JACR: Failure to comply with DICOM, IHE linked to CD viewing problems
A survey published in the January issue of the Journal of American College of Radiology outlined three primary problems associated with portable media exchange: access, importability and viewing issues. The authors also reported noncompliance and a lack of knowledge about compliance with Integrating the Healthcare Enterprise Portable Data for Imaging (IHE PDI) and DICOM.

Review of external images via CD or DVD may be problematic for referring providers and radiologists for several reasons, wrote the report's lead author Vivek Kalia, MS, from the department of radiology and radiological science at the Johns Hopkins University in Baltimore. Kalia and colleagues cited three causes of portable media viewing problems: proprietary file formats that require specialized viewers, unfamiliar proprietary viewer user interfaces and desktop computer security measures that prevent the auto-load functionality of portable media.

The researchers surveyed members of the Association of Administrators in Academic Radiology, Association for Medical Imaging Management and the University HealthSystem Consortium in November 2009 to obtain data on current portable media experiences and practices in academic and nonacademic radiology departments. One hundred and two administrators responded to the 22-question online survey.

Kalia and colleagues found discrepancies in compliance with 98 percent of respondents indicating that portable digital media produced at their institution were DICOM compliant. However, “only 22.2 percent of respondents claimed that their institutions produced [IHE PDI] compliant media, while 71.6 percent were uncertain.

“Viewing of imaging distributed on portable media poses a burden when either DICOM file formats or IHE PDI profiles are not used,” wrote Kalia.

Non-DICOM-format incompatible imaging files topped the list of reasons why outside portable media was nonreadable or inaccessible; 36.7 percent of reasons for nonreadability related to non-DICOM format incompliance. Internal testing for DICOM and IHE PDI occurred routinely at 16 percent of respondents’ institutions; 49 percent did not test and another 35 percent were uncertain about testing.

Compliance issues translate into readability and importability challenges. Kalia and colleagues reported that 60.8 percent of respondents claimed that most (75 to 100 percent) outside media were readable or importable, while 52.9 percent noted that fewer than 10 percent of patients underwent repeat studies because of media problems.

Security represents a roadblock at a handful of institutions. That is, 20.5 percent prohibit auto-run or executable files on portable media, but nearly 80 percent allow these files on any or designated workstations.

The three most common physician complaints regarding the use of portable media were: inability to load images from proprietary formats, lack of familiarity with onboard viewing software and the amount of time it takes to load the media and get the viewer running, observed Kalia and colleagues.

The authors detailed several implications related to their findings. They pointed to a lack of knowledge about DICOM and IHE PDI compliance, noting that radiologists, other users and professional societies should provide guidelines and support at their institutions. However, a broader solution may be in order.

“[T]his study illustrates the need for the adoption of a common viewer rather than individual, distinct third-party viewers that are inscrutable and cumbersome to manage on a day-to-day basis as they evolve rapidly,” added Kalia and colleagues.