DICOM Interoperability Reaches New Heights in Digital Pathology, 2025 Connectathon Shows

The digital pathology community achieved a significant milestone in 2025, with the largest DICOM Connectathon to date demonstrating that standardized, interoperable imaging workflows are now a reality across multiple vendor platforms.

Speaking at Pathology Visions 2025, a panel of experts detailed how 30 vendor participants successfully tested end-to-end interoperability, from slide scanners through archives to viewers and machine learning systems. The results suggest that the field has moved beyond theoretical standards into practical, production-ready implementations.

“Interoperability is more than just DICOM or HL7 or even IHE,” explained Brian Napora, co-chair of the session. “At the end of the day, it’s systems talking together to enable our users and patients to experience better care around them.”

The path to standardization has been gradual but steady. The first DICOM Connectathon for digital pathology took place in 2017 with only five participants. By 2025, the number of participants had grown sixfold. Participants in 2025 spanned image acquisition systems, archival solutions, viewing software, and AI algorithm developers.

Real-World Implementation at Michigan Medicine

Mustafa Yousif, MD, Assistant Professor at the University of Michigan, shared his institution’s journey in implementing DICOM-based digital pathology workflows. Michigan Medicine has adopted what he described as five pillars of enterprise imaging: capture, storage, viewing, image exchange, and analytics.

Michigan Medicine now operates multiple scanner types from different vendors, including Leica, Hamamatsu, Olympus, and Roche systems, all of which produce DICOM-compliant images for primary diagnosis. The standardization has enabled the institution to develop AI-powered quality control tools that automatically flag image quality issues for laboratory technicians.

“With the automation, it’s reduced almost half of the time on manual work,” Yousif noted.

The system provides feedback dashboards not just for individual technicians but for the entire laboratory, helping identify equipment issues and workflow bottlenecks in real time.

2025 Connectathon Results

David Clunie, MD, who served as project manager for the 2025 Connectathon, emphasized the event’s focus on metadata enrichment. The testing included a novel workflow for “naked” DICOM files, which are images without complete metadata, that could be enriched by downstream systems connecting to laboratory information systems.

The results were encouraging across all categories. Nine slide scanners successfully produced standards-compliant images, seven image management systems demonstrated robust archival capabilities, and 15 viewing software packages successfully displayed images and annotations from multiple sources. Eight evidence creators, which are systems that generate annotations, whether human-driven or AI-powered, successfully stored their outputs as DICOM objects.

 “We were surprised that everybody who participated did so well,” Clunie said. “Perhaps this was down to the fact that we did it over such a long period of time that people had a lot of opportunity to iterate and improve their software.”

Looking Ahead to 2026

Kenneth Philbrick, PhD, from Google, outlined plans for 2026, highlighting that the testing program will expand beyond DICOM Working Group 26 to embrace IHE Connectathons. Testing will focus on capabilities such as z-stacks for multiple focal planes, multispectral imaging, and JPEG-XL compression.

“JPEG-XL was added just last year to the DICOM standard to support those next-generation digital pathology use cases,” Philbrick explained.

The new compression format offers the potential to reduce archive sizes by losslessly compressing existing JPEG images without changing underlying pixel information.

Additionally, organizers proposed creating a “living Connectathon”, a persistent online environment where vendors and institutions can test interoperability at any time, rather than during limited event windows.

The panel emphasized that customer demand drives vendor adoption.

“Put it in your RFP and in your contract,” Clunie advised. “Vendors are driven by customers, and they can’t allocate resources to activities that they can’t sell.”