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A Working Group of Our Own (DICOM WG-26)

A Working Group of Our Own (DICOM WG-26). Bruce Beckwith, MD Department of Pathology Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts. Current State. Future State. Outline. DICOM overview DICOM pathology support Use in Pathology Issues to address.

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A Working Group of Our Own (DICOM WG-26)

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  1. A Working Group of Our Own (DICOM WG-26) Bruce Beckwith, MD Department of Pathology Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts

  2. Current State

  3. Future State

  4. Outline • DICOM overview • DICOM pathology support • Use in Pathology • Issues to address

  5. DICOM • Digital Imaging and Communications in Medicine • Initially drafted as jointly sponsored effort of the American College of Radiology and the National Electrical Manufacturers Association (ACR-NEMA), which became the DICOM committee in 1998 • Ver. 1 released 1985 • Physical 50 pin hardware abstraction layer standard • Never implemented • Ver. 2 released 1988 • Initial interest from radiological manufacturing community only • DICOM V3.0 released 1992 • Visible light supplement 1999 (endoscopy/microscopy)

  6. DICOM Governance • Voluntary standards group • Housed at NEMA in Virginia • Currently 26 working groups • Participants • Industry • Professional and trade groups • Standards developing bodies and government agencies • Anyone who has a material interest

  7. Pathology in DICOM • Visible Light working group was initial home • Created Supp. 15 • Minimal pathology activity since then • Dec 2005, created a new group for Pathology (WG-26)

  8. Working Group 26 • Open to all interested parties • 3-4 meetings per year • 70+ subscribers to the mailing list 35+ organizations 9 countries • Working with IHE (Japan and France) and HL7 Pathology groups

  9. DICOM Supplement 15 • Support for • gross images • microscopic images • accession numbers • case history • SNOMEDTM nomenclature and others • some imaging system specifications • compatible with all DICOM database systems

  10. How DICOM is Used • To communicate between image sources (radiographic instruments) and PACS • To communicate between PACS and display workstations • To communicate between RIS and PACS • To communicate between image sources and enterprise image archive

  11. Image Exchange • DICOM standard is for communication related to digital images • Uses externally defined file formats to encode the image data • Includes metadata with the image data • Uses an object oriented data model • 16-part standard document • http://medical.nema.org/dicom/2006/

  12. Typical VL Message Components Service Class Wrapper • Header Constructs • Patient demographics • Study capture parameters • Equipment parameters • Pixel/voxel dimensions • Diagnostic data Optional Components • Structured Reporting Data • Self-referential XML schemata • Clinical Data • Specimen Data • Tissue Array Data • Research Access data • Clinical Trial Data • Chain of custody data • …………………. • Ancillary Schemata/DTD definitions • Ancillary XML • Image Data • Primary image plane data • Overlay data • Arbitrary waveform data • ROI data • Diagnostic ROI-localized modifier data • Access/authentication/watermark data

  13. Picture Archiving & Communication Systems • Store images acquired by multiple instruments • Serves images to various workstations • Uses DICOM for messaging • Typically only utilized for radiology images • May have workflow limitations

  14. Enterprise Image Archive • Centralized storage for medical images • Share across many departments • Not limited to radiology or even DICOM • Not tightly coupled to any workflow • Can be write once – read many (no deletion)

  15. Radiology digital acquisition automatic image capture clinician interpretable many patient requests large storage needs digital images save money large budgets strong standards for storage and transfer Pathology analog primary data manual image capture hard to interpret for non-pathologists few patient requests extreme storage needs digital imaging costs more modest budgets limited pathology specific standards Imaging Comparison

  16. Current State in Pathology • Many PACS vendors are compliant with Visible Light images for pathology, endoscopy, etc. • Growing number of imaging products targeted at pathology are DICOM compliant • Anatomic pathology laboratory information systems offer limited image management • Veteran’s Administration: • Pathology imaging vendors must be DICOM compliant and store images in VISTA PACS • Small, but growing adoption of DICOM

  17. Barriers to Adoption of Current Products • Turf • PACS systems have traditionally been the domain of Radiology • Movement toward storing all medical images in a central location with a single viewing mechanism still in infancy • Workflow • May need to manually annotate files with image description, accession number, etc. • If sending to PACS, need to order study first • Cost • Image acquisition and annotation takes time – no extra reimbursement currently • Slide scanners and storage are costly

  18. Path PACS • Humin Tec (Korea) • PACS system for pathology departments • 21 installations, all in Korea • Communicates with standard radiology PACS • Also offers station for specimen photography • Apollo Telemedicine (USA) • PACS system allows acquisition and storage of images • Installed at Milwaukee Veterans Administration Hospitals • Images can be stored in VISTA imaging system

  19. Academic Center Efforts • Univ. of Pittsburgh • AP LIS is image aware • Gross specimen photos and single field microscopic images saved • Transmitted to Enterprise Image Archive • Clinicians can see only selected images on completed cases • Main clinician interest is specimen photos • Main pathologist use is conferences

  20. Issues to Address • Technical • Need for additional data elements (block, slide, slide status, more detailed imaging system description, etc.) • Support for whole-slide microscopic images DICOM is limited to 64k x 64k pixel images currently • Support for multi-resolution (pyramidal) formats • Support for navigating and selecting a region of interest from within entire slide image • Support for multispectral and hyperspectral modality images • Non-technical • Suggested workflow and use examples (IHE) • Support for DICOM from LIS vendors

  21. Resources • DICOM web site: medical.nema.org • RSNA DICOM Intro www.rsna.org/Technology/DICOM/intro/index.cfm • Medical Imaging FAQ: www.dclunie.com/medical-image-faq/html

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