DICOM pathology C Daniel Le Bozec GP Hospital

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

Working groups (users & vendors) about pathology workflow n 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 ¨ ¨ n Users : UPMC, Harvard University Vendors: Aperio, Trestle, Dmetrix Europe: IHE-Pathology Europe ¨ France (C. Le Bozec), Spain (M. Rojo), Hungary, Italy, Germany n ¨ Users n n ¨ ADICAP, French Society of Pathology (SFP), AFAQAP, GFHC (French Group for Cyto. Hematology), SFCC (French Society for Clinical Cytology) Spanish Society of Health Informatics Vendors n n n Began in 2004, first meeting 5 september 2005 Modalities: Leica Micro. Systems, Zeiss, 3 d 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 n Working groups about pathology workflow (PWF) ¨ Specific n n Specific new attributes are needed in DICOM First issue: Whole Slide Images (WSI) ¨ Digital n n workflow images (including WSI) for daily practice Non specific issues about storage & access to “large images” Agenda? n n Ad-hoc working group within WG 6 New DICOM WG for pathology (P-DICOM)

Objectives n Defining the specific workflow in pathology ¨ Defining n specific IHE integration profiles Making the best use of existing standards to operate this WF HL 7 ¨ DICOM ¨ Others: BPML, OWL, … ¨

Pathology workflow (P-WF) & standards Cyto & Histo pathology Hematopathology IHE Wf. MC Patient registration DICOM HL 7 OWL Order DICOM WL HL 7 v 2 ADT HL 7 v 2 & v 3 Messages (Order) Image Acquisition Multimodality GPWL, Mod WL, Post Process-WL, Compression, Color Presentation Report Image & Report Access Evidence Documents DICOM SR WADO HL 7 v 3 CDA SNOMED CT, ontologies, etc…

Images in pathology Blocks and Slides are the primary archive n They contain much more info than any individual file even WSI n They need iterative and multimodalities studies for catching the info inside the specimen in a diagnostic perspective n Gross imaging ¨ Still images & Whole Slide Images (WSI) ¨ Tissue Micro Arrays (TMA) ¨

Images in pathology Gross imaging Sampling for histology Sampling for tissue bank 4 2 2 2 3 3 1 1 5 6

Images in pathology Still images & Whole Slide Images (WSI)

Structure model of objects in Preprocess of Pathology Service (Make slides and Scan*) Patient Study: One report will be made corresponding to the order Series Image Order Removed organ Biopsy specimen Gross Image Cutting Drawing Image Block Removed organ Biopsy specimen Glass slide Whole slide Image (Virtual slide only)* *Note: In case of optical microscopy, no-whole slide image

Images in pathology Tissue Micro Arrays n Hundred of patients …etc…

DICOM & Pathology Historically: Visible Light (WG-13) n First issue: Storage & access to “large data sets” (Whole Slide Image) n Enhanced CT, MR & XA IODs, OP IOD ¨ Base standard (WG-06) ¨ Compression (DICOM WG-04) ¨ n JPEG 2000 in DICOM files (Supp 61, supp 105, 106) ¨ Data Streaming & Multi-Component Compression

DICOM & Pathology n Specific DICOM WG in pathology ¨ “Good” definition of imaging folder and related information ¨ Acquisition context ¨ Multimodality management: transfer between equipments from different vendors n n n 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 4 3 2 2 5 1 6

Multimodalities issues Link with radiological images

Histo and Cytopathology + Hematology needs User side n n Clients need be able to build an optimized Work. Flow 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 (x 20 to x 40) 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 n Vendors provide for different WSI system offering 2 d, 3 d 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 n 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 n n n PACS systems manage only images which are DICOM-compliant DICOM files are limited in size to 2 GB Most DICOM components cannot use the vendors files ¨ ¨ n TIFF files with a tiled and pyramidal organization jp 2 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

Agenda? n Whole Slide Image: Ad-hoc working group within WG 6 ¨ Vendors: Aperio, Dmetrix, Leica Microsystems, Zeiss, 3 DHistech, Tribvn, Samba Tech, Apollo, Aurora, Trestle ¨ Users: UPMC, Harvard, AFIP, ADICAP-France n New WG for pathology ¨ Members from LDIP, ATA, IHE Japan & IHE-Europe

DICOM with JPIP: Diagram