Ultrasound DICOM and PACS: Getting Images Into the Record
An image that lives only on the scanner is lost when the hard disk fails, the system is traded in or the patient sees another doctor. The DICOM services that matter, the storage options for a clinic, what to check in a conformance statement, and the data protection duties that come with patient images.
Why connectivity matters
- Images on the scanner’s own disk are one failure away from being lost, and the disk fills up.
- USB sticks are easily lost and carry patient data that anyone can read unless they are encrypted.
- Typing patient names on the scanner leads to misfiled images; a worklist removes the typing.
- Referrals and second opinions need images that open on another doctor’s viewer.
- Measurements copied by hand into a report get transcribed wrongly; structured reports carry the numbers across.
The DICOM services that matter
DICOM (Digital Imaging and Communications in Medicine) is both the file format and the network protocol for medical images. A scanner may support some services and not others.
| Service | What it does | Why you want it |
|---|---|---|
| Storage | Sends images and clips from the scanner to PACS or another DICOM destination | The basic requirement: images leave the machine |
| Modality worklist (MWL) | The scanner downloads the day’s booked patients from the clinic or radiology system | Name, ID and exam come across without typing, so images are filed to the right patient |
| Modality performed procedure step (MPPS) | Tells the booking system when an exam starts and finishes | Status tracking in busier departments |
| Storage commitment | PACS confirms it has safely received the images | The scanner can then clear its local copies safely |
| Structured report (SR) | Sends measurements — obstetric biometry, vascular velocities, echo values — as data rather than pictures | Reporting software fills in the numbers without retyping |
| Query/retrieve | Pulls earlier studies back to the scanner | Compare with the last scan at the bedside |
| Sends images to a DICOM film or paper printer | Less common now; thermal printers usually connect by USB |
PACS, cloud or USB?
On-site PACS
A server in the clinic stores and serves the images. Fast on the local network, but the clinic is responsible for backup, power, updates and security.
Cloud PACS or vendor cloud
Images upload to a hosted service and are viewed in a browser. There is no server to look after, but it needs reliable internet and usually a subscription. Handheld scanners often use the maker’s own cloud.
Handhelds and their cloud servicesNetwork folder or USB export
Export as DICOM, JPEG or MP4 to a folder or USB drive. Cheap, but there is no worklist and searching is poor, and JPEG or MP4 files lose the DICOM header that ties the image to the patient. Fine as a stop-gap or for patient copies.
Clinic system integration
Some clinic management systems accept images or PDF reports. Check whether yours speaks DICOM or needs a bridge.
Reading a DICOM conformance statement
Every DICOM device should have a conformance statement — a document that lists exactly which DICOM services and options it supports, as a sender and as a receiver. Ask for the scanner’s and the PACS’s, and check:
- Storage of multi-frame images (clips), not only single frames.
- Modality worklist support, with the fields your clinic system actually sends.
- Structured report templates for the exams you do, such as obstetric, vascular and adult echo.
- Compression options: lossless or lossy, and how clips are compressed.
- Storage commitment and query/retrieve, if you need them.
- Character set support if patient names are entered in Chinese or Tamil script.
- Which DICOM features are licensed options — confirm they appear on the quotation.
Network and IT checks
- A fixed IP address, AE title and port for each scanner, and matching settings in the PACS. Ports 104 and 11112 are the usual DICOM ports.
- A wired network point at the scan room. Wi-Fi is fine for handhelds if it is reliable at the bedside.
- Send a full study with clips as a test, and time it, before the engineer leaves.
- Keep scanners off the guest Wi-Fi, apply the manufacturer’s security updates and change default passwords.
- Back up the PACS to a second location, and test that a restore actually works.
- Plan for network outages: the scanner should queue studies and send them when the link returns.
- Ask for the manufacturer’s MDS2 form (Manufacturer Disclosure Statement for Medical Device Security), which documents the system’s security features.
Read next Power and data points in the scan room
Patient images and the PDPA
Ultrasound images and reports are health information, which the Personal Data Protection Act 2010 treats as sensitive personal data. The Act applies to private clinics; it does not apply to the Federal and State Governments. Amendments passed in 2024 came into force in stages during 2025: data processors such as cloud providers are now directly bound by the security principle, and data controllers have duties to appoint a data protection officer and to notify the Commissioner of data breaches. This is a summary, not legal advice.
- Give each user their own login on the scanner and the PACS, and decide who can view, export and delete images.
- Encrypt USB exports, or stop using USB for patient images.
- Ask a cloud provider where the data is stored, how it is encrypted and how it is returned if you leave; the amended Act sets conditions for transferring personal data outside Malaysia.
- Wipe patient data from the scanner’s disk before it is sold, traded in or sent away for repair.
- Keep images for as long as your medical records policy requires, and delete them securely after that.
Read next Buying or selling a used system
What to ask in a quotation
- Which DICOM services are included, and which are licensed extras.
- Who configures the link to your PACS, cloud or clinic system, and whether that work is in the quotation.
- Whether a PACS or viewer is included, how much storage it has, and what upgrades cost.
- For handhelds: the cloud subscription terms, and what still works without one.
Read next Choosing an ultrasound scannerThe lab equivalent: analyser LIS connectivity (hematologyanalyser.my)
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