Could DICOM Be the Answer for Digital Pathology?

Today’s pathology environment is more digital than ever. Whole slide images, scanners, and AI algorithms are advancing quickly, but too often they operate in silos. Without a shared standard, inefficiencies and frustrations grow for the people who matter most: pathologists, pathologists' assistants, and the labs supporting them.

That’s why more and more of those in the pathology field are asking the question: Could DICOM be the answer?

What DICOM Could Bring to Pathology

DICOM (Digital Imaging and Communications in Medicine) has been the backbone of radiology for decades. Every CT scan, MRI, and X-ray flows through DICOM, ensuring consistency across systems.

In pathology, adopting DICOM could mean:

• Interoperability. Slides from one scanner could be read in another system, a PACS (Picture Archiving and Communication System), or an EHR (Electronic Health Record).
• Consistency. Metadata standards that keep images and case data linked correctly.
• Scalability. A framework for managing archives that grow into the petabytes.
• Integration. A pathway for pathology to align with radiology, oncology, and other specialties already built on DICOM.

Why the Debate Exists

Pathology whole slide images are massive—often gigabytes per file—and far more complex than radiology images. Some experts argue DICOM is too heavy or not yet mature enough to handle the demands of pathology. Others believe it’s the best opportunity to unify the field under a single, proven standard.

The DICOM Standards Committee’s WG-26 working group is leading the charge to define how pathology images, annotations, and metadata should be shared. Events like the WG-26 Connectathon, which Voicebrook participated in, bring vendors together to test interoperability and help determine whether DICOM can truly meet pathology’s needs.

What’s at Stake for Pathologists and PAs

For pathology professionals, this debate isn’t abstract; it’s about daily workflow:

• PAs need gross images tied reliably to reports without extra steps.
• Pathologists want access to slides in the same systems where other clinical data lives.
• Pathology Teams need smoother collaboration with radiology and oncology, where DICOM is already the default.

Ultimately, success isn’t about pixels on a slide. It’s about whether critical diagnostic details—annotations, measurements, algorithmic findings—can move seamlessly into the report. That’s where interoperability could make the difference.

Looking Ahead

Pathology is at a crossroads. The need for a shared standard is undeniable, and DICOM could be the answer. But the debate is far from settled. Some vendors and early-adopting labs are moving quickly toward DICOM, while others remain cautious, weighing whether alternative or hybrid approaches might be better suited.

What’s clear is that the demand for interoperability is only growing. The standards chosen today will shape how pathologists, PAs, and the broader care team work together tomorrow, impacting how quickly patients receive the answers they need.

If you're interested in learning more about how Voicebrook is supporting interoperability and innovation in digital pathology, reach out to us or request a demo.