RANZCO has endorsed calls for ophthalmic device manufacturers to standardise image formats, with proponents stating it is one of the most important issues preventing the profession from greater clinical and academic progress.
The college has endorsed a recommendation by the American Academy of Ophthalmology (AAO), the world’s largest ophthalmic association, urging manufacturers to implement the Digital Imaging and Communications in Medicine (DICOM) standard to facilitate an easier exchange of digital imaging data.
DICOM is the existing medical imaging standard, which includes a system of globally agreed-upon ophthalmological definitions, however compliance is low within the sector.
This is despite the AAO stating adoption of a uniform standard for images could revolutionise ophthalmology practices by promoting more efficient patient care, enabling the creation of comprehensive datasets for research and big data analyses, and developing algorithms for machine learning and artificial intelligence.
Commenting on the recommendation, RANZCO president Professor Nitin Verma said: “Standardising will facilitate greater accessibility of information and enhance efficiency, thus improving the patient’s experience.”
In addition to RANZCO, the recommendation has been supported by the American Society of Retina Specialists, the Asia-Pacific Academy of Ophthalmology, and the UK’s Royal College of Ophthalmologists.
Dr Aaron Lee – an assistant professor and vitreoretinal surgeon at the University of Washington and lead author of a paper describing the issue in the AAO’s journal Ophthalmology this month – said other medical fields like radiology have blazed ahead of ophthalmology by using the standards to their full extent.
“In some ways, it is much harder in our field because we have such a diverse variety of imaging devices and testing modalities,” he said.
“This variety is what makes ophthalmology so rich with information but also makes it difficult for standards to keep up with the constant innovation. My hope is that not only would vendors be willing to adopt and conform to standards but also be willing to define them for new modalities where the DICOM standard does not currently exist. [Our] recommendations … are just the first step in the direction that we need to go.”
No easy way to exchange data
According to Lee, a key issue limiting clinical and research progress in ophthalmology is the lack of standards for imaging and functional testing.
He said the AAO has long championed for the DICOM standard, which promotes the seamless sharing of medical images by detailing how to format and exchange images and the information with which it is associated, such as the text describing the image and patient demographic information.
Even though DICOM compliance is considered low for ophthalmic imaging technologies, he said many so-called “DICOM compliant” devices still fail to fully meet the standards. This means there is no easy way to exchange digital imaging data from one manufacturer’s equipment to another’s without creating a custom interface.
Another issue is image degradation when devices compress files, which the AAO states could be overcome by using ‘lossless compression’ for pixel or voxel data. This would allow access to the raw data as used by manufacturers.
“It is important for this data to be available from the manufacturers so ophthalmologists can provide the best quality care for our patients. Poor image quality can also lead to problems when AI models are being developed or new digital health tools are deployed,” the AAO stated.
Dr Daniel Ting, chair of the Asia Pacific Academy of Ophthalmology’s AI & Digital Innovation Standing Committee, said given the ageing population made worse by COVID-19 pandemic crisis, there is a pressing need for digital transformation in healthcare.
“In ophthalmology, the standardisation of ocular imaging can facilitate the push for artificial intelligence, deep learning and big data analytics to enhance patients’ care and experience for global eye health. Thus, the Asia Pacific Academy of Ophthalmology will support and endorse the AAO recommendation for ocular image standardisation.”