Until the early 2000s, DICOM was often an expensive option. Especially in "single vendor" shops where all hardware was from $VENDOR. BTW, the euro player were a

Until the early 2000s, DICOM was often an expensive option. Especially in "single vendor" shops where all hardware was from $VENDOR. BTW, the euro player were also fond of this. Even with DICOM, not all encodings (either low-level, like value representations, or high-level like transfer syntaxes and image compression algorithms) are supported by all viewers/PACS. Finally, every system assign patients their own local ID and does their own local numbering/coding for precedure IDs and so on. This adds delays and work when loading foreign images into a PACS. I won't get into the bugs. I work in the field and I've seen some low-level DICOM handling functions riddled with quirks, exceptions and work-arounds for buggy imaging machines. With all that, we still see images that are utterly broken and only openable in the original system. When doing the transfer over a network, it's often possible to negotiate down to explicit VR and Big-Endian uncompressed images which is required to be implemented and gets workable (if large, 500+MB for CT) images. With a CD/DVD, you're at the mercy of whatever syntax the creating device felt like using. If you include PET and similar, then you also need proprietary PET/CT or PET/MR fusion software to actually make use of the images.