When your client hands you a CD from their MRI appointment — or when you subpoena imaging records from a hospital — what you receive is almost always a DICOM file. DICOM stands for Digital Imaging and Communications in Medicine. It is the universal standard format for storing and transmitting medical images, and it has been the industry standard since the 1990s.
What Is Actually in a DICOM File?
A DICOM file is not a single image like a JPEG or PDF. A single DICOM study — one MRI of a lumbar spine, for example — can contain hundreds or thousands of individual image slices, organized into series. Each file contains the image data itself plus embedded metadata: the patient's name, date of birth, the date and time of the scan, the imaging facility, the equipment used, and technical parameters of the acquisition.
This metadata is part of why DICOM files require careful handling in litigation. The embedded patient information is protected health information under HIPAA, and the technical metadata can be relevant to questions about the imaging itself.
Why Can't I Just Open It Like a PDF?
DICOM files require specialized software — called a DICOM viewer — to open and display correctly. Standard image viewers, PDF readers, and web browsers cannot render DICOM files. Some DICOM CDs include a basic viewer application on the disc itself, but these are often outdated, Windows-only, and unreliable on modern hardware.
More practically: most attorneys' computers no longer have optical disc drives. Even if yours does, the viewer software on the disc may not install or run correctly. And even if it does, navigating hundreds of image slices in a DICOM viewer is not the same as having a professionally organized, litigation-ready image set.
DICOM vs. the Radiology Report
The DICOM study and the radiology report are two different things. The radiology report is the radiologist's written interpretation — their findings, impressions, and conclusions. The DICOM study is the actual imaging data: the raw images the radiologist reviewed.
In litigation, you often need both. The report tells you what the radiologist found. The images are what your expert witness will review, what you will use at deposition, and what may be displayed at trial. The report alone is not a substitute for the images.
What Do Attorneys Do With DICOM Files?
In litigation, DICOM studies are typically used in several ways. First, they are sent to a medical expert witness for review and opinion. Second, they are converted into organized image sets — physical prints, PDFs, or high-resolution files — for use at deposition, mediation, and trial. Third, duplicate sets are produced for all parties.
None of this happens automatically from the DICOM file itself. It requires a professional process: secure transfer of the study, image preparation per attorney or expert instructions, quality review, and delivery.
What Should Attorneys Do When They Receive a DICOM Study?
Do not attempt to open, copy, or forward the DICOM study via unsecured methods. The embedded patient information is protected health information, and unsecured transmission creates compliance exposure.
The practical steps: preserve the original media, document receipt, and work with a litigation imaging service to produce the image sets your matter requires. A professional imaging service will provide secure transfer instructions, prepare images per your or your expert's instructions, and deliver organized sets to the appropriate parties.
Lightning Medical provides medical image reproduction and litigation-support services. Lightning Medical does not provide medical diagnoses, radiological interpretations, medical opinions, or legal advice.