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AbsLracL ........................................................................................................................................................ 3
1he ulCCM SLandard uoes noL CuaranLee lnLeroperablllLy........................................................................ 4
ulCCM for uummles - A Culck Cvervlew.................................................................................................... 3
ulCCM for uummles - undersLandlng a 1yplcal ulCCM Scenarlo............................................................... 6
Why ls ulCCM So Complex?......................................................................................................................... 7
8esolvlng ulCCM lnLeroperablllLy lssues ..................................................................................................... 8

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1he purpose of an l1 lndusLry sLandard ls Lo:

1. lmprove lnLeroperablllLy beLween dlsparaLe sysLems
2. Lower sysLem lnLegraLlon cosLs
3. 8educe Lhe work efforL requlred Lo lmplemenL sofLware from dlfferenL vendors
4. lmprove l1 workflow

Wlklpedla deflnes ulCCM as follows:

DlglLal Imaglng and CommunlcaLlons ln Medlclne (DICCM) ls a %&'()'*) for handllng, sLorlng,
prlnLlng, and LransmlLLlng lnformaLlon ln medlcal lmaglng.

1here ls no doubL abouL Lhe merlLs of ulCCM compllance for healLhcare enLerprlses and lmaglng
Lechnology vendors allke. WlLhouL ulCCM, lL would be dlfflculL Lo envlslon Lhe lnLeroperablllLy chaos
LhaL would be presenL ln Lhe medlcal lmaglng l1 markeL. Pavlng ulCCM (and lPL) have made
lnLeroperablllLy among ACS, posL-processlng sofLware and modallLy sofLware more efflclenL and more
cosL effecLlve.

Why Lhen are ACS admlnlsLraLors consLanLly challenged wlLh complex lnLeroperablllLy lssues? 1he
reallLy ls LhaL, more ofLen Lhan noL, lmage flles are held capLlve by a vendor's lnLerpreLaLlon of Lhe
ulCCM sLandard or a healLhcare organlzaLlon's unlque deflnlLlons held ln Lhe flle meLadaLa. 1he goal of
Lhls whlLepaper ls Lo explore Lhe rooL causes of Lhese ulCCM challenges and examlne Lhe evldence
behlnd Lhe growlng Lrend for ACS-neuLral / vendor-neuLral soluLlons.
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Wldely adopLed by hosplLals, growlng ln accepLance, and use by oLher healLhcare provlders, ulCCM
(ulglLal lmaglng ln CommunlcaLlons ln Medlclne) ls Lhe sLandard developed by Lhe Amerlcan College of
8adlology and Lhe naLlonal LlecLrlcal ManufacLurers AssoclaLlon for managlng medlcal lmaglng daLa.
ulCCM enables Lhe lnLegraLlon of medlcal lmage daLa beLween modallLles, ACS and posL processlng
worksLaLlons for Lhe purpose of sLorlng, reLrlevlng, sharlng and dlsplaylng lmage daLa.

1hough ulCCM has reached a level of ublqulLous accepLance among medlcal lmaglng Lechnology
provlders and healLhcare enLerprlse organlzaLlons, undersLandlng lLs subLle lmpllcaLlons ls crlLlcal for
users evaluaLlng so-called ulCCM compllanL" soluLlons. CuesLlons LhaL need Lo be addressed:

Pow can a ACS admlnlsLraLor flnd ouL wheLher or noL Lwo ulCCM compllanL"
sysLems lnLeroperaLe as promlsed by boLh vendors ;/:1</ purchaslng a ACS, a
posL-processlng appllcaLlon or a new modallLy?

WhaL should a user do prlor Lo purchaslng Lhe sysLem Lo ensure Lhe new sysLem can
be lnLerconnecLed wlLh exlsLlng sysLems?

Pavlng a ulCCM-compaLlble devlce does noL necessarlly mean LhaL Lhe lmage daLa ls sLored ln a ulCCM-
conformanL formaL. lL also does noL mean LhaL when Lhe daLa ls lmporLed or exporLed from a devlce
LhaL Lhe ulCCM flle wlll conform Lo anoLher sysLem's lnLerpreLaLlon of ulCCM. ulCCM daLa ls supposed
Lo be populaLed ln aLLrlbuLes as speclfled by Lhe ulCCM sLandard. Powever, Lhe ablllLy Lo lnLerpreL Lhe
aLLrlbuLe daLa depends on whaL Lhe sendlng ulCCM devlce has declded Lo lnclude ln each of Lhe
recommend aLLrlbuLes. 1he same goes for Lhe recelvlng ulCCM devlce, as lL may noL process all of Lhe
daLa ln each of Lhe aLLrlbuLes.

lL's lmporLanL Lo noLe LhaL Lhe ulCCM sLandard ls a volunLary sLandard. lL ls noL admlnlsLered by any
ulCCM pollclng organlzaLlon LhaL provldes formal conformance valldaLlon. lor Lhls reason, vendors
developlng soluLlons should LesL Lhelr appllcaLlons agalnsL sofLware lmplemenLaLlons whlch are avallable
ln Lhe publlc domaln. users musL conslder how Lo go abouL LesLlng ulCCM lnLeroperablllLy beLween Lwo
vendors who boLh clalm ulCCM conformance. vendors may have LesLed lnLeroperablllLy lnLernally aL
Lhelr respecLlve faclllLles, buL users sLlll need Lo ask vendors wheLher or noL a conflguraLlon LhaL ls
ldenLlcal Lo Lhelrs has been lmplemenLed successfully. And Lhen follow up on Lhese answers wlLh dlrecL
verlflcaLlon.

1he wlde array of posslble conflguraLlons geLs Lo Lhe hearL of Lhe maLLer. ulCCM ls a large speclflcaLlon.
Clalmlng "ulCCM Compllance" ls for all pracLlcal purposes meanlngless as Lhere ls no easy way Lo verlfy
conformance clalms. And, glven LhaL mosL deploymenLs of ulCCM-compaLlble devlces are unlque, Lhere
ls no pracLlcal way Lo verlfy clalms by checklng wlLh oLher users. 1he real challenge for a user ls how Lo
deLermlne compllance for a speclflc lmplemenLaLlon. 1o do so, users musL deLermlne whaL aspecLs of
ulCCM are belng clalmed, and ensure LhaL Lhe clalms are ln facL compaLlble.

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undersLandlng Lhe ulCCM sLandard requlres more ln-depLh explanaLlon Lhan ls provlded ln Lhls
whlLepaper. Powever, ln order Lo undersLand why Lhe rooL causes of ulCCM compllance challenges
polnL Lo Lhe vlablllLy of ACS-neuLral or vendor-neuLral soluLlons, one musL undersLand Lhe baslcs of
ulCCM. ulCCM servlce classes are a good sLarLlng polnL.

ulCCM deflnes several broad caLegorles of capablllLles called "servlce classes". Among Lhese are
"SLorage", "Cuery/8eLrleve", "rlnL", "WorkllsL ManagemenL" and "Medla SLorage". lor example, a
scanner LhaL only supporLs Lhe ulCCM rlnL Servlce class wlll noL be able Lo communlcaLe wlLh a ACS
LhaL only supporLs SLorage Servlce class, even Lhough boLh are adverLlsed as belng "ulCCM compllanL".

vlrLually all servlces operaLe over a neLwork. lor Lhese servlces, Lhe speclflc Lype of servlce ls called a
"SC Class". 1he posslble roles are a) requesLlng Lhe servlce or b) provldlng Lhe servlce. Common l1
Lermlnology refers Lo Lhe user of Lhe servlce as Lhe "cllenL" or "requesLer" and Lhe provlder of Lhe
servlce Lhe "server". 8uL ulCCM shuns Lhose Lerms Lo relnforce Lhe polnL LhaL ulCCM conslders boLh
sldes Lo be peers. ulCCM refers Lo Lhe user as an "SCu" (for "servlce class user") and Lhe provlder of Lhe
servlce as an "SC" (for "servlce class provlder"). Lach SC class has lLs own unlque ldenLlfler ln Lhe form
of a sLrlng of dlglLs and perlods. lor ulCCM communlcaLlons Lo occur one devlce musL be an SCu (user)
of Lhe deslred Lype of servlce and Lhe oLher devlce musL be an SC (provlder) of exacLly Lhe same
servlce.

1he ulCCM sLandard clearly deflnes servlce class requlremenLs. SysLems LhaL clalm supporL for a
parLlcular servlce class musL speclflcally supporL Lhe servlce class as ouLllned by Lhe ulCCM sLandard. 1o
be more speclflc, SC and SCu supporL musL be embedded for verlflcaLlon, SLorage, SLorage
CommlLmenL, and Cuery/8eLrleve. SCu supporL ls requlred for rlnL, WorkllsL ManagemenL, and
ueLached SLudy ManagemenL.

Slmllarly, ulCCM ldenLlfles speclflc Lypes of "servlces" wlLh each servlce class. uevlces cannoL slmply
clalm Lo supporL a servlce class. vendors musL speclflcally ldenLlfy ln Lhelr conformance sLaLemenL Lhe
role(s) LhaL ls supporLed for speclflc Lypes of servlces ln a servlce class.

1he SCu wlll presenL a number of absLracL synLaxes and Lransfer synLaxes. 1he SC ln Lurn wlll respond
for each absLracL/Lransfer synLax palr wheLher or noL lL wlll accepL Lhe assoclaLlon. 1he SCu Lhen selecLs
whlch absLracL/Lransfer synLax from Lhe llsL of accepLed palrs LhaL lL wlll use Lo Lransfer. lL ls Lhe SCu
LhaL deLermlnes Lhe formaL (e.g., compressed, lossy 8blL !LC, lossless) Lhe lmages wlll be sLored ln. lf
Lhe sofLware ln use provldes an auLo-synch englne whlch supporLs a wlde range of absLracL and Lransfer
synLaxes, lL ls llkely LhaL Lhe SCu wlll flnd an accepLable palr. A flexlble approach would also be Lo
conflgure Lhe sysLem Lo accepL Lhe SC class ln Lhe evenL Lhe soluLlon doesn'L have an accepLable palr.

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ln Lhe Lmergency 8oom, a dlglLal C1 modallLy scans an unldenLlfled paLlenL. 1he lmages are senL from
Lhe C1 ln L8 Lo a ACS vlewlng sLaLlon ln 8adlology. 1he paLlenL name ln Lhe ulCCM aLLrlbuLes ls !ohn
uoe". When a paLlenL ls unldenLlfled aL Lhe Llme of lmage generaLlon lL ls common for Lhese lmages Lo
be mlsslng key paLlenL ldenLlfylng daLa such as Lhe name, paLlenL lu, gender, uo8, eLc., LhaL a ACS
vlewlng sLaLlon ofLen requlres Lo properly reLrleve and revlew prlor exams for Lhe paLlenL. AfLer Lhe
radlologlsL performs Lhe lnlLlal read on Lhe paLlenL, Lhe ACS forwards Lhe lmages Lo Lhe long-Lerm
archlve, lncludlng Lhe mlsslng paLlenL daLa. As such, Lhe archlve now conLalns paLlenL lmage daLa
wlLhouL sufflclenL daLa ln Lhe aLLrlbuLes Lo ldenLlfy Lhe paLlenL ln Lhe sLudy. Why ls Lhls scenarlo allowed
under Lhe ulCCM sLandard?

1he answer ls LhaL Lhe smallesL elemenLs of ulCCM ob[ecLs are called aLLrlbuLes, examples of whlch
lnclude Lhe paLlenL name, gender, uo8, sLudy descrlpLlon, modallLy Lype, eLc. Lach aLLrlbuLe has a
deflned Lype" ln Lhe ulCCM sLandard. 1here are Lhree Lype" deflnlLlons. 1ype 1 means LhaL Lhe
aLLrlbuLe ls mandaLory and musL be populaLed wlLh ulCCM compllanL daLa. A 1ype 2 aLLrlbuLe ls also
mandaLory, buL can be senL as "unknown". A 1ype 3 aLLrlbuLe ls opLlonal whlch means lL may or may noL
have daLa lncluded.

ln Lhe !ohn uoe" scenarlo, where Lhe aLlenL name, lu, gender, uo8, eLc., are noL enLered lnLo Lhe
correspondlng aLLrlbuLes, Lhe ulCCM lmage ob[ecL from Lhe C1 ln L8 ls compllanL wlLh Lhe ulCCM
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sLandard because boLh of Lhese aLLrlbuLes are deflned as 1ype 2. noLwlLhsLandlng Lhls mlsslng paLlenL
daLa, Lhls parLlcular ob[ecL ls unlquely ldenLlfled wlLh Lhe mandaLory 1ype 1 aLLrlbuLes such as SLudy,
Serles, and lmage SC class ulu. uslng Lhese unlque keys, a ACS ls capable of sLorlng and dlsplaylng
Lhese ob[ecLs. lrom an archlve perspecLlve, Lhese ob[ecLs elLher are updaLed wlLh Lhe correcL paLlenL
daLa uslng an PL7 paLlenL daLa updaLe LransacLlon or Lhey end up ln an "excepLlon queue" whlch
requlres reconclllaLlon aL a laLer Llme by a ACS admlnlsLraLor.

Cne of Lhe key lssues aL play here ls LhaL Lhe ulCCM sLandard ls wrlLLen llke an englneerlng speclflcaLlon.
lL ls hard Lo read, and Lhere ls no "ulCCM for uuMMlLS" gulde avallable LhaL can help a user, or even an
lmplemenLaLlon speclallsL, Lhrough an evaluaLlon of ulCCM conformlLy and lLs many unlque buL
conformlng varlances.

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1he ulCCM speclflcaLlon ls raLher exLenslve. Many deflned servlces have yeL Lo be lmplemenLed. Cn Lhe
oLher hand, new Lechnologles such as waveleL compresslon and new medla Lypes are deslgned ouLslde
of ulCCM. ln one sense, Lhe sLandard speclfles Loo much, buL from anoLher perspecLlve, noL enough.
Why ls LhaL?

1he ulCCM sLandard provldes a seL of Lools buL does noL deflne a speclflc archlLecLural soluLlon.
AppllcaLlons LhaL use ulCCM are complex and requlre slgnlflcanL Llme Lo lmplemenL newly-deflned
ulCCM servlces. As a resulL, mosL vendors Lake a plece meal" approach because Lhey are noL able Lo
lnLroduce changes Lo all aspecLs of Lhelr sofLware soluLlon Lo achleve new ulCCM capablllLles ln one
parLlcular release. 1hey adopL Lhe new ulCCM sLandard (or lPL proflle) over a serles of new sofLware
releases.

ln reallLy, some manufacLurers puL more efforL lnLo Lhelr ulCCM conformance sLaLemenLs Lhan oLhers.
SofLware producLs vary ln Lhelr supporL of ulCCM SC classes. lor example, an M8 scanner LhaL only
supporLs sendlng ulCCM compllanL lmage ob[ecLs only supporLs Lhe ulCCM M8 lmage SLorage SC
class. Whereas a ACS worksLaLlon musL supporL much more funcLlonallLy and requlres supporL for
many more SC class speclflcaLlons.

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1hls whlLepaper has provlded a baslc undersLandlng of Lhe ulCCM sLandard. lL ls safe Lo say LhaL Lhe
ulCCM sLandard ls anyLhlng buL sLandard". lor Lhe ma[orlLy of cases, ulCCM works effecLlvely. 8uL lL ls
always Lhe excepLlon use case" LhaL causes Lhe mosL dlsrupLlon.

When confronLed wlLh a ulCCM lnLeroperablllLy lssue, cusLomers Lyplcally Lake Lhe followlng
approaches:

1. 1a|k to the Vendors - 1hls ls Lhe flrsL place Lo sLarL. AfLer all, Lhe problem could be resolved by
slmply maklng a change Lo a ulCCM parameLer by one or boLh vendors lnvolved. 1here are
challenges wlLh Lhls approach:

a. roblem deflnlLlon: ?ou musL be able Lo clearly deflne Lhe problem. 1hls sounds easy
buL ulCCM lnLeroperablllLy problems are manlfesLed ln many dlfferenL ways.
8ecognlzlng a ulCCM lssue may noL be easy.
b. CeLLlng Lo Lhe rlghL vendor represenLaLlve: MosL flrsL and second-llne supporL
represenLaLlves do noL fully undersLand ulCCM lssues. 1he flrsL reacLlon wlll mosL llkely
be lL ls Lhe oLher vendor's lssues as our producL ls ulCCM-conformanL". 8emember,
boLh vendors mlghL Lake Lhls approach.
c. CeLLlng boLh vendors Lo collaboraLe on Lhe problem: 1he cusLomer ls ln Lhe mlddle of
Lhls rock and hard place. CeLLlng Lhe rlghL person on Lhe phone from boLh vendors for a
producLlve dlscusslon on how Lo resolve Lhe lnLeroperablllLy problem can be a real
challenge.

vendor collaboraLlon on Lhe problem aL hand wlLh a focus on problem resoluLlon ls a good sLarL.
lf Lhe vendors can agree on a soluLlon, Lhe soluLlon wlll ofLen be packaged ln a perlodlc updaLe
Lo Lhe producL. unforLunaLely, Lhls Lyplcally means walLlng for Lhe problem Lo be resolved unLll
Lhe nexL sofLware updaLe or upgrade from each vendor - a developmenL LhaL could be monLhs
away.

2. Imp|ement a Manua| rocedure - Many ulCCM lnLeroperablllLy lssues are manlfesLed as a
workflow lssue. 1o address Lhe lssue aL hand, speclal manual procedures Lo resolve Lhe lssue are
deflned. 1hls mlghL mean LhaL a LechnologlsL or a ACS admlnlsLraLor ls called upon Lo perform
speclal resoluLlon procedures. 1hls wlll resulL ln unwanLed work and Llme-delays for geLLlng Lhe
sLudy Lo lLs LargeL desLlnaLlon. ln many cases, Lhe manual workaround wlll resolve Lhe ulCCM
lssue, posslbly creaLlng a LechnologlsL or ACS admlnlsLraLor producLlvlLy (and [ob saLlsfacLlon)
lssue.

3. Lngage a rofess|ona| Serv|ces I|rm - Approaches 1 and 2 are Lhe Lyplcal flrsL course of acLlon.
Cnly afLer deallng wlLh Lhese flrsL Lwo approaches wlll managemenL conslder" engaglng a
professlonal servlces flrm Lo lmplemenL a soluLlon Lo Lhe lssue aL hand. 1hese soluLlons can be
cosLly and Lhey Lyplcally resulL ln a cusLom soluLlon LhaL mlghL have Lo be re-lmplemenLed ln Lhe
fuLure lf new vendor sofLware or new producL ls lnLroduced.

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An a|ternat|ve approach |s to |nsta|| a DICCM "eng|ne" for attr|bute mod|f|cat|on. lL ls common LhaL
ulCCM lnLeroperablllLy challenges number more Lhan one. users can llberaLe ulCCM lmage daLa uslng a
mlddleware appllcaLlon whlch provldes a ACS AdmlnlsLraLor or 8adlology l1 AnalysL wlLh Lhe capablllLy
Lo dlscover Lhe problem, program a rule-based aLLrlbuLe modlflcaLlon or LranslaLlon Lable and resolve
Lhe lssues auLomaLlcally golng forward. Lven wlLh new sofLware upgrades from exlsLlng ACS vendors,
Lhe analysL wlll be able Lo lmplemenL all requlred changes Lo ensure ulCCM compaLlblllLy beLween all
ulCCM sysLems.

A further step can be taken to m|grate the |mag|ng data from propr|etary ACS vendor storage to a
ACS-neutra| or vendor-neutra| arch|ve (VNA) w|th a web-based, zero-footpr|nt, c||n|ca| v|ewer. 1hls
Lype of mlgraLlon offers dlsLlncL beneflLs. llrsL, lL releases and consolldaLes Lhe lmage daLa held capLlve
ln dlsparaLe deparLmenLal and organlzaLlonal ACS archlves. Second, lL lmproves Lhe llfecycle
managemenL of lmage daLa and reduces Lhe need for exLenslve, cosLly daLa mlgraLlons Lo move Lo new
ACS provlders ln Lhe fuLure. 1hlrd, lL ellmlnaLes Lhe need for mulLlple lnLegraLlons requlred Lo provlde
cllnlcal vlewlng access Lo enLerprlse-wlde lmaglng daLa. lourLh, when a ACS-neuLral / vendor-neuLral
archlve ls used ln comblnaLlon wlLh a ulCCM englne, all paLlenL lmages can be shared across any
number of dlsparaLe sysLems for lmproved lmage workflow, cllnlclan efflclency and paLlenL ouLcomes.
lor more lnformaLlon abouL vendor-neuLral archlves (vnA), see our whlLepaper enLlLled: Achlevlng a
vendor-neuLral Archlve (vnA).

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