Zero-hash reproducible DICOM capture enables in-viewer vision-language model integration

A new DICOM viewer architecture preserves diagnostic context by serializing viewer state for offscreen re-rendering, producing pixel-identical images (0 hash mismatches across 50 frames) to feed vision-language models, with capture latency of 4.49-16.69 ms.

• Technical architecture report integrating VLMs directly within a diagnostic DICOM viewer using a split-layout chat interface.
• The system eliminates ad hoc screenshots, ensuring reproducible, auditable evidence by serializing viewing state (plane, window/level, overlays) for re-rendering.
• Key limitation: Performance was benchmarked under controlled conditions and hot cache; clinical workflow impact and VLM diagnostic accuracy remain unevaluated.

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