1. Consideration on work items of IHE-pathology and DICOM for pathology image Sep.25 2005 Ikuo Tofukuji IHE-Japan Pathology-WG

2. WF of Pathology with Optical Microscope Take sample Place order Physician Surgeon etc. Medical technologist Pathologist Receive order, patient data, clinical data Register patient Receive sample Process sample Make slide Refer all data Observe slide Make report Receive report Decide care Take gross picture Make block Gross image Cutting drawing Key image Image archive Image display Preprocess Diagnosis process Attach

3. WF of Pathology with Virtual Microscope Take sample Place order Physician Surgeon etc. Medical technologistPathologist Process sample Make slide Refer all data Observe slide Make report Receive report Decide care Take gross picture Make block Gross image Cutting drawing Key image Scan SlideWhole slide image Reconstruct observation view image Preprocess Diagnosis process Image archive Image display Receive order, patient data, clinical data Register patient Receive sample Annotate and attach

4. Structure model of DICOM Objects in Radiology Preprocess (Archive images) Patient Order Transmitting X-ray CT Front shot Side shot Slice Image Series: One report will be made corresponding to the series Study

5. Patient Order Removed organ Biopsy specimen Block Gross Image Glass slide Block Removed organ Biopsy specimen Cutting Drawing Whole slide Image (Virtual slide only)* Glass slide Whole slide Image (Virtual slide only)* Image Series Study: One report will be made corresponding to the order Structure model of objects in Preprocess of Pathology Service (Make slides and Scan*) *Note: In case of optical microscopy, no-whole slide image

6. Diagnosis process structure model in optical-microscopy (Independent from DICOM) Naked eyes observation (Make diagnosis strategy) Observation of microscopic view (Search characteristic findings) Observe glass slide 2X 20X 10X 4X 2x 40X Refer gross image Make case report (Reply to order) 2X Observe glass slide Key images

7. Diagnosis process structure model in virtual-microscopy (Independent from DICOM) Observation of reconstructed images (Search characteristic findings) Refer whole slide image Refer gross image Make case report (Reply to order) Refer whole slide image Refer staring image (Make diagnosis strategy) 2X 20X 10X 4X 2x 40X 2X Key images

8. 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.

9. 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?

10. 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