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

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working groups users vendors about pathology workflow
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
      • PACS Vendors: AGFA
      • EHR: MEDASYS
  • Japan: IHE-Pathology Japan
    • Users:. Tofukuji, Kyoto University, Iwate Medical School
    • Vendors: Olympus, Nikon
  • 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)
  • 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,…
pathology workflow p wf standards
Pathology workflow (P-WF)& standards

Cyto & Histo pathology Hematopathology



Image & Report Access

Patient registration


Image Acquisition



GPWL, Mod WL, Post Process-WL,


Color Presentation

Evidence Documents





HL7 v3 CDA

HL7 v2 & v3 Messages (Order)

HL7 v2




SNOMED CT, ontologies, etc…

images in pathology
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)
structure model of objects in preprocess of pathology service make slides and scan
Structure model of objects in Preprocess of Pathology Service (Make slides and Scan*)

Study: One report will be made corresponding to the order




Removed organ

Biopsy specimen

Gross Image


Cutting Drawing


Whole slide Image

(Virtual slide only)*


Glass slide

Whole slide Image

(Virtual slide only)*

Glass slide

*Note: In case of optical microscopy, no-whole slide image


Removed organ

Biopsy specimen

images in pathology tissue micro arrays
Images in pathology Tissue Micro Arrays
  • Hundred of patients


dicom pathology
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
dicom pathology1
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)
histo and cytopathology hematology needs user side
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

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

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
  • 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