This presentation, co-developed by Michele Mitchell (Patient Advocate), Dr. Rouba Ali-Fehmi, MD (Professor and Medical Director of Breast Pathology), and Dr. Mustafa Qays Yousif, MD (Director of Digital Pathology, Department of Pathology, and Clinical Assistant Professor of Breast Pathology), explores how digital pathology is transforming patient education and empowerment at Michigan Medicine. It centers on the Breast Pathology Consultation Program-an initiative that uses digital tools to enhance understanding, support shared decision-making, and promote patient engagement.The session highlights the perspective of a breast cancer survivor and advocate. Diagnosed in 2006 with Stage 1A Invasive Ductal Carcinoma (ER/PR-positive, HER2-negative), Michele Mitchell underwent surgery, chemotherapy, radiation, and long-term hormonal therapy. Years later, she viewed a digital representation of her own cancer-a moment that clarified the nature of her disease, including tumor grade, and transformed her understanding. This deeply personal experience inspired her commitment to advancing patient access to diagnostic tools and the power of digital pathology.Mitchell now serves as Co-Chair of the Michigan Medicine Department of Pathology Patient and Family Advisory Council (PFAC), which formally recommended the development of the Breast Pathology Consultation Program in 2023. She also advises several institutional and national efforts aimed at improving transparency, trust, and engagement in healthcare.Dr. Ali-Fehmi and Dr. Yousif will detail how digital pathology is used in the Breast Pathology Consultation Clinic, which has supported more than 120 patients in understanding their disease and engaging more confidently in their care. They will discuss how digitized pathology images and patient-pathologist dialogue improve comprehension and decision-making, helping to bridge the gap between diagnosis and treatment.This presentation will demonstrate the role of digital pathology as a tool to empower patients, personalize care, and improve patient-provider communication. Together, the presenters will showcase a model of innovation and collaboration that may be replicable at other institutions.

Learning Objectives: 

1. Understand how exploring digital pathology can enhance patient education and empowerment, as evidenced by the 120+ patients who have benefited from Michigan Medicine's Breast Pathology Consultation Program.
2. Recognize the impact of viewing digital pathology slides combined with an explanation from the diagnosing pathologist on patient understanding and treatment decisions.
3. Learn how improved patient-pathologist interactions can enhance trust, adherence to treatment plans, and overall patient outcomes.

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.

Live demo of end-to-end interoperability: specimen accessioning, ordering, and processing in the Laboratory Information System (LIS); image acquisition from grossing, electron microscopy, radiographic imaging, immunofluorescence, polarized light, and glass slide scanning across multiple vendor scanners; Quality Control (QC) with Artificial Intelligence (AI) and manual review; final case review in the Picture Archiving and Communication System (PACS); and results reporting to the Electronic Health Record (EHR).

Live demo of end-to-end interoperability: specimen accessioning, ordering, and processing in the Laboratory Information System (LIS); image acquisition from grossing, electron microscopy, radiographic imaging, immunofluorescence, polarized light, and glass slide scanning across multiple vendor scanners; Quality Control (QC) with Artificial Intelligence (AI) and manual review; final case review in the Picture Archiving and Communication System (PACS); and results reporting to the Electronic Health Record (EHR).