To wrap or not to wrap? That is the question…

It’s been a busy 2016! Here’s a December post to cap off the year!

One of the initiatives that I’ve been involved in the past few months, is investigating the opportunity of integrating non-radiology imaging in the Diagnostic Imaging world.  Some of these non-radiology image types could include, but are not limited to:

  • Wound Care
  • Dermatology
  • Ophthalmology
  • Non-DICOM Cardiology
  • and …. Pathology

Let’s spend some time on last, but by no means the least significant item on the list – Digital Pathology. As you are most likely aware, Digital Pathology is extremely large in volume and size.

If we look at this strictly from a formatting/standards perspective, it becomes an interesting exercise. There are two distinct camps on how Digital Pathology should be handled. Just like other opposing groups that we are familiar with (ie. The Montagues vs the Capulets, the Jets vs the Sharks, or Biggie Vs. Tupac, etc.) -these two imaging camps have their own moniker:

DICOM vs. Native Format

DICOM has been around for a little over 30 years and is a proven standard that’s provided interoperability between disparate imaging vendors.

nema-dicom ACR/NEMA 300, version 1.0, released in 1985.

Fast forward to 2016, and this standardized interoperability makes it possible to exchange and share patient’s diagnostic imaging. Additionally this standards-based approach provides customers the possibility (and freedom) of migrating their imaging data to another PACS vendor at any point. The customer isn’t restricted to using only systems that support a ‘proprietary’ imaging format.

Considering all the pros and history of DICOM as a standard for image transfer, it would only make sense for non-Radiology imaging to follow the same approach and to adopt DICOM as an imaging format, right? Well that answer is a bit unclear.

Let’s look at Pathology for example: A lot of effort has been put into DICOM Working Group 26, which is focused on a DICOM based approach to handling Digital Pathology. Not to mention the IHE domain, PaLM (Pathology and Laboratory Medicine), which has coordinated activities and joint meetings with DICOM Working Group 26.

When we compare the work being accomplished in the standards committees to what vendors are doing in real life, we see quite a gap. I recently had a Digital Pathology vendor provide a demo of their product. They touted all the “benefits” of not relying on DICOM and using a proprietary format. According to this vendor, using a proprietary imaging format, provided ‘more flexibility and better performance’. To me that sounds a bit too much like a sales pitch. I’m curious if a customer decides to change vendors at a point in the future,  how difficult will it be to migrate/convert the proprietary imaging format so that it’s acceptable for the new vendor.

It appears that this particular vendor isn’t unique with this behavior. My very informal investigation related to this, has discovered that it’s hard to find a digital pathology vendor that isn’t using a proprietary imaging format.

This leaves us with a bit of a disconnect between the focus of Standards Committees and how vendors are building their solutions for the real world.

After all, these are ‘just’ standards. By definition the purpose of a standard is to reach a certain level of quality or attainment. Standards are not requirements, and the only thing that will drive the vendors to create change is through consumer action.

I would love to hear from others on their experience with integrating Enterprise Imaging in their environment and what you have found from a DICOM vs. Native format perspective. Feel free to comment below.