It is applicable to a networked environment. The ACR-NEMA Standard was applicable in a point-to-point environment only; for operation in a networked environment a Network Interface Unit (NIU) was required. DICOM supports operation in a networked environment using the industry standard networking protocol TCP/IP.

It is applicable to an off-line media environment. The ACR-NEMA Standard did not specify a file format or choice of physical media or logical filesystem. DICOM supports operation in an off-line media environment using industry standard media such as CD-R and MOD and logical filesystems such as ISO 9660 and PC File System (FAT16).

It specifies how devices claiming conformance to the Standard react to commands and data being exchanged. The ACR-NEMA Standard was confined to the transfer of data, but DICOM specifies, through the concept of Service Classes, the semantics of commands and associated data.

It specifies levels of conformance. The ACR-NEMA Standard specified a minimum level of conformance. DICOM explicitly describes how an implementor must structure a Conformance Statement to select specific options.

It is structured as a multi-part document. This facilitates evolution of the Standard in a rapidly evolving environment by simplifying the addition of new features. ISO directives that define how to structure multi-part documents have been followed in the construction of the DICOM Standard.

It introduces explicit Information Objects not only for images and graphics but also for waveforms, reports, printing, etc.

It specifies an established technique for uniquely identifying any Information Object. This facilitates unambiguous definitions of relationships between Information Objects as they are acted upon across the network.