dicom, the enterprise, and digital pathology · standards-based communications (dicom, hl7, web...
TRANSCRIPT
DICOM,the Enterprise,and Digital Pathology
David Clunie ([email protected])Pixelmed Publishing, LLC.
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Enterprise Image Repository, Interface EngineModality Worklist Services
Standards-based Communications (DICOM, Web Services, …)
Standards-based Communications (DICOM, HL7, Web Services, …)
Digital Capture Systems
DICOM Wrap or XDS Import Software
Ope
ratin
g R
oom
s
Pat
holo
gy GI
Vid
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ourc
es
Othe
rs…
..
Med
ical
Cam
era
Impo
rt
Vid
eo C
lip Im
port
Mob
ile P
hoto
App
Imag
e Im
port
AP
I
Othe
rs…
.
CD
Impo
rt/E
xpor
t
Clo
ud S
harin
g A
pp
Por
tals
Rad
iolo
gy
Car
diol
ogy
Orth
oped
ics
Ane
sthe
siol
ogy
Oph
thal
mol
ogy
Obs
tetri
cs a
nd G
ynec
olog
y
Den
tistry
Uro
logy
Sur
gery
Rad
iatio
n O
ncol
ogy
Loca
l HIE
Group #1Native DICOM Image Sources
Group # 2Endoscopes,Microscopes,
In-room Cameras
Group # 3Photography,Video Clips,
Mobile Apps, APIs
Group # 4Image Exchange
Inputs and Outputs
Othe
rs…
. Gateways
EHR
Imaging ProcedureOrder/ScheduleMessages
Imaging Results AvailabilityMessages
Store images imported viaEHR utilities or patient portal into Enterprise Imaging Platform
Communications for viewing imaging exams data and metadata
Othe
rs…
.
ADT Messages
Enterprise Viewer(view content standalone or in EHR)
Roth et al. A Foundation for Enterprise Imaging. JDI. 2016.
Enterprise Image Repository, Interface EngineModality Worklist Services
Standards-based Communications (DICOM, Web Services, …)
Standards-based Communications (DICOM, HL7, Web Services, …)
Digital Capture Systems
DICOM Wrap or XDS Import Software
Ope
ratin
g R
oom
s
Pat
holo
gy GI
Vid
eo S
ourc
es
Othe
rs…
..
Med
ical
Cam
era
Impo
rt
Vid
eo C
lip Im
port
Mob
ile P
hoto
App
Imag
e Im
port
AP
I
Othe
rs…
.
CD
Impo
rt/E
xpor
t
Clo
ud S
harin
g A
pp
Por
tals
Rad
iolo
gy
Car
diol
ogy
Orth
oped
ics
Ane
sthe
siol
ogy
Oph
thal
mol
ogy
Obs
tetri
cs a
nd G
ynec
olog
y
Den
tistry
Uro
logy
Sur
gery
Rad
iatio
n O
ncol
ogy
Loca
l HIE
Group #1Native DICOM Image Sources
Group # 2Endoscopes,Microscopes,
In-room Cameras
Group # 3Photography,Video Clips,
Mobile Apps, APIs
Group # 4Image Exchange
Inputs and Outputs
Othe
rs…
. Gateways
EHR
Imaging ProcedureOrder/ScheduleMessages
Imaging Results AvailabilityMessages
Store images imported viaEHR utilities or patient portal into Enterprise Imaging Platform
Communications for viewing imaging exams data and metadata
Othe
rs…
.
ADT Messages
Enterprise Viewer(view content standalone or in EHR)
Roth et al. A Foundation for Enterprise Imaging. JDI. 2016.
Enterprise Image Repository, Interface EngineModality Worklist Services
Standards-based Communications (DICOM, Web Services, …)
Standards-based Communications (DICOM, HL7, Web Services, …)
Digital Capture Systems
DICOM Wrap or XDS Import Software
Ope
ratin
g R
oom
s
Pat
holo
gy GI
Vid
eo S
ourc
es
Othe
rs…
..
Med
ical
Cam
era
Impo
rt
Vid
eo C
lip Im
port
Mob
ile P
hoto
App
Imag
e Im
port
AP
I
Othe
rs…
.
CD
Impo
rt/E
xpor
t
Clo
ud S
harin
g A
pp
Por
tals
Rad
iolo
gy
Car
diol
ogy
Orth
oped
ics
Ane
sthe
siol
ogy
Oph
thal
mol
ogy
Obs
tetri
cs a
nd G
ynec
olog
y
Den
tistry
Uro
logy
Sur
gery
Rad
iatio
n O
ncol
ogy
Loca
l HIE
Group #1Native DICOM Image Sources
Group # 2Endoscopes,Microscopes,
In-room Cameras
Group # 3Photography,Video Clips,
Mobile Apps, APIs
Group # 4Image Exchange
Inputs and Outputs
Othe
rs…
. Gateways
EHR
Imaging ProcedureOrder/ScheduleMessages
Imaging Results AvailabilityMessages
Store images imported viaEHR utilities or patient portal into Enterprise Imaging Platform
Communications for viewing imaging exams data and metadata
Othe
rs…
.
ADT Messages
Enterprise Viewer(view content standalone or in EHR)
Roth et al. A Foundation for Enterprise Imaging. JDI. 2016.
Correct Misperceptionsl Digital Pathology / WSI should:
• be mainstream DICOM source like radiology (not some lame “digital capture” step-child)
• have appropriate specialty-specific viewer accessible throughout the enterprise, not just the Anatomical Pathology department, just like radiology
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DICOM – Enterprise Imaging
Archive
PACS +/- IS
Manager
Standard Boundary Standard Boundary
Camera
Slide Scanner
Modality
Modality Workstations
Analysis Systems
DICOM – Deconstructed PACS
Archive
Manager
Standard Boundary Standard Boundary
Camera
Slide Scanner
Modality
Modality Workstations
Analysis Systems
So what’s the big deal with WSI?l They’re “big”, really big
• not that much bigger than a CT/PET or DBTl DICOM pixel data encoding
• just another multi-frame, color, compressed image
l Multi-frame rather than lots of single frame• as they get larger, run into timeouts during transfer• can’t saturate transport connection with multiple
simultaneous streams
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An illustration of how digital slides are stored in a pyramid structure.
Wang Y, Williamson KE, Kelly PJ, James JA, Hamilton PW (2012) SurfaceSlide: A Multitouch Digital Pathology Platform. PLOS ONE 7(1): e30783. https://doi.org/10.1371/journal.pone.0030783http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0030783
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Baseline Image Tile
Thumbnail Image (low resolution)
Intermediate Zoom Image Tile
Baseline Image (highest resolution)
Intermediate Zoom Image (intermediate resolution)
Retrieved image region
DICOM Supplement 145Aperio, Digital Slides and Third-Party Data Interchange
Per-frame attributes
Pixel data
Shared attributes
Multi-frame v. Single Frame
Per-frame attributes
Pixel data
Shared attributes
Concatenations
Store & Regurgitate Only?
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Scanner Stores DICOM WSI
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Slide Scanner Archive
DICOM
C-STOREor STOW-RS
DICOM WSI to Black Box PACS
Standard Boundary
Slide Scanner
Slide Scanner
Slide Scanner
Slide Scanner
Virtual Microscopy Viewer Queries/Retrieves DICOM WSI
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Slide Scanner Archive
DICOM
C-STORE
Workstation
?
Virtual Microscopy Viewer Queries/Retrieves DICOM WSI
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Slide Scanner Archive
DICOM
C-STORE
Workstation
QIDO-RS
Find Images
WADO-RS
Get Metadata
WADO-RS
Get Frames
Virtual Microscopy Viewer Queries/Retrieves DICOM WSI
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Slide Scanner Archive
DICOM
C-STORE
Workstation
QIDO-RS
Find Images
WADO-RS
Get Metadata
WADO-RS
Get Frames
“DICOMweb”“Traditional” DICOM
• HTTP• JSON• XML• JPEG
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DICOM Archive Requirementsl Support WSI Storage SOP Classl Support JPEG baseline and J2K Transfer Syntaxesl Be careful at 2GB and 4GB boundaries (e.g., frame byte offset)l Pay attention to timeoutsl Accept and reassemble concatenationsl Support DICOMweb QIDO-RS and WADO-RS for viewer query,
metadata and frame level retrievall Index pathology-specific metadata for queries
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Summaryl Not all “VNAs” are created equall There is no such thing as a “universal viewer” unless
it incorporates the union of all specialty-specific navigation and visualization paradigms and features
l WSI is just another flavor of DICOM – but the devil is in the details
l There is more to WSI than just creating a DICOM file, the viewer interface and workflow are paramount
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