The PACS is capable of reviewing the DICOM image format. It is the international standard for medical images and all the related information that comes with them, and it’s been used in radiology for the past 20 years, Dr. Yousif says. “They solved the compatibility issue more than 20 years ago.”
With PACS, going forward, pathology will follow radiology’s lead by eliminating the need for multiple platforms. We want to “put everything together in one digital platform—or, as we call it, a digital cockpit—to view all digital images at one time, not have to minimize or use multiple windows or go back and forth.”
The infrastructure for the PACS platform “has already been built within the radiology system,” Dr. Yousif explains. “So I encourage institutions that are trying now to move into digital to start communicating with the radiology team. Ask them if they have a solution that can read DICOM pathology, specifically called slide microscopy modality for DICOM pathology.”
As one of the co-chairs of the DICOM Working Group 26, Dr. Yousif helps advocate for standardization through adoption of DICOM. “Every other year we do a lot of work to provide proof of concept that we can integrate DICOM with multiple scanners, we can integrate with multiple PACS or digital platform systems as well as multiple vendor-neutral archives, and we use it even right now for annotation or artificial intelligence applications.”
“Our problem is that nobody within the U.S. can share DICOM pathology for the clinical diagnosis. Right now we have the portal if they want to send some proprietary format.” However, that image by itself, called a naked image, has no patient information, no protected health information, and no medical record number, he explains. “There is nothing so that I can recognize the case. But with DICOM, the metadata can be embedded within that image.” If pathology departments were to use this pathway with DICOM, “it would at least reduce the amount of technology that every department has to put in their budget every year” to reinterpret incoming information, he says.
Within Michigan Medicine, the departments have deep knowledge of DICOM, Dr. Yousif says. “All we need is to push the scanner and the image viewer vendors to adopt standardization.” But machine learning and AI make this a critical moment, he cautions. “An institution might have only one AI-based application that can, for example, detect all the micrometastases or all the tumor invasion for a given organ system in a patient. But the specific input and output data formats in use by this proprietary application might not be generalizable, and this limitation is a substantial barrier to widespread adoption.” DICOM use will allow for greatly simplified deployment of such algorithms across all IMS platforms, he says, as the DICOM standard enforces algorithmic compatibility with its standardized image formats and structured data types.
The workflow differences between pathology and radiology are well known, Dr. Yousif notes, but multiple PACS are already available that can read pathology and radiology. “One is Sectra, which has already been validated, and the FDA has also cleared another scanner for DICOM pathology for clinical use.”
“The rollout of the pathology department’s new workflow was one of the cleanest and most uneventful go-lives I can remember,” Dr. Balis says. Dr. Yousif, who led the rollout, gives some credit to the multiphase process they are using into January and beyond: “We are scanning 100 percent of our slides, every surgical pathology image, from bright-field, from immunofluorescence, from whole mount, from frozen section, polarization scanning, and also they have a PACS which is immunohistochemistry staining. Everything is fully digitized.”