Understanding DICOM Structured Reports


This article is part of my series of articles on the DICOM standard. If you are totally new to DICOM, please have a quick look at my earlier article titled “Introduction to the DICOM Standard” for a quick introduction to the standard. In this article, we will cover a very important role in clinical reporting that is supported by the DICOM standard, and in subsequent articles in my DICOM programming tutorial series, I will dive into how to create, modify and transmit DICOM structured reports

What are DICOM Structured Reports

The DICOM (Digital Imaging and Communications in Medicine) Structured Report (SR) standard is essential in the field of medical imaging. It outlines the rules for encoding, transmitting, and storing imaging diagnostic reports, which are integral to electronic health records (EHRs). Unlike traditional narrative reports, DICOM SR is structured, linking text to other data like images, waveforms, and coordinates. This structured approach, using standardized codes, allows for semantic understanding of the data and is crucial for EHR deployment.

Key Advantanges of Structured Reporting

In the field of medical imaging, traditional clinical reporting faces several challenges, chiefly due to its lack of standardization. Typically, these reports are created in free-text format, where radiologists and medical professionals detail their findings in their own words. This method, while flexible, can lead to inconsistencies in information delivery, potentially resulting in misunderstandings or misinterpretations among healthcare providers. Such variations are particularly troublesome in multidisciplinary teams, where precise and clear communication is vital for effective patient care.

Furthermore, crafting free-text reports is often a time-intensive process and may omit crucial details needed for a thorough understanding of the patient’s condition. Their narrative style makes them less conducive to searchable or analyzable data, hindering research and quality improvement initiatives. The integration of these reports into Electronic Health Records (EHRs) also presents challenges, affecting the efficient sharing and accessibility of vital patient information.

On the other hand, DICOM structured reports significantly mitigate these and many other issues. They offer a uniform reporting format, complete with predefined fields and terminology, ensuring consistent data capture and easing the understanding and actionability of the findings for healthcare professionals. This standardization not only improves the clarity and accuracy of communication, thereby reducing error risks, but also enhances system interoperability, as structured data integrates more seamlessly into EHRs.

“A river cuts through rock, not because of its power, but because of its persistence.” ~ Jim Watkins

Key Benefits of using DICOM Structured Reports

Structured reports using DICOM (Digital Imaging and Communications in Medicine) offer several significant benefits, particularly in the medical imaging field. Here are 10 important benefits:


DICOM structured reports provide a standardized format for reporting, which ensures consistency and clarity across different healthcare providers and systems.

Improved Accuracy

The standardized format reduces errors and inconsistencies in reporting, leading to more accurate diagnosis and treatment plans.

Enhanced Interoperability

As a widely accepted standard, DICOM facilitates better interoperability between different medical imaging systems and software, allowing for easier exchange and interpretation of medical images and reports.

Data Integration

Structured reports allow for the integration of images and related data into Electronic Health Records (EHRs), enhancing the comprehensiveness of patient records.

Efficiency and Time-Saving

The use of structured templates can speed up the reporting process, as radiologists can quickly fill in required information without needing to write extensive free-text reports.

Improved Communication

Standardized reports make it easier for different healthcare professionals to understand and act upon the findings, improving multidisciplinary collaboration.

Better Data Analysis

Structured data is easier to analyze and mine for research and quality improvement purposes, contributing to advances in medical knowledge and practice.

Enhanced Patient Safety

Consistent and clear reporting reduces the risk of misinterpretation and errors, thereby enhancing patient safety.


Over time, the efficiency and accuracy improvements can lead to cost savings for healthcare providers by reducing the need for repeat imaging studies and minimizing diagnostic errors.

Regulatory Compliance

Using structured reports helps in meeting various regulatory and accreditation requirements, ensuring that documentation meets the necessary legal and professional standards.

“Time is the most valuable thing a man can spend.” ~ Theophrastus

Common Operations involving Structured Reports

In the rapidly evolving landscape of medical imaging and digital healthcare, the manipulation and management of DICOM Structured Reports (SR) are essential skills for healthcare IT professionals and software developers. In this context, two powerful libraries, fo-DICOM for .NET and PixelMed for Java (both these libraries have been used extensively in my previous articles on DICOM), stand out for their robust features and capabilities in handling DICOM SR files. These libraries offer a range of functionalities, from basic operations like reading and parsing to more complex tasks such as integrating with healthcare systems. Let’s explore how these libraries support various operations on DICOM SR files, which will be covered in detail in subsequent articles in my DICOM programming tutorial series.

Reading and Parsing DICOM SR Files

fo-dicom excels in reading and parsing DICOM SR files, allowing users to extract crucial information such as patient data, study details, and the structured report’s content. Similarly, PixelMed offers robust capabilities for reading and interpreting the contents of DICOM SR files, ensuring seamless access to essential information in Java environments.

Modifying DICOM SR Data

With fo-dicom, modifications within a DICOM SR file, like updating patient information or altering report annotations, are straightforward. PixelMed also provides Java developers with tools to edit and update the contents of DICOM SR files efficiently.

Creating New DICOM SR Files

Creating new DICOM SR files from scratch is a breeze with fo-dicom, which enables users to define the report’s structure and populate it with necessary data elements. PixelMed mirrors this functionality in Java, offering a comprehensive suite for constructing and encoding new DICOM SR files.

Extracting and Embedding Images

Both fo-dicom and PixelMed support the extraction and embedding of images in DICOM SR files. This feature is crucial for enhancing reports with relevant visual data, contributing to more informative and comprehensive medical records.

Converting DICOM SR to Other Formats

Conversion of DICOM SR files into more accessible formats like PDF or plain text is another area where fo-dicom excels, facilitating the integration of structured reports into diverse documentation systems. PixelMed offers similar conversion capabilities in Java, ensuring that the valuable data in DICOM SR files can be utilized in various formats.

Validating DICOM SR Files

Ensuring compliance with the DICOM standard is vital, and fo-dicom provides robust validation tools for this purpose. PixelMed also emphasizes compliance and standard adherence, offering Java-based validation tools for DICOM SR files.

Integration with PACS and EHR Systems

Integrating DICOM SR data with Picture Archiving and Communication Systems (PACS) and Electronic Health Records (EHR) is a critical functionality provided by fo-dicom. Likewise, PixelMed facilitates this integration in Java environments, enabling the efficient sharing and transfer of structured reports within medical systems.

Querying and Retrieving Data from DICOM SR

Lastly, both fo-dicom and PixelMed support DICOM networking capabilities, allowing for the querying and retrieval of DICOM SR files from PACS or other DICOM servers, streamlining access to medical imaging data.

In upcoming articles, I will dive into each of these operations, showcasing how fo-dicom and PixelMed can be effectively utilized in .NET and Java environments, respectively, to manage and manipulate DICOM Structured Reports. These insights will equip you with the knowledge to handle these critical aspects of medical data management in your software applications.

Some Additional References on DICOM Structured Reporting

For those of you interested in expanding your understanding of DICOM Structured Reports, I highly recommend checking out ‘Structure of DICOM SR Documents’ published by the DICOM committee. This resource offers an in-depth look into how these reports are encoded and can be found here. Additionally, the book ‘DICOM Structured Reporting’ by Dr. Clunie, which has been generously made available for free and is also available for purchase, is a valuable reference. I personally own a copy and find it immensely useful.


In conclusion, DICOM structured reports represent a significant advancement in the realm of medical imaging and clinical reporting. By standardizing the format and content of reports, they greatly enhance the accuracy, clarity, and efficiency of medical communications, leading to improved patient care and streamlined healthcare operations. The adoption of DICOM structured reports marks a pivotal shift from traditional free-text reporting, addressing many of its inherent challenges and opening up new avenues for data analysis and integration into healthcare systems.

Looking ahead, to further explore the practical applications and operations of DICOM structured reports, stay tuned for upcoming articles. We will delve into the technical aspects of handling these reports, with a focus on demonstrating common operations in two popular programming environments: .NET and Java. My aim is to provide a hands-on guide for healthcare IT professionals and developers, showcasing how to effectively work with DICOM structured reports in these environments. Until then!