1. DICOM & pathology C. Daniel Le Bozec (GP Hospital) - USERS J
DICOM & pathology C. Daniel Le Bozec (GP Hospital) - USERS J. Klossa (TRIBVN) - VENDORS

2. Working groups (users & vendors) about pathology workflow
US: CAP-LDIP (B..Beckwith )
US based, began in 2004
Goal is to define XML pathology image specification for both research and clinical use
Users : UPMC, Harvard University
Vendors: Aperio, Trestle, Dmetrix
Europe: IHE-Pathology Europe
France (C. Le Bozec), Spain (M. Rojo), Hungary, Italy, Germany
Began in 2004, first meeting 5 september 2005
Users
ADICAP, French Society of Pathology (SFP), AFAQAP, GFHC (French Group for CytoHematology), SFCC (French Society for Clinical Cytology)
Spanish Society of Health Informatics
Vendors
Modalities: Leica MicroSystems, Zeiss, 3d Histech, Tribvn/Aperio, SAMBA Tech, etc
LIS: TECHNIDATA, INFOLOGIC, etc
PACS Vendors: AGFA
EHR: MEDASYS
Japan: IHE-Pathology Japan
Users:. Tofukuji, Kyoto University, Iwate Medical School
Vendors: Olympus, Nikon

3. Outlines Working groups about pathology workflow (PWF)
Specific workflow
Specific new attributes are needed in DICOM
First issue: Whole Slide Images (WSI)
Digital images (including WSI) for daily practice
Non specific issues about storage & access to “large images”
Agenda?
Ad-hoc working group within WG 6
New DICOM WG for pathology (P-DICOM)

4. Objectives Defining the specific workflow in pathology
Defining specific IHE integration profiles
Making the best use of existing standards to operate this WF
HL7
DICOM
Others: BPML, OWL,…

5. Pathology workflow (P-WF) & standards
Cyto & Histo pathology Hematopathology
IHE
WfMC
Image & Report Access
Patient registration
Order
Image Acquisition
Report
Multimodality
GPWL, Mod WL, Post Process-WL,
Compression,
Color Presentation
Evidence Documents
DICOM SR
DICOM
WADO
DICOM WL
HL7 v2
ADT
HL7 v2 & v3 Messages (Order)
HL7 v3 CDA
HL7
OWL
SNOMED CT, ontologies, etc…

6. Images in pathology Blocks and Slides are the primary archive
They contain much more info than any individual file even WSI
They need iterative and multimodalities studies for catching the info inside the specimen in a diagnostic perspective
Gross imaging
Still images & Whole Slide Images (WSI)
Tissue Micro Arrays (TMA)

7. Images in pathology Gross imaging1 2 3 4 5 6
Sampling for histology
Sampling for tissue bank

8. Images in pathology Still images & Whole Slide Images (WSI)

9. Structure model of objects in Preprocess of Pathology Service (Make slides and Scan*)
Study: One report will be made corresponding to the order
Patient
Series
Image
Removed organ
Biopsy specimen
Order
Gross Image
Cutting Drawing
Image
Block
Glass slide
Whole slide Image
(Virtual slide only)*
Glass slide
Whole slide Image
(Virtual slide only)*
Block
*Note: In case of optical microscopy, no-whole slide image
Removed organ
Biopsy specimen

10. Images in pathology Tissue Micro Arrays
Hundred of patients
…etc…

11. DICOM & Pathology Historically: Visible Light (WG-13)
First issue: Storage & access to “large data sets” (Whole Slide Image)
Enhanced CT,MR & XA IODs, OP IOD
Base standard (WG-06)
Compression (DICOM WG-04)
JPEG2000 in DICOM files (Supp 61, supp 105, 106)
Data Streaming & Multi-Component Compression

12. DICOM & Pathology Specific DICOM WG in pathology
“Good” definition of imaging folder and related information
Acquisition context
Multimodality management: transfer between equipments from different vendors
Multi-Frame CT & CR
Spatial Representation
General Purpose WL, Mod WL, Post Process. WL, Direct push between modalities ??
Color Presentation State
Structured Reporting (DICOM WG-8)
Image & report access (WADO)
Acquisition context
Technical:
Medical: By pathologists (not technical staff), related to reporting process
Navigating in imaging folders thanks to the macroscopic image with annotations including blocks’ localization
Like scout view in CT scan
Multi-experts annotations
Still image
Manual acquisition by pathologist (and not by technical staff)
Selecting key image for report
WSI
Automatic acquisition + manual complementary images
Blocks & slides
Different techniques
Slide coordinates
Magnifications
Multidimentional

13. Acquisition context 4 2 2 1 3 5 6

14. Multimodalities issues Link with radiological images

15. Histo and Cytopathology + Hematology needs User side
Clients need be able to build an optimized WorkFlow for digital image in Pathology through the creation of IHE profiles
Clients are pathologists, clinicians, patients or image analysis machines
Different modalities produce images that need to be combined or/and registered for individual diagnostic strategy: macro images, medium resolution (x20 to x40) RGB images, multispectral or chemical imaging, ...
Clients need quick and selective access (Zoom, Pan, Multi Z, ..) to this multidimensional set of data which is available from the vendors through different modalities

16. Histo and Cytopathology + Hematology needs Vendor side
Vendors provide for different WSI system offering 2d, 3d or more dimension possibilities, but
size of individual file and
quality of service provided (Selective, Quick and Smooth zoom and pan needed),
prevent them from using current DICOM VL objects
Vendors want to access the clinical market; so they need to implement IHE profiles based upon a standardized DICOM solution for archiving and handling those data

17. Whole Slide Imaging (WSI) needs: Technical side
PACS systems manage only images which are DICOM-compliant
DICOM files are limited in size to 2GB
Most DICOM components cannot use the vendors files
TIFF files with a tiled and pyramidal organization
jp2 files
The entire image is transmitted from the server to the client, and loaded into the client’s memory: large images are slow to load, slow to view, and slow (when no impossible) to process

18. Agenda? Whole Slide Image: Ad-hoc working group within WG 6
Vendors: Aperio, Dmetrix, Leica Microsystems, Zeiss, 3DHistech, Tribvn, Samba Tech, Apollo, Aurora, Trestle
Users: UPMC, Harvard, AFIP, ADICAP-France
New WG for pathology
Members from LDIP, ATA, IHE Japan & IHE-Europe

19. DICOM with JPIP: Diagram