FAILURE TO FOLLOW THE CUSTOMARY STANDARD OF SAVING THE DICOM IMAGES, OF A CT SCAN, IN THE PROPER SEQUENCE.

Before I describe the malicious scrambling of the tomographic images of CT scans, that is done by new Windows software (from Altamond Software Inc) being included in some CT scan DVDs given to patients of the Miami VA Health Care System. I must include a brief introduction and description of CT scans and the DICOM format used to store the tomographic images created during a CT scan.

A Computed Tomography Scan (CT scan) formerly known as Computed Axial Tomography Scan (CAT scan) is a medical imaging technique used to obtain detailed internal imaging of the body. In my humble opinion, they should not have removed the "axial" word from it's name, because it is very important to know that the tomography images, that look like X-ray slices, are captured sequentially in 3 different axis (planes).

The three planes (axis), used to capture the tomography images (x-ray slices), are named:
Sagittal plane, Coronal plane, and Axial plane.

Bellow I show the direction used to capture (sequentially) the tomography images in each of the defined planes. And I include a sample image of each.

 
The images are saved, in computer file, in a unique format called DICOM (Digital Imaging and Communications in Medicine). The National Electrical Manufacturers Association (NEMA) holds the copyrights to the DICOM standard and they make it available for download, from their website, for free, in many formats (i.e. PDF, HTML, etc). However, I believe that the standard does not specifies that the DICOM images should be store sequentially in the media that is given to patients. Probably because it is obvious, logical, and rational to do so. Only an idiot or a malicious software developer would scramble the DICOM images files of all three planes, and renumber the DICOM file names with numbers different than the numbers that were assigned by the CT scanner when the images where created.

Why would a malicious software developer scramble and renumber the DICOM images of all three planes? To ensure that only their Windows software will be able to display the DICOM images sequentially. Anyone trying to view the images, with a different Windows application (DICOM viewer), or trying to view them one at a time, sequentially, using a different viewer, from a different OS, would not be able to do so.

The only viewer that does this crazy scrambling and false number renaming of files, in the DICOM folder (directory),  is the new viewer that the Miami VA is including in their CT-scan DVDs. The viewer is made by "Altamont Software". Shame on you Altamont Software.

 The VA is also using "ClearRead CT" from Riverain Technologies. An excellent AI DICOM image analyser, capable of finding and measuring  anomalies in DICOM images and doing a differential diagnosis. Kudos to Riverain Technologies developers for creating such an excellent software.

However, for me to find the ClearRead CT summary files in the DICOM folder, I had to open each of the 799 scrambled and renumbered DICOM files, in the DICOM directory. So that I could print the ClearRead Summaries. And that took me longer than the time I spent creating this HTML file for this portal.

The Miami VA previously used the "Centricity DICOM viewer" later replaced by "Gearview". Those viewers did not scramble the DICOMs. Niether does other viewers such as pbcdview, Viewlite, and Rediant.

UPDATE (August 31):

What a weird coincidence! The morning after I first posted this page, an administrator from the radiology department of the Miami VA, called me on the phone. About some CT scan survey that I had responded to a few days ago. However, the administrator did not have the necessary technical knowledge to understand the problems created by scrambling and renumbering the files in the DICOM folder (directory). One of the questions he asked was "How is it you know these things?", and he is wright, must people (perhaps 99.99 %) do not view DICOM images individually, with special viewers, nor do they colorized the images. But I wonder "How is it that he does not?". I will try to send him a link to this page, so that he becomes more knowledgeable regarding DICOM images.

I am guessing that he has never viewed a DICOM image with a good DICOM (single file viewer) that allows the user to shift the grey scales used in the DICOM images and also change the contrast of the DICOM images. I can even "colorize" the images, I am including a colorized image bellow to illustrate how a cyst in a liver is more visible when the image is colorized.



REFERENCE LINKS:

https://en.wikipedia.org/wiki/CT_scan
https://commons.wikimedia.org/wiki/Scrollable_high-resolution_computed_tomography_images_of_a_normal_thorax

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