TRIAD Setup Overview

This article presents the steps involved to set up and configure TRIAD for participation in the Dose Index Registry (DIR). TRIAD enables the collection, de-identification, and transmission of radiation dose data securely from modality workstations or PACS to the DIR database.  A single TRIAD Site Server can support all facilities within a NRDR Corporate Account.

Download and Install TRIAD

You can begin the TRIAD installation process once DIR registration is complete for each facility contributing radiation dose data. TRIAD software must be downloaded, installed, configured, and maintained on either a dedicated physical or a virtual server behind the facility’s firewall. The setup and maintenance is often performed by someone with a service user NRDR profile (see NRDR Accounts and Profiles article).

Note: Personnel supporting TRIAD set up should have both the necessary NRDR user account and administrative access to the computer that runs the TRIAD Site Server. If someone from your IT department will manage the TRIAD installation and activation, refer to the Manage User Profile article for how to create a Service User account for them. 

The basic system requirements are presented below and the TRIAD installation website provides detailed installation instructions.

TRIAD System Requirements




Intel Core2 Duo or above


At least 4 GB

Hard disk

At least 50 GB; 200 GB recommended


Windows 10 - 32/64 bit

Windows Server 2008 SP2/R2 – 32/64-bit

Windows Server 2012 SP2/R2 Enterprise Edition – 32/64-bit

Note: Windows updates and security updates should not affect Site Server.


.NET Framework 4.5.2, full version


Connect CT Scanners, Fluoroscopes, PET/CT or PACS to the TRIAD Site Server

The Digital Imaging and Communications in Medicine (DICOM) Standard defines the Radiation Dose Structured Report (RDSR) to record and store radiation dose information from imaging scanners and systems. The DICOM RDSRs from designated modalities at participating DIR Facilities are transferred to the local TRIAD® Site Server, where they are anonymized before being forwarded to the DIR Central Server at ACR.

Basic Data Flow Between Facilities and the ACR

Note: New facilities registering for the DIR in 2021 will be permitted to send only records using the Radiation Dose Structured Report (RDSR). Secondary capture image data can be sent in addition to the RDSR but will not be accepted as the sole means of transmission. Facilities that have previously sent secondary capture as their sole transmission method can continue to do so; however, the registry intends to discontinue secondary capture later in 2021.

TRIAD® Scanner and Systems Configuration

Any CT scanner or fluoroscope from which a facility wishes to send a RDSR to the DIR must be configured locally in the TRIAD Site Server configuration console using the respective Station Name. Facilities can filter out specific systems from sending data to the registry by not configuring these in the TRIAD Site Server configuration console. RDSRs received from systems that are not configured are stored on the TRIAD Site Server for 14 days, after which they are deleted.

Note: It is recommended that configuration information entered be limited to the Station Name. All configuration information for scanners and systems in the Site Server console must match what is in the RDSR for the data to be processed by the TRIAD Site Server.

Imaging modalities can be connected to the TRIAD Site Server using several different configuration paths which are described below. While sending data directly from the scanner or device to the local TRIAD Site Server is preferred, other configuration paths, i.e., PACS, third-party Radiation Dose Index Monitoring system (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 (RDSR) 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 the TRIAD Site Server

The simplest and preferred configuration is to establish a direct DICOM connection between each scanner or system and the local TRIAD Site Server and then configure each to automatically create and transfer the RDSR to the Site Server after each procedure as shown in figure 1.

Figure 1

  1. Transfer to the TRIAD Site Server 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 the TRIAD Site Server 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 the TRIAD® Site Server 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 the TRIAD Site Server (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 the TRIAD Site Server (see figure 3b) or in parallel to the TRIAD Site Server and an RDIM (see figure 3c) using this architecture.

Figure 3

Note: If you would like to transmit data from your PACS, please first review the TRIAD Site Server Installation and User Guide found on the TRIAD installation website and then create a ticket with the NRDR Help Desk for an appointment to walk you through the setup process.

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