Medical images are essential for quality patient care, yet accessing them remains complex.
The DICOM standard brought some unity but required software installation.
Dicom online access promised convenience but complex backends and proprietary viewers persist.
When will we see true universal zero footprint image access?
What is DICOMweb?
The Digital Imaging and Communications in Medicine (DICOM) standard dates back to 1993 when an ACR-NEMA committee sought to unify medical imaging.
This enabled communication between modalities and storage but not seamless access.
DICOMweb uses web technology for image distribution. Released in 2008, it enables zero footprint viewers allowing instant access without installing software. This “universal image access” requires:
- Standard protocols
- Modern enterprise infrastructure
- Feature-rich zero footprint viewers
If fully adopted, any web-enabled device could view images instantly. But as we’ll see, the reality has not yet matched the vision.
Where We Stand on Adoption
DICOMweb has seen steady if slow adoption since its release:
- 2008 – Released in DICOM Supplement 104
- 2011 – IHE profiles capitalize on RESTful APIs
- 2013 – Vendor demonstrations at RSNA annual meeting
- 2017 – FDA allows Medical Device Data Systems to leverage capabilities
- 2022 – Growing support but far from universal
So what is preventing ubiquitous adoption? Below we analyze the lingering barriers.
Barriers to Universal Adoption
Though momentum slowly builds, several factors hinder DICOMweb ubiquity:
Legacy Infrastructure and Workflows
- Entrenched complex backends make transitioning to new architectures difficult
- Proprietary viewers lock users into vendor solutions
- Resistance to change from institutions and clinicians comfortable with status quo
Transitioning to DICOMweb requires modernizing infrastructure and workflows. This demands significant capital expenditure and acceptance of disruption.
Commercial Rather Than Clinical Drivers
- Vendor lock-in promotes proprietary solutions over open interoperability
- Lack of regulation enables the imaging market to perpetuate fragmentation
- Peer enterprises rather than healthcare authorities governing direction
Market forces have influenced direction more than clinical needs. Correcting this imbalance is essential for patient-focused unity.
Uneven PACS Support
Though most next-gen PACS offer DICOMweb integration, rollout varies significantly across providers:
| PACS Vendors | DICOMweb Support |
| GE Healthcare | Full support |
| Philips | Limited support |
| Fuji | Basic support |
| Siemens | Full support |
Universal availability in PACS offerings is prerequisite for adoption. This remains a work in progress.
Deficient Viewer Capabilities
While platforms like Xero offer cross-speciality viewing, most fall short of specialty use cases. Universal access necessitates matching the breadth of thick clients.
Enriched visualization, manipulation, and quantification require ongoing viewer development.
Timeline for Realizing the Vision
Given these adoption barriers, what is a realistic timeline for universal access?
- 2023 – Federal guidelines demand basic DICOMweb integration
- 2025 – Enterprise viewer feature parity with thick clients
- 2027 – Widespread PACS availability meets clinical imaging needs
- 2030 – Infrastructure modernization reaching majority of institutions
We predict meeting all requirements for universal access by 2030. This depends on addressing persistent fragmentation through regulation and cooperation.
The Bottom Line
DICOMweb has struggled to deliver seamless image availability fifteen years since inception.
However, progress accelerates with modernized backends, enriched viewers, and growing standardization.
Aligning clinical, commercial and technological forces behind this vision will determine if and when it translates from promise to widespread reality. What happens in the next five to ten years will prove decisive.
The long wait for ubiquitous image access may soon draw to a close if all stakeholders maintain this trajectory.
