DICOM & pathologyC. 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 2004Goal is to define XML pathology image specification for both research and clinical usewww.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 Vendors: Olympus, Nikon

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)

Objectives

Defining the specific workflow in pathologyDefining 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

Patient registration

IHE

WfMC

DICOM

HL7

OWL

DICOM WL

MultimodalityGPWL, Mod WL, Post Process-WL,

Compression,Color Presentation

WADOEvidence

DocumentsDICOM SR

HL7 v2 & v3 Messages (Order)

HL7 v2 ADT

HL7 v3 CDA

Order Image Acquisition ReportImage & Report Access

SNOMED CT, ontologies, etc…

Cyto & Histo pathology Hematopathology

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)

11

2

2

33

4

5

6

Sampling for histologySampling for tissue bank

2

Images in pathologyGross imaging

Images in pathologyStill images & Whole Slide Images (WSI)

Patient

Order Removed organBiopsy specimen

Block

Gross Image

Glass slide

Block

Removed organBiopsy specimen

Cutting Drawing

Whole slide Image(Virtual slide only)*

Glass slide Whole slide Image(Virtual slide only)*

Image

ImageSeries

Study: One report will be made corresponding to the order

Structure model of objects in Preprocess of Pathology Service (Make slides and Scan*)

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

Images in pathology Tissue Micro Arrays Hundred of patients

…etc…

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 & 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

1

2

3

4

56

2

Multimodalities issuesLink with radiological images

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

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

Histo and Cytopathology + Hematology needs Vendor 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 Imaging (WSI) needs: Technical side

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

DICOM with JPIP: Diagram