Modern medical imaging systems do much more than store images.
They need to acquire imaging data, manage large volumes of studies, make images available to authorised clinicians, exchange information with other healthcare systems and increasingly support AI-based analysis.
That makes interoperability an important part of medical imaging architecture.
For developers and healthcare technology teams, three concepts are particularly important: DICOM, PACS and healthcare interoperability.
Understanding how these components work together is essential when designing medical imaging software that needs to integrate with an existing healthcare environment.
What Is PACS?
PACS, or Picture Archiving and Communication System, is used to store, manage and access medical images.
A typical PACS environment may receive images from different imaging modalities and make them available to authorised users through diagnostic viewers and connected healthcare applications.
However, PACS rarely operates completely on its own.
It may need to exchange information with Radiology Information Systems (RIS), EHR and EMR platforms, hospital systems and other clinical applications.
This is where integration becomes important.
Why DICOM Is Important
DICOM is a standard used for communicating and managing medical imaging information.
It allows imaging equipment and healthcare systems to exchange images and associated information using a common framework.
For developers, supporting DICOM means thinking beyond the image file itself.
A medical imaging application may need to handle:
• Image acquisition
• Patient and study information
• Modality communication
• Image storage
• Query and retrieval
• Image viewing
• Data transfer
• Integration with other systems
The Australian Digital Health Agency's medical technology guidance states that systems that store, transmit, retrieve, process or display medical imaging must support DICOM.
That makes DICOM support an important consideration when developing imaging software for the Australian healthcare environment.
PACS and RIS Need to Work Together
PACS manages imaging information, while a Radiology Information System (RIS) supports many operational aspects of radiology workflows.
Depending on the environment, RIS can support scheduling, orders, worklists and reporting.
Connecting RIS and PACS can reduce the need for manual movement of information between systems.
For example, an imaging workflow might look like:
Order → Scheduling → Imaging → Storage → Interpretation → Report → Clinical System
A well-integrated architecture allows information to move between these stages more reliably.
Connecting Imaging With EHR and Other Systems
Medical imaging rarely exists separately from the wider healthcare ecosystem.
Imaging information may need to connect with:
• EHR and EMR systems
• Hospital information systems
• Clinical applications
• Laboratory systems
• Referral platforms
• Patient applications
• AI analysis tools
APIs and healthcare interoperability standards can help create these connections.
FHIR is increasingly important for exchanging structured healthcare information. The Australian Digital Health Agency provides FHIR guidance as part of Australia's broader approach to digital health interoperability.
DICOM and FHIR serve different purposes within an integrated architecture.
DICOM primarily supports medical imaging communication and information, while FHIR is designed for exchanging broader healthcare information between systems.
Using the appropriate standard for each part of the workflow can help create a more interoperable healthcare environment.
A Simple View of the Architecture
A modern imaging environment could be thought of as:
Imaging Devices
↓
DICOM Layer
↓
PACS / Imaging Platform
↓
Viewer & Image Analysis
↓
EHR / RIS / Clinical Applications
Integration APIs can connect these components with other healthcare systems.
The exact architecture will depend on the organisation, existing infrastructure, clinical workflows and interoperability requirements.
There is no single architecture that fits every imaging environment. The important consideration is how each component communicates with the systems around it.
Where Cloud Imaging Fits
Cloud-based imaging platforms can provide benefits such as centralised access, scalable storage and support for geographically distributed teams.
However, moving imaging workflows to the cloud does not remove the need for good architecture.
Teams still need to consider:
• Secure data transfer
• Identity and access management
• Encryption
• Availability
• Disaster recovery
• Performance
• Integration
• Data governance
For Australian healthcare organisations, these considerations are particularly important when sensitive health and imaging information is being stored or exchanged across systems and locations.
The technology should be selected based on the workflow and requirements rather than simply choosing cloud because it is a current trend.
Adding AI to Medical Imaging
AI can sit alongside the imaging workflow to support tasks such as image classification, segmentation, detection and quantitative analysis.
A typical workflow might look like:
Image acquisition → PACS → AI analysis → Results → Clinician review
The important point is that AI should not become another isolated application.
It needs to integrate with the existing imaging workflow so that results can be reviewed and used appropriately.
For example, an AI system may analyse an image and generate a result, but that result still needs to reach the appropriate clinical application or viewer in a way that fits the radiologist's workflow.
This makes integration an important consideration when introducing AI into existing medical imaging environments.
Designing for Interoperability From the Start
Retrofitting interoperability after a system has already been built can be difficult.
It is usually better to consider integration during the architecture stage.
For a new medical imaging software development project, teams should define:
• Which imaging modalities need to connect
• Which clinical systems need integration
• Which standards are required
• How patient identity will be managed
• How data will be secured
• How the platform will scale
• How future integrations will be added
It is also useful to understand the existing workflows before deciding on the technical architecture.
This creates a more flexible foundation for future development and can make it easier to connect additional systems as requirements change.
The Future of Medical Imaging Systems
Medical imaging technology is moving towards more connected, accessible and intelligent workflows.
PACS remains important, but modern imaging platforms increasingly need to connect with EHRs, RIS, cloud infrastructure, AI tools and other healthcare applications.
For Australian healthcare organisations, building around established standards such as DICOM and FHIR can help create systems that are easier to integrate and evolve.
The strongest imaging platforms will not simply store images.
They will connect imaging with the wider healthcare ecosystem.
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