Home >> ALL ISSUES >> 2017 Issues >> ‘Connectathon’ opens door to interoperability in digital pathology

‘Connectathon’ opens door to interoperability in digital pathology

image_pdfCreate PDF

Valerie Neff Newitt

December 2017—With the FDA having approved whole slide imaging for primary diagnosis this year, one obstacle to full acceptance of digital pathology remains: lack of interoperability. To topple that barrier, the Digital Pathology Association, the CAP through its Digital Pathology Committee, and DICOM Working Group 26 convened in October, during the Pathology Visions conference, the first Connect­athon for digital pathology.

“The uptake of digital pathology hasn’t been as rapid as everyone had anticipated,” says Liron Pantanowitz, MD, professor of pathology and biomedical informatics, University of Pittsburgh Medical Center. “Many pathology departments know that if they purchase a digital pathology system it will not be easy to bring it back to the lab, plug it in, and get it to interact with everything else. There has been no plug-and-play option in digital pathology, and that has been a huge stumbling block.”

Dr. Parwani

Dr. Parwani

Dr. Pantanowitz, a member of the CAP Digital Pathology Committee, says Connectathon was a milestone almost as big as the FDA’s recent approval itself. “Connectathon not only provided a venue for connecting machines able to talk to each other, but also it connected an entire industry with a commitment to move digital pathology forward.”

Anil Parwani, MD, PhD, MBA, a member of the CAP committee and a professor of pathology, vice chair of anatomic pathology, and director of pathology informatics and digital pathology shared re­sources, Ohio State University Wex­ner Medical Center, says of Connect-athon: “We thought it would be great if we could bring vendors together and have them show us that, yes, they can all connect and, yes, we can use standards”—in the way radiology does, for example—“and, yes, we can share these images.”

By all accounts, “yes, yes, and yes” were on full display at Connectathon, and a pathway to industry cooperation and digital pathology progression was blasted wide open.

One of the goals of Connectathon was to raise pathologists’ awareness that using DICOM for interoperability in digital pathology does work, says Bruce Beckwith, MD, one of Connectathon’s organizers and initial co-chair of DICOM Working Group 26. “We needed a public demonstration to proclaim, ‘We have a DICOM standard, and it is a good thing. Now use it,’” says Dr. Beckwith, chair of pathology at North Shore Medical Center, Salem, Mass. Support for whole slide imaging in DICOM—the Digital Imaging and Communications in Medicine standard for handling, storing, and transmitting images—was approved in 2010 and took the form of supplement 145, developed by DICOM Working Group 26.

But important questions have yet to be answered. Since the FDA approval in April of the Philips IntelliSite Pathology Solution for primary diagnosis, the CAP Digital Pathology Committee and the Digital Pathology Association have been getting a lot of questions from pathologists. Says Dr. Parwani: “Concerns range from ‘How do we store these images? What do we do when they are displayed?’ to ‘What is the end point of these images? What will happen to them? How will we have interoperability between these systems?’” The questions are right on target, Dr. Parwani says, because “even though we’ve been making digital slides for many years now, we’ve been using them in silos—in pathology departments.”

Pantanowitz@2x

Dr. Pantanowitz

Lab information systems and digital pathology systems need to be connected bidirectionally from this point on, Dr. Pantanowitz says. “We need to be able to run certain applications, such as image analysis algorithms, or cloud storage, on top of digital pathology platforms. But it has all been lacking because there hasn’t been one standard for the vendors to follow.” Instead, he adds, each digital pathology system is proprietary and “locked down.”

“What would happen if the manufacturer of a digital pathology platform were to go out of business? How could pathologists access slides locked away in a defunct closed, proprietary system?”

Connectathon organizers, DICOM supporters, and others want to unlock closed systems. A precedent has been set in radiology, where the DICOM standard has been used for years. “There is no reason it can not work for pathology, too,” Dr. Pantanowitz says. “If everyone agrees to speak the same ‘language,’ it would be possible for all systems—LIS, scanners, viewers, software—to talk to and interact with each other. But to move digital pathology forward in this way requires vendors to cooperate, work, and ease competitiveness with each other.”

In advance of the October event, Dr. Beckwith explains, slides were sent to scanner manufacturers, with fictional clinical histories. They scanned the slides on their systems, doing whatever manipulations were needed to make the slides compliant with the DICOM interoperability standard, and then sent them to the picture archiving and communication system, or PACS. The manufacturers of viewers used DICOM compatibility to pull out the information they needed from the PACS. At the event, the viewers of the participating companies were set up side by side so attendees could look from one screen to the other to compare the images and information.

“Talking about interoperability is one thing; making it work properly is another,” says radiologist David Clunie, MBBS, who says Connectathon “served as a forcing function.” He is a medical informaticist, DICOM open source software author, and editor of the DICOM standard, and he was a presenter at Pathology Visions. “When people start turning up to look at your equipment, you have to get it right,” he says. “But there are a lot of details behind the scenes in terms of what a manufacturer has to encode and the decisions made around that data.”

CAP TODAY
X