Available in LEADTOOLS Medical Imaging toolkits.
Overlays
LDicomDS::GetOverlayAttributes
LDicomDS::GetOverlayActivationLayer
LDicomDS::GetOverlayBitmap
LDicomDS::GetOverlayBitmapList
LDicomDS::GetOverlayCount
LDicomDS::SetOverlayAttributes
LDicomDS::SetOverlayBitmap
LDicomDS::SetOverlayBitmapList
LDicomDS::DeleteOverlay