Teleradiologists encounter a ubiquitous challenge in the interpretation of remotely acquired images: Patient imaging examinations cannot be interpreted accurately without the patient's ancillary clinical information. Accurate interpretations require the radiologist be aware of all patient information submitted by the referring physician, the patient, and written notes by the technologist who performs the imaging examination. Consequently, we developed software designed to address and automate the task of incorporating the paperwork/handwritten clinical patient information directly into the DICOM image examination via a fax machine.

The software work cycle is initiated by the arrival of a new examination on any designated DICOM server. DICOMfaxadder retrieves and stores the DICOM header information from the new examination. It also simultaneously generates a barcoded fax cover sheet that arrives via fax on the fax machine at the examination origination site. The site operator simply matches this coversheet with the proper patient paperwork, and faxes it back to DICOMfaxadder. Decoding of the barcode and database retrieval of the corresponding DICOM header information for that examination is then done. All paperwork associated with the barcoded faxed cover sheet is transformed into DICOM format and sent to the DICOM server as series 0 for that examination. Upon opening the case for interpretation, the first images seen are the clinical paperwork, followed by the actual imaging examination.

The DICOMfaxadder has been successfully handling over 500 imaging examinations per daily cycle for several years, attaching an average of 3 paper sheets to each examination. We have found it extremely effective at allowing our radiologists to practice teleradiology in an appropriate manner by allowing the evaluation of all of the patient’s pertinent clinical data at the same time the images are interpreted. It can also be advantageous to teleradiology practices by allowing more parsimonious delegation of non-physician employees, who no longer need to be delegated to matching and sorting faxes and pdf files to the appropriate DICOM examination for radiologists.