DICOM in Digital Pathology… What’s Next?

May 21, 2024

DICOM has become the “de facto” standard for digital pathology imaging, providing a robust framework for image management, interoperability, and data exchange. Despite the potential benefits, the widespread adoption of DICOM in digital pathology remains very low. Important issues regarding the sustainability of using the standard remain unanswered:

  • Very few scanners can natively output DICOM even today.
  • The DICOM standard could make proprietary images larger, increasing storage costs.
  • DICOM wasn’t originally built for digital pathology, and further development is required.

Martin Weihrauch, MD, Specialist in Digital Pathology and Radiological Imaging, emphasized the need for improved DICOM integration: “For anyone who works for a scanner company: please create a single file-for-all-zoom-layers DICOM. Everything else is just terrible for transporting the images...”

Nikola Apostolov, the CEO of Tiger Health Technology, added to the discussion: “While interoperability is crucial, there are other important considerations to address, such as the storage costs associated with lossless WSI in DICOM. Data sizes for large hospitals are projected to reach 5-15 PB over the retention period, making this a growing concern. Additionally, compressed files may not be suitable for AI applications, and determining acceptable standards requires expertise and informed decision-making. We need to balance interoperability, storage costs, and data quality to find sustainable solutions”

Key questions moving forward

“Although the exact timeline is unclear, the adoption of DICOM in pathology is inevitable” concluded Alexandra Bream from Signify Research in a recent publication. DICOM’s Working Group 26 (WG-26) started in 2005 to develop and extend the DICOM medical imaging standard for pathology and whole slide imaging (WSI). Continued development and adoption of DICOM for digital pathology, along with the integration of DICOM-compatible systems, will facilitate interoperability and streamline processes in the field. To realize the full potential of DICOM in digital pathology, several critical questions must be addressed:

  • How can we speed up DICOM adoption?
  • How can we centralize the process and/or make sharing easier?
  • How can DICOM support AI adoption?

Our commitment at Tiger Health Technology

At Tiger Health Technology, we are actively working on solutions to these challenges through our software platform for lifecycle management of unstructured medical data - ‘Health BRIDGE’. We collaborate with scanner manufacturers, software developers, and healthcare institutions to support joint efforts to integrate DICOM into existing systems. We introduce the hybrid approach to cloud adoption and facilitate secure sharing, storage, and retrieval of medical images. We enhance DICOM metadata to accommodate AI-specific information, including annotations for example.

Our 'Health BRIDGE' platform can potentially convert proprietary medical imaging formats into DICOM, preserving image integrity and diagnostic value while ensuring future-proof interoperability. We are dedicated to advancing the field of digital pathology by providing innovative tools that could speed up the adoption and usability of DICOM standards.

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