Track 2: Medical Imaging Digital Pathology

Abstract: Pathology is a medical subspecialty that focuses on disease diagnosis. Tissue microscopic examination reveals information that allows the pathologist to make accurate diagnoses and guide therapy. Although the basic process by which anatomic pathologists make diagnoses has remained relatively unchanged over the last century, advances in information technology now provide significant opportunities in image-based diagnostic and research applications. Pathology has lagged behind other healthcare practices, such as radiology, in terms of digital adoption. As devices that generate whole slide images become more practical and affordable, practices will increasingly adopt this technology, resulting in an explosion of data that will quickly outnumber the already massive amounts of radiology imaging data. These advancements bring significant challenges for data management and storage, but they also open up new avenues for improving patient care by streamlining and standardizing diagnostic approaches and uncovering disease mechanisms. Commercial diagnostic systems already include computer-based image analysis, but further advances in image analysis algorithms are required to fully realize the benefits of digital pathology in medical discovery and patient care. Pathology image analysis will progress beyond streamlining diagnostic workflows and reducing interobserver variability in the coming decades to provide diagnostic assistance, identify therapeutic targets, and predict patient outcomes and therapeutic responses.

Keywords: Digital Pathology Conference, conference history.

Introduction: Pathology is primarily concerned with identifying structural anomalies with the naked eye or a microscope, as well as detecting possible relationships with functional disorders of tissues, and thus identifying diseases. Pathology's goal has remained consistent over time, focusing on the analysis and comparison of tissue specimens on specific glass slides. Since optical microscopes were the only available instrumentation for centuries, their use has been critical in this regard [1]. Despite the use of very methodical analysis workflows, the same professional can reach different conclusions about the same specimen at different times. Furthermore, soliciting second opinions is common practice, and specific cases may be included in conferences or external quality assurance programs [2]. As a result, infrastructure for storing and delivering glass slides is required. However, the specimen storage process is costly because it necessitates greater accessibility, cleaning, and protection, which necessitates greater care by specialized staff. In contrast, digital storage and distribution reduces these costs while increasing pathology laboratory throughput.

DICOM: (Digital Imaging and Communications in Medicine)

The DICOM Standard has been the primary driving force behind the adoption of Picture Archive and Communication Systems (PACS). DICOM defines not only the storage format for medical images, but also the communication protocol for exchanging images and related meta-data among various PACS applications. DICOM objects include a plethora of meta-data about the image, the acquisition procedure, and the various stakeholders involved, such as patients, physicians, and institutions. The standard specifies exactly what information should be included in each modality, as well as how images should be organized in DICOM files. This enables DICOM to meet the requirements of medical imaging workflows while also providing general purpose and vendor image formats.

DICOM was initially designed as a standard for radiology modalities. Nonetheless, due to the benefit of aggregating all patient imaging history in the PACS, it has rapidly expanded its coverage to other medical specialties such as cardiology and ophthalmology. The addition of the visible light supplement in 1999 marked the first attempt to incorporate microscopy into DICOM. As stated in the scope of this supplement, visible light images acquired by endoscopes, microscopes, or photographic cameras were supported. Endoscopy (ES), Microscopy (GM), Automated-Stage Microscopy (SM), and Photography were added to the standard as extensions (XC). Because WSI was still in its early stages, it was not included in this supplement. As a result, pathologists' needs were not met, and they continued to work without standard digital imaging end systems. Nonetheless, the automated stage microscopy modality paved the way for DICOM automated whole-slide scanners.

Visualization of whole-slide imaging

The arrangement of image pixel data in the storage data structure has a significant impact on the performance of the visualization processes. The most basic and widely used method of storing two-dimensional images is in a single frame/page, with the image pixels stored in a sequential array. Pixels are typically oriented horizontally by rows, but they could equally easily be oriented vertically. However, this organization's WSI screening paradigm has limitations because it does not provide direct access to 2D sub-regions. As a result, all overlapping rows in the regions must be loaded completely, which may be impossible due to the enormous size of WSI. This limitation is illustrated on the left side of Fig. Because the pixels in red are arranged sequentially, retrieving the green region necessitates retrieving all of the pixels in red.

Conclusion

As stated in the introduction, interest in digital and computational pathology has skyrocketed in the last decade. For example, while two papers with the term computational pathology were published in 2014, a similar search on PubMed yielded 92 papers in 2021. While it is difficult to say that the DPC directly caused this increase in research interest, there is no doubt that the conference did provide some impetus for the increase in research interest in this space.

The DPC's continued success is due in large part to the outstanding efforts of the program committee, who carefully constructed the program, provided valuable feedback to the authors, and chaired the sessions, SPIE Symposium Chairs, and SPIE staff, who kindly guided us through all the steps of program organization and assisted with all aspects of program organization.

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