DICOM

At 4:17 in the morning, a scan finishes in a hospital basement, and no one has to think about how the image will reach the doctor who needs it. That invisibility is the achievement.

Behind every medical image transmitted, stored, and read anywhere in the world sits DICOM: a forty-year-old data standard almost no patient has heard of, built by a committee of rival manufacturers who had every incentive not to cooperate. It works, most of the time.

When it doesn't, the cost lands on patients. DICOM: The Invisible Pipeline explains how medical images actually move, what interoperability really requires, and what happens when a system that was never supposed to be visible finally fails. The failures are traced through FDA recall records, court opinions, ransomware investigations, and the everyday judgment calls of the people who keep the pipeline running.

Inside the book:

• How DICOM came to exist, and why every scanner once spoke its own language


• What routers, archives, and worklists decide long before a radiologist opens a study


• Why a system can be fully compliant and still not work


• How patient names, identifiers, and metadata get lost between systems


• Teleradiology, rural access, and the legal questions that arise when two scans disagree


• Veterinary imaging, pathology, and the other fields that borrowed the standard


• Exposed servers, security failures, and what AI actually sends back to the pipeline


• Long-term archives, cloud storage, and what happens when a vendor disappears


• What a reliable pipeline requires, and who pays when it isn't built

Mark W. Carr has worked in medical imaging for more than thirty years. He began his career as a CT/MR technologist, later moved into PACS administration, and now serves as a healthcare CIO overseeing enterprise imaging and DICOM integration for a large radiology company.

Standards solve agreement. They do not solve implementation. This book is about the distance between the two.