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García-Rojo M, De Mena D, Muriel-Cueto P, Atienza-Cuevas L, Domínguez-Gómez M, Bueno G. New European Union Regulations Related to Whole Slide Image Scanners and Image Analysis Software. J Pathol Inform 2019; 10:2. [PMID: 30783546 PMCID: PMC6369630 DOI: 10.4103/jpi.jpi_33_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/12/2018] [Indexed: 12/03/2022] Open
Abstract
Whole slide imaging (WSI) scanners and automatic image analysis algorithms, in order to be used for clinical applications, including primary diagnosis in pathology, are subject to specific regulatory frameworks in each country. Until May 25, 2018, in the European Union (EU), in vitro diagnostic (IVD) medical devices were regulated by directive 98/79/EC (in vitro diagnostic medical device directive [IVDD]). Main scanner vendors have obtained a Conformité Européenne mark of their products that in Europe were classified as General Class IVDD, so that conformity is only based on a self-declaration of the manufacturer. This contrasts with the initial classification of the US Food and Drug Administration (FDA) of WSI system as Class III medical devices, although the first digital pathology WSI system to be cleared by FDA was classified as Class II, with special controls. Other digital pathology solutions (automated cervical cytology slide reader) are considered of higher risk by US and European regulations. There is also some disparity in the classification of image analysis solutions between Europe and the United States. All IVD-MDs must be approved under the new European regulation (in vitro diagnostic medical device regulation) 2017/746 after May 26, 2024. This means the need of a performance evaluation, including a scientific validity report, an analytical performance report, and a clinical performance report. According to its clinical use (e.g., screening, diagnosis, or staging of cancer), a WSI slide scanner can be now classified as Class C device. A special regulation is applied to companion diagnostics. The new EU regulation 2017/746 contemplates the use of standard unique identifiers for medical devices and the creation of a European database on medical devices (Eudamed). Existing validation studies and clinical guidelines already available in the literature are a sound basis to avoid that this new regulation becomes a barrier for digital pathology development in Europe.
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Affiliation(s)
| | - David De Mena
- Department of ICT, Andalusian Public Health Service, Seville, Spain
| | - Pedro Muriel-Cueto
- Department of Pathology, Puerta del Mar Universitary Hospital, Cádiz, Spain
| | | | | | - Gloria Bueno
- VISILAB, Superior Engineering School, Castilla-La Mancha University, Ciudad Real, Spain
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Clunie D, Hosseinzadeh D, Wintell M, De Mena D, Lajara N, Garcia-Rojo M, Bueno G, Saligrama K, Stearrett A, Toomey D, Abels E, Apeldoorn FV, Langevin S, Nichols S, Schmid J, Horchner U, Beckwith B, Parwani A, Pantanowitz L. Digital Imaging and Communications in Medicine Whole Slide Imaging Connectathon at Digital Pathology Association Pathology Visions 2017. J Pathol Inform 2018; 9:6. [PMID: 29619278 PMCID: PMC5869966 DOI: 10.4103/jpi.jpi_1_18] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 02/05/2018] [Indexed: 11/06/2022] Open
Abstract
As digital pathology systems for clinical diagnostic work applications become mainstream, interoperability between these systems from different vendors becomes critical. For the first time, multiple digital pathology vendors have publicly revealed the use of the digital imaging and communications in medicine (DICOM) standard file format and network protocol to communicate between separate whole slide acquisition, storage, and viewing components. Note the use of DICOM for clinical diagnostic applications is still to be validated in the United States. The successful demonstration shows that the DICOM standard is fundamentally sound, though many lessons were learned. These lessons will be incorporated as incremental improvements in the standard, provide more detailed profiles to constrain variation for specific use cases, and offer educational material for implementers. Future Connectathon events will expand the scope to include more devices and vendors, as well as more ambitious use cases including laboratory information system integration and annotation for image analysis, as well as more geographic diversity. Users should request DICOM features in all purchases and contracts. It is anticipated that the growth of DICOM-compliant manufacturers will likely also ease DICOM for pathology becoming a recognized standard and as such the regulatory pathway for digital pathology products.
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Affiliation(s)
| | | | - Mikael Wintell
- Department of Regional Health, Region Västra Götalandsregionen, Sweden
| | - David De Mena
- Department of Pathology/UGC Anatomía Patológica, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Nieves Lajara
- VISILAB, Grupo de Visión y Sistemas Inteligentes, E.T.S. Ingenieros Industriales, Universidad De Castilla-La Mancha, Ciudad Real, Spain
| | - Marcial Garcia-Rojo
- Department of Pathology/UGC Anatomía Patológica, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Gloria Bueno
- VISILAB, Grupo de Visión y Sistemas Inteligentes, E.T.S. Ingenieros Industriales, Universidad De Castilla-La Mancha, Ciudad Real, Spain
| | | | | | | | - Esther Abels
- Philips Digital Pathology Solutions, Best, The Netherlands
| | | | | | | | | | | | - Bruce Beckwith
- Department of Pathology, North Shore Medical Center, Salem, MA, USA
| | - Anil Parwani
- Department of Pathology, Ohio State University, Columbus, OH, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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