ISO/FDIS 12052

ISO/DISFDIS 12052:2025(en)
ISO/TC 215
Secretariat: ANSI
Date: 2025-05-2811-17
Health informatics — Digital imaging and communication in
medicine (DICOM) including workflow and data management
Informatique de santesanté — Imagerie numérique et communication dans laen médecine (DICOM) incluant le
déroulement des opérations et la gestion des données
FDIS stage
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Published in Switzerland
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ISO/DISFDIS 12052:2025(en)
Contents
Foreword . iv
Introduction . v
1 Scope . 1
2 Normative references . 1
3 Terms and definitions . 1
4 Abbreviated terms . 3
5 Requirements: Conformance . 4
6 Overview of the content of the DICOM standard . 4
6.1 Document structure of the DICOM standard . 4
6.2 PS3.2: Conformance . 5
6.3 PS3.3: Information Object Definitions . 8
6.4 PS3.4: Service Class Specifications . 9
6.5 PS3.5: Data Structures and Encoding . 9
6.6 PS3.6: Data Dictionary. 10
6.7 PS3.7: Message Exchange . 10
6.8 PS3.8: Network Communication Support for Message Exchange . 10
6.9 PS 3.9: Retired (formerly Point-to-point Communication Support for Message Exchange)11
6.10 PS3.10: Media Storage and File Format for Media Interchange . 11
6.11 PS3.11: Media Storage Application Profiles . 13
6.12 PS3.12: Media Formats and Physical Media for Media Interchange . 15
6.13 PS3.13: Retired (formerly Print Management Point-to-point Communication Support) . 15
6.14 PS3.14: Grayscale Standard Display Function . 15
6.15 PS3.15: Security and System Management Profiles . 16
6.16 PS3.16: Content Mapping Resource . 16
6.17 PS3.17: Explanatory Information . 16
6.18 PS3.18: Web Services . 16
6.19 PS3.19: Application Hosting . 16
6.20 PS3.20: Imaging Reports using HL7 Clinical Document Architecture . 18
6.21 PS3.21: Transformations between DICOM and other Representations . 19
6.22 PS3.22: Real-Time Communication . 19
7 Referencing the DICOM standard . 19
Bibliography . 21

Contents
iii
Foreword
ISO (the International Organization for Standardization) is a worldwide federation of national standards
bodies (ISO member bodies). The work of preparing International Standards is normally carried out through
ISO technical committees. Each member body interested in a subject for which a technical committee has been
established has the right to be represented on that committee. International organizations, governmental and
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International Electrotechnical Commission (IEC) on all matters of electrotechnical standardization.
The procedures used to develop this document and those intended for its further maintenance are described
in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the different types of
ISO documentdocuments should be noted. This document was drafted in accordance with the editorial rules
of the ISO/IEC Directives, Part 2 (see www.iso.org/directives).
ISO draws attention to the possibility that the implementation of this document may involve the use of (a)
patent(s). ISO takes no position concerning the evidence, validity or applicability of any claimed patent rights
in respect thereof. As of the date of publication of this document, ISO [had/had not] received notice of (a)
patent(s) which may be required to implement this document. However, implementers are cautioned that this
may not represent the latest information, which may be obtained from the patent database available at
www.iso.org/patents. ISO shall not be held responsible for identifying any or all such patent rights.
Any trade name used in this document is information given for the convenience of users and does not
constitute an endorsement.
For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and expressions
related to conformity assessment, as well as information about ISO'sISO’s adherence to the World Trade
Organization (WTO) principles in the Technical Barriers to Trade (TBT), see www.iso.org/iso/foreword.html.
This document was prepared by Technical Committee ISO/TC 215, Health informatics, in collaboration with
the European Committee for Standardization (CEN) Technical Committee CEN/TC 251, Health informatics, in
accordance with the Agreement on technical cooperation between ISO and CEN (Vienna Agreement).
This third edition cancels and replaces the second edition (ISO 12052:2017), which has been technically
revised.
The main changes are as follows:
— — updates to Clause 3Clause 3 to add several terms;
— — updates to 6.106.10 to clarify the relationship of DICOM media interchange to data set specifications
in Figure 3Figure 3;;
— — updates to 6.216.21 to describe and reference PS3.21 for transformation between DICOM and NCI AIM;
— — updates to 6.226.22 to describe and reference PS3.22 for real-time communication of DICOM content;
— — updates to Clause 7Clause 7 to clarify references to units of conformance are not acceptable in lieu of
a conformance statement document for a product.
Any feedback or questions on this document should be directed to the user’s national standards body. A
complete listing of these bodies can be found at www.iso.org/members.html.
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ISO/DISFDIS 12052:2025(en)
Introduction
0.1 0.1  General
Digital Imaging and Communications in Medicine (DICOM) is the standard for the communication and
management of medical imaging information and related data.
The DICOM standard facilitates interoperability of medical imaging equipment by specifying:
— — Forfor network communications, a set of protocols to be followed by devices claiming conformance to
the DICOM standard;
— — Thethe syntax and semantics of Commands and associated information which can be exchanged using
these protocols;
— — Forfor media communication, a set of media storage services to be followed by devices claiming
conformance to the StandardDICOM standard, as well as a File Format and a medical directory structure
to facilitate access to the images and related information stored on interchange media;
— — Informationinformation to be supplied with an implementation for which conformance to the DICOM
standard is claimed.
The DICOM standard does not specify:
— — Thethe implementation details of any features of the DICOM standard on a device claiming
conformance;
— — Thethe overall set of features and functions to be expected from a system implemented by integrating
a group of devices each claiming conformance to the DICOM standard;
— — Aa testing/validation procedure to assess an implementation'simplementation’s conformance to the
DICOM standard.
The DICOM standard facilitates interoperability of systems claiming conformance in a multi-vendor
environment, but does not, by itself, guarantee interoperability.
0.2 0.2  History
With the introduction of computed tomography (CT) followed by other digital diagnostic imaging modalities
in the 1970's1970s, and the increasing use of computers in clinical applications, the American College of
Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) recognized the emerging need
for a standard method for transferring images and associated information between devices manufactured by
various vendors. These devices produce a variety of digital image formats.
The American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA)
formed a joint committee in 1983 to develop a standard to:
— — promote communication of digital image information, regardless of device manufacturer;
— — facilitate the development and expansion of picture archiving and communication systems (PACS) that
can also interface with other systems of hospital information;
— — allow the creation of diagnostic information data bases that can be interrogated by a wide variety of
devices distributed geographically.
v
[ ]
ACR-NEMA Standards Publication No. 300-1985 4, , published in 1985, was designated version 1.0. The
Standard was followed by two revisions: No. 1, dated October 1986 and No. 2, dated January 1988. These
Standards Publications specified a hardware interface, a minimum set of software commands, and a consistent
set of data formats.
ACR-NEMA Standards Publication No. 300-1988, published in 1988, was designated version 2.0. It included
version 1.0, the published revisions, and additional revisions. It also included new material to provide
command support for display devices, to introduce a new hierarchy scheme to identify an image, and to add
data elements for increased specificity when describing an image.
In 1993, ACR-NEMA Standard 300 was substantially revised and replaced by the standard, designated Digital
Imaging and Communications in Medicine (DICOM). It embodies a number of major enhancements to previous
versions of the ACR-NEMA Standard:
— — It is applicable to a networked environment. The ACR-NEMA Standard was applicable in a point-to-
point environment only; for operation in a networked environment a Network Interface Unit (NIU) was
required. DICOM supports operation in a networked environment using the industry standard networking
protocol TCP/IP.
— — It is applicable to off-line media exchange. The ACR-NEMA Standard did not specify a file format or
choice of physical media or logical filesystem. DICOM supports operation in an off-line media environment
using industry standard media such as CD-R, DVD-R and USB and common file systems.
— — It is a service-oriented protocol, specifying the semantics of commands and associated data, and how
devices claiming conformance to the DICOM standard react to commands and data being exchanged.
Specified services include support for management of the workflow of an imaging department. The ACR-
NEMA Standard was confined to the transfer of data with only implicit service requirements.
— — It specifies levels of conformance. The ACR-NEMA Standard specified a minimum level of conformance.
DICOM explicitly describes how an implementor structures a Conformance Statementconformance
statement to select specific options.
In 1995, with the addition of DICOM capabilities for cardiology imaging supported by the American College of
Cardiology, the ACR-NEMA Joint Committee was reorganized as the DICOM Standards Committee, a broad
collaboration of stakeholders across all medical imaging specialties.
0.3 0.3  Principles
0.3.1 0.3.1  Global applicability and localization
DICOM is a world-wide standard that can be used in every locale. It provides mechanisms to handle data that
support cultural requirements, such as different writing systems, character sets, languages, and structures for
addresses and person names. It supports the variety of workflows, processes and policies used for biomedical
imaging in different geographic regions, medical specialties and local practices.
Localization to meet the requirements of national or local health and workflow policies can be done without
deviating from the DICOM standard. Such localization can include specifying code sets (e.g. procedure codes),
or profiling data element usage (both specifying locally allowed values, and making elements that are optional
in the DICOM standard mandatory for local use).
Localization and profiling can be specified in a number of mechanisms outside the purview of the DICOM
Standard. One such mechanism is Integration Profiles from the Integrating the Healthcare Enterprise (IHE)
organization. It is important that profiling adhere to the concept of non-contradiction. A profile can add
requirements but not contradict DICOM requirements, as that would make it impossible to complyconform
with both DICOM and the profile.
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ISO/DISFDIS 12052:2025(en)
0.3.2 0.3.2  Continuous maintenance
The DICOM Standard is an evolving standard and it is maintained in accordance with the Procedures of the
DICOM Standards Committee. Proposals for enhancements are welcome from all users of the DICOM standard,
and can be submitted to the Secretariat. Supplements and corrections to the DICOM standard are balloted and
approved several times a year. When approved as Final Text, each change becomes official, is published
separately, and goes into effect immediately. At intervals, all of the approved Final Text changes are
consolidated and published in an updated edition of the DICOM standard. Once changes are consolidated into
an updated edition of the DICOM standard, the individual change documents are not maintained; readers are
directed to use the consolidated edition of the DICOM standard.
A requirement in updating the DICOM standard is to maintain effective compatibility with previous editions.
The maintenance process can involve retirement of sections of the DICOM standard.
Retirement does not imply that these features cannot be used. However, the DICOM Standards Committee will
not maintain the documentation of retired features. The reader is referred to earlier editions of the DICOM
standard.
The use of the retired features is discouraged for new implementations, in favour of those alternatives
remaining in the DICOM standard.
0.3.3 0.3.3  Information objects and unique object identification
Many DICOM services involve the exchange of persistent information objects, such as images. An instance of
such an information object can be exchanged across many systems and many organizational contexts, and
over time. While minor changes can be made to the attributes of an instance to facilitate its handling within a
particular organization (e.g. by coercing a Patient ID to the value used in a local context), the semantic content
of an instance does not change.
Each instance is identified by a globally unique object identifier, which persists with the instance across all
exchanges. Changes to the semantic content of an instance are defined to create a new instance, which is
assigned a new globally unique object identifier.
0.3.4 0.3.4  Conformance
Conformance to the DICOM standard is stated in terms of Service-Object Pair (SOP) Classes, which represent
Services (such as Storage using network, media, or web) operating on types of Information Objects (such as
CT or MR images).
SOP Class specifications in the DICOM standard are only changed in a manner that is intended to be forward
and backward compatible for all editions of the DICOM standard. Systems that claim conformance to the same
SOP Class are thus compatible across all editions of the DICOM standard. Conformance requirements and
conformance claims are therefore referenced to the identifier of the SOP Class, and never referenced to an
edition of the DICOM standard.
Each implementation is required to provide a DICOM Conformance Statement, in accordance with a consistent
pro forma structure, facilitating comparison of products for interoperability.
0.3.5 0.3.5  Consistency of information model
A large number of information objects defined in the DICOM standard followfollows a common composite
information model with information entities representing Patient, Study, Series, Equipment, Frame of
Reference, and the specific instance data type. This information model is a simplification of the real-world
concepts and activities of medical imaging; for acquisition modalities, a Study is approximately equivalent to
an ordered procedure, and a Series is approximately equivalent to a performed data acquisition protocol
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element. In other domains, such as Radiotherapy, the Study and Series are less clearly related to real world
entities or activities, but are still required for consistency. This simplified model is sufficient for the pragmatic
needs of managing imaging and related data collected in routine practice.
New information objects defined in DICOM will typically conform to this existing common information model,
allowing reuse of implementations with minimal changes to support the new objects.
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DRAFT International Standard ISO/DIS 12052:2025(en)

Health informatics — Digital imaging and communication in medicine
(DICOM) including workflow and data management
1 Scope
Within the field of health informatics, the DICOM (digital imaging and communication in medicine) standard
addresses the exchange of digital images, and information related to the production and management of those
images, between both medical imaging equipment and systems concerned with the management and
communication of that information, such as PACS, HIS and RIS.Picture Archiving anc Communication System
(PACS), Hospital Information System (HIS) and Radiology Information System (RIS).
This document is equivalent to part 1 of DICOM. As such, it normatively describes the content of DICOM
(Clause 6(Clause 6)) and the requirements to make a claim of conformance (Clause 5(Clause 5).).
The DICOM standard is applicable to diagnostic medical imaging as practiced in radiology, cardiology,
pathology, dentistry, ophthalmology and related disciplines, and image-based therapies such as interventional
radiology, radiotherapy and surgery. It is also applicable to a wide range of image and non-image related
information exchanged in clinical, research, veterinary, and other medical environments.
2 Normative references
There are no normative references in this document.
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
ISO and IEC maintain terminology databases for use in standardization at the following addresses:

— — ISO Online browsing platform: available at https://www.iso.org/obp
— — IEC Electropedia: available at https://www.electropedia.org/
3.1 3.1
attribute
property of an information object (3.10(3.10))
Note 1 to entry: An attribute has a name and a value which are independent of any encoding scheme.
3.2 3.2
command
request to operate on information across a network
3.3 3.3
command element
encoding of a parameter of a command (3.2(3.2)) which conveys this parameter'sparameter’s value
3.4 3.4
command stream
result of encoding a set of DICOM command elements (3.3(3.3)) using the DICOM encoding scheme
3.5 3.5
conformance statement
formal statement that describes a specific implementation of the DICOM standard
Note 1 to entry: It specifies the service classes (3.1.5),, information objects (3.10(3.10),), communication protocols,
security profiles, and media storage application profiles supported by the implementation.
3.6 3.6
data dictionary
registry of DICOM data elements which assigns a unique tag, a name, value characteristics, and semantics to
each data element (3.7(3.7))
3.7 3.7
data element
unit of information as defined by a single entry in the data dictionary (3.6(3.6))
3.8 3.8
data set
exchanged information consisting of a structured set of attributes (3.1(3.1))
Note 1 to entry: The value of each attribute (3.1(3.1)) in a data set is expressed as a data element (3.7(3.7).).
3.9 3.9
data stream
result of encoding a data set (3.8(3.8)) using the DICOM encoding scheme (Data Element Numbers and
representations as specified by the data dictionary (3.6(3.6))))
3.10 3.10
information object
abstraction of a real information entity (e.g. CT Image, Structured Report) which is acted upon by one or more
DICOM commands (3.2(3.2))
Note 1 to entry: Information object is also referred to in the DICOM standard as an information object definition.
Note 2 to entry: Note 1 to entry: This term is primarily used in DICOM PS3.1, with a few references in DICOM PS3.3. It is
an informal term corresponding to a formal term that is introduced in DICOM PS3.3. In all other parts (3.14(3.14)) of the
DICOM standard this formal term is known as an Information Object Definition.
3.11 3.11
information object class
formal description of an information object (3.10(3.10)) which includes a description of its purpose and the
attributes (3.1(3.1)) it possesses
Note 1 to entry: It does not include values for these attributes (3.1). Also referred to in the DICOM standard as a SOP Class
or Service-Object Pair Class.
Note 2 to entry: This term is only used in DICOM PS3.1. It is an informal term corresponding to a formal term that is
introduced in DICOM PS3.4. This formal term is known as a service-object pair class (3.16(3.16)) or more commonly as a
SOP Class.
ISO/DISFDIS 12052:2025(en)
3.12 3.12
information object instance
representation of an occurrence of a real-world entity, which includes values for the attributes (3.1(3.1)) of
the information object class (3.11(3.11)) to which the entity belongs
Note 1 to entry: Information object instance is also referred to in the DICOM Standard as a SOP Instance.
Note 2 to entry: Note 1 to entry: This term is only used in DICOM PS3.1. It is an informal term corresponding to a formal
term that is introduced in DICOM PS3.4. This formal term is known as a service-object pair instance or more commonly
as a SOP Instance.
3.13 3.13
message
data unit of the message exchange protocol exchanged between two cooperating DICOM applications
Note 1 to entry: A message is composed of a command stream (3.4(3.4)) followed by an optional data stream (3.9(3.9).).
3.14 3.14
part
subdivision of the DICOM standard that covers related subject material
3.15 3.15
RESTful web service
web service implemented using REST architecture and HTTP (see
http://www.ics.uci.edu/~fielding/pubs/dissertation/fielding_dissertation.pdf)
Note 1 to entry: See https://www.ics.uci.edu/~fielding/pubs/dissertation/fielding_dissertation.pdf3.16.
3.16
service class
structured description of a service which is supported by cooperating DICOM applications using specific
DICOM commands (3.2(3.2)) acting on a specific class of information object (3.10(3.10))
3.17 3.17
service-object pair class
SOP class
pair of an information object (3.10(3.10)) and either a DICOM message service element (DIMSE) service group,
a media storage service, or a web service
4 Abbreviated terms
ACSE Associationassociation control service element
API Applicationapplication programming interface
CT Computedcomputed tomography
DICOM Digital Imagingdigital imaging and Communicationscommunications in Medicinemedicine
DICOM- DICOM Real-Time Videomessage service element
RTVDIMSE
DIMSE DICOM Message Service Element
HIS Hospital information system
HTTP Hyper-Text Transfer Protocolhyper-text transfer protocol
HTTPS Hyper-Text Transfer Protocol Secure
IOD Informationinformation object definition
JIRA Japan Medical Imaging and Radiological Systems Industries Association
OSI Open Systems Interconnectionopen systems interconnection
PACS Picturepicture archiving and communication systems
PTP Precision Time Protocol
REST Representational State Transferrepresentational state transfer
RIS Radiology information system
RTP Real-Time Transport Protocol
SMPTE Society of Motion Picture and Television Engineers
SOP Service-Object Pairservice-object pair
STOW-RS STore Overstore wver the Webweb by RESTful Servicesweb services
TCP/IP Transmission Control Protocol/Internet Protocoltransmission control protocol/internet
protocol
WADO-RS Web Accessweb access to DICOM Objectsobjects by RESTful Servicesweb services
WADO-URI Web Access to DICOM Objects by URI
5 Requirements: Conformance
A claim of conformance to the DICOM standard, with regard to a given product, shall only be valid when
supported by a DICOM Conformance Statement written in accordance with the provisions of the DICOM
standard, PS 3PS3.2 (Part 2) which includes, but is not limited to, a list of all data IOD items communicated by
the product and confirmation by the implementer that their content conforms to the specifications of DICOM
PS 3PS3.
6 Overview of the content of the DICOM standard
6.1 Document structure of the DICOM standard
DICOM consists of the following parts:
— — PS3.1: Introduction and Overview (equivalent to this document)
— — PS3.2: Conformance
— — PS3.3: Information Object Definitions
— — PS3.4: Service Class Specifications
— — PS3.5: Data Structures and Encoding
— — PS3.6: Data Dictionary
— — PS3.7: Message Exchange
— — PS3.8: Network Communication Support for Message Exchange
ISO/DISFDIS 12052:2025(en)
— — PS3.9: Retired
— — PS3.10: Media Storage and File Format for Media Interchange
— — PS3.11: Media Storage Application Profiles
— — PS3.12: Media Formats and Physical Media for Media Interchange
— — PS3.13: Retired
— — PS3.14: Grayscale Standard Display Function
— — PS3.15: Security and System Management Profiles
— — PS3.16: Content Mapping Resource
— — PS3.17: Explanatory Information
— — PS3.18: Web Services
— — PS3.19: Application Hosting
—
...