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          Abstract

          DICOM and DICOM Browsers The 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.[1] 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.[2–4] 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). Free DICOM Browsers Available Online: A Functional Classification The DICOM browsers can be broadly and functionally segregated into four groups: for viewing DICOM images, for teaching, for use as mini-PACS servers, and for research purposes. Let us examine each of these individually. DICOM browsers for basic viewing of DICOM images The 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 [Table 1] 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. Table 1 Free DICOM browsers - basic viewing software Free DICOM software Web address Free/limits DICOM query Thumbnail view Display layout Flip/rotation Invert b/w Linear measure Angle measure Cine viewer Compare view Scout localizer support Software required Additional features 3D-Doctor Viewer v 4.0.070803 http://www.ablesw.com/3d-doctor/get3dview.html Free No No 1 × 1 No No No No Yes No No None Full version is an advanced 3D visualization and processing tool CarDiCon v 1.53B http://fhs-consulting.com/cardicon/E_cardicon.html Free No Yes 1 × 1 No No No No Yes Yes No None Primarily a browser for angiographic studies DCM View http://www.rmrsystems.co.uk/dcmview.htm Free No Yes 1 × 1 to all-in-one No No No No No No No None No installation. Small program DCM Vista v 3.2 http://www.charruasoft.com/downen.php Free Yes and data import function Yes 1 × 1 to 4 × 5 Yes Yes Yes No Yes No No None No installation. Small program Dicomlight v 5.4 http://www.charruasoft.com/downen.php Free No No 1 × 1 to 4 × 5 No Yes No No No No No None No installation. Small program DICOM Scope v 3.5.1 http://dicom.offis.de/dscope.php.en Free No No 1 × 1 Yes Yes Yes Yes No No No Java Offers structured reporting ImRead DICOM Viewer http://www.uchsc.edu/sm/neuroimaging/download/imread/imread1.htm Free No No 1 × 1 Yes No No No No No No Tomovision http://www.tomovision.com/ Can open only five images at a time No No 1 × 1 No No No No Yes No No DICOM browsers useful for teaching Of late, more and more departments are beginning to use electronic media for teaching. The rising cost of x-ray films and the ease with which digital images can be archived, queried, retrieved, and presented, have seen the gradual replacement of the ‘departmental film library’ by a ‘virtual library’ of ‘teaching collections.’ The greatest advantage of creating digital teaching files is the ease with which they can be stored and distributed. The database of a single server can hold much more image data than several rooms containing shelves and shelves of ageing and disintegrating radiographs and this data can be accessed simultaneously by several users across a network or over the World Wide Web. The addition of non-radiological medical images, such as clinical photographs, endoscopic views, and photomicrographs, enables the creation of a comprehensive multimodality teaching file. Images in DICOM format are usually converted to other image formats such as JPEG, GIF, or TIFF prior to creation of the teaching file. These formats are more compact than the original image and are recognized by most non-medical image management software that can be used to create teaching files and albums. Software for this purpose must have the capability to adjust image quality, size, and resolution [Table 2]. Batch conversion of a series of images saves the operator from having to vary the window level and width in individual images; (this feature is available with DicomWorks.) The ability to produce movie files from a series of individual images (a feature available with CarDiCon and DicomWorks) and to visualize 3D data (which is possible with 3D Doctor Viewer and FP Image Viewer) are an added advantage.[5] Table 2 Free DICOM browsers useful for teaching Free DICOM Software Web address Input format Thumbnail view Display layout Flip/rotate Invert b/w Text annotations Measurements Cine viewer Export Formats Annotations Off Additional software required Additional features Radfiler DICOM for PowerPoint http://www.radfiler.com/ DICOM No 1 × 1 No No No No No No No Microsoft PowerPoint Provides DICOM functionality within a presentation DicomLitev1.01 http://www.3d-head.com DICOM No 1 × 1 No No No No No TIFF No None No installation. Small program DCM2JPG http://www.sph.sc.edu/comd/rorden/ezdicom.html DICOM No No No No No No No BMP, JPEG No None Command line conversion to JPG/BMP formats DICOM Browser from FP Image http://www.fpimage.com/info.html DICOM No 1 × 1 No No No No No JPEG Yes DicomWorks v 1.3.5 http://dicom.online.fr/ DICOM No 1 × 1 No No No No Yes JPEG, AVI Yes MPR and CMPR Recon of 3D data, Direct e-mail of images Eviewbox http://eviewbox.sourceforge.net/ DICOM Yes Auto No No No No Slideshow GIF No Java MPR and CMPR Recon of 3D data, Direct e-mail of images ezDICOMv1.0 http://www.sph.sc.edu/comd/rorden/ezdicom.html DICOM, Medical image formats No 1 × 1 No Yes No No No BMP, JPEG Medical image formats Yes None Primarily aimed at converting data into other medical image formats ImageJ v 1.38x http://rsb.info.nih.gov/ij/ DICOM No 1 × 1 Yes No Yes Yes Yes JPEG, GIF, TIFF, BMP, PNG, AVI No Java Image Stacking, reslicing, Z-project, 3D Project, ImRead DICOM Processor http://www.uchsc.edu/sm/neuroimaging/download/imread/imread1.htm DICOM No 1 × 1 Yes No No No No JPEG, TIFF No Java Small program IrfanView v 4.1 http://www.irfanview.com/ DICOM No 1 × 1 Yes Yes No No Slide-show Can be converted into a large number of image formats No Additional plugin Image management software with DICOM image support JiveX [dv] Viewer v 4.2.1 http://www.visus-tt.com/DICOM_Viewer.59.0.html DICOM images Yes 1 × 1 to 4 × 4 Yes Yes Yes Yes Yes image, matrix, series disabled Yes Java version 1.4 Save presentation state to unique format; needs key MEDISP v 1.0.2 http://medisp.bme.teiath. gr/downloadMEDISPDI-COMViewer.htm DICOM Yes 1 × 1 to 4 × 4 Yes Yes Yes Yes Yes JPEG, TIFF, BMP, PNG, AVI Yes None Osiris v 4.19 http://www.sim.hcuge. ch/osiris/01 _Osiris_Presentation_EN.htm DICOM No 1 × 1 Yes Yes Yes Yes Yes JPEG, BMP, TIFF, AVI Yes Yes No An earlier publication has described the integration of DICOM viewer functions into Microsoft PowerPoint presentations by the installation of ActiveX components and add-ins.[6] A freely available software - Iconotech[7] - 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. DICOM browsers for mini-PACS servers A 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,[8] Dicomscope,[9] KPACS,[10] Tudor DICOM Viewer,[11] and Sante DICOM Viewer.[12] 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 Applications Anonymization 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 [Table 3]. 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. Table 3 Free DICOM browsers useful for research Free DICOM Software Web address Free/limits Input format DICOM query View DICOM Info Edit DICOM Info Anonymize Export function DICOM Browser FP Image http://www.fpimage.com/info.html Free DICOM No Yes No Yes JPEG DicomWorks v 1.3.5 http://dicom.online.fr/ Free DICOM Yes Yes No Yes JPEG, AVI MEDISPv 1.0.2 http://medisp.bme.teiath.gr/downloadMEDISPDICOMViewer.htm Free DICOM Yes Yes No Yes JPEG, TIFF, BMP, PNG, AVI MRIcro v 1.4 http://www.mricro.com Free DICOM and other formats Yes Yes No Yes Conversion into a wide variety of medical image formats for functional analysis Same DICOM Viewer 6 (Demo mode) http://users.forthnet.gr/ath/mkanell/ Unlimited time with watermarks and options disabled DICOM and DICOMDIR Yes Yes No Yes Watermarked JPEG, TIFF, BMP, PNG, HTML, AVI Summary There is a large array of DICOM browsers that can be downloaded from the Net free of cost. These can prove to be effective alternatives to commercially available programs and radiologists can implement these solutions to augment their clinical practice, taking into consideration their individual requirements as well as the software's functional capabilities and limitations.

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          Free DICOM image viewing and processing software for your desktop computer: what's available and what it can do for you.

          Whether or not a radiology department is "filmless," there is often a need to store images digitally for teaching or presentation purposes. Most computed tomographic and magnetic resonance images are in the Digital Imaging and Communications in Medicine (DICOM) 3 format, which has many advantages; however, these files can be very large and rapidly consume storage space. Converting DICOM files to smaller file formats such as the Joint Photographic Experts Group (JPEG) format can save space and allow insertion of images into presentations created with software such as Microsoft PowerPoint. Some picture archiving and communication systems can convert images from DICOM to other formats; however, many free options are also available. The World Wide Web was searched for free DICOM image viewing or processing software, and programs that were thought to be user-friendly and compatible with the Microsoft Windows operating systems were evaluated. There are many free programs that enable manipulation and processing of DICOM images on a desktop computer, allowing the user to easily window images and convert them to a smaller and more usable format, such as JPEG. Copyright RSNA, 2003
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            Extending PowerPoint with DICOM image support.

            Although PowerPoint has become a ubiquitous presentation tool in medical imaging, it does not support the Digital Imaging and Communications in Medicine (DICOM) standard. Users must go through a laborious conversion process that includes guessing the appropriate brightness and contrast to convert 16-bit DICOM images into 8-bit formats. A PowerPoint add-in was developed that incorporates features of a DICOM viewer into a presentation. Users can interactively manipulate large series of 16-bit images in stack mode with scroll, crop, zoom, and window width and level functions, as well as sort through images by location or series. Multiple DICOM image series can be placed on a single slide, and one can interactively scroll through stacks of images during a presentation to demonstrate imaging findings. The problem created by the varying contrast and brightness of different projector systems is overcome by interactively adjusting the image window level during presentations. Bone and lung window views can be shown without having to create separate images. Combining DICOM images into stacks as part of a PowerPoint presentation can result in a more effective and higher-quality presentation of medical images. Copyright RSNA, 2003
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              Digital imaging and communications in medicine: A basic review

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                Author and article information

                Journal
                Indian J Radiol Imaging
                IJRI
                The Indian Journal of Radiology & Imaging
                Medknow Publications (India )
                0971-3026
                1998-3808
                February 2008
                : 18
                : 1
                : 12-16
                Affiliations
                Department of Radiology, Krishna Institute of Medical Sciences, 1-8-31/1, Minister Road, Secunderabad - 500 003, Andhra Pradesh, India
                Author notes
                Correspondence: Dandu Ravi Varma, Department of Radiology, Krishna Institute of Medical Sciences, 1-8-31/1, Minister Road, Secunderabad - 500 003, Andhra Pradesh, India. E-mail: varmaji@ 123456rediffmail.com
                Article
                IJRI-18-12
                10.4103/0971-3026.38503
                2766899
                2a4a98bd-d28a-4f4d-a05e-98d19c04ef40
                © Indian Journal of Radiology and Imaging

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Computers in Radiology

                Radiology & Imaging
                Radiology & Imaging

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