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JSON converter erroneously assumed InlineBinary values should be an
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To ensure backwards compatibility with JSON files generated with 5.0.x
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fo-dicom logo

Fellow Oak DICOM

NuGet build development codecov


This library is licensed under the Microsoft Public License (MS-PL). See License.txt for more information.


  • Targets .NET Standard 2.0
  • DICOM dictionary version 2022b
  • High-performance, fully asynchronous async/await API
  • JPEG (including lossless), JPEG-LS, JPEG2000, and RLE image compression (via additional package)
  • Supports very large datasets with content loading on demand
  • Image rendering to System.Drawing.Bitmap or SixLabors.ImageSharp
  • JSON and XML export/import
  • Anonymization
  • DICOM services
  • Customize components via DI container


Easiest is to obtain fo-dicom binaries from NuGet. This package reference the core fo-dicom assemblies for all Microsoft and Xamarin platforms.

NuGet Packages

Valid for version 5.0.0 and later

Package Description
fo-dicom Core package containing parser, services and tools.
fo-dicom.Imaging.Desktop Library with referencte to System.Drawing, required for rendering into Bitmaps
fo-dicom.Imaging.ImageSharp Library with reference to ImageSharp, can be used for platform independent rendering
fo-dicom.NLog .NET connector to enable fo-dicom logging with NLog
fo-dicom.Codecs Cross-platform Dicom codecs for fo-dicom, developed by Efferent Health (


Documentation, including API documentation, is available via GitHub pages:

Usage Notes

Image rendering configuration

Out-of-the-box, fo-dicom defaults to an internal class FellowOakDicom.Imaging.IImage-style image rendering. To switch to Desktop-style or ImageSharp-style image rendering, you first have to add the nuget package you desire and then call:

new DicomSetupBuilder()
    .RegisterServices(s => s.AddFellowOakDicom().AddImageManager<WinFormsImageManager>())


new DicomSetupBuilder()
    .RegisterServices(s => s.AddFellowOakDicom().AddImageManager<ImageSharpImageManager>())

Then when rendering you can cast the IImage to the type by

var image = new DicomImage("filename.dcm");
var bitmap = image.RenderImage().As<Bitmap>();


var image = new DicomImage("filename.dcm");
var sharpimage = image.RenderImage().AsSharpImage();

Logging configuration

By default, logging defaults to the no-op NullLogerManager. There are several logmanagers configurable within DicomSetupBuilder like

s.AddLogManager<ConsoleLogManager>()  // or ...
s.AddLogManager<NLogManager>()   // or ...

LogManager.SetImplementation(ConsoleLogManager.Instance);  // or ...
LogManager.SetImplementation(NLogManager.Instance);        // or ...

Sample applications

There are a number of simple sample applications that use fo-dicom available in separate repository here. These also include the samples that were previously included in the Examples sub-folder of the VS solutions.


File Operations

var file = DicomFile.Open(@"test.dcm");             // Alt 1
var file = await DicomFile.OpenAsync(@"test.dcm");  // Alt 2

var patientid = file.Dataset.GetString(DicomTag.PatientID);

file.Dataset.AddOrUpdate(DicomTag.PatientName, "DOE^JOHN");

// creates a new instance of DicomFile
var newFile = file.Clone(DicomTransferSyntax.JPEGProcess14SV1);

file.Save(@"output.dcm");             // Alt 1
await file.SaveAsync(@"output.dcm");  // Alt 2

Render Image to JPEG

var image = new DicomImage(@"test.dcm");
image.RenderImage().AsBitmap().Save(@"test.jpg");                     // Windows Forms

C-Store SCU

var client = DicomClientFactory.Create("", 12345, false, "SCU", "ANY-SCP");
await client.AddRequestAsync(new DicomCStoreRequest(@"test.dcm"));
await client.SendAsync();


var server = new DicomServer<DicomCEchoProvider>(12345);

var client = DicomClientFactory.Create("", 12345, false, "SCU", "ANY-SCP");
for (int i = 0; i < 10; i++)
    await client.AddRequestAsync(new DicomCEchoRequest());
await client.SendAsync();

C-Find SCU

var cfind = DicomCFindRequest.CreateStudyQuery(patientId: "12345");
cfind.OnResponseReceived = (DicomCFindRequest rq, DicomCFindResponse rp) => {
	Console.WriteLine("Study UID: {0}", rp.Dataset.Get<string>(DicomTag.StudyInstanceUID));

var client = DicomClientFactory.Create("", 11112, false, "SCU-AE", "SCP-AE");
await client.AddRequestAsync(cfind);
await client.SendAsync();

C-Move SCU

var cmove = new DicomCMoveRequest("DEST-AE", studyInstanceUid);

var client = DicomClientFactory.Create("", 11112, false, "SCU-AE", "SCP-AE");
await client.AddRequestAsync(cmove);
await client.SendAsync(); 

N-Action SCU

// It is better to increase 'associationLingerTimeoutInMs' default is 50 ms, which may not be
// be sufficient
var dicomClient = DicomClientFactory.Create("", 12345, false, "SCU-AE", "SCP-AE",
DicomClientDefaults.DefaultAssociationRequestTimeoutInMs, DicomClientDefaults.DefaultAssociationReleaseTimeoutInMs,5000);
var txnUid = DicomUIDGenerator.GenerateDerivedFromUUID().UID;
var nActionDicomDataSet = new DicomDataset
    { DicomTag.TransactionUID,  txnUid }
var dicomRefSopSequence = new DicomSequence(DicomTag.ReferencedSOPSequence);
var seqItem = new DicomDataset()
    { DicomTag.ReferencedSOPClassUID, "1.2.840.10008." },
    { DicomTag.ReferencedSOPInstanceUID, "" }
var nActionRequest = new DicomNActionRequest(DicomUID.StorageCommitmentPushModelSOPClass,
                DicomUID.StorageCommitmentPushModelSOPInstance, 1)
    Dataset = nActionDicomDataSet,
    OnResponseReceived = (DicomNActionRequest request, DicomNActionResponse response) => 
        Console.WriteLine("NActionResponseHandler, response status:{0}", response.Status);
await dicomClient.AddRequestAsync(nActionRequest);
dicomClient.OnNEventReportRequest = OnNEventReportRequest;
await dicomClient.SendAsync();

private static Task<DicomNEventReportResponse> OnNEventReportRequest(DicomNEventReportRequest request)
    var refSopSequence = request.Dataset.GetSequence(DicomTag.ReferencedSOPSequence);
    foreach(var item in refSopSequence.Items)
        Console.WriteLine("SOP Class UID: {0}", item.GetString(DicomTag.ReferencedSOPClassUID));
        Console.WriteLine("SOP Instance UID: {0}", item.GetString(DicomTag.ReferencedSOPInstanceUID));
    return Task.FromResult(new DicomNEventReportResponse(request, DicomStatus.Success));

C-ECHO with advanced DICOM client connection: manual control over TCP connection and DICOM association

var cancellationToken = CancellationToken.None;
// Alternatively, inject IDicomServerFactory via dependency injection instead of using this static method
using var server = DicomServerFactory.Create<DicomCEchoProvider>(12345); 

var connectionRequest = new AdvancedDicomClientConnectionRequest
    NetworkStreamCreationOptions = new NetworkStreamCreationOptions
        Host = "",
        Port = server.Port,

// Alternatively, inject IAdvancedDicomClientConnectionFactory via dependency injection instead of using this static method
using var connection = await AdvancedDicomClientConnectionFactory.OpenConnectionAsync(connectionRequest, cancellationToken);

var associationRequest = new AdvancedDicomClientAssociationRequest
    CallingAE = "EchoSCU",
    CalledAE = "EchoSCP"

var cEchoRequest = new DicomCEchoRequest();

using var association = await connection.OpenAssociationAsync(associationRequest, cancellationToken);
    DicomCEchoResponse cEchoResponse = await association.SendCEchoRequestAsync(cEchoRequest, cancellationToken).ConfigureAwait(false);
    await association.ReleaseAsync(cancellationToken);

New to DICOM?

If you are new to DICOM, then take a look at the DICOM tutorial of Saravanan Subramanian: The author is also using fo-dicom in some code samples.