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

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

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

  2. 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 • Vendors: Olympus, Nikon

  3. 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)

  4. 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,…

  5. 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…

  6. 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)

  7. Sampling for histology Sampling for tissue bank 4 2 2 2 1 3 1 5 3 6 Images in pathologyGross imaging

  8. Images in pathologyStill images & Whole Slide Images (WSI)

  9. 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

  10. Images in pathology Tissue Micro Arrays • Hundred of patients …etc…

  11. 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

  12. 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)

  13. Acquisition context 4 2 2 1 5 3 6

  14. Multimodalities issuesLink with radiological images

  15. 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

  16. 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

  17. 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

  18. 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

  19. DICOM with JPIP: Diagram

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