Authentication, integrity, and confidentiality in DICOM-structured reporting: concept and implementation

With the release of 'DICOM Structured Reporting' (SR) as an official extension of the standard about two years ago, DICOM has entered a new domain that is only indirectly related to medical imaging. Basically, DICOM SR is a general model allowing to encode medical reports in a structured manner in DICOM's tag-based format. Therefore, the existing DICOM infrastructure can be used to archive and communicate structured reports, with only relatively small changes to existing systems. As a consequence of the introduction of medical reports in a digital form, the relevance of security measures increases significantly. We have developed a prototype implementation of DICOM structured reporting together with the new security extensions for secure transport connections and digital signatures. The application allows to create, read and modify any SR document, to digitally sign an SR document in whole or part and to transmit such documents over a network. While the secure transport connection protects data from modifications or unauthorized access only during transmission, digital signatures provide a lifetime integrity check and, therefore, maintain the legal document status of structured reports. The application has been successfully demonstrated at RSNA 2000 and ECR 2001, and is freely available on the Internet.