Transferring DICOM images to PowerPoint.

Moving your Digital Imaging and Communication in Medicine (DICOM) images into Microsoft PowerPoint slides can be frustrating at times, especially where there are a number to be inserted. At present PowerPoint does not have the built in ability to import DICOM files, although it is reportedly planned for the next version. There are add-ons offering direct DICOM importation into PowerPoint, but they require installation (1) (an Internet search for 'PowerPoint' and 'DICOM' will reveal more of these). This therefore means that in most cases the DICOM files will have to be converted, typically into Joint Photographic Experts Group (JPEG) images that PowerPoint does handle. (2) These files are recognised by having a .jpg file name extension; e.g. 'mountain.jpg'.

There are two options for obtaining JPEG files from DICOM files at this stage--most commonly, using your preferred DICOM viewing workstation software to save the files in JPEG format. This is by far the easiest. Make a note of the folder into which the JPEG files have been saved (or they can be stored onto a USB stick)

Alternatively, use a stand-alone software graphics conversion programme such as IrfanView (http://www.irfanview.com--remember to also download the Plugins/AddOns that allow DICOM viewing).2 This is a free image viewing programme that deals with almost all DICOM formats--the one requirement however is that the file be named with a .dcm extension. Having copied the DICOM directory structure from your workstation to a new folder on your computer (do not use the original DICOM data), one will see a range of numbered folders. Within these will be individual files which need to be renamed (e.g. '1234' becomes '1234.dcm'). Batch file renaming software is available, including Total Commander at www.ghisler.com. IrfanView then has a multi-file batch conversion option which allows conversion of DICOM to JPEG or other common imaging formats.

Once PowerPoint is open, successively select 'Insert /Picture/ From File' in the menu bar (Fig. 1). In the selection window, locate the JPEG files where they have been stored. Note that selecting multiple images in this option will stack them one on top of each other. If you wish to have one picture per slide, see the 'New Photo Album' option below.

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If the image is in colour, but should be grayscale (as when taken with a digital camera), convert it to grayscale by left-clicking on the picture in the slide. Then find the Picture toolbar--this is a floating toolbar, and may be anywhere on the screen. If this toolbar is not visible, go to 'View/ Toolbars' and make sure the 'Picture' option is ticked, and the Picture toolbar should appear. It may be docked on the sides or top and bottom of the window. The second icon from the left is the color icon; left-click this and select grayscale (Fig. 2).

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The picture toolbar allows selection of a few other options, including contrast and brightness--a basic windowing option (Fig. 3). To resize the picture, left-click on the picture and look for the small white circles at every corner, and in the midsection of each side. Click and drag these to resize. Use only the corner blocks if you wish to retain aspect ratio. To move the image, left-click in the picture and drag while holding the left mouse button down (a 4-headed arrow should appear).

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If the inserted picture is too large, left-click the picture and then select the 'zoom' icon in the menu bar above and choose 25%, or type in a smaller figure. One way to avoid the oversize image, is to first select the space in the picture area of the slide layout--the picture is then constrained by the outline.

Cropping is also very useful when extraneous parts of the picture need to be removed (Fig. 4). Select the 7th icon from the left in the picture toolbar; black bars with white outlines appear where the resize circles were. Dragging these into the picture, cut off the outlying parts of the image.

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A quicker means of inserting multiple pictures is to use 'Insert/ Picture/ New Photo Album' (Fig. 5), and to select multiple files, then choose 'ALL pictures black and white'--this really means grayscale (Fig. 6). But beware--once the picture is imported using this method, it cannot be cropped. The picture has to be pre-cropped before insertion. The other picture adjustments are feasible. There are commercial add-ins available that do allow cropping, or alternatively the picture can be copied (right-click picture; select copy) and pasted into IrfanView (open IrfanView, 'Edit/Paste'), cropped in IrfanView (click and drag a box, select 'Edit/ Crop selection' in IrfanView), then copy ('Edit/Copy' in IrfanView) and paste (select slide, 'Edit/Paste', in PowerPoint), back into PowerPoint.

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There are alternative ways of performing most of these actions; some may be quicker.

The core activity, in summary--DICOM to JPEG; PowerPoint: 'Insert/Picture/FromFile'/ adjust picture.

To minimise the PowerPoint file size, click on the 10th icon from the left in the Picture toolbar, select 'Web/Screen' in 'Change resolution', then 'All pictures in document' in the Apply-to option. Remember this will lower the resolution of your pictures, so ensure that you retain copies of your original images.

(1.) Haider MA. Extending PowerPoint with DICOM image support. Radiographics 2003; 23: 1683-1687.

(2.) Escott EJ, Rubinstein D. Free DICOM image viewing and processing software for your desktop computer: what's available and what it can do for you. Radiographics 2003; 23: 1341-1357.

S Beningfield, MB ChB, FFRad (D) Department of Radiology, University of Cape Town