Dr. Hyatt is absolutely correct in noting the need for use of a standard image file format and informational tags for diagnostic images that are to be transferred between practitioners providing care to a given dental patient. This standard already exists and, as mentioned in the special supplement on digital imaging, is the International Organization for Standardization– referenced Digital Imaging and Communications in Medicine (DICOM) (National Electrical Manufacturers Association, Rosslyn, Va.) format.1
This format is advocated by the American Dental Association (ADA) and has been demonstrated by the leading manufacturers of dental digital imaging equipment at each of the past several annual sessions of our Association. Should inter-operability of diagnostic images for portability of patient data be desired, then dentists should be careful to buy only digital imaging equipment and imaging software that permits DICOM image export and import.
DICOM images have information tags that include unique patient identifiers, the source and date of the acquired image, the image’s laterality and whether it is original or enhanced. Without such attached information, a digital image should be considered no different than a loose film radiograph found in the bottom of a filing cabinet. In other words, non-tagged digital images should not be used for diagnostic purposes, as their provenance and integrity cannot be verified.
A second issue needs to be addressed: namely, confidentiality of protected health information as required by the Health Insurance Portability and Accountability Act of 1996. Nonsecured e-mail should never be used for transmission of patient data, including diagnostic images.2,3 Failure to hold protected health information confidential can result in significant penalties. Suitable encryption or use of secure networks is essential.
The ADA is actively involved in promoting standards such as DICOM through its Standards Committee on Dental Informatics (SCDI)4 and through membership in various standards bodies. The SCDI has various active working groups that involve manufacturers, users (that is, dentists) and other interested parties. ADA members are encouraged to consider participating in helping improve standards for the profession by contributing to the SCDI process.
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