c o m p u t e r m e t h o d s a n d p r o g r a m s i n b i o m e d i c i n e 1 0 4 ( 2 0 1 1 ) 235–242 jo ur n al hom ep age : www.intl.elsevierhealth.com/journals/cmpb Design and implementation of a distributed teleradiaography system: DIPACS Tolga Utku Onbay, Aylin Kantarcı * Computer Engineering Department, Ege University, Bornova, 35100 Izmir, Turkey a r t i c l e i n f o Article history: Received 22 October 2010 Received in revised form 21 April 2011 Accepted 18 May 2011 Keywords: PACS DICOM Radiology Information Systems Medical image management Teleradiography Distributed systems a b s t r a c t Medical imaging informatics has origins spanning back over two or more decades. Currently, sharing of radiological images for diagnosis, collaborative and administrative purposes is one of the challenging issues in both medicine and computer science. In this study, we designed and implemented a distributed PACS system, namely DIPACS, for small and medium scale medical networks. DIPACS forms a virtual organization by combining the storage of health centers and providing transparent access to images. In this study, we introduce the DIPACS architecture together with the implementation details. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Progresses in digital imaging fostered the interdisciplinary evolution of medical imaging informatics. In 1980s, Picture Archive and Communications Systems (PACS) was introduced as an initial effort to create a repository for digital medical images. PACS eliminated the limitations of paper based films by making images available anywhere and enabling simulta- neous access by multiple individuals. Existence of multiple information systems and modalities such as MRI, CT, X-Ray, ultrasound images and the requirement of exchange between various imaging systems of different vendors resulted in the release of Digital Imaging and Communication in Medicine (DICOM) Standard in 1994 [1]. DICOM defines an ontology for data and stringent formats for various image types to provide interoperability. It also specifies network communication rules for fast transfer of images between different devices [2,3]. * Corresponding author. Tel.: +90 232 3434000x5316; fax: +90 232 3399405. E-mail addresses: tolgaonbay@gmail.com (T.U. Onbay), aylin.kantarci@ege.edu.tr, aylin.kant@gmail.com (A. Kantarcı). To comprehend how PACS and DICOM work together, it is sufficient to examine the workflow in a medical imaging system. The main components of a PACS system include a server and acquisition interfaces. The latter capture, digitize and convert medical images to DICOM format which are then stored on the PACS server. Upon the request of a physician, images are sent to the display workstation in compliance with DICOM communication rules [4]. A PACS system also includes interfaces for integration with Radiological Information Sys- tems (RIS) and Hospital Information Systems (HIS) [5,6]. The next major step ensuing the quick adoption of DICOM Standard came with the teleradiography applications which made distributed health care and life long learning applications popular [7]. Pianykh classifies teleradiography applications into two categories, namely light and heavy tel- eradiography applications [8]. Light applications include web based applications that access a PACS archive from PCs or 0169-2607/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.cmpb.2011.05.006