Until the early 2000s, DICOM was often an expensive option. Especially in &quot;single vendor&quot; shops where all hardware was from $VENDOR. BTW, the euro player were also fond of this.<p>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&#x2F;PACS.<p>Finally, every system assign patients their own local ID and does their own local numbering&#x2F;coding for precedure IDs and so on. This adds delays and work when loading foreign images into a PACS.<p>I won&#x27;t get into the bugs. I work in the field and I&#x27;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.<p>When doing the transfer over a network, it&#x27;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&#x2F;DVD, you&#x27;re at the mercy of whatever syntax the creating device felt like using.<p>If you include PET and similar, then you also need proprietary PET&#x2F;CT or PET&#x2F;MR fusion software to actually make use of the images.