A comprehensive R interface to the 'DICOM' Toolkit ('DCMTK'), providing native R bindings for reading, writing, modifying, and visualizing Digital Imaging and Communications in Medicine ('DICOM') files. Features include 'tidyverse'-compliant data structures, 'ggplot2'-based image visualization, interactive 'Shiny' viewers, 'PACS' networking (C-ECHO, C-FIND, C-STORE, C-MOVE), structured report handling, 'DICOM' deidentification, and integration with local and cloud-based large language models ('LLM') via 'Ollama' and 'OpenAI'-compatible APIs for AI-assisted medical image analysis. The 'DCMTK' C++ library is bundled and compiled from source, requiring no external installation.