How do we handle non-DICOM content? What system allows us to store photos from dermatology and wound care alongside standard X-rays?

The usual solution is enterprise imaging, rather than forcing everything to be a traditional X-ray-only PACS.

A good architecture is:

• DICOM remains the common storage/interchange format. Standard X-rays stay as their normal DICOM objects.
• Dermatology and wound photographs can also be converted into DICOM. DICOM has a Visible Light (VL) Photographic Image object specifically for camera-acquired images.
• For dermoscopy, DICOM now has a dedicated Dermoscopic Photography Image IOD with modality DMS and metadata intended for skin/lesion imaging.
• The images can then be stored in a VNA (Vendor Neutral Archive) / enterprise imaging repository, alongside the radiology PACS content, and displayed through an enterprise viewer.
• If the source is an ordinary JPEG/PNG from a camera or mobile device, an acquisition/import service can associate the patient/encounter metadata and wrap the image as DICOM, rather than leaving an orphaned file in a departmental system.

So, if you're asking “what system allows photos from dermatology and wound care to live alongside X-rays?”, the answer is generally:

An enterprise imaging platform with a VNA/DICOM archive and clinical viewer. The key distinction is that the archive doesn't have to be limited to radiology modalities. DICOM supports visible-light photography, and enterprise imaging platforms are designed to manage these broader image types. The HIMSS-SIIM enterprise-imaging work specifically describes dermatology, photography, endoscopy and other visible-light applications in this context.

For wound care in particular, I'd favor a workflow where the mobile/camera application captures the photo against the patient's encounter/order, sends it through an enterprise-imaging/DICOM gateway, and stores it in the same longitudinal imaging record—not simply as an attachment in the EHR.

A Vendor Neutral Archive (VNA) allows you to store non-DICOM content like dermatology photos and wound care images alongside standard X-rays.

How Non-DICOM Content is Handled

Hospitals and clinics use specific tools and standards to capture, convert, and store non-traditional files (such as JPEGs, PDFs, or MP4s) so they live in the patient's main medical record:

• Vendor Neutral Archive (VNA): A central storage system that accepts both DICOM (standard medical imaging like X-rays and MRIs) and non-DICOM files (photos, PDFs, videos) in their native formats.
• DICOM Encapsulation: The process of "wrapping" a non-DICOM photo or document inside a standard DICOM wrapper. This gives the photo a virtual DICOM header so legacy systems and standard PACS (Picture Archiving and Communication System) can recognize, index, and display it.
• Enterprise Imaging Viewers (Universal Viewers): Software that connects to the Electronic Medical Record (EMR) to display both radiology scans and clinical photography side-by-side without needing heavy conversion.

Systems Used for Storage

If you would like, I can share more details on how to set up DICOM encapsulation or how mobile clinical capture apps work with your current EMR.

The standard system designed to store non-DICOM content (like JPEG/PNG clinical photography from dermatology and wound care) alongside traditional DICOM radiology studies (X-rays, CTs, MRIs) is an Enterprise Imaging Vendor-Neutral Archive (VNA).

Traditional PACS are built strictly for DICOM data, but a VNA acts as a centralized, patient-centric repository that manages multi-departmental multimedia content.

How Non-DICOM Content is Handled

Healthcare organizations generally use two primary technical approaches to ingest and manage specialty photography:

1. DICOM Encapsulation (DICOM-Wrapping):
   • The system takes the native photo (JPEG, PNG, or MP4) and wraps it inside a DICOM metadata envelope.
   • This allows the non-DICOM asset to travel through standard DICOM routing, populate a DICOM Modality Worklist, and be viewed in traditional diagnostic DICOM viewers.
2. Native Format Storage via Standards (XDS / DICOMweb / FHIR):
   • The file is stored in its native format alongside metadata mapped via integrating healthcare standards like IHE XDS (Cross-Enterprise Document Sharing) or DICOMweb.
   • Clinicians can launch and view the photos directly from the Electronic Health Record (EHR/EMR) via web viewers without needing to force the image into a rigid DICOM structure.

Key Systems Involved

• Enterprise VNA: The core architectural backend (such as Sectra VNA or Fujifilm Synapse VNA ) that safely stores and indexes both DICOM and non-DICOM objects.
• Enterprise Capture / Encounter-Based Workflows: Mobile apps, dedicated clinical cameras, or EHR-integrated capture tools that associate the photo with the correct patient ID, encounter, and anatomical site metadata at the point of care.

If you are planning an implementation, would you like to discuss DICOM-wrapping vs. native format storage , or do you need help integrating a specific EHR or specialty workflow?

The usual solution is a Vendor Neutral Archive (VNA) as part of an enterprise imaging platform.

A VNA sits alongside—or underneath—your traditional radiology PACS and provides a patient-centric archive for both DICOM and non-DICOM clinical media. That makes it suitable for keeping standard X-rays/CT/MR studies together with dermatology and wound-care photographs, PDFs, videos, and other specialty images.

How it works

• Radiology: X-rays, CT, MRI, etc. remain DICOM studies and can continue flowing through the PACS.
• Dermatology/wound care: JPEG/PNG photographs from cameras, phones, or dedicated capture devices can be ingested into the VNA.
• Patient association: The capture workflow attaches the photo to the correct patient/encounter and captures useful metadata such as body site, laterality, date/time, and encounter.
• DICOM wrapping: Where appropriate, a native photograph can be converted/wrapped into a DICOM Visible Light Photography or Secondary Capture object. DICOM explicitly supports visible-light photography, and essentially any image file can be encapsulated in DICOM.
• Native storage: Alternatively, the VNA can retain the original JPEG/PNG/etc. and manage it as non-DICOM content. A VNA implementation can support both approaches.
• Unified access: An enterprise/zero-footprint viewer can present the X-ray study and the dermatology/wound photos as part of the patient's longitudinal imaging record, often through the EHR.

This is particularly relevant to dermatology because many photographs are still acquired with ordinary phones/tablets rather than DICOM-native devices. HIMSS/SIIM specifically identifies VNA/EHR/PACS integration as an appropriate destination for these images, with secure capture and patient matching being important considerations.

So, in architecture terms:

Camera/phone → clinical capture workflow → VNA/enterprise imaging repository ← PACS ← X-ray/CT/MR

The key distinction is that PACS is primarily the DICOM imaging workflow/archive, whereas a VNA/enterprise imaging repository is designed to become the broader multimedia imaging archive, encompassing DICOM and non-DICOM content.

If you're evaluating systems, I'd specifically look for non-DICOM ingestion, DICOM wrapping, patient/encounter matching, dermatology/wound-care workflow, metadata capture, EHR integration, and a universal viewer rather than simply asking whether a PACS "supports JPEG."

Handling non-DICOM content—such as clinical photography from dermatology, wound care, ophthalmology, or surgical video feeds—requires an Enterprise Imaging strategy powered by a Vendor Neutral Archive (VNA).

Traditional PACS (Picture Archiving and Communication System) are built specifically for diagnostic radiology and DICOM formats. A VNA, however, unifies DICOM and non-DICOM data into a single, patient-centric archive.

How Non-DICOM Content is Handled

1. Capture & Ingestion: Clinicians take photos or videos using clinical-grade mobile devices, specialized medical cameras, or point-of-care tools. Middleware or multimedia gateways capture the media, strip unneeded device metadata/geolocation for privacy, and bind the correct patient identifiers (via HL7 or FHIR patient lookups).
2. Storage Strategy (Native vs. DICOM-Wrapped):
   • Native Format: Storing the file as a standard JPEG, PNG, or MPEG alongside its specific clinical metadata. This preserves original quality and private tags.
   • DICOM-Encapsulation ("DICOM-Wrapping"): Placing a standard DICOM header around the non-DICOM file so it can travel down traditional routing and worklist pipelines.
3. Interoperability Standards: Modern systems rely on standards like IHE XDS (Cross-Enterprise Document Sharing) or DICOMweb to manage and transport these multimedia objects.
4. Viewing: Clinicians view both X-rays and wound/skin photos side-by-side using an enterprise zero-footprint HTML5 universal viewer embedded directly inside the Electronic Health Record (EHR).

Systems That Store Both

• Vendor Neutral Archive (VNA): The core foundational technology for this exact problem. Leading enterprise options include the Fujifilm Synapse VNA, Sectra VNA / Enterprise Imaging , and AGFA HealthCare Enterprise Imaging VNA.
• Enterprise PACS with VNA Capabilities: Some modern installations use an enterprise-class PACS (such as Sectra's unified platform) that functions as both a diagnostic viewer for radiology and an integrated repository for multi-departmental non-DICOM photography.

If you're currently evaluating a rollout, let me know:

• Are you looking for a standalone VNA or an EHR-integrated capture solution?
• What devices (smartphones, dedicated medical cameras) will clinicians use to take the photos?

The usual solution is a Vendor Neutral Archive (VNA)—an enterprise imaging archive designed to store both DICOM and non-DICOM content in a patient-centric repository.

For your example:

• X-rays: stored as standard DICOM studies.
• Dermatology photos: JPEG/PNG images can be ingested and associated with the patient/encounter, often with DICOM metadata added or through a VNA's native non-DICOM object management.
• Wound-care photos: similarly stored alongside the patient's imaging record, rather than being trapped as ordinary attachments in the EHR.
• PDFs, videos, etc.: a capable VNA can also archive these alongside imaging. VNAs are specifically used for DICOM plus non-DICOM multimedia across departments.

How it fits together

A typical architecture is:

Camera / mobile app → image-ingestion service → VNA → enterprise viewer/EHR

The VNA becomes the long-term archive, while PACS remains heavily oriented toward radiology DICOM workflows. DICOM itself also has mechanisms for encapsulating certain non-DICOM files, and DICOMweb/STOW-RS can facilitate web-based ingestion of appropriately represented images.

So if the requirement is “store dermatology and wound photographs next to X-rays and make everything available through one patient-centric imaging workflow,” I'd look for an enterprise VNA/image archive with native non-DICOM support, rather than simply expanding a traditional radiology PACS.

If you're evaluating systems, the important question isn't just “does it store JPEGs?”—it's whether it can associate non-DICOM images with the correct patient, encounter/study, body site and clinical context, retain metadata/audit history, and present them alongside DICOM studies in the same viewer/workflow.

The usual solution is a PACS/VNA that supports DICOM Visible Light (VL) Photography, rather than treating dermatology or wound photos as completely separate “non-DICOM” files.

• Dermatology and wound-care photos can be converted/wrapped into DICOM VL Photographic objects. DICOM specifically defines a VL Photographic Image IOD for camera-acquired images, with patient, study, series, acquisition, and image metadata.
• That lets the photos live in the same imaging archive/PACS/VNA as X-rays, associated with the patient's imaging study or encounter. DICOM's storage model is designed for PACS and other archives to store persistent imaging objects.
• For dermatology, the standard is becoming more specific: DICOM now has work focused on dermoscopy, and newer work covers total-body photography and other dermatologic imaging.
• If photos originate as ordinary JPEG/PNG files, an import/capture service can add the appropriate patient and study metadata and create a DICOM object. This approach has specifically been described for dermatologic images.
• DICOMweb then provides modern REST APIs—STOW-RS for storing, QIDO-RS for searching, and WADO-RS for retrieving—the resulting objects.

So, architecturally, I'd think of it as:

Phone/camera → image-capture/import service → DICOM VL Photography → PACS/VNA → EHR/image viewer

rather than:

Phone/camera → file share → JPEGs disconnected from the imaging record.

If by “what system” you mean which commercial product (PACS, VNA, or wound/dermatology imaging platform) supports this, I can compare the leading options and specifically identify ones that can store X-rays + wound photos + dermatology/dermoscopy in one archive.

Handling non-DICOM content—such as clinical photography from dermatology or wound care—alongside traditional DICOM X-rays requires an Enterprise Imaging (EI) strategy backed by the right infrastructure.

How Non-DICOM Content is Handled

Healthcare organizations typically use two main technical approaches to ingest and manage standard consumer file formats (like JPEG, PNG, MP4, or PDF) alongside DICOM studies:

1. Native Storage with Metadata Tagging: The non-DICOM file is kept in its native format, but it is bound to critical patient context (such as MRN, encounter ID, and anatomical site) via HL7 or FHIR integration.
2. DICOM Encapsulation (Wrapping): The system converts or "wraps" the non-DICOM photo or video into a DICOM object (such as a DICOM Secondary Capture IOD). This allows the non-DICOM file to travel through standard DICOM routing and archiving pathways as if it were a traditional radiology scan.

The System: Vendor-Neutral Archive (VNA) with Enterprise Viewer

The primary system that allows you to store, manage, and view photos from dermatology and wound care alongside standard X-rays is a Vendor-Neutral Archive (VNA) working in tandem with a Multimedia Gateway/Capture workflow and a Universal (Zero-Footprint) Viewer.

• Vendor-Neutral Archive (VNA): Unlike a traditional radiology PACS (which is built exclusively for DICOM data), a modern VNA is format-agnostic. It ingests, indexes, and stores both DICOM and non-DICOM multimedia, acting as a single source of truth for all patient imaging history.
• Enterprise/Universal Viewer: This provides clinicians with a single, web-based viewing window inside the Electronic Health Record (EHR) where an X-ray from Radiology and a wound-care photograph from Nursing or Dermatology can be displayed side-by-side.

If you are planning an implementation, let me know:

• Are you looking to integrate mobile capture devices/smartphones , or dedicated clinical cameras/dermatoscopes?
• Which EHR platform (e.g., Epic, Oracle Health) are you trying to image-enable?

I can share more details on workflow capture strategies or IHE compliance standards for your setup.

Handling non-DICOM content—such as clinical photography from dermatology and wound care, scanned documents, or visible light videos —requires an Enterprise Imaging (EI) strategy rather than relying solely on a traditional radiology PACS (Picture Archiving and Communication System).

The System: Vendor-Neutral Archive (VNA) with Enterprise Viewer

The primary infrastructure designed to store non-DICOM photos alongside standard X-rays, CTs, and MRIs is a Vendor-Neutral Archive (VNA) paired with a Universal/Enterprise Viewer.

Unlike legacy department-specific archives, a modern VNA is purpose-built to ingest, index, and manage both DICOM and non-DICOM data formats under a single, patient-centric record.

How Non-DICOM Content is Handled

1. Ingestion & Normalization (Wrapping)
   • Native vs. DICOM Conversion: Non-DICOM files (like JPEGs from clinical cameras or smartphones) can be ingested in their native format or wrapped/encapsulated into a standard DICOM "Visible Light" Information Object Definition (IOD).
   • Standards-Based Integration: Systems leverage standards like IHE-XDS (Cross-Enterprise Document Sharing) or DICOMweb to securely package and route unstructured files alongside traditional studies.
2. Metadata Tagging & Patient Reconciliation
   • Consumer photos lack embedded medical metadata. To solve this, the capture workflow uses HL7/FHIR queries or barcode scanning (linking the photo to a patient encounter, accession number, or MRN at the point of capture) so the VNA can bind the correct demographic data to the image.
3. Unified Viewing
   • Clinicians do not need to bounce between an EHR, a dermatology folder, and a radiology PACS. An Enterprise Universal Viewer provides a single zero-footprint, browser-based interface to display a patient's X-ray right next to their sequential wound or dermatology progression photos.

If you are planning an implementation, let me know:

• Are you looking to integrate mobile/smartphone capture for clinicians?
• What EHR system are you currently using?

I can share more details on specific workflow architectures or vendor options.

The system you’re looking for is typically a Vendor Neutral Archive (VNA) as part of an enterprise imaging platform.

A VNA can serve as the common archive for:

• DICOM images — X-rays, CT, MRI, ultrasound, etc.
• Non-DICOM clinical photos — JPEG/PNG photographs from dermatology, wound care, surgery, etc.
• PDFs, videos, and other multimedia, depending on the VNA.
• Patient/encounter metadata so the content can be associated with the correct patient and surfaced alongside conventional imaging.

There are two common approaches for the dermatology/wound images:

1. Keep the photo in its native format (e.g., JPEG) in the VNA, with patient and clinical metadata attached. This preserves the original file and is often preferable for photographs.
2. Convert/wrap the photo as DICOM, commonly using an appropriate Secondary Capture DICOM object. The DICOM standard explicitly supports converting non-DICOM images into DICOM Secondary Capture objects.

So, conceptually:

Dermatology/wound camera → image capture/integration → VNA → enterprise viewer/EHR

while

X-ray modality → DICOM → PACS/VNA → enterprise viewer/EHR

Both ultimately become part of the patient's longitudinal imaging record. A published enterprise VNA implementation specifically describes migrating dermatology non-DICOM images alongside conventional DICOM imaging.

If you're designing the architecture, I'd generally favor a VNA that natively supports both DICOM and non-DICOM objects, rather than forcing every clinical photograph into DICOM. DICOMweb can then provide standardized web-based access to the DICOM portion of the archive.