DICOM - a Standard Under Construction

As pathology is going digital our need for standardization is plain as day. For this DICOM (Digital Imaging and Communications in Medicine) is a necessary step on the standardization journey offering independence on scanners and connected software solutions. However, the road to standardization comes with a series of bumps along the way.

DICOM makes medical imaging information interoperable. Its core function is to integrate image-acquisition devices, PACS, workstations, VNAs and analysis software from different manufacturers such as Visiopharm. People are actively developing and maintaining it to meet the evolving technologies and needs of medical imaging, and it is free to download and use (source: https://www.dicomstandard.org). 

​​Not quite there yet
In my opinion, DICOM isn't developed enough to be used as an out-of-the-box solution. We've taken the first steps in using DICOM in clinical practice and have gotten quite far since I wrote about standardizing digital pathology in 2014. Nonetheless every customer who joins DICOM today will be doing pioneering work and should be aware of it.

There is more to DICOM than meets the eye, as DICOM doesn't only consist of the file-format, but also a series of standardized communication components.

In recent Connectathons, it has been demonstrated that it is possible to use DICOM to create a vendor-spanning configuration consisting of a scanner, archive, and viewing. However, there is still too little practical experience on how such systems behave and prove themselves in routine operation over a more extended period. 

​The missing piece – or at least one of them
There is still an important component missing to have a complete DICOM scenario, and that is the IHE-PaLM/DICOM compliant communication with the Pathology LIS/LIMS. The standardization committees (WG26 / IHE-PaLM) are just now considering which technology should be the standard in the future. Today a proprietary solution is still needed to enable communication between the scanner and Pathology LIS/LIMS to exchange the metadata.

From Visiopharm's point of view, our solution already supports quite a few image formats and DICOM implementations, such as pyramid structure, z-stacks, concatenations, and storage commitment to name a few. However, there are many shortcomings. Alone in reading info from image data, scanners currently only support RGB brightfield scans. Currently, Multispectral/fluorescence images are not supported.

The potential is there
All in all, the idea of DICOM is excellent, and the experiences from past Connectathons are quite convincing and promising.  Adding to this, several pioneering hospitals such as VGR in Sweden have implemented a version of DICOM including streaming from VNA.

However, DICOM in digital pathology still needs time for development, validation, and verification. Every customer who gets involved with DICOM is to be welcomed, as they contribute to advancing the DICOM standard in digital pathology. It is important that they are aware of the given situation and all its consequences if we are to succeed with DICOM.

Do you want to know more about Visiopharm's integrations?
Download our Connect brochure and find out how Oncotopix® Diagnostics seamlessly integrates with a laboratory's existing LIS/LIMS, IMS, PACS or VNA system; technologists and pathologists will access the solution through this familiar environment.

About the author

Martin Kristensson, M.Sc. - Senior Vice President, Sales Europe 

Martin Kristensson is Senior Vice President, responsible for sales in Europe, leading the EU based sales team. He received his M.Sc. in Biomedical Engineering from the Technical University of Denmark in 2011, specializing in Signal and Model-based Diagnostics, combined with Image Diagnostics and Radiation Physics. In 2014, he became a certified Project Manager.

Together with his team, he coordinated the development of Visiopharm's clinical products, and the change management processes used to implement the tools in the daily clinical routine across Denmark. In close collaboration with colleagues and customers, he continues to investigate new applications of image analysis within pathology, pursuing new ways of offering standardized high-quality data and diagnosis.

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