Imaging, Standards and Interoperability

Let’s hop into the Delorean and travel back in time…

The date is November 8, 1895 and a 50 year old bearded man named Wilhelm Roentgen is testing the results of passing electric current through a combination of low pressure gases.  Working in complete darkness, he notices a screen across the room become bright fluorescent as the electric currents pass through discharge tube.

This is the moment Wilhelm discovers X-rays.

Wilhelm starts experimenting, capturing images of different sized objects in the X-rays’ path. He calls to his wife, and creates the first ‘x-ray’ by developing the image of his wife’s hand.

It doesn’t take long for manufacturers to start building technology to satisfy the demand for this new technology. The year following Roentgen’s discovery, the world’s first radiology department is launched in the Glasgow Royal Infirmary in 1896.

From this point on, diagnostic imaging continues to evolve. Skip ahead to the late 1940’s and we see ultrasound imaging being used for diagnosis. In the mid-1960’s, the Egan Method for capturing mammography imaging is used. In the decade that gave us disco and punk-rock, we are introduced to the CT scanner and MRI imaging.

With the 1980’s, the adoption of information technology increases and ‘PACS’ is introduced in order to exchange diagnostic imaging digitally. This drives the need for standardization across the industry. Thus DICOM is born and the eventual creation of the IHE framework we rely on today for standardization.

The timeline below demonstrates how far we’ve come, from the discovery of different imaging methods, to our reliance on standards.


  • Wilhelm Roentgen discovers X-Rays.

    Wilhelm Roentgen discovers X-Rays.

     Captures the first x-ray of his wife’s hand.

  • First Commercial X-Ray Machines

    First Commercial X-Ray Machines

    GE and Siemens develop electrical equipment for production of X-Ray.    

  • World’s First Radiology Department

    World’s First Radiology Department

    Glasgow Royal Infirmary starts first radiology department.

  • First Annual RSNA meeting

    First Annual RSNA meeting

    The first  Annual RSNA meeting held at Hotel Sherman in Downtown Chicago

  • Ultrasound Imaging

    Ultrasound Imaging

    Ultrasound is used as a Diagnostic tool used in USA in late 1940’s

  • The Egan Technique

    The Egan Technique

    Robert Egan publishes book called ’Mammography’. The “Egan technique”, as it became known, enabled physicians to detect calcification in breast tissue.

  • Computed Tomography Imaging

    Computed Tomography Imaging

    Computed Tomography (CT) scan invented by Godfrey Houndsfield. These early CT scanners took several hours to acquire the raw data for a single  slice and took days to reconstruct a single image.

  • Magnetic Resonance Imaging

    Magnetic Resonance Imaging

    Magnetic Resonance Imaging is used as a medical diagnostic technique to create images of the human body using the principle of nuclear magnetic resonance.

  • HL7


    Precursor activities begin in 1979, that would eventually result in HL7 as a standards development organization.

  • PACS


    The first large-scale PACS installation is implemented at the University of Kansas.



    ACR and NEMA join forces and form a standards committee that would eventually be known as DICOM.

  • IHE


    Integrating the Health Exchange (IHE) created to identify workflow scenarios and document how to use established standards to solve workflow challenges.

(This timeline demonstrates how far we’ve come from the discovery of different imaging methods, to our reliance on standards. Standards are essential for interoperability.)


Now that we’re all caught up to the present day, we can hop out of the Delorian and explore the idea of interoperability.

Interoperability doesn’t have to be an abstract concept related to exchanging information across computer systems. We experience social interoperability on a daily basis. Marriage is an example of interoperability. In marriage, two separate parties attempt to come together and achieve a common goal. Most likely, both partners speak the same language, but may have different ways of interpreting delivered messages, with different communication protocols.

In our Imaging IT world, there are always ways to find non-standard workarounds to achieve desired results in specific use cases; however without standards it can be near-impossible to replicate those results.

A little over a decade ago, the goal to see ‘one patient, one record’ across Canada was established. In order to achieve ‘one patient, one record’ from a diagnostic imaging (DI) perspective, the need was identified that outside DI studies and reports should seamlessly integrate directly into local PACS. In Canada, the method of sharing outside imaging directly into the local PACS became known as ‘foreign exam management’ (see linked journal entry for more on this topic).

Providing a local PACS with the ability to ingest and manage foreign exams is an interoperability challenge. Unfortunately there was no defined standard or framework for foreign exam management. This resulted in regions across Canada rolling out different degrees and variations of implementations that supported this function. Many of these implementations relied on unique and custom built proxy boxes.

Over the past year I’ve been fortunate enough to sit on the IHE Radiology Planning and Technical Committees and witness the development the profile, Import and Display of External Priors. This is a profile that intends to address the use-cases related to foreign exam management.

It’s been quite an experience to see the development of an IHE profile, from the initial identified need addressed with multiple custom workarounds, to the development of an IHE profile that will rely on mature established standards.

Roentgen wouldn’t have been able to imagine what imaging would be like today. The word interoperability didn’t even exist back then.

It’s hard to predict what the future will look like as imaging continues to evolve and new tools emerge to manage our changing needs. One thing can be certain, as technology moves forward, so will our standards.

Keep it going… /What are your thoughts?

A few final thoughts before closing this post off.

  • If there is anything on the timeline that you think would be useful to add, leave a comment and let me know. It would be great to see this timeline continue to grow with feedback from our Imaging IT community.
  • I’ve had a fun time being involved and watching the development of an IHE profile. Feel free to get involved and participate! IHE relies on vendor and customer participation to keep our standards moving forward.