Towards an Information Infrastructure for Medical Image Sharing

  • Gustavo H. M. B. MottaEmail author
  • Danilo A. B. Araújo
  • Juracy R. Lucena-Neto
  • Paulo M. Azevedo-Marques
  • Saulo S. Cordeiro
  • Severino A. Araújo-Neto


Information infrastructures involve the notion of a shared, open infrastructure, constituting a space where people, organizations, and technical components associate to develop an activity. The current infrastructure for medical image sharing, based on PACS/DICOM technologies, does not constitute an information infrastructure since it is limited in its ability to share in a scalable, comprehensive, and secure manner. This paper proposes the DICOMFlow, a decentralized, distributed infrastructure model that aims to foment the formation of an information infrastructure in order to share medical images and teleradiology. As an installed base, it uses the PACS/DICOM infrastructure of radiology departments and the internet e-mail infrastructure. Experiments performed in real and simulated environments have indicated the feasibility of the proposed infrastructure to foment the formation of an information infrastructure for medical image sharing and teleradiology.


Digital imaging and communications in medicine (DICOM) Information infrastructure Medical image sharing Picture archive and communication systems (PACS) Systems architecture Teleradiology 



  1. 1.
    Bowker GC, Baker K, Millerand F, Ribes D: Toward information infrastructure studies: Ways of knowing in a networked environment. In: Hunsinger J, Klastrup L, Allen M Eds. International Handbook of Internet Research. Dordrecht: Springer, 2010, pp. 97–117Google Scholar
  2. 2.
    Monteiro E, Pollock N, Hanseth O, Williams R: From artefacts to infrastructures. Comput Support Coop Work 22:575–607, 2013CrossRefGoogle Scholar
  3. 3.
    Aanestad M, Grisot M, Hanseth O, Vassilakopoulou P: Information infrastructures and the challenge of the Installed Base. In: Aanestad M, Grisot M, Hanseth O, Vassilakopoulou P Eds. Information infrastructures within European health care: Working with the Installed Base. Cham: Springer, 2017, pp. 25–33CrossRefGoogle Scholar
  4. 4.
    Hanseth O, Lyytinen K: Design theory for dynamic complexity in information infrastructures: The case of building internet. J Inf Technol 25:1–19, 2010CrossRefGoogle Scholar
  5. 5.
    Star SL, Ruhleder K: Steps toward an ecology of infrastructure: Design and access for large information spaces. Inf Syst Res 7:111–134, 1996CrossRefGoogle Scholar
  6. 6.
    Aanestad M, Hanseth O: Implementing open network technologies in complex work practices: A case from telemedicine. Organizational and Social Perspectives on Information Technology, Aalborg, Denmark, 2000, 355–369Google Scholar
  7. 7.
    Huang HK: PACS and imaging informatics: Basic principles and applications, 2nd edition. New Jersey: Wiley-Blackwell, 2010Google Scholar
  8. 8.
    National Electrical Manufacturers Association Digital Imaging and Communications in Medicine (DICOM). 2011 Available at: Accessed 18 October 2018
  9. 9.
    Pianykh OS: Digital imaging and Communications in Medicine (DICOM): A practical introduction and survival guide, 2nd edition. Heidelberg: Springer, 2012CrossRefGoogle Scholar
  10. 10.
    Ribeiro LS, Costa C, Oliveira JL: Current trends in archiving and transmission of medical images. In: Erondu OF Ed. InTech, 2011, 89–106Google Scholar
  11. 11.
    Chatterjee AR, Stalcup S, Sharma A, Sato TS, Gupta P, Lee YZ, Malone C, McBee M, Hotaling EL, Kansagra AP: Image sharing in radiology—A primer. Acad Radiol 24:286–294, 2017CrossRefGoogle Scholar
  12. 12.
    Silva LAB, Costa C, Oliveira JL: DICOM relay over the cloud. Int J Comput Assist Radiol Surg 8:323–333, 2013CrossRefGoogle Scholar
  13. 13.
    Monteiro EJM, Costa C, Oliveira JL: A cloud architecture for teleradiology-as-a-service. Methods Inf Med 55:1–12, 2016CrossRefGoogle Scholar
  14. 14.
    Yuan Y, Yan L, Wang Y, Hu G, Chen M: Sharing of larger medical DICOM imaging data-sets in cloud computing. J Med Imaging Heal Informatics 5:1390–1394, 2015CrossRefGoogle Scholar
  15. 15.
    Godinho TM, Viana-Ferreira C, Bastiao-Silva LA, Costa C: A routing mechanism for cloud outsourcing of medical imaging repositories. IEEE J Biomed Heal Informatics 20:367–375, 2016CrossRefGoogle Scholar
  16. 16.
    Viana-Ferreira C, Guerra A, Silva JF, Matos S, Costa C: An intelligent cloud storage gateway for medical imaging. J Med Syst 41:141, 2017CrossRefGoogle Scholar
  17. 17.
    Zhang K, Ling T, Yang Y, et al.: Clinical experiences of collaborative imaging diagnosis in Shanghai district healthcare services. SPIE Medical Imaging 2016: PACS and Imaging Informatics: Next Generation and Innovations, 2016, 9789, 97890XGoogle Scholar
  18. 18.
    Langer SG, Tellis W, Carr C, Daly M, Erickson BJ, Mendelson D, Moore S, Perry J, Shastri K, Warnock M, Zhu W: The RSNA image sharing network. J Digit Imaging 28:53–61, 2015CrossRefGoogle Scholar
  19. 19.
    Simalango MF, Kim Y, Seo YT, Choi YH, Cho YK: XDS-I gateway development for HIE connectivity with legacy PACS at Gil Hospital. Healthc Inform Res 19:293–300, 2013CrossRefGoogle Scholar
  20. 20.
    Ribeiro LS, Viana-Ferreira C, Oliveira JL, Costa C: XDS-I outsourcing proxy: Ensuring confidentiality while preserving interoperability. IEEE J Biomed Heal Informatics 18:1404–1412, 2014CrossRefGoogle Scholar
  21. 21.
    Integrating the Healthcare Enterprise (IHE) IT infrastructure technical framework (ITI TF-1), vol. 1, 2017. Available at: Accessed 18 October 2018
  22. 22.
    Paina L, Peters DH: Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health Policy Plan 27:365–373, 2012CrossRefGoogle Scholar
  23. 23.
    Edwards P, Jackson S, Bowker G, Knobel C: Report of a Workshop on History and Theory of Infrastructures: Lessons for New Scientific Infrastructures, Univ. Michigan, School of Information, 2007. Available at Accessed 18 October 2018
  24. 24.
    Hanseth O: Gateways—Just as important as standards: How the internet won the ‘religious war’ over standards in Scandinavia. Knowledge, Technol Policy 14:71–89, 2001CrossRefGoogle Scholar
  25. 25.
    David PA, Bunn JA: The economics of gateway technologies and network evolution: Lessons from electricity supply history. Inf Econ Policy 3:165–202, 1988CrossRefGoogle Scholar
  26. 26.
    Jensen TB: Design principles for achieving integrated healthcare information systems. Health Informatics J 19:29–45, 2013CrossRefGoogle Scholar
  27. 27.
    Internet X: 509 public key infrastructure certificate and certificate revocation list (CRL) profile, IETF RFC, 2008, 5280Google Scholar
  28. 28.
    Secure/Multipurpose Internet Mail Extensions (S/MIME) Version 3.2 Message Specification, IETF RFC 2010, 5751Google Scholar
  29. 29.
    Transport Layer Security (TLS), IETF RFC 2008, 5246Google Scholar
  30. 30.
    Extensible Messaging, Presence Protocol: (XMPP): Address format, IETF RFC 2015, 7622Google Scholar
  31. 31.
    Noumeir R: Sharing medical records: The XDS architecture and communication infrastructure. IT Professional 13:46–52, 2011CrossRefGoogle Scholar
  32. 32.
    Integrating the Healthcare Enterprise (IHE), Cross-enterprise document sharing for imaging (XDS-I.b), 2017. Available at: Accessed 18 October 2018
  33. 33.
    Guo Y, Hu Y, Afzal J, Bai G: Using P2P technology to achieve e-health interoperability. 8th international conference on service systems and service management. IEEE:722–726, 2011Google Scholar
  34. 34.
    Urovi V, Olivieri AC, Torre AB et al.: Secure P2P cross-community health record exchange in IHE compatible systems. Int J Artif Intell Tools 23:1440006, 2014CrossRefGoogle Scholar
  35. 35.
    Figueiredo JFM, Motta GHMB: SocialRAD: An infrastructure for a secure, cooperative, asynchronous teleradiology system. Stud Health Technol Inform 192:778–782, 2013Google Scholar
  36. 36.
    Ribeiro LS, Bastião L, Costa C, et al.: Email-P2P gateway to distributed medical imaging repositories. Proc. HEALTHINF 2010 310–315Google Scholar
  37. 37.
    Weisser G, Walz M, Ruggiero S, Kämmerer M, Schröter A, Runa A, Mildenberger P, Engelmann U: Standardization of teleradiology using DICOM e-mail: Recommendations of the German radiology society. Eur Radiol 16:753–758, 2006CrossRefGoogle Scholar
  38. 38.
    Simple Mail Transfer Protocol (SMTP), IETF RFC 2008, 5321Google Scholar
  39. 39.
    Weisser G, Engelmann U, Ruggiero S, Runa A, Schröter A, Baur S, Walz M: Teleradiology applications with DICOM-e-mail. Eur Radiol 17:1331–1340, 2007CrossRefGoogle Scholar
  40. 40.
    Oliveira MAL: Forming an information infrastructure for teleradiology: A series of case studies based on the design theory for dynamic complexity. M.Sc. Thesis, Dept. informatics, fed. Univ. Paraíba, João Pessoa, Brazil, 2015Google Scholar
  41. 41.
    Fielding RT: Architectural styles and design of network-based software architectures. Ph.D. dissertation, Univ. California, Irvine, CA, 2000Google Scholar
  42. 42.
    Internet Message Access Protocol (IMAP), IETF RFC 2003 3501Google Scholar
  43. 43.
    Amazon Web Services, Inc., Authenticating requests using the REST API. [online]. Available at: Accessed 18 October 2018
  44. 44.
    Keyed-hashing for message authentication (HMAC), IETF RFC 1997, 2104,Google Scholar
  45. 45.
    Lucena-Neto JR: DICOMStudio: Multidomain platform for teleradiology. M.Sc. thesis, Dept. Informatics, Fed. Univ. Paraíba, João Pessoa, Brazil, 2018Google Scholar

Copyright information

© Society for Imaging Informatics in Medicine 2019

Authors and Affiliations

  1. 1.Center of InformaticsFederal University of ParaíbaJoão PessoaBrazil
  2. 2.Center of Imaging Sciences and Medical Physics, Ribeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
  3. 3.Center of Medical SciencesFederal University of ParaíbaJoão PessoaBrazil

Personalised recommendations