DICOM Send issue

Hi Forum,

My name is Thomas and I currently work for a company called IMV Imaging providing support for medical imaging devices. We usually only deal with DICOM and PACS in terms of setting up SCU’s and SCPs to receive (not the nitty gritty of DICOM) I have recently been tasked with finding a solution for a customer in France who are complaining the ultrasound system is taking to long to send to cloud PACS because their internet speed is to slow.

the issue being the DICOM push doesn’t work in the background causing the ultrasound to be inoperable till the DICOM push is completed.

I am testing having the ultrasound send to a PC locally for speed which will then handle routing to Cloud freeing the Ultrasound to be operable.

I created a study with 54 DICOM files - 4 Cine’s 64Mb to 215Mb and DICOM images 50 images 1.5Mb per image about 500MB in total.

The Set up
PC 1Gb connection
ExaPad 1Gb connection
Switch 1Gb connection

When I push the whole study from the Exapad to the PC its taking 18minutes (to long)

I installed a 3rd party DICOM push software on the Exapad to test how that software sent. same setup. now the whole study send in 1 minute 7 seconds. (massive difference)

I used wireshark to capture the packets to analyse here is my findings

Exapad capture
TCP Connection Established> DICOM Association>DICOM Release>TCP Connection Closed> Connection Established>DICOM Association>P-Data C-Store Request> Data Sent

after every DICOM File this happens

I spoke with software developers and they have advised that they have the coded for the Association and close after every file (this is fine not causing much latency in sending images split seconds)

I also notice the C-Store was configured a priority 0 on the Exapad and 2 on the 3rd party software (see pic below of PDV)

see link at bottom

3rd Party Software
See link at bottom

I asked them to update the c-store priority to 2 to match and add the DICOM library. DLL to Ultrasound and tested

this cut about 9 minutes off send time from 18 minutes to 8 minutes 50 seconds

During this test i noticed something very weird which I need assistance with.

during the test I captured the packets again and what I noticed this time was the DICOM images send fine but when a Cine’s is sent I see the last fragment message on wireshark and would expect to see a DICOM release as the Exapad is set to DICOM release and close connection after every DICOM file but the Exapd takes 1 minute 10 seconds before it initiates the DICOM release which with 4 cine’s in the study its adding 4 minutes and 40 seconds to the transfer time. I don’t receive anything on wireshark but the Exapad is still loading when it should be moving onto next cine in the study.

does anyone have any idea what could be causing this.

Link to images

1 Like


I work for Pukka-j, we have a product called Nexus which is used extensively in the market place for sending DICOM to external sites or internally, extremely fast, can perform lots of logic, DICOM tag mapping etc. Happy to discuss as it may be a product you can have in your portfolio for a variety of tasks in a reseller capacity etc.