As pathology is going digital our need for standardization is plain as day. For this DICOM (Digital Imaging and Communications in Medicine) is a necessary step on the standardization journey offering independence on scanners and connected software solutions. However, the road to standardization comes with a series of bumps along the way.

DICOM makes medical imaging information interoperable. Its core function is to integrate image-acquisition devices, PACS, workstations, VNAs and analysis software from different manufacturers such as Visiopharm. People are actively developing and maintaining it to meet the evolving technologies and needs of medical imaging, and it is free to download and use (source: https://www.dicomstandard.org). 

​​Not quite there yet

In my opinion, DICOM isn’t developed enough to be used as an out-of-the-box solution. We’ve taken the first steps in using DICOM in clinical practice and have gotten quite far since I wrote about standardizing digital pathology in 2014. Nonetheless every customer who joins DICOM today will be doing pioneering work and should be aware of it.

There is more to DICOM than meets the eye, as DICOM doesn’t only consist of the file-format, but also a series of standardized communication components. 

In recent Connectathons, it has been demonstrated that it is possible to use DICOM to create a vendor-spanning configuration consisting of a scanner, archive, and viewing. However, there is still too little practical experience on how such systems behave and prove themselves in routine operation over a more extended period. 

​The missing piece – or at least one of them

There is still an important component missing to have a complete DICOM scenario, and that is the IHE-PaLM/DICOM compliant communication with the Pathology LIS/LIMS. The standardization committees (WG26 / IHE-PaLM) are just now considering which technology should be the standard in the future. Today a proprietary solution is still needed to enable communication between the scanner and Pathology LIS/LIMS to exchange the metadata.

From Visiopharm’s point of view, our solution already supports quite a few image formats and DICOM implementations, such as pyramid structure, z-stacks, concatenations, and storage commitment to name a few. However, there are many shortcomings. Alone in reading info from image data, scanners currently only support RGB brightfield scans. Currently, Multispectral/fluorescence images are not supported.

The potential is there

All in all, the idea of DICOM is excellent, and the experiences from past Connectathons are quite convincing and promising.  Adding to this, several pioneering hospitals such as VGR in Sweden have implemented a version of DICOM including streaming from VNA.

However, DICOM in digital pathology still needs time for development, validation, and verification. Every customer who gets involved with DICOM is to be welcomed, as they contribute to advancing the DICOM standard in digital pathology. It is important that they are aware of the given situation and all its consequences if we are to succeed with DICOM.

Do you want to know more about Visiopharm’s integrations? 

Download our Connect brochure and find out how Oncotopix® Diagnostics seamlessly integrates with a laboratory’s existing LIS/LIMS, IMS, PACS or VNA system; technologists and pathologists will access the solution through this familiar environment. 

It’s now possible for you to download the new 2018.9 version of VIS. It includes major improvements to Viewing, APP Development and handling of Overlays. The new release also allows you to run our two new state of the art products within the field: AI Deep Learning and ​Phenomap. 

Please note that this release is for Research Use Only. Download VIS 2018.9

​​​​​​​​​​​​​​​​​​​​​​​​​​New features include

New and Improved APP Author Dialogue
All the menus for the APP Author are now in a one-page view. This makes it easier for you to access relevant features and define image classes directly in the APP Author Window.

You are guided through the different steps of the APP development workflow with our new Quick Guide Help dialogue.

Free Rotation of Images
An enhancement of the software now allows you to rotate images freely – Try it out! 

Wheel Menu Updates

Easier access to a range of different overlay drawing tools including additions such as an eraser, arrow etc.Enter your text here …

Training videos

Watch training videos explaining all the functionalities of the New Wheel Menu and the APP Author dialogue in our Customer Center. You can find them under Training Videos & Webinars – Getting Started – Upgrade to 2018.9.

The ability to align and subsequently analyze digitized serial sections is gaining importance for a number of research and diagnostic applications related to tissue based biomarkers.

Tumor Cell Detection:

 One popular application is tumor detection using tumor markers such as Cytokeratin, Melan-A, or other immunohistochemical (IHC) tumor markers. Also H&E stained tissue sections can be useful for tumor detection, despite obvious and well known limitations in robustness and dynamic range.

Tumor Micro Environment:

In research applications requiring a quantitative description, e.g. tumor micro-environment, it is often important to be able to look at the co-localization of multiple biomarkers. Here, the alignment of serial sections is a highly efficient approach (see example above).

Visiopharm’s Tissuealign™ module on alignment of any number of whole slide images of serial sections was granted first in Europe, and then subsequently in the United States in 2012.

Visiopharm’s patented alignment technology VirtualDoubleStaining™ (VDS) consists of two crucial steps: First, an alignment at low magnification that handles rotation, translation, and local deformations in the tissue samples. Then a second step where the alignment at high-magnification is based on the knowledge established in the first step, and then used for aligning local regions at high resolution.

In practical terms, it will be difficult to implement alignment methods with sufficient computational efficiency, speed, and accuracy for whole slide images, without using this approach, which was also the basis for Visiopharm’s patented algorithm.

This fast and highly accurate technology is implemented in the Tissuealign™ module. The module can be used for a range of practical applications, and is currently being used in routine diagnostics and by leading biopharmaceutical companies for drug development and biomarker discovery. Examples are Virtual Double Staining for tumor cell detection using IHC or a more rudimentary H&E. It is simple and efficient to implement this useful principle either for full sections, and Visiopharm is the only company who also has an efficient integration of this principle with TMA workflows. Any number of serial sections can be aligned, and subsequently analyzed simultaneously using Visiopharm’s suite of image analysis modules.

There are a number webinars available on Visiopharm’s YouTube channel on the technology: “VirtualDoubleStaining^TM for beginners” and you can also view the title “Virtual Double Staining: A New Approach for Combining Biomarkers in Research.”