Radiology departments in Bangladesh often struggle to handle large volumes of outpatient diagnostic X-rays, leading to delays in report delivery and increased burdens on low-income patients. Although digital X-ray machines are in use, existing systems lack efficiency in report generation and communication. This paper presents the Online Digital X-ray Archiving and Communication System (ODXACS), a low-cost, web-based solution that utilizes Digital Imaging and Communications in Medicine (DICOM) standards to enable real-time archiving, image processing, and secure dissemination of X-ray reports. The system features a scalable, role-based architecture tailored to the needs of resource-constrained healthcare settings. Experimental evaluation shows high image quality (PSNR > 31 dB, SSIM > 0.89), fast processing speeds, and system availability above 99.5%, demonstrating its effectiveness in improving diagnostic workflows. ODXACS reduces operational costs, accelerates report generation, and enhances access to timely medical care, offering a practical solution to improve radiology services in underserved regions.
References
[1]
Bougourzi, F. and Hadid, A. (2025) Recent Advances in Medical Imaging Segmentation: A Survey. https://arxiv.org/abs/2505.09274
[2]
Greczynski, G. and Hultman, L. (2024) Binding Energy Referencing in X-Ray Photoelectron Spectroscopy. NatureReviewsMaterials, 10, 62-78. https://doi.org/10.1038/s41578-024-00743-5
[3]
Fang, Y., Gupta, A.P., Tivnan, M., Hecla, J., Desai, D., Wu, D., et al. (2025) Head-to-Head Comparison of Analog-Filament vs a Digital-CNT X-Ray Sources: A Paradigm Shift in Radiology. Proceedings of the SPIE, 13405, 134053G. https://doi.org/10.1117/12.3048833
[4]
Pfeiffer, D., Pfeiffer, F. and Rummeny, E. (2020) Advanced X-Ray Imaging Technology. In: Schober, O., Kiessling, F. and Debus, J., Eds., Molecular Imaging in Oncology, Volume 216 of RecentResultsinCancerResearch, Springer International Publishing, 3-30. https://doi.org/10.1007/978-3-030-42618-7_1
[5]
Kanter, B.M., Artemiev, B.V., Vladimirov, L.V. and Artemyev, I.B. (2017) Challenges in X-Ray Medical Diagnosis. BiomedicalEngineering, 50, 410-415. https://doi.org/10.1007/s10527-017-9667-x
[6]
Melingui, B.F., Basant, J., Taguebue, J.v., Massom, D.M., Leroy Terquem, E., Norval, P.Y., et al. (2024) Implementation of Digital Chest Radiography for Childhood Tuberculosis Diagnosis at District Hospital Level in Six High Tuberculosis Burden and Resources Limited Countries. TropicalMedicine&InternationalHealth, 29, 979-989. https://doi.org/10.1111/tmi.14053
[7]
Dalla Palma, L., Grisi, G., Cuttin, R. and Rimondini, A. (1999) Digital vs Conventional Radiography: Cost and Revenue Analysis. EuropeanRadiology, 9, 1682-1692. https://doi.org/10.1007/s003300050910
[8]
Zennaro, F., Oliveira Gomes, J.A., Casalino, A., Lonardi, M., Starc, M., Paoletti, P., et al. (2013) Digital Radiology to Improve the Quality of Care in Countries with Limited Resources: A Feasibility Study from Angola. PLOSONE, 8, e73939. https://doi.org/10.1371/journal.pone.0073939
[9]
Dinov, I.D. (2016) Volume and Value of Big Healthcare Data. JournalofMedicalStatisticsandInformatics, 4, Article No. 3. https://doi.org/10.7243/2053-7662-4-3
[10]
Dreyer, K.J., Thrall, J.H., Hirschorn, D.S. and Mehta, A. (2006) PACS: A Guide to the Digital Revolution. Springer.
[11]
Herrmann, M.D., Clunie, D.A., Fedorov, A., Doyle, S.W., Pieper, S., Klepeis, V., et al. (2018) Implementing the DICOM Standard for Digital Pathology. JournalofPathologyInformatics, 9, Article No. 37. https://doi.org/10.4103/jpi.jpi_42_18
[12]
Larobina, M. (2023) Thirty Years of the DICOM Standard. Tomography, 9, 1829-1838. https://doi.org/10.3390/tomography9050145
[13]
Mansoori, B., Erhard, K.K. and Sunshine, J.L. (2012) Picture Archiving and Communication System (PACS) Implementation, Integration & Benefits in an Integrated Health System. AcademicRadiology, 19, 229-235. https://doi.org/10.1016/j.acra.2011.11.009
[14]
Bauman, R.A., Gell, G. and Dwyer, S.J. (1996) Large Picture Archiving and Communication Systems of the World—Part 1. JournalofDigitalImaging, 9, 99-103. https://doi.org/10.1007/bf03168603
[15]
Choplin, R.H., Boehme, J.M. and Maynard, C.D. (1992) Picture Archiving and Communication Systems: An Overview. RadioGraphics, 12, 127-129. https://doi.org/10.1148/radiographics.12.1.1734458
[16]
Meyer-Ebrecht, D. (1994) Picture Archiving and Communication Systems (PACS) for Medical Application. InternationalJournalofBio-MedicalComputing, 35, 91-124. https://doi.org/10.1016/0020-7101(94)90061-2
[17]
Abdekhoda, M. and Salih, K.M. (2017) Determinant Factors in Applying Picture Archiving and Communication Systems (PACS) in Healthcare. Perspectives in Health Information Management, 14, 1c. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559691/
[18]
Suapang, P., Yimmun, S. and Puditkanawat, A. (2011) Web-Based Medical Image Archiving and Communication System for Teleimaging. 2011 11th International Conference on Control, Automation and Systems, Gyeonggi-do, 26-29 October 2011, 172-177. https://ieeexplore.ieee.org/document/6106400
[19]
Acuña, C.J., Marcos, E., de Castro, V. and Hernández, J.A. (2004) A Web Information System for Medical Image Management. In: Barreiro, J.M., et al., Eds., Biological and Medical Data Analysis, Springer, 59-66.
[20]
Yee, D., Soltaninejad, S., Hazarika, D., Mbuyi, G., Barnwal, R. and Basu, A. (2017) Medical Image Compression Based on Region of Interest Using Better Portable Graphics (BPG). 2017 IEEE International Conference on Systems, Man, and Cybernetics (SMC), Banff, 5-8 October 2017, 216-221. https://doi.org/10.1109/smc.2017.8122605
[21]
Bick, U. and Lenzen, H. (1999) PACS: The Silent Revolution. EuropeanRadiology, 9, 1152-1160. https://doi.org/10.1007/s003300050811
[22]
Li, K.C., Marcovici, P., Phelps, A., Potter, C., Tillack, A., Tomich, J., et al. (2013) Digitization of Medicine: How Radiology Can Take Advantage of the Digital Revolution. AcademicRadiology, 20, 1479-1494. https://doi.org/10.1016/j.acra.2013.09.008
[23]
Alhajeri, M., Aldosari, H. and Aldosari, B. (2017) Evaluating Latest Developments in PACS and Their Impact on Radiology Practices: A Systematic Literature Review. InformaticsinMedicineUnlocked, 9, 181-190. https://doi.org/10.1016/j.imu.2017.08.005
[24]
Huang, H.K. (2011) Short History of PACS. Part I: Usa. EuropeanJournalofRadiology, 78, 163-176. https://doi.org/10.1016/j.ejrad.2010.05.007
[25]
You, J.J., Yun, L. and Tu, J.V. (2008) Impact of Picture Archiving Communication Systems on Rates of Duplicate Imaging: A Before-After Study. BMCHealthServicesResearch, 8, Article No. 234. https://doi.org/10.1186/1472-6963-8-234
[26]
Pérez-Sanpablo, A.I., Quinzaños-Fresnedo, J., Gutiérrez-Martínez, J., Lozano-Rodríguez, I.G. and Roldan-Valadez, E. (2025) Transforming Medical Imaging: The Role of Artificial Intelligence Integration in PACS for Enhanced Diagnostic Accuracy and Workflow Efficiency. CurrentMedicalImagingFormerlyCurrentMedicalImagingReviews, 21, e15734056370620. https://doi.org/10.2174/0115734056370620250403030638
[27]
Alhajeri, M. and Shah, S.G.S. (2018) Limitations in and Solutions for Improving the Functionality of Picture Archiving and Communication System: An Exploratory Study of PACS Professionals’ Perspectives. JournalofDigitalImaging, 32, 54-67. https://doi.org/10.1007/s10278-018-0127-2
[28]
Souto, M., Correa, J., Tahoces, P.G., Carrascal, F., Méndez, A., Lado, M.J., et al. (1996) A Limited PACS Dedicated to a Research Environment. Nine Years’ Experience in Santiago De Compostela. MedicalInformatics, 21, 123-132. https://doi.org/10.3109/14639239608995014
[29]
Samei, E., Seibert, J.A., Andriole, K., Badano, A., Crawford, J., Reiner, B., et al. (2004) AAPM/RSNA Tutorial on Equipment Selection: PACS Equipment Overview. RadioGraphics, 24, 313-334. https://doi.org/10.1148/rg.241035137
[30]
Ratib, O., Swiernik, M. and McCoy, J.M. (2003) From PACS to Integrated EMR. ComputerizedMedicalImagingandGraphics, 27, 207-215. https://doi.org/10.1016/s0895-6111(02)00075-7
[31]
Raman, B., Raman, R., Raman, L. and Beaulieu, C.F. (2004) Radiology on Handheld Devices: Image Display, Manipulation, and PACS Integration Issues. RadioGraphics, 24, 299-310. https://doi.org/10.1148/rg.241035127
[32]
França, R.P., Monteiro, A.C.B., Arthur, R. and Iano, Y. (2022) An Overview of the Impact of PACS as Health Informatics and Technology E-Health in Healthcare Management. In: Zhang, Y.-D. and Sangaiah, A.K., Eds., Cognitive Data Science in Sustainable Computing, Elsevier, 101-128. https://doi.org/10.1016/b978-0-12-824410-4.00007-6
[33]
Goodarzi, H., Khatami, S., Javadzadeh, H., Mahmoudi, S., Khajehpour, H., Heidari, S., et al. (2016) User Acceptance of Picture Archiving and Communication System in the Emergency Department. IranianJournalofRadiology, 13, e20102. https://doi.org/10.5812/iranjradiol.20102
[34]
R. Babić, R., Milošević, Z., Đinđić, B. and Stanković-Babić, G. (2012) Radiology In-formation System. ActaMedicaMedianae, 51, 39-46. https://doi.org/10.5633/amm.2012.0406
[35]
Khaleel, H.H., Rahmat, R.O.K. and Zamrin, D.M. (2021) Components and Implementation of a Picture Archiving and Communication System in a Prototype Application. Reports in Medical Imaging, 12, 1-8. https://www.dovepress.com/components-and-implementation-of-a-picture-archiving-and-communication-peer-reviewed-fulltext-article-RMI
[36]
Vadera, S., Jha, P., et al. (2023) Picture Archiving and Communication System. https://radiopaedia.org/articles/picture-archiving-and-communication-system
[37]
Mustra, M., Delac, K. and Grgic, M. (2008) Overview of the DICOM Standard. 2008 50th International Symposium ELMAR, Borik Zadar, 10-12 September 2008, 39-44. https://ieeexplore.ieee.org/document/4747434
[38]
Mildenberger, P., Eichelberg, M. and Martin, E. (2002) Introduction to the DICOM Standard. EuropeanRadiology, 12, 920-927. https://doi.org/10.1007/s003300101100
[39]
Gibaud, B. (2008) The DICOM Standard: A Brief Overview. In: Lemoigne, Y. and Caner, A., Eds., Molecular Imaging: Computer Reconstruction and Practice, Springer, 229-238. https://doi.org/10.1007/978-1-4020-8752-3_13
[40]
Riddle, W.R. and Pickens, D.R. (2005) Extracting Data from a DICOM File. MedicalPhysics, 32, 1537-1541. https://doi.org/10.1118/1.1916183
[41]
Putra, Y.D., Sigit, R. and Yuniarti, H. (2021) Portable Device-Based Medical Service System for DICOM to PNG Conversion. 2021 International Electronics Symposium (IES), Surabaya, 29-30 September 2021, 451-457. https://doi.org/10.1109/ies53407.2021.9593962
[42]
Moreno-Torres, O.H., Ballesteros-Ricaurte, J.A. and Gonzalez Sanabria, J.S. (2015) Transformación de Archivos Dicom a Formatos XML, JPEG y PNG. RevistaCientífica, 1, 71-80. https://doi.org/10.14483/udistrital.jour.rc.2015.21.a7
[43]
Puri, I. (2020) A Study on Role of Front Office Administration in Max Super Speciality Hospital Bathinda. Journal of Ayurveda and Integrated Medical Sciences, 5, 321-329. https://www.jaims.in/jaims/article/view/1628
[44]
Genereaux, B.W., Dennison, D.K., Ho, K., Horn, R., Silver, E.L., O’Donnell, K., et al. (2018) Dicomweb™: Background and Application of the Web Standard for Medical Imaging. JournalofDigitalImaging, 31, 321-326. https://doi.org/10.1007/s10278-018-0073-z
[45]
Kahn, C.E., Carrino, J.A., Flynn, M.J., Peck, D.J. and Horii, S.C. (2007) DICOM and Radiology: Past, Present, and Future. JournaloftheAmericanCollegeofRadiology, 4, 652-657. https://doi.org/10.1016/j.jacr.2007.06.004
[46]
Zhang, J., Lu, X., Nie, H., Huang, Z. and van der Aalst, W.M.P. (2009) Radiology Information System: A Workflow-Based Approach. InternationalJournalofComputerAssistedRadiologyandSurgery, 4, 509-516. https://doi.org/10.1007/s11548-009-0362-6
[47]
Nance Jr, J.W., Meenan, C. and Nagy, P.G. (2013) The Future of the Radiology Information System. AmericanJournalofRoentgenology, 200, 1064-1070. https://doi.org/10.2214/ajr.12.10326
Muto, H., Tani, Y., Suzuki, S., Yokooka, Y., Abe, T., Sase, Y., et al. (2011) Filmless versus Film-Based Systems in Radiographic Examination Costs: An Activity-Based Costing Method. BMCHealthServicesResearch, 11, Article No. 246. https://doi.org/10.1186/1472-6963-11-246
[50]
Beyan, O., Choudhury, A., van Soest, J., Kohlbacher, O., Zimmermann, L., Stenzhorn, H., et al. (2020) Distributed Analytics on Sensitive Medical Data: The Personal Health Train. DataIntelligence, 2, 96-107. https://doi.org/10.1162/dint_a_00032
[51]
Oida, T., Okuyama, T. and Finley, M.R. (2005) A Security Gateway System for Medical Communication Networks Inter-Hospital Use of the Secure Socket Layer. Joint International Conference on Autonomic and Autonomous Systems and International Conference on Networking and Services—(icas-isns’05), Papeete, 23-28 October 2005, 35. https://doi.org/10.1109/icas-icns.2005.9
[52]
Silva, P. (2015) Davis’ Technology Acceptance Model (TAM) (1989). In: Al-Suqri, M.N. and Al-Oufi, A.S., Eds., Information Seeking Behavior and Technology Adoption: Theories and Trends, IGI Global, 205-219. https://doi.org/10.4018/978-1-4666-8156-9.ch013
[53]
Rajabalinejad, M., van Dongen, L. and Ramtahalsing, M. (2020) Systems Integration Theory and Fundamentals. SafetyandReliability, 39, 83-113. https://doi.org/10.1080/09617353.2020.1712918
[54]
Liu, B., Zhu, M., Zhang, Z., Yin, C., Liu, Z. and Gu, J. (2007) Medical Image Conversion with DICOM. 2007 Canadian Conference on Electrical and Computer Engineering, Vancouver, 22-26 April 2007, 36-39. https://doi.org/10.1109/ccece.2007.16
[55]
Mayer, R.S., Fliedner, F., Mathisen, I.F., Laib, A., Bein, J., Eichelberg, M., et al. (2025) Lossy DICOM Conversion May Affect AI Performance. ScientificReports, 15, Article No. 24470. https://doi.org/10.1038/s41598-025-02851-w
[56]
Woda, M. and Torbiarczyk, M. (2018) Use of Distributed Machine Learning Toolkit for Searching Content Promoting Hate Speech on the Web. In: Zamojski, W., Mazurkiewicz, J., Sugier, J., Walkowiak, T. and Kacprzyk, J., Eds., Contemporary Complex Systems and Their Dependability, DepCoS-RELCOMEX 2018, Springer International Publishing, 536-544. https://doi.org/10.1007/978-3-319-91446-6_50
[57]
Taylor, A.G., Mielke, C. and Mongan, J. (2018) Automated Detection of Moderate and Large Pneumothorax on Frontal Chest X-Rays Using Deep Convolutional Neural Networks: A Retrospective Study. PLOSMedicine, 15, e1002697. https://doi.org/10.1371/journal.pmed.1002697
[58]
Hustinawati, H., Kurnia Himawan, A. and Latifah, L. (2014) Performance Analysis Framework Codeigniter and Cakephp in Website Creation. InternationalJournalofComputerApplications, 94, 6-11. https://doi.org/10.5120/16549-5946
[59]
Zhang, C., Sun, F., Zhang, M., Liu, W., Yu, Q., Babyn, P., et al. (2017) Design and Implementation of a Medical Image Knowledge Base for Pulmonary Nodules Diagnosis. 2017 3rd IEEE International Conference on Computer and Communications (ICCC), Chengdu, 13-16 December 2017, 2071-2075. https://doi.org/10.1109/compcomm.2017.8322901
[60]
Zhu, W., Zhao, C., Li, W., Roth, H., Xu, Z. and Xu, D. (2020) LAMP: Large Deep Nets with Automated Model Parallelism for Image Segmentation. In: Martel, A.L., et al., Eds., Medical Image Computing and Computer Assisted Intervention—MICCAI 2020, Springer International Publishing, 374-384. https://doi.org/10.1007/978-3-030-59719-1_37
[61]
Ogiela, M.R. and Hachaj, T. (2014) Natural User Interfaces in Medical Image Analysis: Cognitive Analysis of Brain and Carotid Artery Images, Volume 1 of Advances in Computer Vision and Pattern Recognition. Springer.
[62]
Pai, F.-Y. and Huang, K.-I. (2011) Applying the Technology Acceptance Model to the Introduction of Healthcare Information Systems. TechnologicalForecastingandSocialChange, 78, 650-660. https://doi.org/10.1016/j.techfore.2010.11.007
[63]
Wang, Z. and Bovik, A.C. (2022) Modern Image Quality Assessment. Synthesis Lectures on Image, Video, and Multimedia Processing. Springer.
[64]
Sara, U., Akter, M. and Uddin, M.S. (2019) Image Quality Assessment through FSIM, SSIM, MSE and PSNR—A Comparative Study. JournalofComputerandCommunications, 7, 8-18. https://doi.org/10.4236/jcc.2019.73002
[65]
Scholl, I., Aach, T., Deserno, T.M. and Kuhlen, T. (2011) Challenges of Medical Image Processing. ComputerScience—ResearchandDevelopment, 26, 5-13. https://doi.org/10.1007/s00450-010-0146-9
[66]
Reiner, B.I. (2009) The Challenges, Opportunities, and Imperative of Structured Reporting in Medical Imaging. JournalofDigitalImaging, 22, 562-568. https://doi.org/10.1007/s10278-009-9239-z
[67]
Kasban, H., El-Bendary, M.A.M. and Salama, D.H. (2015) A Comparative Study of Medical Imaging Techniques. International Journal of Information Science and Intelligent System, 4, 37-58. https://ilearn.th-deg.de/pluginfile.php/480243/mod_book/chapter/8248/updated_JXIJSIS2015.pdf
[68]
Bland, J.M. and Altman, D.G. (1996) Statistics Notes: Transformations, Means, and Confidence Intervals. BMJ, 312, Article No. 1079. https://doi.org/10.1136/bmj.312.7038.1079
[69]
GE Healthcare (2023) Ge Healthcare Centricity PACS. https://www.gehealthcare.com
[70]
Jodogne, S., Bernard, C., Devillers, M., Lenaerts, E. and Coucke, P. (2013) ORTHANC—A Lightweight, Restful DICOM Server for Healthcare and Medical Research. 2013 IEEE 10th International Symposium on Biomedical Imaging, San Francisco, 7-11 April 2013, 190-193.
Hore, A. and Ziou, D. (2010) Image Quality Metrics: PSNR vs. SSIM. 2010 20th International Conference on Pattern Recognition, Istanbul, 23-26 August 2010, 2366-2369. https://doi.org/10.1109/icpr.2010.579
[73]
Larobina, M. and Murino, L. (2014) Medical Image File Formats. JournalofDigitalImaging, 27, 200-206. https://doi.org/10.1007/s10278-013-9657-9
[74]
Bahga, A. and Madisetti, V.K. (2013) A Cloud-Based Approach for Interoperable Electronic Health Records (EHRs). IEEE Journal of Biomedical and Health Informatics, 17, 894-906. https://doi.org/10.1109/JBHI.2013.2257818
[75]
Mollura, D.J., Shah, N., and Mazal, J. (2014) White Paper Report of the 2013 RAD-AID Conference: Improving Radiology in Resource-Limited Regions and Developing Countries. Journal of the American College of Radiology, 11, 913-919. https://doi.org/10.1016/j.jacr.2014.03.026
