Digital Imaging and Communications in Medicine Whole Slide Imaging Connectathon at Digital Pathology Association Pathology Visions 2017

Abstract

As digital pathology systems for clinical diagnostic work applications become mainstream, interoperability between these systems from different vendors becomes critical. For the first time, multiple digital pathology vendors have publicly revealed the use of the digital imaging and communications in medicine (DICOM) standard file format and network protocol to communicate between separate whole slide acquisition, storage, and viewing components. Note the use of DICOM for clinical diagnostic applications is still to be validated in the United States. The successful demonstration shows that the DICOM standard is fundamentally sound, though many lessons were learned. These lessons will be incorporated as incremental improvements in the standard, provide more detailed profiles to constrain variation for specific use cases, and offer educational material for implementers. Future Connectathon events will expand the scope to include more devices and vendors, as well as more ambitious use cases including laboratory information system integration and annotation for image analysis, as well as more geographic diversity. Users should request DICOM features in all purchases and contracts. It is anticipated that the growth of DICOM-compliant manufacturers will likely also ease DICOM for pathology becoming a recognized standard and as such the regulatory pathway for digital pathology products.

Implementing the DICOM Standard for Digital Pathology

“…[ 68 ] We chose to implement the full encoding scheme because it improves access performance by reducing overhead when transmitting metadata over the network as well as loading and parsing it into memory. [ 28 ] The DICOM standard thereby enables encoding of multiscale, tiled whole-slide images in a standardized fashion.…”

“…Only very recently have commercially available whole slide imaging systems started to produce images encoded according to the DICOM standard. [ 28 69 ] In the interim, to support the installed based of scanners – only capable of producing proprietary format images, commercial and open-source implementers have begun to develop conversion tools. [ 70 71 ] To evaluate the capabilities and limitations of DICOM for the representation of digital pathology whole slide images, we implemented a process to generate DICOM PS3.10 files based on existing vendor-specific file formats and validated their integrity and standard conformance using established automated validation tools as well as manual expert review as described in the Methods section.…”

“…Some systems can be configured to allow the user to select alternative compression schemes, including lossy forms of JPEG 2000 and other proprietary formats. [ 28 ]…”

“…[ 27 ] These groups (in which many vendors participate) recently met for the first time to evaluate the image data exchange using DICOM representations and protocols. [ 28 ] Intellectual property obstacles, which previously hindered implementation by vendors, have been resolved. [ 28 29 ] Vendors now generally embrace the standard and agree on implementation details for improved interoperability.…”

“…[ 28 29 ] Vendors now generally embrace the standard and agree on implementation details for improved interoperability. [ 28 ] These large-scale efforts need to be supplemented by pilot implementations in pathology departments for various practical reasons: (1) the evaluation of capabilities and limitations requires first-hand experience at the user level (especially by content experts in pathology); (2) the demonstration of compatibility with existing clinical systems (e.g., pathology laboratory information systems [LIS], enterprise-wide Picture Archiving and Communication Systems) requires local, laboratory-based proofs of principle; and (3) reliance on external advice and guidelines cannot replace local stakeholder involvement and active definition of resource requirements. Importantly, adoption of the DICOM standard represents an opportunity for pathology to leverage established enterprise medical imaging infrastructure and software solutions.…”