Seamless Remote Rendering of DICOM Images

Many solutions display DICOM images locally or in a web browser but require that the full DICOM images be transported over the network or on a physical medium. As DICOM image size and the number of DICOM images increase, their transport over the Internet becomes more difficult. Contemporary computer resources used by physicians cannot keep up with the ever-increasing amount of new DICOM data, which complicates and prolongs diagnosis. This problem is exacerbated in the COVID crisis, making it difficult to examine patients, communicate between patients and physicians, and have physical access to DICOM images and volumetric data. In this paper, we present a distributed architecture for remote rendering of DICOM images. We propose an innovative web-based solution hierarchically divided into several levels that can be used to manage patient data, DICOM images, and radiology reports based on those images. The architecture is organized to leverage existing hardware, storage, and telecommunications infrastructure. We have approached the solution in such a way that the images are stored in healthcare facilities, preferably where they were taken, and only the necessary data is securely and seamlessly transported to the physicians. Our carefully engineered solution shows significant improvements in terms of rendering time and speed of data transfer, which is about 110 ms for an image with a resolution of 1996 by 2457 pixels, achieving seamless user experience for at least Full HD images.

I. Introduction

DICOM (Digital Imaging and Communications in Medicine) is the international standard for medical images and related information developed by the American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA). It is divided into 22 parts and is republished several times a year [1]. It is used to store, exchange, and transmit medical images of different modalities (PET, CT, MR, etc.) and is a good basis for PACS (Picture Archiving and Communication System) systems. In addition to the data format, DICOM describes several layers of the ISO/OSI network model - WADO (Web Access to DICOM Persistent Objects) [2]. Due to its popularity, DICOM is used not only in large medical facilities, but also in dental clinics and veterinary practices. Current solutions usually show local DICOM images, or may employ a web browser for viewing, but require that the full DICOM images be transported over the network or on a physical medium, such as CD, DVD, or USB drive to a local computer. As network speeds increase and the cost of telecommunication services decreases, transporting DICOM images over the Internet is becoming easier. At the same time, however, DICOM image size and the number of DICOM images are increasing, so that transport over the Internet is once again becoming a problem. On the other hand, the computer resources used by physicians cannot keep up with the larger amount of new DICOM data, which complicates and prolongs diagnosis and can have serious consequences for patient health. This problem is exacerbated in the current COVID crisis, making it difficult to examine patients, communicate between patients and physicians, and have physical access to DICOM images.