Digital Pathology DICOM State of Interoperability Now and Tomorrow

DICOM is the interoperability standard through which digital pathology imaging is communicated. DICOM enables high performance image archival, metadata search and retrieval, and data / time efficient pixel imaging retrieval. Key for digital pathology, DICOM provides mechanisms to selectively retrieve sub regions of digital pathology images, to transcode imaging, and transform medical imaging to reference color profiles for interoperable display. In 2025, DICOM Working Group 26 conducted a Connectathon to test end-to-end interoperability, scanner-to-archive-to-consumer(viewer or ML), between vendors implementing actors using the DICOM and IHE defined interoperability standards. The 2025 connectathon brought together the largest collection of vendor participants, N=30 vendor participants, spread across image acquisition, archival, viewer, and ml actor rolls. The connectathon was a resounding success demonstrating the ability of multiple slide scanner vendors to generate and store medical imaging with LIS metadata within multiple DICOM VNAs. Viewing software and ML systems were able to retrieve the imaging and generate annotations which were themselves stored as DICOM within the participating archives. These results demonstrate that systems built to support the existing interoperability standards can be easily connected to implement end-to-end enterprise imaging workflows. The DICOM standard is an evolving standard that grows in response to vendor / customer technical advancement. Current areas of active work include, the recently added support for JPEGXL encoded imaging, and defining the standards representation for multi-spectral imaging, imaging with multiple focal points (z-stacks), and vector graphics annotation with holes.