Open Access Highly Accessed Open Badges Research

Image standards in Tissue-Based Diagnosis (Diagnostic Surgical Pathology)

Klaus Kayser1*, Jürgen Görtler2, Torsten Goldmann3, Ekkehard Vollmer3, Peter Hufnagl4 and Gian Kayser5

Author affiliations

1 UICC-TPCC, Institute of Pathology, Charite, Berlin, Germany

2 IBM DeepComputing, Brussels, Belgium

3 Institute of Pathology, Research Center Borstel, Borstel, Germany

4 Department of Telemedicine, Institute of Pathology, Charite, Berlin, Germany

5 Institute of Pathology, University Freiburg, Freiburg, Germany

For all author emails, please log on.

Citation and License

Diagnostic Pathology 2008, 3:17  doi:10.1186/1746-1596-3-17

Published: 18 April 2008



Progress in automated image analysis, virtual microscopy, hospital information systems, and interdisciplinary data exchange require image standards to be applied in tissue-based diagnosis.


To describe the theoretical background, practical experiences and comparable solutions in other medical fields to promote image standards applicable for diagnostic pathology.

Theory and experiences

Images used in tissue-based diagnosis present with pathology – specific characteristics. It seems appropriate to discuss their characteristics and potential standardization in relation to the levels of hierarchy in which they appear. All levels can be divided into legal, medical, and technological properties. Standards applied to the

    first level
include regulations or aims to be fulfilled. In
    legal properties
, they have to regulate features of privacy, image documentation, transmission, and presentation; in
    medical properties
, features of disease – image combination, human – diagnostics, automated information extraction, archive retrieval and access; and in
    technological properties
features of image acquisition, display, formats, transfer speed, safety, and system dynamics. The next lower
    second level
has to implement the prescriptions of the upper one, i.e. describe how they are implemented.
    Legal aspects
should demand secure encryption for privacy of all patient related data, image archives that include all images used for diagnostics for a period of 10 years at minimum, accurate annotations of dates and viewing, and precise hardware and software information.
    Medical aspects
should demand standardized patients' files such as DICOM 3 or HL 7 including history and previous examinations, information of image display hardware and software, of image resolution and fields of view, of relation between sizes of biological objects and image sizes, and of access to archives and retrieval.
    Technological aspects
should deal with image acquisition systems (resolution, colour temperature, focus, brightness, and quality evaluation procedures), display resolution data, implemented image formats, storage, cycle frequency, backup procedures, operation system, and external system accessibility. The lowest
    third level
describes the permitted limits and threshold in detail. At present, an applicable standard including all mentioned features does not exist to our knowledge; some aspects can be taken from radiological standards (PACS, DICOM 3); others require specific solutions or are not covered yet.


The progress in virtual microscopy and application of artificial intelligence (AI) in tissue-based diagnosis demands fast preparation and implementation of an internationally acceptable standard. The described hierarchic order as well as analytic investigation in all potentially necessary aspects and details offers an appropriate tool to specifically determine standardized requirements.