Integrating DICOM conformant imaging equipment with a PACS.

Purpose/Background As medical centers purchase commercial PACS to integrate with their imaging equipment, the fact that each component is often purchased at different times and with differing levels of DICOM conformance may become a problem. When the PACS is installed, major incompatibilities are often discovered between DICOM conformant pieces of equipment. Commercial PACS vendors are sometimes reluctant to take responsibility for the final integration of these components. The purpose of this paper is to document the nature and extent of these problem at one medical center, to report on how we are trying to solve them, and recommendations for the future. Methods A large commercial PACS (IMPAX(TM), Bayer Corporation, Agfa division) installed at the West Los Angeles VA medical Center was recently upgraded to be DICOM 3.0 conformant. Recently purchased DICOM conformant CT and MRI units and an older CT were already present. The problems in interfacing and integrating these imaging modalities with the upgraded DICOM- compliant PACS were investigated. Both software and hardware incompatibilities and human factors in bringing the different commercial vendors together were analyzed. Results Major hardware and software incompatibilities were discovered. The use of DICOM-gateways is not always able to solve problems of incompatibility. The typical lag time between discovery of a problem and provision of a solution was 4 to 5 months. For more severe problems and also for a few of the lesser problems, resolution took over a year and is still ongoing. Repeated requests had to be made to the vendors to get together with us and solve these problems.