Ophthalmology is among the departments with the greatest volume of image data. OCT (optical coherence tomography) cross-sectional images, fundus camera photographs, anterior-segment photographs, visual field results—in diseases followed over the long term, such as glaucoma, age-related macular degeneration, and diabetic retinopathy, the same patient's images accumulate with every visit. Many ophthalmology clinics struggle with in-house server capacity running short, images stored in different places for each device, and time spent searching for old images. This article explains the basics of DICOM, the standard for medical images, and the points for managing ophthalmic images centrally and securely through cloud storage.
What is DICOM?
DICOM (Digital Imaging and Communications in Medicine) is an international standard for exchanging medical images and related information. Its defining feature is that, in addition to the image itself, it handles accompanying information (metadata) such as patient ID, examination date, imaging device, and imaging conditions.
DICOM originally spread in radiology (CT, MRI, etc.), but specifications for ophthalmic images such as fundus photographs and OCT have also been incorporated into the standard. Between DICOM-compatible devices, or between devices and an electronic chart or image management system, images and their accompanying information can be exchanged in a standard way even across manufacturers.
DICOM matters in ophthalmology for the following reasons.
- Works across manufacturers: Even in mixed environments—OCT from company A, fundus camera from company B—images are easy to consolidate in the same format
- Reliable patient linkage: Because the metadata contains the patient ID, there is no need to rely on file names or manual linking
- Resilient to future device replacement: Even when devices are replaced, past images are easier to carry over in a standard format
On the other hand, some devices offer DICOM output only as an option or save in a proprietary format by default. It is important to confirm before implementation whether your clinic's devices can output DICOM. For the overall picture of device integration including examination values, see Integrating Ophthalmic Examination Devices with the Electronic Chart.
Common challenges in storing ophthalmic images
Conventional operation—storing images on in-house servers and PCs—tends to face the following challenges.
- Tight capacity: High-resolution OCT images and wide-field fundus images are large per case, and storage runs short within a few years
- Scattered storage locations: Images are stored in each device's bundled viewer or PC, forcing back-and-forth between screens during consultations
- Backup burden: Backups for disasters and equipment failure must be maintained in-house indefinitely
- Difficult chronological comparison: Finding and lining up past images takes effort and eats into consultation time
The capacity problem in particular often surfaces several years after opening, and each server expansion or replacement brings cost and data-migration effort.
Cloud storage as an option
Storing images in the cloud is spreading as a solution to these challenges. The main benefits of cloud storage are as follows.
- Images can keep accumulating without worrying about in-house server capacity
- Redundancy on the data-center side lightens the burden of in-house backup operation
- Images can be referenced on the same foundation as the electronic chart, making chronological comparison from the consultation screen easier
On the other hand, entrusting medical information to the cloud makes security confirmation essential. When medical institutions use cloud services, they must confirm alignment with the Ministry of Health, Labour and Welfare's "Guidelines for the Safety Management of Medical Information Systems" and the guidelines for service providers from the Ministry of Economy, Trade and Industry and the Ministry of Internal Affairs and Communications (the so-called "three ministries, two guidelines"). For the overall approach, see The Three-Ministry Guidelines Explained, and for points to check when choosing a cloud, see Cloud Security for Medical Institutions.
Checkpoints for handling ophthalmic images in the cloud
When choosing a system to manage ophthalmic images in the cloud, confirm the following perspectives.
- DICOM support: Can it auto-import via DICOM from your clinic's OCT, fundus camera, perimeter, and so on?
- Approach to capacity: Can images keep being stored without additional capital investment as they grow?
- Encryption: Is data encrypted both at rest and in transit?
- Access management and auditing: Can it record who accessed which data and when?
- Data separation: Is data logically separated from that of other medical institutions?
- Guideline compliance: Are design and operation aligned with the three-ministry, two-guideline framework?
- Ease of chronological comparison: Can images be lined up and compared by eye and date?
DICOM integration and cloud storage in AI Karte Ophthalmology
The ophthalmology product of "AI Karte," developed by Pottech, is designed with DICOM integration and cloud storage of ophthalmic images as a premise. See the AI Karte Ophthalmology page for details.
- Automatic import via DICOM: Data is automatically imported via DICOM from examination devices such as OCT, fundus cameras, tonometers, and autorefractometers
- Supports major manufacturers' devices: For example, for OCT and fundus cameras, TOPCON (3D OCT-1 Maestro2, TRC-NW400), NIDEK (RS-3000 Advance2, AFC-330), Carl Zeiss (CIRRUS HD-OCT, CLARUS 500), and CANON (OCT-S1, CR-2 AF); for perimeters, Carl Zeiss (HFA III) and HAAG-STREIT (Octopus 900), among others. Standard integration is possible with DICOM-compatible devices, and unsupported devices can be discussed individually
- No capacity concerns with cloud storage: Because cloud storage is used, even high-resolution image data can be stored and viewed securely without worrying about capacity
- Encryption: AES-256 encryption is applied both at rest and in transit
- Audit logs and data separation: Audit logs are recorded for all CRUD operations, and a multi-tenant design completely separates data for each medical institution. Passkey authentication is also supported
- Compliance with the three-ministry, two-guideline framework: Designed in line with the guidelines of the Ministry of Health, Labour and Welfare, the Ministry of Economy, Trade and Industry, and the Ministry of Internal Affairs and Communications, with continuous system monitoring and an incident response system
Furthermore, in AI Karte, imported examination data and images are managed on the same foundation as the chart and billing. Because they can be combined with examination trend summaries by the AI assistant and findings drafts from examination results, images connect not only to "being stored" but to "being used in care." For the overall picture of why AI Karte excels in ophthalmology, see Why AI Karte Suits Ophthalmology.
In closing
Ophthalmic images are an irreplaceable asset for following a patient's course. That is exactly why you want to avoid a state where capacity limits and scattered storage keep them from being fully used. By combining standard integration through DICOM with guideline-compliant cloud storage, images can be managed centrally—securely, without capacity concerns, and in a form that can be referenced immediately in care.
Through the provision of AI Karte, Pottech serves as the optimal business partner for clinics—supporting not only better working conditions for physicians, nurses, and medical clerical staff, but also helping clinics achieve to the fullest what they want to accomplish.
For details, please do not hesitate to contact us.