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MINUTES
DICOM WORKING GROUP TWENTY-SIX
(Pathology)
February 27, 2011
Called to order: 8:00 AM CST
Meeting closed: 11:55 AM CST
Presiding Officer: Michael Meissner
Attendance:
ORGANIZATION
3DHistech
AGFA
AGFA
Aperio
Aurora
Barco
Barco
Cerner
College American Pathologists
Dako
Elekta Impac
GE Healthcare
Genetix – Leica
ICCS
i-Path
Mass General Hosp
Motic
Newport Instruments
Omnyx
Philips
Sunquest
Vastro Gotalands Regioneu
Person
Varga, Viktor
Galbrun, Jerome
Huszka, Csaba
Eichorn, Ole
Smith, Matthew
Besnehard, Quentin
Willaert, Stephane
Nolen, JD
MacDonald, Jim
Schmid, Joachim
Macmillan, Rob
Solomon, Harry
Burke, Julian
Holden, Jeannine
Hamilton, Peter
Gilbertson, John
Chen, Jin
Leif, Robert
Meissner, Michael
Van Wijngaarden, Hans
Page, Kenin
Wintell, Mikael
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DICOM WG-26 – Pathology
February 27, 2011
Work Items assigned:
1. Michael Meissner to look into how to accomplish a better audio experience for remote
attendees.
2. Harry Solomon to formalize the multi-spectral presentation state (keep research in mind,
not only the clinical use)
3. Harry Solomon and Michael Meissner to continue the (offline) dialogue with flow
cytometry community.
4. Harry Solomon to contact HL7 AP and GS1 to establish dialogue around specimen ID.
5. Need to define first set of Procedure (Steps) and parameters:
a. bright-field scanning (device independent)  John Gilbertson
b. Higher-level basic stain parameters  John Gilberston / Julian Burke / Harry
Solomon
c. Higher-level post-processing request(s)  TBD
d. Grossing image  TBD
6. Michael Meissner and others to try to get reference labs involved in WG26
7. Michael Meissner to update and discuss the WG26 strategy document at Helsinki
meeting.
8. Everybody is asked to reach out to pathologists to get more participation and input.
Having John Gilbertson is great but having a few more pathologists would be very
helpful
Notes:
The meeting began with a welcome and brief introduction to the planned agenda of the meeting.
We welcomed those present and asked people to introduce themselves.
We then began working through our agenda items:

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WG26 Strategy document – Michael Meissner (postponed to next meeting)
Multispectral / ICC – Harry Solomon
Flow Cytometry Update – Jeannine Holden, Harry Solomon, and Michael Meissner
HL7 AP SR Update – John David Nolen
WG08 Reporting Update – Harry Solomon
Bar Coding – James MacDonald
DICOM Worklists – Harry Solomon
Future Meetings – All
Additional material is available:
 Multi-spectral, specimen tracking, and DICOM Worklist: ftp://d9workgrps:goimagego@medical.nema.org/medical/private/dicom/WORKGRPS/WG26/20
11/2011_02_San_Antonio/Topics_for_20110227.ppt
 Christel Daniels AP SR slides: ftp://d9workgrps:goimagego@medical.nema.org/medical/private/dicom/WORKGRPS/WG26/20
11/2011_02_San_Antonio/20110225_IHE_AP_DICOMWG26.ppt
Some of the discussion highlights are listed below:
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DICOM WG-26 – Pathology
February 27, 2011
Multispectral / ICC: (see H.Solomon discussion slides 2-10)
Bas Hulsken had prepared a proposal how to implement something along the lines of ICC for
multi-spectral data. In the absence of Bas, Harry explained the topic and suggested to instead
utilize a multi-spectral presentation state, similar to what is done for blending PET and CT data.
Had a broad discussion on what is needed to properly do unmixing of multi-spectral data (even
ICC might not be sufficient) but reached conclusion that unmixing is responsibility of the
modality vendor. What WG26 could help with is to provide a mechanism how to store the data
so that it could be rendered by other (software) systems. Decided to refine the proposal based on
the PET/CT work, defining a multi-spectral presentation state.
Flow Cytometry:
Provided update on initial discussions (conference call) between WG26, ISAC, and ICCS
(represented by Jeannine Holden). Agreement was reached that this generally a very important
topic but that WG26 is currently not the right platform to focus on this issue. Need to resolve the
main clinical challenges in AP first. Decided to continue having separate conference calls and
Harry + Michael will attend the ICCS Conference in fall in Portland, OR. Jeannine will organize
a 2 hour session at the conference so that Harry can present on available standards and
frameworks to that community.
HL7 AP SR: (see C.Daniel slides 16-29)
JD Nolen provide an update on the recent HL7 AP SR meeting. Generally, the work is
progressing and the proposal is getting very close to “final”. From an LIS perspective, this is
good enough to go (don’t over-engineer it). The significant advantages are the backward
compatibility and that data can be moved from LIS to LIS. Michael asked how the 81 CAP
checklists and the currently support 21 templates from AP SR do fit / converge. JD mentioned
that it is time to get it implemented and over time the issue of which template(s) (structure) will
prevail will be resolved.
WG08 Reporting: (see H.Solomon discussion slides 11-12)
Harry Solomon reported on the recent WG08 work on imaging (radiology) reports encoded in
CDA, using templates developed by clinical subspecialty groups. Target is a single patient report,
with initial work based on the 100+ templates from RSNA. John Gilbertson commented that
what WG26 needs is a specimen report, not a patient report. Harry clarified that a specimen
report is temporary / intermediate report that could potentially flow in, leading to the actual
patient report. The framework / structure would allow for that, especially for measurements
made in DICOM Structured Reports that should be importable to CDA. More progress is going
to be made in the months ahead.
Bar Coding: (see H.Solomon discussion slides 13-16)
James MacDonald mentioned that CAP and others share concerns and are looking into how to
improve patient data and reduce mismatched labels due to a lack of standard of where to put
them and how to ensure their integrity over time. Question came up on whether this is related to
the physical bar code or the actual ID stored in the bar code. Clarification lead to the ID being
the issue as different vendors store different information in the bar code, some a proprietary
token that has no meaning and hence leads to the issue of having multiple bar codes on slides.
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DICOM WG-26 – Pathology
February 27, 2011
Harry mentioned that bar code formats and reliability is defined by standards such as ISO. In
addition there is a Healthcare division in GS1 (global supply chain labels standard), which has
some expertise applicable to this issue. Their solution does include a prefix for a (global) site
context identifier. Agreement was reached that a unique specimen ID is essential and Harry
mentioned that HL7 AP work group should parent this effort but that one would need to start the
dialogue / bring together / work with IHE and GS1.
DICOM Worklists: (see H.Solomon discussion slides 23-40)
Harry Solomon introduced the framework of DICOM Worklists and its basic concepts. John
Gilbertson mentioned that accession might come from AP but likely not from clinician. Harry
clarified that there still would be an order that stipulates the work but that maybe we need to fill
a gap. John Gilbertson said it might work if the imaging is using DICOM Worklists but that
more than just imaging should be addressed. JD Nolen suggested a trial / demo between LIS and
imaging vendor but that also lab systems could be included in such a trial / demo. Joachim
Schmid mentioned that all LIS are different and the market, especially outside the US, is very
fragmented. Discussion evolved around what would be the best first steps to take, aside from
imaging, and what would the parameters of such procedure (steps) look like? Agreement was
reached that device specific settings should be handled by the modalities but that a higher level
of parameters more closely related to the pathologist needs would need to be defined.
There was a consensus reached that DICOM Worklists would be an appropriate framework for
establishing connectivity between lab equipment, LIS, modalities, algorithm, and viewing
software vendor and that we should take a stab at defining a few procedures and related
procedure steps to get started. Harry mentioned that the first Connectathon in 2012 could then
serve as platform for testing connectivity between vendors supporting this. The first procedure
(steps) are:
1. Scanning bright-field images
2. Staining
3. IHC post-processing workflow (quantification)
4. Gross-image, including annotations
John Gilbertson added that the “blue dot” is really the only valuable / important annotation.
During the call, Mikael Wintell asked a question:
When they state share or exchange what do they mean? about AP SR and IHE, outlined
something like using existing IHE integration profiles to share an exchange pathology
information. reason for my question is the ability to share and collaborate with not
finalized clinical information
When it comes to DMWL we need to take a more longer perspective than we did within
radiology. how will the workflow look like when sharing information created in one
department and read and reported within another dept.?
Intra LIS workflow is also a vital detail to look into, in radiology we needed to
implement a new status (pause) that the sending RIS stated within that case during the
information went to another RIS
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DICOM WG-26 – Pathology
February 27, 2011
Harry Solomn responded:
The APSR Profile is a content profile for a CDA document, and is agnostic to the
transport mechanism, or to the finalization/signature status of a particular document
instance. The IHE Cross-Enterprise Document Sharing (XDS) Profile, a transport
mechanism, does not itself restrict the types of documents that are shared or their status,
although a particular health information exchange organization that uses XDS may
impose restrictions. In summary, there is no prohibition on sharing unfinalized reports,
but you may not want to do that in an XDS environment intended for broad sharing of
patient information. There are other IHE XDS-related mechanisms (e.g., XDR point-topoint sharing) that may be more appropriate for sharing unfinalized reports. Additionally,
there is the IHE XDS for Imaging (XDS-I) profile for sharing “evidence data”, e.g.,
images and other preliminary information stored in a DICOM repository (PACS), that
typically stays within the department.
The issue of cross-departmental workflow is interesting, and I suppose this is getting to
your concern about sharing unfinalized reports. First, note that DICOM Modality
Worklist is really oriented toward relatively simple technical work steps that typically
(although not always) produce some evidentiary output (e.g., images) from a particular
type of device. In the DICOM Modality Worklist model, there is no “paused” state for a
procedure step. A modality performed procedure step can be Discontinued, and noted as
being ended for a particular reason. The definition of a procedure step involves the
resources assigned to perform it, so in a production environment if the step is no longer
being done with the assigned resources, that step is over and the device needs to move on
to the next piece of work.
I should have noted in the meeting that there is a similar broader purpose (and somewhat
more complex) DICOM SOP Class, Unified Worklist and Procedure Step (UPS), that is
better suited to more (human) analytic tasks, such as diagnostic reporting. However, it is
new, and in fact Final Text has not yet been published. That service does indeed allow a
performing system to report its progress as “Suspended” (although this is simply a textual
indication within the “In Progress” status). In UPS, actors separate from the worklist
manager (e.g., a user on an independent diagnostic workstation) are able to dynamically
create new procedure steps on the manager and monitor their status. Under MWL/MPPS,
only the worklist manager can create worklist entries.
As mentioned prior to this meeting, recommended reading on this topic is again the IHE
Radiology Technical Framework, volume 1, section 3 (Scheduled Workflow) which begins on
page 41.
http://www.ihe.net/Technical_Framework/upload/ihe_tf_rev9-0ft_vol1_2008-06-27.pdf
Future meetings:
We discussed that holding the meeting in Helsinki will be important to continue the dialogue
with the European community, even though the HL7 AP meeting will have a “lighter”
attendance. This meeting would be a joint meeting with HL7 AP and Jacques Klossa will
coordinate the room with Marcial Garcia Roji and schedule with Christel Daniels. We decided to
consider another US meeting in the fall, likely coinciding with the Pathology Visions conference
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DICOM WG-26 – Pathology
February 27, 2011
in San Diego. In addition, some of us will be attending the IHE / HL7 AP WG / HL7 Imaging
Integration WG meeting on May 16-17 in Orlando, FL, to establish and continue the dialogue
around specimen tracking.
We agreed on at least two more meeting dates and locations for 2011:
 Late August 2011, in conjunction with European Congress of Pathology, Helsinki,
Finland.
 October at the Pathology Visions conference, San Diego, CA
An additional meeting will be considered if needed.
Reported by:
Michael Meissner, Co-Chair
March 10, 2011
Reviewed by counsel:
March 17, 2011
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DICOM WG-26 – Pathology
February 27, 2011