Digital pathology is quickly scaling, however many laboratories are discovering that merely digitizing glass slides is the straightforward half. The tougher, and more and more pressing, problem is making these photos interoperable throughout distributors, methods and establishments, in a method that helps enterprise imaging, AI and lengthy‑time period knowledge reuse.
That downside, and a concrete technique to resolve it, was the main focus of the current Digital Pathology Affiliation (DPA) webinar, “Advancing Imaging Interoperability Collectively: A DPA–CAP–SIIM Collaboration to Enhance Standardized Workflow Adoption.” The session introduced collectively leaders from the DPA, the School of American Pathologists (CAP) and the Society for Imaging Informatics in Drugs (SIIM) to report out on their joint DICOM toolkit effort and to stipulate what success ought to appear to be over the following one to a few years.
From Radiology’s Expertise to Pathology’s Second
The webinar opened by situating digital pathology inside a broader enterprise imaging arc. Moderator Jennifer Samboy, digital transformation chief at Philips and co‑chair of the DPA Training Committee, framed the objectives of the session as threefold: to summarize key findings from a DICOM toolkit collectively developed by DPA, CAP and SIIM; to supply a deeper dive on why DICOM and imaging well being info trade requirements matter; and to explain how DPA can speed up cross‑organizational collaboration to advance interoperability for each medical operations and innovation.
Radiology’s journey offers a robust precedent. Alex Towbin, M.D., from Cincinnati Kids’s Hospital and the upcoming president of SIIM, traced how radiology moved from proprietary, vendor‑particular codecs within the Eighties to at the moment’s mature, DICOM‑primarily based ecosystem.
As he defined, early radiology methods produced digital photos, however every vendor used its personal proprietary format, leaving organizations with “a number of scanners and no technique to view it.” DICOM emerged as a technique to resolve precisely that downside: a regular file format and metadata mannequin that may enable photos from completely different modalities and distributors to be managed and seen collectively.
Towbin emphasised that metadata is the place “the actual energy” of DICOM lies. Past pixel knowledge, structured tags about modality, examine description, orientation and lots of different parameters assist refined routing, hanging protocols, AI workflows and multi‑modality viewing. Those self same capabilities, he argued, are immediately relevant to pathology.
Pathology “deserves to be on this place as effectively,” he stated, alongside radiology, ophthalmology, endoscopy, level‑of‑care ultrasound and different picture sorts in an enterprise imaging setting.
DICOM for Pathology: The “Delivery Container” for Photographs
Kevin Schap of CAP, Secretariat for DICOM Working Group 26 (WG-26) and a frontrunner in IHE PaLM (Pathology and Laboratory Drugs), took the viewers deeper into what DICOM means particularly for entire slide imaging.
Schap described DICOM as “a really detailed algorithm for the way medical photos are saved, described, transmitted and understood throughout methods.” Whereas radiology has used DICOM for many years, pathology is a more moderen entrant, and it’s dealing with most of the similar points radiology confronted many years in the past: very giant photos, extremely proprietary codecs, and restricted interoperability between distributors.
To make the idea extra tangible, Schap borrowed an analogy: “You may consider DICOM like a delivery container for international commerce. Earlier than delivery containers, items had been transported in all types of inconsistent packaging, barrels, crates, sacks. It was inefficient, onerous to trace and tough to maneuver between ships, vans and trains. So then got here the standardized container, similar measurement, the identical construction, universally acknowledged. Now, any port truck or crane on the earth is aware of precisely the best way to deal with it.”
Within the pathology context, DICOM doesn’t simply carry the pixels; it carries the which means — affected person info, acquisition particulars, organ web site, tissue kind, stains and immunohistochemistry. With out standardized encoding of those parts, he argued, interpretation and secondary use change into extraordinarily tough.
Schap additionally underscored why DICOM usually feels “difficult,” and why that’s acceptable and even essential. It isn’t merely a file format, he stated, however “a knowledge mannequin, it’s a communication protocol, it’s a workflow framework.” That complexity is the tradeoff for interoperability and future‑proofing in an setting of quickly evolving modalities and AI instruments.
Making Requirements Actionable in Workflows
If DICOM defines how photos and metadata are structured and exchanged, IHE (Integrating the Healthcare Enterprise) defines how that construction is definitely utilized in real-world workflows.
Schap walked by means of how IHE develops profiles that sew collectively requirements reminiscent of DICOM, HL7 and SNOMED CT to assist finish‑to‑finish processes. In digital pathology, that features:
- Digital Pathology Picture Acquisition (DPI): launched, centered on creation, storage, show of DICOM information and the mapping of LIS metadata into photos.
- Digital Pathology Ordering Workflow: in improvement, defining communication between order fillers, picture managers and acquisition managers when new entire slide photos are created.
- Digital Pathology Proof Creation: centered on how AI‑derived measurements and annotations are related to entire slide photos, saved and accessed.
Schap famous that scanners is not going to natively know all the pieces a few specimen; they have to name again to the LIS for specimen kind, web site, stains and different attributes. IHE profiles specify how these calls and transactions ought to work, in order that completely different distributors’ parts could be combined and matched with out bespoke integrations.
Radiology’s Maturity and Pathology’s Gaps
The panel dialogue shifted to the classes pathology can be taught from radiology, and to the sensible limitations that also impede DICOM adoption.
Towbin highlighted two key radiology classes: the boundaries of free‑textual content fields and the variability in how completely different specialties and distributors implement the usual. Many human‑dealing with fields, like process and sequence descriptions, are successfully “rubbish” from an informatics standpoint as a result of they’re unstructured and establishment‑particular. But he additionally famous that, with trendy AI, this may increasingly change into much less of an issue as algorithms can ingest and interpret giant, messy metadata units in methods people can not.
He additionally emphasised that, in trendy radiology, using DICOM is not debated: “Is that this even a dialogue amongst radiology departments whether or not you ought to be implementing a DICOM versus a non-DICOM compliance system in radiology? Is it even a query?” he was requested.
“No, no, it’s not,” Towbin replied. Radiologists, he added, usually have no idea or have to know the technical particulars of DICOM. “The usual simply means issues work,” enabling teleradiology, second opinions and multi‑web site workflows to “simply work as a result of it everybody’s utilizing that commonplace.”
Boundaries: Storage, Distributors, Incentives and Consciousness
Whereas the technical requirements for pathology at the moment are strong, particularly Complement 145 for entire slide imaging, actual‑world adoption is uneven.
Mustafa Yousif, M.D., from the College of Michigan and co‑chair of DICOM Working Group 26, described Michigan’s enterprise implementation and the limitations they encountered. Storage was the primary and most blatant problem: single entire slide photos can exceed 4 GB, and lengthy‑time period archival shortly reaches petabyte scale, far past what conventional radiology PACS had been designed to deal with. That has compelled establishments to assume by way of sizzling/chilly storage tiers and reasonable retention methods centered on diagnostic and tumor board time home windows.
Yousif additionally pointed to an immature vendor ecosystem. Many digital pathology scanner distributors nonetheless deal with DICOM as an optionally available output quite than a native format, and few provide strong DICOM viewers. That leaves shoppers struggling to validate photos and metadata, and it feeds persistent myths reminiscent of the concept there are “a number of variations” of pathology DICOM.
In actuality, he confused, “it’s one DICOM commonplace … the pathology photos and radiology photos dwell below the identical commonplace, use the identical foundational metadata construction, and might actually use as one commonplace when appropriately carried out.”
Rajesh Sprint, M.D., of Duke College and co‑chair of IHE PaLM, centered on economics and incentives. From the attitude of follow leaders, he stated, digital pathology and requirements‑primarily based implementations should show a transparent return on funding. At a nationwide stage, he pointed to precedents reminiscent of licensed EHR incentives that accelerated adoption and prompt comparable coverage levers might assist drive interoperable digital pathology.
With out such nudges, distributors have weak incentives to desert proprietary codecs that could be cheaper for them to keep up, although they improve prices downstream for healthcare organizations, payers and finally sufferers.
A Toolkit, Connectathons and a Path to Success
One concrete output of the DPA–CAP–SIIM collaboration is a DICOM starter toolkit for pathology, primarily based partially on a survey of pathologists. As Towbin reported, greater than three‑quarters of respondents stated such a toolkit could be useful, with over half answering “sure” outright. Essentially the most requested parts had been:
- An summary of the DICOM commonplace and the way it applies to pathology
- A step‑by‑step implementation information
- Instruments for changing proprietary codecs to DICOM
- Workflow integration steerage and pattern DICOM information
Schap prompt that, past training, the toolkit can arm organizations with particular questions to ask distributors throughout RFPs and negotiations, and might even sign to distributors what they are going to be anticipated to show. A number of panelists additionally confused the significance of IHE and DICOM Connectathons as actual‑world proving grounds the place a number of distributors check interoperability in frequent use circumstances.
Trying forward one to a few years, panelists converged on a number of measures of success:
- Extra distributors producing native DICOM output solely, with strong conformance statements.
- Clearer, extra detailed procurement necessities from hospitals that transcend “do you assist DICOM?” to “how do you assist it?”
- Elevated vendor participation, and profitable testing, in IHE and DICOM Connectathons for digital pathology profiles.
- Wider use of standardized metadata fields crucial for AI and affected person care, together with SNOMED CT‑primarily based coding.
Moderator John Groth, M.D., of Endeavor Well being and representing the DPA regulatory and requirements activity drive, framed this as a “good time” to push, citing current FDA indicators round DICOM, rising Superior Analysis Tasks Company for Well being (ARPA‑H) initiatives, and multi‑society efforts on interoperability and affected person entry. He characterised the present second as one the place “there are dozens of individuals throughout the spectrum particularly associated to pathology which are assembly weekly in some capability,” and the place international collaboration is not aspirational however operational.
The webinar closed with an necessary reminder from the seller aspect: a consultant within the viewers famous that this dialog is “equally necessary to us because the distributors who’re attempting that will help you by means of this course of as effectively,” underscoring that standardization will finally require coordinated motion by skilled societies, regulators, healthcare organizations and business.
If radiology is any information, the top state shouldn’t be one the place pathologists discuss DICOM day-after-day, however one the place, as Towbin put it, utilizing DICOM is “not even a query.” The work described on this webinar goals to make that future a actuality for digital pathology.
