We developed a DICOM image database system having bookmark and annotation function handled on a separate layer covering the DICOM image to avoid changing the original DICOM files. We can comfortably see a DICOM image with or without the covering layer including markings and comments we drew and wrote on the layer.

     This system is useful to overview the MRI of patients, especially those with multiple brain metastases.

      

     We place a proxy server computer between the PACS server and client computers. The proxy server computer works as a subsystem of PACS of DICOM images and includes a database system of the layers, which enables us to see images quickly. The database system has bookmark and annotation function handled on a separate layer covering the DICOM image. In addition, this database can add bookmark to MRI studies, series, and images.

     The patient with brain metastasis sometimes had many lesions scattering in various sites in the brain. During making a dose plan of stereotactic radiosurgery we have to pay attention to all lesions to treat as targets. In addition, on subsequent follow-up images we have to investigate the changes in each lesion treated before.  

     This is a retrospective study.

     With this database system we can comfortably choose and see a DICOM image with or without the covering layer including markings and comments we drew and wrote on the layer.

     This database system is useful especially in managing patients with multiple brain metastases.