DICOM as an Option?

Imagine you have purchased a new car over the winter and, as summer approaches, you are trying to switch on the AC. Unfortunately, you get a message on your console that the AC option is not enabled (even though installed) and must be purchased separately to make it work. Unless you live in Alaska, Siberia, Iceland, or another country close to the North or South Pole, having an AC is pretty much a necessity in most cars today especially with global warming, and having to pay extra for that feature could be considered an unpleasant “marketing trick”. Even worse, if all the options are not explained clearly when signing the purchase agreement, I would consider this a very poor practice.

When the first DICOM connections were deployed, more than 30 years ago, there was a need for a separate interface board (the infamous ACR/NEMA 50-pin connector as shown in the illustration) and one would be OK with having to pay extra for this interface feature. However, when DICOM 3.0 came out, which was based on built-in TCP/IP network connectivity, it was just a matter of upgrading the software to include DICOM connectivity. That is when the nickel-and-dime game started: vendors would include “DICOM Store” as part of the standard package to allow image export to a PACS, but DICOM Print or DICOM Worklist would be an extra purchasable option. And by the way, don’t expect to be able to burn DICOM CDs even though the device might have a CD player, it would yet be another option.

The problem with these options is that they are not clearly stated upfront and finding a budget to pay for it later is often an issue. I have experienced this problem in two recent cases, first with an Ultrasound from a major manufacturer who had only a printer interface while the export feature to send images to a PACS and share them with other physicians was not enabled. To enable this required a simple software configuration to make this happen. In another instance, a CR system was configured to send images to the PACS but pushing them back to the modality to make a copy to the attached printer was yet another purchasable option. Both units were donated to a different hospital in Africa, which is probably the worst scenario as there is usually little money left to buy these options. I am only involved with a few installs in those LMIC countries; I can imagine that this practice is widespread.

Therefore my plea to all imaging vendors is to stop playing games and sell only fully featured DICOM-enabled devices, it will make you look good and provide goodwill, especially in countries that have limited resources.

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