Evolution of the filmless cardiac angiography suite: promise and perils of the evolving digital era.

Although cineangiography has been in use for 35 years, it has important limitations. Films are expensive to produce, cannot be readily copied or transmitted electronically, are bulky, and require a large storage space. Digital angiography will soon replace film for archiving cardiac catheterization images, ultimately offering powerful new capabilities at a reduced cost. The transition toward the filmless angiogram is characterized by both great promise and important risks. Current nonfilm archiving systems (such as super-VHS videotape or analog optical disks) have not met the needs of the cardiovascular community, owing to poor image quality and resolution inferior to that of cine films. Analog storage media can result in a standard error in lesion measurements exceeding 1 mm and have a suboptimal signal-to-noise ratio. While digital media record adequate image detail, proprietary formats preclude the universal compatibility supplied by cine film. As a consequence of incompatibility, referred patients must undergo repeat catheterization prior to surgery or intervention. To resolve the compatibility problem, a committee established by the American College of Cardiology in conjunction with manufacturers (DICOM) has developed a standardized digital recording format using CD-ROM to transfer images between medical centers. The availability of this standardized interchange medium will have a positive impact on research as well as on patient care by eliminating barriers to image exchange throughout the cardiovascular community. Support for the DICOM approach by practitioners is vital to the transition to digital future.