Consideration on work items of IHE-pathology and DICOM for pathology image

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Consideration on work items ofIHE-pathology
and DICOM for pathology image

• Sep.25 2005
• Ikuo Tofukuji
• IHE-Japan Pathology-WG

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WF of Pathology with Optical Microscope
Physician Surgeon etc.
Image archive Image display
Medical technologist
Pathologist
Preprocess
Take sample Place order
Receive order, patient data, clinical data
Register patient Receive sample
Take gross picture Make block
Gross image Cutting drawing
Process sample Make slide
Diagnosis process
Refer all data Observe slide Make report
Key image
Receive report Decide care
Attach
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WF of Pathology with Virtual Microscope
Physician Surgeon etc.
Image archive Image display
Medical technologist
Pathologist
Take sample Place order
Preprocess
Receive order, patient data, clinical data
Register patient Receive sample
Take gross picture Make block
Gross image Cutting drawing
Process sample Make slide
Scan Slide
Whole slide image
Diagnosis process
Reconstruct observation view image
Refer all data Observe slide Make report
Key image
Receive report Decide care
Annotate and attach
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Structure model of DICOM Objects in
RadiologyPreprocess (Archive images)
Study
Patient
Series One report will be made corresponding to
the series
Image
Transmitting X-ray
Front shot
Order
Side shot
Image
CT
Slice
Slice
Slice
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Structure model of objects in Preprocess of
Pathology Service (Make slides and Scan)
Study One report will be made corresponding to
the order
Series
Patient
Image
Removed organ Biopsy specimen
Gross Image
Order
Cutting Drawing
Image
Whole slide Image (Virtual slide only)
Block
Glass slide
Whole slide Image (Virtual slide only)
Glass slide
Note In case of optical microscopy, no-whole
slide image
Block
Removed organ Biopsy specimen
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Diagnosis process structure model in
optical-microscopy(Independent from DICOM)
Naked eyes observation (Make diagnosis strategy)
Observation of microscopic view (Search
characteristic findings)
Make case report (Reply to order)
Refer gross image
Observe glass slide
2X
40X
2X
10X
20X
10X
4X
Key images
2x
Observe glass slide
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Diagnosis process structure model in
virtual-microscopy(Independent from DICOM)
Refer staring image (Make diagnosis strategy)
Observation of reconstructed images (Search
characteristic findings)
Make case report (Reply to order)
Refer gross image
Refer whole slide image
2X
40X
2X
10X
20X
10X
4X
Key images
2x
Refer whole slide image
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Note on pathology observation process

• Diagnosis process strategy is arranged by
  pathologist based on his experience and diagnosis
  purpose.
• Diagnosis process is dynamically constructed
  according to findings in view fields.
• Diagnosis process is not recorded.
• Recording is desirable for QA or education
• No another medical section records decision
  process
• Key images include important findings, may be
  taken and attached to the report with annotation,
  usually not be stored in PACS.

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IHE-pathology work items to be discussed

• Workflow profiles for routine diagnosis services
• First step pathology cytology
• Procedures report, cytology includes screening
  procedure
• Observation optical-microscopy,
  virtual-microscopy (bright field)
• Second step frozen section, autopsy
• Third step telepathology (frozen, second
  opinion)
• Technical framework actors and transactions
• Define actors functions
• Define messages to be transferred among actors
• Terminology and code?

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Pathology DICOM work items to be discussed

• Image format
• Object gross picture, virtual slide
• Subject compression, reconstruction display
• Image attached information items
• Patient
• Specimen
• Block
• Slide
• Structured report optimized for pathology
  diagnosis
• Report structure and items to be included
• Attaching key image with annotation