Having built workstations in imaging that used DICOM extensively, I disagree with the fact that DICOM is ancient and painful to work with. Yes, it is difficult to understand but there are plenty of great toolkits and examples to get started (DCMTK, dcm4che). And it also has open source implementations (dcm4chee).

DICOm has a portable media extension which let's anyone transport studies using USB, keep it in a folder. And it works well when it needs to be fed into a PACS, RIS l

It has stood the test of time when stuff like HL7 went from V2 to V3, CDA and related tailspins till FHIR came about (and let's not talk about ISO13606, OpenEHR).

It's UID space is well defined that's it's used in the aircraft inventory space.