Secretariat (U.S)College of American Pathologists (CAP)
Doug Murphy,
Kelly Westfall,
Secretariat (Europe)Sociedad Española de Informática de la Salud (SEIS)
Marcial García Rojo,
ChairCo-Chair Dan Hosseinzadeh, PathCore Inc
Co-Chair Mikael Wintell
Last strategy update2016-12-01
MinutesWG-26 minutes


To extend the DICOM Standard to support Pathology images (including cytopathology, surgical pathology, and clinical pathology and autopsy pathology studies). Specific actions are related to:

  • Technical standards to facilitate pathology image acquisition, display, transfer and storage. The group will be responsible for formulating components of the DICOM Standard that relate to imaging in the domain of Pathology. The primary focus will be digital formats for clinical imaging, but digital imaging for research applications may also be addressed as appropriate. This would include, for example, conventional imaging, whole slide microscopic imaging, micro-array imaging, flow cytometric “imaging”, and molecular “imaging”. Multi-spectral imaging shall be addressed in the context of how to properly handle the cross-channel dependencies.
  • Issues related to specimen and patient identification and workflow integration. The group will address improving the information model for subject identification and workflow integration within DICOM. This is required to account for the specimen-driven nature of the subject in pathology, which differs from the primarily patient-driven model in radiology. The goal is a common model shared between DICOM and other Electronic Medical Records standards, such as HL7, that will facilitate consistent specimen identification from acquisition through analysis and reporting.
  • Development of standards for integrating images and derived information into pathology reports. These include image annotation, templates for common image-based measurements and analyses, and integration of image-based information with textual and coded pathology report information, including structured pathology reports. Some of these activities may overlap with other standardization groups such as IHE and HL7, e.g. HL7 AP SR, and the group is responsible for coordinating such efforts with the respective counterparts in such groups.
  • Special technical issues specific to these application domains. These include compression of multi-gigabyte imagery, as well as efficient whole slide microscopic image browsing, microscopic image analysis etc. This could also include methods for correlating clinical images (radiologic PET/CT, endoscopy, etc.) and pathology images as well as potential workflow integrations related to those.


The WG-26 roadmap is based upon the analysis of the pathology workflow through the IHE framework to specify information objects and services to fully digitize and integrate data flow from different imaging systems within the pathology department. The ultimate goal is a comprehensive, standards-based digital platform for pathology practice, of which DICOM-based imaging is a significant part.

To be useful in the clinical environment, such a standards based digital platform must support:

  • A wide range of diverse imaging approaches and systems,
  • Strong interactions between said systems,
  • Integration of “tissue processes” (such as histology) and “imaging processes”,
  • Tight consultation between health care providers,
  • Correlation of image, textual, coded, and numeric medical data (clinical imaging, …)
  • Efficient Analysis and Retrieval functionalities

Standardized interchange of correlated data is critical in this environment. There are important distinctions among:

  • Acquisition and primary processing of image data in image capture systems,
  • Distribution and sharing of image data among multiple systems, within and across enterprises,
  • Creation of image-based analysis data and reports in workstations and software packages, and
  • Persistent archive.

This group will focus on better defining the data exchange environment among these domains.

Completed Work

  • Supplement 145 to the DICOM Standard providing for “Whole Slide Microscopic Image IOD and SOP Classes” was formally approved in 2010.
  • Supplement 145 to the DICOM standard introduces an SOP class for WSI
  • Supplement 122 to the DICOM Standard providing for “Specimen Module and Revised Pathology SOP Classes” was formally approved in 2008.
  • The Specimen Module has been harmonized with the HL7 v2 SPM segment and the HL7 v3 draft Specimen Domain Information Model.
  • Supplement 122 to the DICOM standard introduces a new mechanism of pathology specimen identification and revisions to composite Information Object Definitions to use that mechanism.

Current Work Items

  • 2018 Proof of concept, Basic Workflow Pathology Domain together with IHE PaLM, meeting in May 29th to influence IHE PaLM to adress the basic workflow
  • CP 1713 More compact use of Per-Frame Functional Group Macros in Non-Sparse VL Whole Slide Microscopy Image IOD
  • CP 1740 Parts 3 WSI is missing Frame Type
  • Planned meeting with IHE PaLM, planing for a F2F meeting in Helsinki 2018, preparation by reading and reviewing their whitepaper, demand for:
  • Workflow showcase (refer to showcase at Pathology Informatics 2018 Pittsburgh, ECDP 2018 Helsinki, Pathology Vision San Diego 2018)


Integration with other Electronic Medical Records standards can be difficult if they have a different approach incompatible with DICOM. Whole-slide microscopic imaging is only beginning to be used in Pathology department, and there are some technical issues (large storage needs, speed of scanning, slide reading efficiency) that need to be improved.

Challenges and Opportunities

  • As we go ahead and put some connectathons behind we get a lot of input that needs to be adressed and some of this input will definitely result in new CP:s ex filetable setup when it comes to larger files and also how and in which context to use concatenations.

Liaisons and Joint Meetings with Other Relevant Standards Groups

  • Association pour le Développement de l’Informatique en Cytologie et en Anatomie Pathologique (ADICAP)
  • American Telemedicine Association (ATMA) – Special Interest Group for Pathology
  • Association for Pathology Informatics (API) – Laboratory Digital Imaging Project
  • College of American Pathologists (CAP) – Council for Scientific Affairs (pathology reporting standards)
  • DICOM WG-04 (Compression) (JPEG2000 interactive protocol and multi-component transfer syntax)
  • DICOM WG-08 (Structured Reporting)
  • DICOM WG-11 (Display Function Standard)
  • DICOM WG-13 (Visible light)
  • Health Level 7 (HL7) – Pathology Special Interest Group
  • Integrating the Healthcare Enterprise (IHE) – Pathology Committee
  • Japanese Society of Pathology
  • Sociedad Española de Informática de la Salud, (SEIS = Spanish Society of Health Informatics)
  • European Cooperation in the field of Scientific and Technical Research – COST Action IC0604 “Euro-Telepath”