DICOM vs. PACS: The 9 Differences That Matter | 3DBiology.com (2023)

Some of the main areas of work in the area of ​​medical imaging are the management, distribution and analysis of medical images. Whether you're performing a CT scan, MRI or X-ray, you need to be sure that patient information is secure once the image is captured and that all major equipment can display the images correctly.

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DICOM vs. PACS: The 9 Differences That Matter | 3DBiology.com (1)

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To do this, you need to work with PACS and DICOM. These are two types of software that work together and independently to provide you with optimal control over your medical images and associated data. Because they are so deeply connected, it can be difficult to understand what sets them apart.

Below are the main differences that separate the two and how these distinctions work together.

DICOM and PACS have different medical functions

Although they work together, PACS (Image Archiving and Communication System) and DICOM (Digital Imaging and Communications in Medicine) are separate software programs that perform different functions for healthcare professionals. In its simplest terms, PACS is intended to store medical images captured by hardware such as X-ray scanners and MRIs (Magnetic Resonance Imaging).

Please note that all of these images are digital as they are primarily stored (technically called "files") by photographic or recording equipment.The following features represent how PACS manages these digital images based on the acronym:

  • WHENsceneryrefers to digital image data shared by medical devices.
  • AN -filingrefers to the transfer process by which digital images are sent to the PACS.
  • C-Communicationrepresents the system's ability to distribute these medical images to various connected devices, especially DICOM-compliant devices, healthcare IT (information technology) systems, and more.
  • S-Systemof course it refers to all the components responsible for executing PACS functionality.

(Those ones:IT solutions for healthcare)

On the other hand, DICOM is a global communication.Pattern- not exactly the mechanism - by which medical professionals can manipulate, store, print and transmit medical images.It also represents the file format in which these images can be saved. Thus, DICOM has many more applications than PACS in medical practice.

Further explanation of DICOM features

As mentioned above, DICOM is a multifaceted system that offers a wide range of medical image management, manipulation, storage, and distribution capabilities. Through DICOM, medical professionals can add multiple sets of data, just as a JPEG tag can be embedded with metadata. (Source:contribution)

You can store a lot of important information in DICOM metadata, including patient ID, date of birth, and more.Due to the sensitive data in these files, DICOM has an anonymization security measure in place.

Images are not the only medical files that can be transferred between devices using DICOM. If you need to share reports and other clinically relevant documents between systems and devices, DICOM can do that too.

DICOM and PACS have different purposes for the user

DICOM is the standard way of communicating for almost everything related to the acquisition, storage and distribution of medical images. Rather, PACS is the management system itself. As they are two distinct components of medical image management, they are used very differently by the physician, radiologist, or other medical professional.

(Video) What is a DICOM file? Lecture 001

PACS systems are capable of archiving medical image files received from scanning and imaging hardware. However, you are limited to separate functions with no method to exchange these files. This is where DICOM comes in. DICOM is the communication "bridge" that allows PACS systems to transmit the information stored in them. (Source:IT solutions for healthcare)

DICOM and PACS have different functional components

PACS and DICOM contain different functional components.PACS consists of four main parts (source:Ampronix medical imaging technology):

  • Imaging hardware (e.g. MRI, CT scan, X-ray, etc.)
  • Secure network for sharing patient information between healthcare centers
  • devices and workstations for viewing and analyzing medical images
  • The process of storing and retrieving images and documents.

All of these components work together to enable the PACS to transmit medical images digitally, eliminating the need for manual document processing and handling. In addition, medical professionals can acquire, store and share film sleeves digitally within and outside their departments and organizations.

DICOM requires the following "objects"* to function properly:

  • AE title: The application entity title (eg "Heart CT") is assigned to a device so that it can be identified on a network. AE is used in conjunction with IP.
  • DICOM Message Service Element (DIMSE): This item allows the exchange of information between connected AEs. (Source:pynetdicom)
  • Service object pair (SOP): The connection of IOD and DIMSE is the central determining factor of an SOP. It prescribes the attributes of the IOD or the rules according to which the DIMSE can perform communication services. (Source:dicom library)
  • Information Object Descriptor (IOD): This is a computer model that allows AEs to display pre-exchange object information shared between DICOM devices (instead of separate displays).
  • Entity Relationship (E-R): Refers to an IE (Information Entity) or computer model of a tangible object (eg, a study or an image). (Source:OTpedia)
  • IP (Internet Protocol) address.
  • Unique Identifier (UID): this element ensures that an object has a unique identity that uniquely distinguishes it from other objects accessed over the same DICOM network. (Source:DICOM)
  • Value Representation (VR): represents the type and format of the data element. (Source:DICOM)

*Also called IODs, objects are formulations of elements that define instances of an entity such as CT, MR (magnetic resonance imaging), US (ultrasound), etc.The attributes of these objects are defined in "modules". For example, patient modules contain the patient's name and other identifying information, while study modules contain the study date, accession number, and unique identifier (UID).

DICOM and PACS have different levels of functional independence

Medical professionals can use DICOM and PACS in different capacities, each with different degrees of functional independence.

for example justDICOM ensures that files remain intact and that all metadata remains associated with the appropriate file.Depending on the type of PACS you have (ie, on-premises or in the cloud), you can access your DICOM data remotely or through a workstation. Therefore, it can be argued that DICOM is functionally more versatile than PACS.

The difference of,PACS can almost only be operated in conjunction with DICOM, as the "universal format for storing and transmitting images in PACS is DICOM".Thanks to DICOM, PACS retains its ability to transmit data. (Source:PeekMed)

DICOM also refers to the file format, usually a DCM or DCM30 (DCM3.0) file extension. While specific devices are still required for compatibility, this represents another facet of the DICOM suite of applications: it is not just a communication system and imaging tool, but also a file storage component. (Source:Medical LNB)

DICOM and PACS meet different communication requirements

As two distinct image acquisition, storage, management, and distribution components, DICOM and PACS address different facets of the file management process.

(Video) Picture Archiving and Communication System (PACS) - Part 1

DICOM covers five main areas of functionality related to communication and distribution:

  • Transmission and storage of medical images, waveforms, structured reports and documents, each called a "whole object".
  • Query and recovery of previous objects
  • Perform the requested actions on these objects
  • Workflow Management
  • Image quality and consistency (both for digital viewing and printing)

PACS is "just part of a larger IT infrastructure at an institution".It connects all of the following systems exclusively for data transmission (source:UCSF-RORL):

  • Radiology Information System, RIS for short
  • Electronic Medical Record, also known as EMR0
  • voice recognition software
  • Primary diagnostic reading tasks
  • Show business workstations
  • Radiation dose engine (only in some cases)

PACS is primarily intended to simplify image management, particularly images critical to patient care and recovery. By using PACS, team members can search and retrieve data as needed. DICOM is the method that allows imaging devices to communicate with the server, allowing medical personnel to perform these actions. (Source:Advanced Systems Corporation)

DICOM and PACS interact differently with workstations

Most medical imaging devices can optionally be operated via workstations, the functions of which are listed below:

  • Workstations are not connected to the Imaging Console. Thanks to the convenient and fast remote control, this allows healthcare professionals to continuously examine patients.
  • Workstations can reprocess DICOM RAW data captured from imaging hardware.
  • Medical professionals can remotely analyze and interpret the collected images.

So what does this have to do with PACS and DICOM? As modalities need to capture and archive images for later distribution and analysis, they must interface with PACS and DICOM.Images would primarily need to be stored in the DICOM file format to ensure smooth switching between systems.

In the context of workstations, DICOM does not face as many functional dilemmas as PACS. For example, a hospital or clinic may face challenges with PACS depending on the infrastructure. If each department has its own PACS infrastructure, images cannot be shared across all devices and systems. On the other hand, DICOM would not be limited to specific departments if all devices were DICOM compliant.

DICOM is more flexible than PACS

PACS across health departments uses DICOM to store and transmit medical images, but can be functionally hampered by infrastructure differences across departments.

DICOM works the other way around, connecting different systems together, especially when using VNAs (Vendor Independent Archives). VNAs separate PACS to provide a single rather than multiple viewing experience, regardless of the image source.

This is not possible with PACS as it must be used with DICOM. However, DICOM can be used in conjunction with VNA and PACS.It sometimes works better with VNA as vendors often agree on "DICOM image storage, a standard DICOM network interface, and administrative updates". This allows you to avoid common interoperability issues. (Source:HIT-Infrastructure)

PACS manages the DICOM workflow, but not the other way around

While DICOM has proven to be much more versatile than PACS, it could be argued that in some cases both are equally necessary. This is primarily because PACS stores DICOM-compliant images and allows you to perform functions related to these images.

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To understand this better, think of PACS as the "central coordinator" that hosts and oversees the following DICOM resources:

  • DICOM standard grayscale display function (allows DICOM to calibrate and optimize images for display)
  • Anonymize or anonymize medical imaging and comply with HIPAA (Health Insurance Portability and Accountability Act) to protect patient safety
  • Structured DICOM radiation dose reporting (a way to report dose metrics from a CT scanner)

While DICOM is "clearly the only standard for the PACS mode of communication", it still requires PACS to perform the core workflow. PACS is a facet of the DICOM workflow that enables the exchange of information between devices and systems.Without them, DICOM devices would not have access to the medical documentation they wanted.

The different workflow requirements between PACS and DICOM

PACS and DICOM also differ in another important way; Each has different workflow requirements. DICOM has more features and simpler workflow while PACS has more unique features and much more complex workflow.

PACS requires the following components to support an optimal DICOM workflow:

Those onesThe hardware that generates the medical image is called a "source". When the hardware detector recognizes the image, the data is transferred to the computer where the healthcare professional can view it. Once received, medical images are stored as DICOM files.
medical imaging storageThe DICOM server acts as an archiving system that optimizes image storage organization. Depending on the type of DICOM server you are working with, you can upload and share images directly online.
DICOM workstation

(two options)

· proprietary software: normally included with the source device and requires the DICOM software and source device to be used in the same location.

· third party software: Can be used separately from source device. Hospitals with high patient throughput would benefit significantly from this version of the DICOM workstation as it helps speed up image acquisition and therefore interpretation and analysis.

· Use: A PACS server must be able to stream DICOM images to third-party DICOM applications. With the DICOM receiver software integrated into the application, the radiologist should be able to access image data from the PACS server or from external storage devices such as CD or DVD drives.

DICOM file sharingThis allows for export and anonymization of files, an essential part of distributing images for educational purposes, particularly for magazine publications. This prevents images from being traced back to specific patients.
Software DICOM-DruckerIf access to a PACS server is not available, you might want to watch movies. If this is the case, you must have DICOM printer software to print the saved DICOM images. You may also need a DICOM-compliant printer.

As DICOM is not a "coordinator" but a standard for versatile management of digital medical data, the workflow is clearer.In essence, the DICOM workflow includes the following (source:US National Library of Medicine):

image managementThe Study Management and Study Component Management SOP classes provide complete control over imaging procedures.
communication network· Network image management: refers to DICOM monitoring of interactions between devices, i.e. sending image data and the two-step process of querying and receiving that data.

· Management of image interpretation on the network: Defines the storage object and the services to be managed and executed in the DICOM standard.

· network print management: Allows compatible devices and associated workstations to share printers on the DICOM network.

storeHealthcare professionals can manually exchange DICOM files on storage devices such as CD-ROMs.

DICOM allows manipulation of images while PACS does not.

DICOM workstation software allows radiologists many different imaging options that PACS cannot directly provide (source:postDICOM), such as:

  • quality control: Even on the simplest DICOM viewers, compatible workstation software helps improve image quality by allowing image brightness, color and contrast to be modified.
  • image editing: Medical professionals can manipulate and extract new information from medical images using advanced DICOM workstation software.
    • One of the best examples of this is multiplanar reconstruction (MPR), where three separate files can be combined to create a 3D image.
  • Location of visual focus: Medical professionals can better identify anatomical abnormalities using maximum and minimum intensity projections (MIP and MINIP), respectively.
  • reports: Depending on your viewer, you can create a report directly from the transferred data and export it to a word processor.

DICOM allows direct control and manipulation of the image and extracted data. These controls are not available through PACS.

Below is a nice video about DICOM and PACS:


Although closely intertwined in their functionality, DICOM and PACS are two very different technologies with separate (but related) applications in the medical field. DICOM acts as an international communication standard and file format through which PACS transmits medical imaging data while PACS controls the DICOM workflow.

DICOM also allows direct control over the image and data, while PACS is a little more convenient, only allowing the capture, storage and transfer of files to and between DICOM devices. Despite its importance, PACS is functionally much more limited than DICOM, as the latter can be used with other software such as VNS.

(Video) Informatics - Radiology Workflow

Click on the link below for more information on this.View DICOM on a Mac.


What is the differences between DICOM and PACS? ›

The difference between PACS and DICOM is that PACS is a medical image storage and archive hub, fed by medical modalities such as X-ray scanners and MRI machines, while DICOM represents the international communication standard – not a device or structure – used by healthcare professionals in storing, processing, ...

How is DICOM used with PACS? ›

PACS use digital imaging and communications in medicine (DICOM) to store and transmit images. DICOM is both a protocol for transmitting images and a file format for storing them. Medical imaging devices communicate with the application server through the DICOM protocol.

What is the difference between RIS and PACS? ›

PACS are used to store and transport patient medical images securely. A radiology information system (RIS) is an electronic health record (EHR) designed specifically for use in radiology, allowing practitioners to store and manipulate data, and distribute radiologists' reports.

What are the four main components of PACS picture archiving and communication system describe each? ›

PACS consists of four major components: image acquisition devices (imaging modalities), communication networks, PACS archive and server, and integrated display workstations (WS). PACS can be further connected to RIS and HIS health care systems via PACS communication networks as shown in Figure 3.

What are the 4 core functions of a PACS system? ›

PACS has four major components: hardware imaging machines; a secure network for the distribution and exchange of patient images; a workstation or mobile device for viewing, processing and interpreting images; and electronic archives for storing and retrieving images and related documentation and reports.

What does a PACS system do? ›

In medical imaging, electronic picture archiving and communication systems (PACS) have been developed in an attempt to provide economical storage, rapid retrieval of images, access to images acquired with multiple modalities, and simultaneous access at multiple sites.

How do I get DICOM images from PACS? ›

Your PACS viewer will typically have an 'Export' function in the file menu. Keep in mind that different PACS systems have different user interfaces and different features. Your IT department or radiology department can assist you in finding the Export function.

What is the main advantage of DICOM data? ›

The main advantage with DICOM is that it is a standard. Using a standard for file format and communication allows the pathology department to connect scanners and PACS from different vendors and replace them without incompatibility problems.

What are the 5 basic DICOM file movement operations? ›

DICOM addresses five general application areas: (1) network image management, (2) network image interpretation management, (3) network print management, (4) imaging procedure management, (5) off-line storage media management.

What is the importance of DICOM in radiology? ›

DICOM is the international standard to communicate and manage medical images and data. Its mission is to ensure the interoperability of systems used to produce, store, share, display, send, query, process, retrieve and print medical images, as well as to manage related workflows.

What are the different types of PACS systems? ›

Image types PACS handles
  • Ultrasound (US)
  • Magnetic resonance (MR)
  • Nuclear Medicine imaging.
  • Positron emission tomography (PET)
  • Computed tomography (CT)
  • Endoscopy (ES)
  • Mammograms (MG)
  • Digital radiography (DR)
Nov 17, 2021

How does DICOM work? ›

DICOM files typically have a . dcm extension and data contains both patient data and the image/pixel data. The patient data comes from the EMR/EHR/HIS systems as HL7 data which gets tightly coupled with the equipment, procedures and image/pixel data created by the radiology medical imaging devices as DICOM data.

What are the 4 major ingredients in the PACS infrastructure design? ›

Four major ingredients in the PACS infrastructure design concept are system standardization, open architecture and connectivity, reliability, and security.

What are the disadvantages of using DICOM? ›

Implementing a DICOM Header Can be Difficult

Out of which some are optional and mandatory to use. The scanner vendors might find this difficult to choose the tags in the DICOM header. However, some pathologists find this as a major disadvantage because it contains the patient's information and other details.

What are the three methods to evaluate PACS system? ›

In reviewing the literature, the methods most often used in evaluating PACS were: (a) questionnaires/surveys, (b) data collection sheets, (c) administrative data/project documents, (d) time and motion studies, (e) direct observation, (f) video recording, and (g) interviews.

What are the advantages of PACS? ›

The best benefit of the PACS system is that it provides easy and quick access to patient images and reports. It allows tests to be performed easily and anywhere, while the results can be shared to other facilities electronically as well.

What language is used by PACS? ›

The clinical PACS uses an object-oriented Oracle SQL (systems query language) database, and interfaces to the Radiology Information System using the HL7 (Health Languages 7) standard.

What are the three common PACS architectures? ›

They are direct attached storage (DAS), storage area network (SAN), and network attached storage (NAS). The details of the storage types are thoroughly discussed in Chapter 16. The intention of the following is to give a basic understanding of the 3 storage strategies and how they relate to PACS architecture.

What type of data is stored in a PACS? ›

What type of data is stored in a PACS? Healthcare facilities use a medical imaging technology system called PACS to store their DICOM files. PACS stands for Picture Archiving and Communications System. The technology replaces the need for hard copy films and film archives.

Why do we do PACS in radiology? ›

A PACS works best in helping radiologists study patient reports in a better way. It is a cloud-based system that allows radiology data to be transferred, stored, and viewed in a much organized and quick manner, allowing results to be more accurate.

How are PACS useful in radiology? ›

Picture archiving and communication system (PACS) is a modality of imaging technology which helps in image transmission from the site of image acquisition to multiple physically-disparate locations.

Is DICOM an image or 3D? ›

Images in the DICOM format can be processed using 2D or 3D methods. Various 2D segmentation methods have recently been proposed (Bagheri et al., 2020, Ito et al., 2019, Wu et al., 2020).

What port is used for DICOM? ›

Port 104 is the standard port for DICOM communications, and you may want to use this unless the supplier of your remote DICOM node tells you otherwise. Note, however, that you may need Administrator access (root permission) to use port 104.

How long are images stored on PACS? ›

There, electronic PACS images are typically stored for 12 to 18 months on fast-access, spinning disc media, such as RAID (redundant array of inexpensive disks) with a retrieval rate of two to five seconds.

What protocol does DICOM use? ›

DICOM Makes use of the OSI network model. It uses the 2 network protocols on which the Internet is based and which allow data transfer, TCP / IP, and the HTTP hypertext transfer protocol.

How are DICOM images stored? ›

A DICOM file consists of a header and image data sets packed into a single file. The information within the header is organized as a constant and standardized series of tags. By extracting data from these tags one can access important information regarding the patient demographics, study parameters, etc.

What is DICOM used for in healthcare? ›

Digital Imaging and Communications in Medicine (DICOM) is a clinical messaging syntax used to exchange medical images between medical equipment and information systems.

What are the 2 components of DICOM? ›

Two fundamental components of DICOM, described in detail in Chapter 47, are information object class and service class. The information objects define the contents of a set of images and their relationship (e.g., patients, modalities, studies).

What is the latest DICOM standard? ›

The current version of DICOM is called DICOM version 3.0. Typically, updated versions of the DICOM standard are published every other year.

Is DICOM a hardware or software? ›

Digital Imaging and Communications in Medicine (DICOM) is a software integration standard used in Medical Imaging. It's a set of specifications and interfaces to provide a diagnostically accurate representation of medical imaging data and includes tools to transfer, store, and display the information.

What are the features of DICOM? ›

DICOM medical images go through different processes—acquisition, storage, editing, secondary processing, sharing and printing, and retrieval. All aspects of this workflow are managed by a central server, referred to as PACS.

What are the data elements in DICOM? ›

DICOM uses three different Data Element encoding schemes. With Explicit Value Representation (VR) Data Elements, for VRs that are not OB, OW, OF, SQ, UT, or UN, the format for each Data Element is: GROUP (2 bytes) ELEMENT (2 bytes) VR (2 bytes) LengthInByte (2 bytes) Data (variable length).

What is DICOM in healthcare? ›

The Digital Imaging and Communications in Medicine (DICOM) Standard specifies a non-proprietary data interchange protocol, digital image format, and file structure for biomedical images and image-related information.

What is the communication standard for information between PACS and imaging modalities? ›

DICOM stands for Digital Communications in Medicine, and is one of the most successfully applied standards in clinical computing. It is used for the exchange of image data between PACS (picture archiving and communication system) and other systems.

What is the difference between PACS and teleradiology? ›

Due to a host of technological, interface, operational and workflow limitations, teleradiology and PACS/RIS were historically developed as separate systems serving different purposes. PACS/RIS handled local radiology storage and workflow management while teleradiology addressed remote access to images.


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