Importance of Adopting Imaging Standards in Ophthalmology


Michael Mbagwu, MD, Senior Medical Director

Ophthalmic imaging has become an integral aspect of modern eye care. Similar to many of my colleagues, I regularly use instruments like optical coherence tomography (OCT) to diagnose and monitor conditions such as glaucoma and age-related macular degeneration. However, envision a scenario where the images captured today could contribute to the care of a patient in the examination chair tomorrow. The potential for real-world imaging data to advance clinical research and facilitate the development of artificial intelligence (AI) algorithms is vast. Yet, to achieve this on a large scale, it is crucial we widely adopt a set of standardized imaging practices.

The Digital Imaging and Communications in Medicine (DICOM) serves as the universal gold standard for medical imaging devices, and is recognized by the Food and Drug Administration. These standards establish image formats and guarantee the inclusion of essential elements in each image, encompassing patient demographics, technical details, and more. Despite this, compliance with the DICOM standard is not mandatory, and this potentially limits how useful an image will be in the future.

DICOM Conformance

A recent Verana Health study explored the feasibility of linking patient imaging data with electronic health records (EHRs) within the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). The study focused on analyzing DICOM metadata tags from imaging files generated on two imaging manufacturers, both identified as “DICOM compliant.” While most metadata tags across vendors could be linked to synonymous or analogous terms, 43 tags could not be reconciled. This indicates potential variance in how the DICOM standard is interpreted, the terminology used in embedded DICOM data, and the essential data elements required for “compliance.” Overall, this may introduce ambiguity on how to appropriately handle images with “non-compliant” metadata. These findings highlight a significant obstacle in integrating imaging data from disparate sources, further compartmentalizing this valuable information.

Benefits of Imaging Standards 

The widespread use of imaging data standardization holds the potential to enhance the quality of patient care. At times, access to previous imaging studies plays a pivotal role in improving clinical understanding of a patient’s journey with a specific disease. The absence of such studies, often due to poor interoperability, unfortunately can impede medical decision-making. 

From a research perspective, ophthalmic images linked to EHRs have enormous potential to create AI algorithms that could lead to novel discoveries and insights. Especially when dealing with substantial datasets, as is frequently seen with OCT images, the importance of data standardization and interoperability is heightened. Adhering to common standards not only streamlines the sharing and comparison of images across institutions but also proves foundational for research collaboration and facilitating clinical trials.

Support of DICOM Standards

Verana Health, as well as the American Academy of Ophthalmology (Academy), strongly support the broad adoption and use of imaging standards. The Academy has been promoting interoperability and standardized images since 1998 and has sponsored DICOM working groups in eye care for the past couple of decades. 

Other organizations have also developed working groups to promote this important message. A roadmap to interoperable imaging standards was recently published in the Ophthalmology journal, and may be viewed here.

It is my sincere hope to eliminate these barriers and empower data to fulfill its full potential; we owe it to our future patients.

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