Open Access

Isabel Härtl, Denise JungerORCiD, Patrick BeyersdorfferORCiD, Oliver BurgertORCiD, Christian KüchererORCiD

• The Digital Imaging and Communications in Medicine (DICOM) standard has evolved from a radiological data exchange protocol into a foundational element for surgical informatics. DICOM Working Group 24 - “Surgery” aims to facilitate intra-operative usage of the DICOM standard to optimize surgical procedures. This paper presents a structured overview of DICOM-based use cases in surgery, spanning preoperative planning, intraoperative guidance, and postoperative documentation. Based on a comprehensive user story schema, we categorize and analyze over 20 real-world scenarios that demonstrate how DICOM services-such as segmentation (DICOM-SEG), structured reporting (DICOMSR), and Unified Procedure Steps (UPS)-enable interoperability, precision, and automation in surgical environments. We highlight the benefits of standardized data exchange for surgical planning, intraoperative decision support, and quality assurance, while also addressing integration with clinical information systems and data protection. The findings underscore DICOM’s potential to serve as a unifying framework for data-driven, context-aware surgical workflows.