This article provides an overview of data submission to the Dose Index Registry (DIR) using the ACR Connect platform plus a  DIR Link application. In 2023, the ACR Connect team began working with DIR participating facilities to transition from the use of the TRIAD Site Server software for data submission to employing the ACR Connect + DIR Link technology.  New sites joining the DIR will work with the ACR Connect team to install the ACR Connect + DIR Link software.


Note: To learn more about installing ACR Connect + DIR Link view the video or PowerPoint presentation available in the ACR Connect Knowledge Base. While these resources discuss transitioning from the TRIAD Site Server to ACR Connect + DIR Link, the installation process is basically the same but new sites will not need to deinstall the TRIAD Site Server. 


For questions about getting started with ACR Connect + DIR Link, please contact ACR Connect Support

The Basics of RDSR Transmission

The Digital Imaging and Communications in Medicine (DICOM) Standard defines the Radiation Dose Structured Report (RDSR) that records and stores radiation dose information from scanners, fluoroscopes, and x-ray devices at the time of an imaging exam. Exam RDSRs from workstations, PACS, and Radiation Dose Index Monitoring (RDIM) systems are routed to DIR Link where they are anonymized before being transmitted to the DIR Central Server at ACR. 

DIR Link does not accept secondary capture images. For details please see this article.

System Requirements

The ACR Connect software can be installed on a stand-alone server, an on-premise virtual machine (VM), or on a VM from a cloud provider, e.g., AWS, Azure, or GCP.

Windows Spec




Windows Server 2016 

 Windows Server 2019


Intel Xeon or equal  

 Intel Xeon or equal

# of Cores    




16 GB  

32 GB

Local storage       

150 GB 

500 GB

The minimum requirements listed in the above table  will work for most sites and several additional installation considerations include:

  • The Security Certificate is to be installed in "cert:\LocalMachine\My“

  • The URL for local access to ACR Connect + DIR Link is on the local network via the Web

  • Server 2022 is not currently supported

  • ACR Connect is required to be installed on the C drive

Configuration Overview

Any CT scanner or fluoroscope from which a facility wishes to send an RDSR to the DIR must be configured locally in the DIR Link application using the respective facility-assigned Station Name. Facilities can filter out specific scanners from sending data to the registry by not configuring them. RDSRs received from systems that are not configured are stored for 14 days, after which they are deleted.

Imaging modalities can be connected to DIR Link using several different configuration paths which are described below. Sending data directly from the scanner or device to DIR Link is preferred; however, other configuration paths, i.e., PACS, third-party Radiation Dose Index Monitoring systems (RDIMs), are allowed and may be more efficient for managing multiple modalities, scanners, or devices across DIR facilities.

Configuration Options

As you review the options, please be aware that creating and transferring the Radiation Dose Structured Reports (RDSRs) to another DICOM node may require service-level access and is typically performed by the local service engineer under the guidance of the medical physicist.

  1. Direct Connection to DIR Link

The simplest and preferred configuration is to establish a direct DICOM connection between each scanner or system and DIR Link and then configure each to automatically create and transfer the RDSR to DIR Link after each imaging exam or procedure as shown in Figure 1.

Figure 1

  1. Transfer to DIR Link through a Radiation Dose Index Monitoring (RDIM) System

Facilities that have systems already connected to an RDIM may elect to have the RDIM automatically forward RDSR to DIR Link as shown in Figure 2. 

Figure 2

If you elect this type of configuration,  contact your RDIM vendor early in the start-up process to ensure proper configuration and avoid potential pitfalls.  Following is the list of current vendors for which the ACR has confirmed RDIM connectivity: Dose Monitor, GE DoseWatch, Imalogix, INFINITT,  Qaelum, Radimetrics, and Sectra. 

Alert: If choosing this configuration, the RDIM must forward/pass through RDSR without modification.

  1. Auto routing to DIR Link from the facility’s Picture Archiving and Communication System (PACS)

Facilities with in-house PACS administrator expertise may elect to configure their PACS to automatically forward all RDSR from specific modalities or Station Names to DIR Link (see Figure 3a). This simplifies DICOM configuration as only a single DICOM destination is needed for each scanner or device.  Further, this destination likely already exists and is used to archive images. It is also possible for the PACS system to forward only to DIR Link (see Figure 3b) or in parallel to DIR Link and an RDIM (see Figure 3c) using this architecture.

Figure 3

DIR Data Dictionary 

The DIR Data Dictionary lists all DICOM and Structured Report data field tags, concept names, values, and descriptions that we attempt to collect during data transmission.

Last reviewed: 05/06/2021