Clinical pathology laboratories will soon archive digital pathology images in their hospitals’ PACS


Digital pathology moves one step forward toward true “plug and play” with the recent approval of the DICOM supplement 145. These are the technical specifications that support whole-slide digital pathology images. Approval of these standards now makes it possible for clinical laboratories and pathology groups to store digital pathology images in a form that is compatible with the same DICOM archive systems used by hospitals and other providers to store radiology images.

The approval was issued in August and is a direct result of five years of work by the DICOM Working Group 26. There is a key benefit to DICOM supplement 145. When whole slide images and associated information are formatted to its specifications, it will be possible for an anatomic pathologist to retrieve and manage those images—regardless of which manufacturer’s digital pathology system produced the image.

New Digital Pathology Standards

The new DICOM supplement 145 standards are expected to accelerate acceptance and use of digital pathology images in two ways. First, by design, use of these standards will make it possible for existing PACS systems used in radiology and other medical imaging modalities to archive digital pathology images. For pathologists in multi-hospital systems, this feature means their digital pathology images can be archived in existing PACS systems, making it easier to share images across the clinical service sites in the health system.

Second, by intent of DICOM Working Group 26, DICOM supplement 145 standards will allow vendors to design and sell DICOM-compatible scanners and digital pathology systems. In coming years, this will encourage an “open systems” market for digital pathology products. That, in turn, is predicted to bring about wider adoption of digital pathology technology by the nation’s 3,300 anatomic pathology group practices.

In its August 25, 2010 blog, Aperio Technologies, Inc., of Vista, California noted that the DICOM 145 supplement includes the following standards:

  • One major new DICOM Information Object Definition (Whole Slide Imaging) with new concepts to manage the huge WSI data set,
  • A major revision of a DICOM Information Entity (Specimen) with a rigorous information model,
  • 56 new data elements added to the DICOM Standard in 14 new or revised modules,
  • 7 new or revised DICOM structured data templates and 18 new defined value sets,
  • 80 new coded terminology concepts added to SNOMED, and 36 added to DICOM,
  • 40 pages of explanatory information about pathology workflow and imaging.

Experts observe that this feature now makes it possible for vendors to manufacturer and sell “open” systems. Currently, almost all digital pathology systems available for purchase have proprietary aspects that make it difficult for pathologists to share whole-slide images that will allow pathologists and clinical laboratory managers to buy best-of-breed systems.

This is a transformative event in pathology. It marks another milestone on the path to full integration of healthcare information. Digital pathology images formatted according to these specifications will certainly be made available through the growing number of health information exchanges (HIE) that are becoming operational in different regions across the nation.

Whole slide imaging equipment manufacturers, along with EHR, LIS, and PACS vendors, are likely to begin competing with features in their products that handle digital pathology images that comply with the new standard.

Harry Solomon, who is the Interoperability Architect at GE Healthcare, and Supplement 145 Editor agrees. In a press release, he stated that “Use of the single standard for medical imaging, DICOM, means that we can foresee better clinical integration across radiology, pathology, surgery, and radiation oncology, enabling a comprehensive evidentiary trail from screening to biopsy to diagnosis to treatment.”

Related Information:

DICOM supplement 145 approved! – Whole-slide microscopic images

All aboard—new DICOM standard for digital images

2101 Project Week DICOM Supplement 145

Digital Imaging and Communications in Medicine (DICOM)