DICOM

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DICOM pathologyC. Daniel Le Bozec (GP
Hospital) - USERS J. Klossa (TRIBVN) - VENDORS
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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
• www.ldip.org
• 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

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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)

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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,

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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
WADO
DICOM
DICOM WL
HL7 v3 CDA
HL7 v2 v3 Messages (Order)
HL7 v2 ADT
HL7
OWL
SNOMED CT, ontologies, etc
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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)

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Images in pathologyGross imaging
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Images in pathologyStill images Whole Slide
Images (WSI)
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Structure model of objects in Preprocess of
Pathology Service (Make slides and Scan)
Study One report will be made corresponding to
the order
Series
Patient
Image
Removed organ Biopsy specimen
Gross Image
Order
Cutting Drawing
Image
Whole slide Image (Virtual slide only)
Block
Glass slide
Whole slide Image (Virtual slide only)
Glass slide
Note In case of optical microscopy, no-whole
slide image
Block
Removed organ Biopsy specimen
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Images in pathology Tissue Micro Arrays

• Hundred of patients

etc
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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

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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)

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Acquisition context
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2
2
1
5
3
6
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Multimodalities issuesLink with radiological
images
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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

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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

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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 clients
  memory large images are slow to load, slow to
  view, and slow (when no impossible) to process

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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

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DICOM with JPIP Diagram