Storage and distribution of pathology digital images using integrated Web-Based viewing systems

Archives of Pathology & Laboratory Medicine,  May 2002  by Marchevsky, Alberto M,  Dulbandzhyan, Ronda,  Seely, Kevin,  Carey, Steve,  Duncan, Raymond G

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* Context.-Health care providers have expressed increasing interest in incorporating digital images of gross pathology specimens and photomicrographs in routine pathology reports.

Objective.-To describe the multiple technical and logistical challenges involved in the integration of the various components needed for the development of a system for integrated Web-based viewing, storage, and distribution of digital images in a large health system.

Design.-An Oracle version 8.1.6 database was developed to store, index, and deploy pathology digital photographs via our Intranet. The database allows for retrieval of images by patient demographics or by SNOMED code information.

Setting.-The Intranet of a large health system accessible from multiple computers located within the medical center and at distant private physician offices.

Results.-The images can be viewed using any of the workstations of the health system that have authorized access to our Intranet, using a standard browser or a browser configured with an external viewer or inexpensive plug-in software, such as Prizm 2.0. The images can be printed on paper or transferred to film using a digital film recorder. Digital images can also be displayed at pathology conferences by using wireless local area network (LAN) and secure remote technologies.

Conclusions.-The standardization of technologies and the adoption of a Web interface for all our computer systems allows us to distribute digital images from a pathology database to a potentially large group of users distributed in multiple locations throughout a large medical center.

(Arch Pathol Lab Med. 2002;126:533-539)

Health care providers have expressed increasing interest in the use of digital images as a substitute for gross photography and microphotography, image analysis, telepathology, and other medical applications.1-21 Megapixel cameras that acquire excellent-quality photographs are now available at relatively low cost.22 Several commercially available systems integrate hardware and software for digital gross photography and microphotography. Recent studies have demonstrated that the use of digital photography in a large pathology laboratory is cost-effective.2,3,6-8 For example, Belanger et al2 from the Department of Pathology at Yale University demonstrated the successful implementation of digital photography in their busy autopsy service, resulting in improved efficiencies and reduced costs. Several commercial laboratories now include color photomicrographs as part of some of their standard surgical pathology reports in an effort to make this information more readily accessible. It is controversial whether these enhanced paper-based reports improve patient care to a degree that justifies the additional costs.

The introduction of digital photography in a large anatomic pathology laboratory poses multiple technical and logistical challenges. Substantial numbers of large image files need to be stored in a database that is integrated with the laboratory information system and other legacy systems. This process requires the acquisition of image database software, development of software interfaces, purchase of additional hardware to accommodate increased memory space needs, and development of adequate backup systems. The image database needs to provide for easy retrieval of the image files by laboratory staff working in multiple offices dispersed throughout a large laboratory and health system. In addition, there is a need to distribute the digital photographs to the medical staff and their patients, either electronically through the use of the health system's Intranet or printed as part of image-enhanced pathology reports. The system needs to facilitate the use of the digital images for teaching conferences and publications.

The goal of this article is to describe the multiple technical and logistical challenges involved in the integration of the various components needed for the development of a system for integrated Web-Based viewing, storage, and distribution of digital images in a large health system. We describe our recent experience with developing a method for health system-wide storage and distribution of pathology digital images using integrated Web-based viewing technology. The system was deployed in our Department of Pathology and Laboratory Medicine in collaboration with the Enterprise Information Services of our health system.

Hardware Requirements for Digital Photography

Multiple hardware platforms for digital photography can currently be used in a pathology laboratory. A detailed review of available hardware is beyond the scope of this article. Basic hardware requirements for a gross digital photographic system include a photography stand with appropriate illumination and a megapixel digital camera. We acquired an integrated photographic system that includes an RDC-5300 digital camera (Ricoh Co, Tokyo, Japan) and fully motorized controls (Photodyne Technologies Inc, Northridge, Calif). The digital camera records images at 1792 x 1200 (2300000)-pixel resolution and has a video interface that allows for connection to an external monitor for real-time focusing of the images (Figure 1). Images can be stored in SmartMedia memory cards in joint photographic experts group (JPEG) format. A similar motorized photographic system equipped with a 35mm camera has been in use in our department for many years, and the evolution into digital photography was made almost seamlessly. Digital cameras can also be attached to light microscopes, via standard C-type mounts, for photomicroscopy. We are currently testing the use of Olympus DP-11 digital cameras (Olympus America, Melville, NY) for that purpose. The system has been in use in our autopsy service for the past few months and will be made available to our surgical pathology and electron microscopy laboratories as soon as new hardware is acquired.