Image Standards in Digital Pathology

When it comes to whole slide imaging (WSI), you have certainly heard about Digital Imaging and Communications in Medicine (DICOM), the international standard when it comes to handling, storing, printing, and transmitting information in medical imaging.

DICOM was originally developed for radiology, where it has become ubiquitous as the core standard on which Picture Archiving and Communications Systems (PACSs) are based. It has since been adopted by many other medical imaging specialties including ophthalmology, dentistry, cardiology, nuclear medicine, oncology, surgical specialties who perform image-guided surgery (e.g., neurosurgery, ENT, orthopedics), and specialties that acquire endoscopic or laparoscopic imaging.1

However, in the field of digital pathology, the vast majority of adopters are using proprietary systems offered by scanner manufacturers and software developers. These companies offer bundled solutions or a system of devices, adding much-needed innovation to the field of pathology. Depending on the system in use, the file types may seem endless. Here are just a few:

● .SVS by Leica Biosystems


● .VMS by Hamamatsu

All advertise unprecedented digital slide image quality and resolution and high functionality and flexibility. It’s important for customers to understand which systems and file types truly fit their pathology needs, current and future, when going digital. At the very least, for the referral of cases between sites with different systems, the ability to export to and import from a standard format using a standard protocol is essential.2

As digital pathology systems for clinical diagnostic work applications become mainstream, interoperability between these systems from different vendors becomes critical. For the first time, multiple digital pathology vendors including Leica-Aperio, Philips, and Roche-Ventana have publicly revealed the use of the DICOM standard file format and network protocol to communicate between proprietary whole slide acquisition, storage, and viewing components. It is anticipated that the growth of DICOM-compliant manufacturers will likely also ease DICOM for pathology becoming a recognized standard and as such the regulatory pathway for digital pathology products.3

Built on the vision of better patient outcomes, Instapath was founded in 2017 by engineers and scientists to enable patients to immediately know their cancer diagnosis. Our team made it our mission to develop fast and easy digital pathology technology so diagnosis can be made in minutes instead of days. To learn more about Instapath and our technology, visit or contact us at


1 Caffery LJ, Clunie D, Curiel-Lewandrowski C, Malvehy J, Soyer HP, Halpern AC. Transforming Dermatologic Imaging for the Digital Era: Metadata and Standards. J Digit Imaging. 2018;31(4):568–577.

2Clunie DA, Dennison DK, Cram D, Persons KR, Bronkalla MD, Primo HR, et al. Technical challenges of enterprise imaging: HIMSS-SIIM collaborative white paper. J Digit Imaging. 2016;29:583–614.

3 Clunie D, Hosseinzadeh D, Wintell M, et al. Digital Imaging and Communications in Medicine Whole Slide Imaging Connectathon at Digital Pathology Association Pathology Visions 2017. J Pathol Inform. 2018;9:6.

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