• 🌐 The challenge for VNAs is to not only store but also view a multitude of DICOM and non-DICOM images, which may require additional metadata management through systems like XDS registries.

Q & A

What is DICOM and how does it relate to medical imaging?

DICOM stands for Digital Imaging and Communications in Medicine. It is a standard protocol for the transmission, sharing, and archiving of medical images and related information, such as patient data and study details. It allows for the digital processing and transfer of images from the point of care to the radiologist's display monitor.

Who were the key figures in the discovery and development of X-rays and radiation?

William Rankin discovered the use of X-rays in 1895. Physicists Marie Curie, Pierre Curie, and Henri Becquerel were awarded the Nobel Prize in 1903 for their discovery of radiation. Their work has significantly influenced the field of medical imaging.

How were X-rays processed and viewed in the past before digitalization?

In the past, X-rays were printed onto films that needed to be processed in a dark room, washed, dried, and then hung against a light source for radiologists to view. This process was time-consuming and required physical handling of the films.

What is the difference between a PACS and a VNA in the context of medical imaging?

A PACS (Picture Archiving and Communication System) is a digital solution for the storage, transfer, and viewing of medical images, primarily used in radiology departments. A VNA (Vendor Neutral Archive), on the other hand, is a more comprehensive system designed to store, transmit, and view all types of medical images from various departments, regardless of the vendor or image format.

What is a 'hanging protocol' in the context of X-ray films?

A hanging protocol refers to the deliberate arrangement of X-ray films against a light source based on the type of exam performed. This arrangement helps radiologists efficiently review and interpret the images during a study.

How are annotations made on digital X-ray images in a PACS system?

In a PACS system, annotations such as measurements and arrows are made digitally on the images. These annotations are stored as part of the PACS system and can be viewed by other users, enhancing the collaborative aspect of medical image analysis.

What is the significance of DICOM tags in organizing patient files?

DICOM tags are metadata elements within a DICOM file that contain specific information such as patient name, date of service, and other demographic details. They are crucial for organizing and searching patient files within a PACS or VNA system.

How does a VNA handle non-DICOM images?

A VNA handles non-DICOM images by utilizing an XDS (Cross-Enterprise Document Sharing) registry to store metadata instead of DICOM tags. This allows the VNA to manage and retrieve images that do not conform to the DICOM standard.

What is the role of NEMA in the DICOM standard?

NEMA (National Electrical Manufacturers Association) is responsible for determining the specific categories or 'classes' that medical images must fall into within the DICOM standard. This ensures consistency and interoperability across different medical imaging devices and systems.

Why is the transition to digital imaging important in medical settings?

The transition to digital imaging is important because it allows for faster image transfer, easier storage and retrieval, and more efficient collaboration among healthcare professionals. It also reduces the risk of physical damage to images and enhances the overall quality of patient care.

Outlines

00:00

📈 Evolution of Medical Imaging: From X-Ray Films to DICOM

This paragraph delves into the history and modernization of medical imaging, highlighting the transition from traditional X-ray films to digital imaging. It discusses the discovery of X-rays by William Rankin and the contributions of Marie Curie, Pierre Curie, and Henry Bacarell to the field of radiation, which have been pivotal in shaping medical imaging. The paragraph explains how X-rays were once printed on films, processed in dark rooms, and viewed against light sources by radiologists. It contrasts this with the current digital age where images are transferred directly from X-ray devices to display monitors in DICOM file format, using the DICOM operation. The paragraph also touches upon the physical arrangement of films according to a 'hanging protocol' and the annotation process, which have been digitized in modern systems.

05:02

🖥️ The Digital Transformation of Medical Imaging with PACS and VNA

The second paragraph focuses on the digital transformation of medical imaging, particularly the role of Picture Archiving and Communication Systems (PACS) and Vendor Neutral Archives (VNA). It describes how PACS has replaced the traditional film-based workflow in radiology departments, streamlining the storage, transfer, and viewing of medical images. The paragraph explains the concept of digital hanging protocols and annotations in PACS, which have replaced physical film annotations. It introduces VNA as a future-oriented solution for imaging, extending beyond radiology to include other departments like cardiology and nuclear medicine. The paragraph discusses the challenge of a VNA to store and view a wide variety of image types, both DICOM and non-DICOM, from different vendors. It mentions the use of an XDS registry by VNAs to manage metadata for non-DICOM images. The paragraph concludes with a call to action for viewers to visit the website for more information and resources on becoming a PACS administrator.

Keywords

💡DICOM

DICOM stands for Digital Imaging and Communications in Medicine. It is a standard protocol for the transmission and sharing of medical images and related information. In the video, DICOM is central to the discussion as it is the file format used to store and transfer medical images, such as X-rays. The script explains how DICOM files are used to replace the older film-based processes, streamlining the workflow in medical imaging departments.

💡Picture Archiving Communication System (PACS)

PACS is a medical imaging technology that provides a digital solution for the storage, retrieval, distribution, and presentation of images. The video discusses how PACS has become the standard software solution in radiology departments, replacing the traditional film-based workflow. PACS allows for the digital transfer and viewing of DICOM images, enhancing efficiency and accessibility in medical imaging.

💡Vendor Neutral Archive (VNA)

VNA refers to a type of archive system that is not tied to any specific vendor's products, allowing for the storage and management of medical images from various sources. The video mentions VNA as the future of imaging, extending beyond radiology to include other medical specialties. VNA is expected to handle a wide range of image types, both DICOM and non-DICOM, providing a unified solution for medical image storage and retrieval.

💡X-rays

X-rays are a form of electromagnetic radiation used in medical imaging to visualize the internal structure of the body. The script discusses the historical use of X-rays and how the technology has evolved from film-based images to digital DICOM files. X-rays are a prime example of the types of medical images that are now managed and stored using PACS and VNA systems.

💡Radiologist

A radiologist is a medical professional who specializes in interpreting medical images, such as X-rays, to diagnose and treat diseases. In the context of the video, radiologists are key users of PACS and VNA systems, as these technologies facilitate the viewing, interpretation, and annotation of medical images. The video explains how digital annotations are now made directly on DICOM images within PACS.

💡Hanging Protocol

A hanging protocol is a method of organizing and displaying medical images in a specific order based on the type of examination performed. The video describes how, in the past, physical X-ray films were arranged according to a hanging protocol using a backlight. In modern digital workflows, PACS systems replicate this functionality with digital hanging protocols, allowing radiologists to view studies in a structured manner.

💡Annotations

Annotations are notes or markings added to medical images to provide additional information, such as measurements or directions. The script explains that while annotations were once made on physical X-ray films with markers or stickers, they are now made digitally within PACS systems. These digital annotations are stored as part of the DICOM file, enhancing the image's clinical value.

💡Computed Radiography (CR)

CR refers to a digital X-ray imaging technology where the image is captured on a photostimulable phosphor plate and then processed to produce a digital image. The video mentions CR as an example of a DICOM image type, which is classified and stored within PACS systems. CR images are part of the digital transformation in medical imaging, contributing to the efficiency and precision of radiological diagnostics.

💡Digital Radiography (DR)

DR is a type of X-ray imaging where the image is captured digitally without the need for film processing. The video discusses DR as another example of a DICOM image type, highlighting the shift from traditional film-based radiography to digital imaging. DR images are stored as DICOM files and managed within PACS and VNA systems for efficient image handling.

💡DICOM Tags

DICOM tags are data elements within a DICOM file that contain specific information about the image or the patient. The video explains that each line of information in a DICOM file is considered a tag, such as patient name or date of service. These tags are crucial for organizing and searching medical images within PACS and VNA systems, allowing for efficient retrieval and management of patient data.

Highlights

Introduction to DICOM and its relation to PACS and VNA systems.

Historical context: Wilhelm Röntgen's discovery of X-rays in 1895 and the Nobel Prize awarded to Marie Curie, Pierre Curie, and Henri Becquerel in 1903 for the discovery of radiation.

Transition from traditional film-based X-rays to digital imaging technology, making the darkroom process obsolete.

DICOM file format combines both the image and patient demographics (metadata) for easy storage and transfer.

Explanation of the 'hanging protocol' in radiology, which involves arranging films or images for radiologists to review.

Modern medical images are now captured digitally as CR (computed radiography) or DX (digital radiography) and stored in DICOM format.

DICOM tags are used to store metadata such as patient name, date of service, and reason for the exam, aiding in efficient image organization.

PACS (Picture Archiving and Communication System) is the digital solution for storing, transferring, and viewing medical-grade imaging.

PACS has largely replaced the traditional film workflow in radiology departments over the past three decades.

Introduction to VNA (Vendor Neutral Archive) as the future of imaging, aiming to handle all types of medical images, including non-DICOM and proprietary formats.

VNA systems are expected to store and view images from various departments such as radiology, cardiology, and dental, regardless of the vendor.

The challenge for VNAs is the ability to view non-DICOM images, as they lack the metadata (DICOM tags) needed for easy organization.

Explanation of XDS registry used by VNAs to store metadata for non-DICOM images.

The future goal of VNAs is to be able to handle and view both DICOM and non-DICOM images seamlessly.

Promotional mention of PAX Bootcamp website for further resources, practice exams, and guidance on becoming a PACS administrator.

Transcripts

hey guys so in this video we'll talk

about the medical imaging standard

called dicom

and how it relates to the picture

archiving communication system

and the vendor neutral archive pax and

vna

1895 william rankin discovers the use of

x-rays

in 1903 physicists marie curie pierre

curie

and henry bacarell were awarded the

nobel peace prize

for the discovery of radiation their

names live on today

their accomplishments have shaped the

world in particular

medical imaging until recently

x-rays were still being printed onto

films these films would need to be

processed in a dark room

washed dried then hung up against a

light source for a radiologist to view

them

in the digital age this process is

almost completely obsolete

images are transferred directly from the

x-ray device to a display monitor

of the radiologist almost immediately

after capture

the images are stored in a dicom file

format

and transferred using the dicom

operation diacom is both the file type

and method of transfer in the old days

an x-ray film will typically be placed

in a physical folder with patient

demographics

the folder would contain contents such

as name patient id

date of birth and reason for exam some

demographics can be written directly

onto the x-ray film itself

for example the name of the patient

the physical films will actually be hung

up against a bright

backlight the films are arranged in a

specific protocol

this deliberate arrangement is based on

the type of exam that was performed

this is called a hanging protocol

and as these films are being reviewed a

radiologist can make notes with the

marker or sticker such as measurements

and arrows directly on the x-ray film

these are called annotations

modern imaging with the advent of

technology

this process is now entirely digital

let's review a modern x-ray image

the x-ray is captured as a computed

radiograph cr

or a digital radiography image dx

the x-ray is classified as a specific

dicom image type

this classification is called a soft

class the image itself and the patient

demographics

the metadata are combined into a dicom

file

this dicom file has a specific method of

tcp ip communication

which allows the file to be transferred

to another dicom system

in a standard method

wait what was that okay let's start over

if this is your first time hearing any

of this it does sound like techno jargon

so in the old days when an x-ray film is

developed the patient demographics can

be printed directly on the film itself

since the x-ray today is now digital the

image

and the demographics are combined into

one file

a digital file each line of information

can be considered a dicom tag

for example a tag for the patient name

and a tag for the

date of service and so on these tags are

helpful in the organization of the

patient files

a user can search for these images based

on the data within the dicom tags

for the sake of organization and

standardization

each medical image must fall into a

specific category

the category is determined by nema the

smart guys behind the dicom standard

for example the x-ray images created by

the device will be stored as

a computed radiography image stop

class other devices that use dicom

will know what a computed radiography

image storage subclass is

that's a mouthful other devices will

know how to store transfer query and

view a

computed radiography image storage soft

the most common system that has the

ability to transfer store query and view

these images

as a pax cr images are sent from the

x-ray device

directly to pax for storage

the picture archive and communication

system

otherwise known as pax is the digital

solution to storage

transfer and viewing of medical grade

imaging

the pax has become the software solution

in medical imaging technology for the

past three decades

this has been apparent in the radiology

departments

it replaced the film workflow other

departments have been slow to catch on

such as cardiology and nuclear medicine

however by today's standards most of our

medical imaging has been converted

digital format most pax images are

stored and transferred

in dicom format specific

decades ago films were physically hung

up against a light source in order for a

radiologist to read the study

today the pax replaces this

functionality with digital hanging

protocols

when a study is opened in packs the

system knows to display the images in a

specific manner based on the study type

the radiologist can still make

annotations on the images except now

it's digital

annotations such as measurements and

arrows are stored in the packs as

ko or pr objects these images

can be made available for other pax

users to view as well

as you can see dicom and pax is a

replacement and improvement of real

world functionality

if you've heard of a pax you may have

also heard of a vna

a vendor neutral archive what is a vna

well a vna is theoretically the future

of imaging which extends past the

radiology

cardiology and nuclear medicine

departments which have already

adhered to the dicom standard the need

for digital pathology

dermatology and dental images has called

for a single solution

that fulfills the needs of each

individual pax

the idea is to have a solution that can

store transmit view

all types of images regardless of which

vendor created

dicom or non daikon proprietary or

native

a radiology pack system is expected to

store radiology specific

images these dicom image types will be

referred to as subglasses

naturally a cardiology pack system is

expected to store

cardiology specific images ideally the

vendor neutral archive should have the

ability to store soft classes from all

departments

whether it's radiology cardiology dental

or ophthalmology the bna should be able

to store and view

all soft classes

most of the vna vendors today have the

ability to store a multitude of soft

classes

however the challenge is for the vna to

also be able to

view these soft classes as well our

website

paxbootcamp.com provides an analysis of

the type of images some vnas are able to

view today

and also some images that vnas are not

able to view at this time

check out the link in the description

and while you're at it please like and

subscribe to this page

in addition to the long list of dicom

images a vendor neutral

archive is expected to store and view

non-dicom images this poses an

additional challenge as there are

several proprietary images

that are specific to certain vendor

applications

in reality some vnas have a greater

ability to view more non-dicomp data

than others

since these images are not dicom they're

lacking metadata of the patient

demographics we talked about before

since they don't have the dicom tags the

vna

utilizes something else called a xds

registry instead

to store the metadata and we'll get into

more detail about this in a separate

video since this video we're talking

about today is more dicom specific

there you have it guys i hope you've

learned the fundamentals of dicom

especially in context of pax and vna

system

if you haven't already please like and

subscribe to our channel and visit our

website paxbootcamp.com for tons of free

content

including practice exams and a

step-by-step guide

if you're serious about becoming a pax

administrator

then you're in the right place stay

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see you guys later

you