The PACS of an image management and communications system (IMACS) must have a communications infrastructure that supports not just the transmission of images, but the transmission of images with minimal latency while utilizing the bandwidths available in emerging high-speed networks that provide transfer rates between 100 Mbps and 2.3 Gbps. At the Bowman Gray School of Medicine, the ACR/NEMA Digital Imaging and Communication (DICOM) Document has been modified to use standard networks and protocols in lieu of the lower layers of the ACR/NEMA document, providing valuable insight into the use of the ACR/NEMA upper layers. This paper compares the performance of three communications mechanisms that use TCP/IP and XTP for data transport. The first application uses a communication paradigm that has been proposed for the new version of ACR/NEMA. Even though DICOM version 3 does not support the emerging high-performance protocols, XTP is also used in this mechanism. The other two applications employ a communication paradigm used by PAPYRUS, in which the actual transfer syntax (often called ''ACR/NEMA logical'') is used with standard network protocols that move data within application programs. One utilizes transfers from an application program, and the other uses standard file system transfers.
William J. Chimiak,
"Performance of image communications using TCP/IP, XTP, and Ethernet", Proc. SPIE 1654, Medical Imaging VI: PACS Design and Evaluation, (1 July 1992); doi: 10.1117/12.60279; https://doi.org/10.1117/12.60279