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Decentralized Patient-Centric Medical Image Exchange: A Hybrid Blockchain and DICOMweb Architecture

Tajima, Y.

2025-12-30 health informatics
10.64898/2025.12.29.25343172 medRxiv
Show abstract

The fragmentation of medical imaging data across isolated Picture Archiving and Communication Systems (PACS) creates significant barriers to interoperability. This paper presents a functional Proof of Concept (PoC) for a decentralized, patient-centric medical image exchange system. By combining an Ethereum-based smart contract layer for access control and settlement with an off-chain Node.js "Worker" bridge, the system enables automated, peer-to-peer transfer of DICOM studies between disparate Orthanc PACS nodes. We introduce a token-based incentive model to compensate data providers and a cryptographic "Alias" system to preserve patient privacy, complying with recent amendments to Japans Next Generation Medical Infrastructure Law. The proposed architecture leverages standard DICOMweb protocols (QIDO-RS, WADO-RS, STOW-RS), ensuring compatibility with existing hospital infrastructure while shifting data sovereignty to the patient. The complete source code is available at https://github.com/cacaobean77-ops/kaken23K14851.

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The top 5 journals account for 50% of the predicted probability mass.

1
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"Similar papers" are the closest papers from that journal in the model's embedding space. They show what the match is built on, but the ranking comes mostly from a classifier over the whole training set, not from these examples alone.