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MINUTES
DICOM WORKING GROUP TWENTY-SIX
(Pathology)
August 27, 2011
Called to order: 8:30 AM GMT-2
Meeting closed: 13:00 PM GMT-2
Location: Room 203 of the Exhibition & Convention Centre, Helsinki, Finland
Presiding Officer: Michael Meissner
Attendance:
ORGANIZATION
3DHistech
3DHistech
ADICAP, APHP, INSERM
AGFA
Barco
CAP
CAP/MGH
CAP
Charite
CNRS
Cornell
Dako
GE Healthcare
IHE Pathology
JAHIS
Kaunas University Technology
Leica Microsystems
Leica Microsystems
Lithuania Center for Pathology
Omnyx
PathXL
Philips
Philips
Portugal
TRIBVN
Person
Varga, Viktor
Ferenc, Szipüöcs
Daniel, Christel
Huszka, Csaba
Willaert, Stephane
Booker, David
Beckwith, Bruce
Ranaur, Ron
Schrader, Thomas
Racoceanu, Daniel
Brodsky, Victor
Skovsen, Soren
Solomon, Harry
Garcia Rojo, Marcial
Kondo, Megumi
Punys, Pytenis
O’Shea, Donal
Schutrups, Jan
Laurinauicius, Arvoyas
Meissner, Michael
McKinley, Katie
Baas, Wil
Husken, Bas
Goncalves, Luis
Klossa, Jacques
1
Role
Voting
Voting
Voting
Observer
Observer
Voting
Voting
Voting
Observer
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Observer
Voting
Voting
Voting
Observer
Observer
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Voting
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Voting
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DICOM WG-26 – Pathology
August 27, 2011
University Hospital Regensburg
University of Loughborough
University of Udine
Ventana
VGR (Vastro Gotalands Region)
University of Nottingham
Blobel, Bernd
Schaefer, Gerald
Della Mea, Vincenzo
Sabata, Bikash
Wintell, Mikael
Qiu, Guoping
Observer
Observer
Observer
Observer
Observer
Observer
Pictures from the event:
Work Items assigned:
1. Michael to revise the strategy document and circulate for final comments
2. All to provide final feedback and comments
3. Harry to coordinate room for San Antonio meeting
4. Harry to bring up report + image linking in San Diego to discuss further
5. Bas + Harry to draft proposal for muli-spectral presentation state based on ICC
6. Michael to clarify with Ron Ranaur who will lead the specimen ID effort at CAP
7. Michael to start discussion with imaging vendors to refine the scan procedure (step(s))
and what specifications would correlated to 20X and 40X
8. Harry to start discussion with Bas, Viktor, Donal, and others on stain information
9. Michael + Harry to contact LIS vendors whether they could perform if()else for scan
parameters or whether this has to be decide by scanner
10. Soren + Donal + Biash to follow-up on IHE device automation integration profiles, as
mentioned by Christel
11. All try to invite pathologists as well as lab representatives to attend this meeting
12. Michael to share slides and meeting material of all presenters
13. Michael to summarize meeting, get them approved and published
Notes:
The meeting began with a welcome and brief introduction to the planned agenda of the meeting.
We welcomed those present, asked people to introduce themselves, and re-stated the antitrust
rules. We then began working through our agenda items:
1. Upcoming meeting locations:
Discussed the locations for the upcoming meetings in 2012. Throughout the discussion, it
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DICOM WG-26 – Pathology
August 27, 2011
became clear that finding meeting locations that bring together HL7, pathologists, and
various vendors is not going to work well. HL7 has little to no pathologists and no vendors
(LIS, imaging, etc.). Will need to strike a balance and rotate co-location. Tentatively decided
on:
 October 2011: San Diego, CA
 January 2012: together with the HL7 AP group in San Antonio, TX
 June 2012” at the 11th Telepathology Congress in Venice, Italy
 Fall 2012: either at the Pathology Visions conference (San Diego, CA) or the Pathology
Informatics conference (Chicago, IL)
2. WG26 Strategy document:
Michael went over the strategy document and changes he had made ahead of the meeting.
People provided input and further edits were made and/or suggested. The few highlights that
drew more attention were:
 Linking of image information in the report and validity of data once a report is sent out to
another institution. Bernd Blobel mentioned that there are HL& and IHE efforts on the
way and that HIMS is a good platform for this. Mikael Wintell mentioned that it is
important to keep end customer in mind and XDS-I is really the standard here. Viktor
Varga mentioned that there are many use cases as hematopathologists are very interested
in the images and Christel Daniel mentioned that the 2nd opinion use case is not
sufficiently supported in XDS-I. Harry Solomon mentioned that there are gaps in report
image linking but that those are to be taken on by other groups outside WG26. Images
were never part of reports and now that they are, some challenges arise.
 Display of information. Harry Solomon referred to how calibration is done in radiology
and that larger bit depth (>8) are supported in greyscale (greyscale display function, not
yet available for color). Stephane Willaert mentioned that three are more bits in the data
than on the display which requires a mechanism to handle that properly. Harry Solomon
stated that in radiology the display of data has been left out of scope of DICOM. Bas
Hulsken mentioned that RGB supports 16 bit and that ICC defines transform. ICC
provides gamut but not dynamic range. Harry Solomon commented that it needs to be
solved but WG11 and display vendors are really the ones who need to take this on, not
WG26.
Will finalize the strategy document at the next WG26 meeting and circulate the revised draft
prior to it. The revised strategy document can be found here:
ftp://medical.nema.org/medical/private/dicom/WORKGRPS/WG26/2011/2011_08_27_Helsi
nki/WG26 Strategy - revised.docx
3. Multi-spectral Presentation State proposal:
Bas Bulsken went through his presentation, outlining his thinking and work with Harry on
utilizing the ICC framework for a multi-spectral presentation state. The advantages of the
ICC based blending pipeline are its flexibility, no need to modify the raw data, and the fact
that it is already established. The limitations would be the currently supported 16 input
channels and 3 output channels but suitable for display purposes. Bas’ presentation can be
found here:
ftp://medical.nema.org/medical/private/dicom/WORKGRPS/WG26/2011/2011_08_27_Helsi
nki/Hulsken - Proposal for DICOM multispectral blending presentation state.pptx
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DICOM WG-26 – Pathology
August 27, 2011
Harry the followed-up on painting the bigger picture of source images, sharpened images,
potential spatial registration, leading to derived images that then need to be blended.
Decided to leave sharpening and registration out and have the respective device deal with
that. The important data to the end user is what comes off the scanner, not what exists
internally on an interim basis. The ICC profile based approach would then allow the vendor
to supply the “unmixing” of the data. Michael Meissner and David Booker mentioned that
multi-plexing is coming and that registration then might become something that needs to be
considered but across separate image acquisitions. Agreed to move forward with a proposal
that utilizes the bottom path from derived images to display from slide #5 of Harry’s
presentation which can be found here:
ftp://medical.nema.org/medical/private/dicom/WORKGRPS/WG26/2011/2011_08_27_Helsi
nki/Solomon - Multispectral and DICOM Worklists.ppt
4. Flow Cytometry and Specimen ID Update:
Harry Solomon mentioned that he and Michael Meissner had a few conference calls with the
ICCS and ISAC folks on reviewing standardization opportunities of flow-cytometry data.
Recently included participants from LabCorp and Clarient. Harry will give a presentation on
standardization in medical imaging at the ICCS conference in Portland, OR, in October and
then have a brain storming session with folks there to evaluate what the future steps might be.
Briefly discussed the specimen ID project and the fact that James MacDonald is no longer
with CAP. Will need a new contact person. Bruce Beckwith mentioned that CAP reorganized
the standards / informatics group and that Ron Ranaur will be leading that.
5. DICOM Managed Workflows:
Harry Solomon presented the concept of Order, Requested procedure, and Procedure Step as
well as how this could be leveraged in pathology around the imaging related tasks. Goal
would be for users not having to set parameters manually at a scanner but to get to a fully
automated WSI generation process. For this to work, the order would have to be translated
into scan parameters for the respective WSI scanner(s). The LIS might be the location where
this is occurring. Harry Solomon also presented the current DICOM CP-1148 and CP-1149
and asked what steps the pathologists would want. Bruce Beckwith confirmed that the default
list would be sufficient. Viktor Varga suggested that rescan of ROIs a common use-case.
Donal O’Shea mentioned that with the advent of faster and better scanners, ROI use case will
become obsolete and Bruce Beckwith confirmed that this seems right. Bas Hulsken
commented that the multi-spectral scanning might be an exception due to the large amount of
data and Bikash Sabata suggested for the pathologists draw ROI. Bruce Beckwith was not in
favor as he would not want the pathologist to become a bottle-neck, just scan it all. Viktor
Varga raised the issue of focus computation in empty areas and asked by “scanning all”
whether it means “scanning all areas” or “scanning all tissue”? Bruce Beckwith clarified that
he would not want to scan truly empty areas but for the tissue segmentation to be by-passed.
Michael Meissner asked what 20X and 40X truly mean. Discussion went along the lines of
microns per pixel, placing 20X into the range of 0.5 micron while 40X is in the range of
0.25micron. Reached consensus that the concept of 20X and 40X has meaning to
pathologists and that they would request that but that each one of those then has technical
specifications associated with and a scanner would chose best match to perform the actual
scan. Stephane Willaert mentioned that the microns still need to be translated onto the screen
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DICOM WG-26 – Pathology
August 27, 2011
(resolution). Decided that the screen (resolution) is a separate issue that needs to be dealt
with by the display application but that the requested scan as part of an order should be tied
to the meaningful terms “20X” and “40X”. Thomas Schrader mentioned that during the first
scanner contest they noticed that 40X images were not as good as the 20X ones. Michael
Meissner mentioned that there are other factors such as quality of the optical path, NAV,
FOV, etc. Decided not to hard code the scanning as part of the procedure step but to leave it
at “20X” / “40X” but to provide technical specification guidelines of what those are expected
to mean on the scanning side.
Secondly, we discussed the request of a staining procedure where the bulk of work will be
H&E. Bas Hulsken raised the issue of mixed stains. Donal O’Shea mentioned that the
information of tissue type and stain is important for the scanner to scan properly. Harry
Solomon asked for what the codes are and Donal O’Shea replied that there are many
permutations. Bas Hulsken suggested stipulating those from the outside. Need to follow-up
on this offline.
Harry’s slides can be found here, starting with slide #10: ftp://d9workgrps:goimagego@medical.nema.org/medical/private/dicom/WORKGRPS/WG26/2011/
2011_08_27_Helsinki/Solomon - Multispectral and DICOM Worklists.ppt
6. IHE / Pathology Workflow(s):
Thomas Schrader presented high-level workflows. Mikael Wintell commented that
telepathology is deep down and asked why the LIS is not deciding whether or not a
telepathology workflow should be used and why it always requires a manual step. Thomas
Schrader replied that telepathology could be the primary workflow and explained that this
was done without a WSI in place. Fully digital framework (WSI, DICOM Worklists, etc.)
could change this entire process but the primary read would then be WSI based and the
consult via telepathology would still be second. Christel Daniel commented that a gap
analysis needs to be conducted across a number of use cases. There are differences in the
basic workflow and the cytology workflow due to cytology and/or the specimen collection
process. Thomas Schrader’s slides can be found here:
ftp://medical.nema.org/medical/private/dicom/WORKGRPS/WG26/2011/2011_08_27_Helsi
nki/ Schrader - GeneralPathologyProcess_v002
and here:
ftp://medical.nema.org/medical/private/dicom/WORKGRPS/WG26/2011/2011_08_27_Helsi
nki/Schrader - WG01.presentation.pptx
Christel Daniel then presented an IHE overview, mentioning the ordering process (device
automation integration profiles relevant to Dako, Leica, Ventana, etc.), intra-hospital /
department workflow, opinion request workflow, knowledge driven workflows, etc. the
current list of profiles is not complete and there is a need for several more integration profiles
around workflow, post-processing, scanning, etc. Need to get (more) vendors involved.
XDW is a relevant standard/framework (cross-enterprise document workflow). Christel
Daniel’s slides:
ftp://medical.nema.org/medical/private/dicom/WORKGRPS/WG26/2011/2011_08_27_Helsi
nki/Daniel DICOM WG26 IHE.pptx
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DICOM WG-26 – Pathology
August 27, 2011
7. Agenda for San Diego meeting:
Tentatively agreed to make progress and refine the discussions around DICOM Worklists,
Multi-spectral presentation state, and the lab workflow (with Joachim, Donal, Bikash, and
others).
Reported by:
Michael Meissner, Co-Chair
2011-10-22
Reviewed by counsel: 2011-11-02
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DICOM WG-26 – Pathology
August 27, 2011