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Image standardization in tissue – based diagnosis


Application of virtual slides in research and routine diagnosis requires specific standards that still have to be defined, developed, and generally accepted.

Basic conception

Virtual microscopy, i.e., the microscopic diagnostics on images derived from completely digitized glass slides has to be distinguished into (1) human performance and (2) automated machine algorithms. Both methods can result in diagnostic errors that have to be graded (or scored) according to their clinical significance. A proposed system includes 10 different scores, reaching from main significant errors {normal <> abnormal tissue, (0)} to {identical findings (10)}. The system developed by Mireskandari et al [1] is appropriate for and has been tested in telepathology sessions to grade differences between primary and secondary diagnosis. The procedure can be embedded into a general hierarchic standardization method which includes three levels {aim, methodology, and specific limitations} [2]. Three different “columns”, i.e., legal, medical, and technical aspects can be implemented into the hierarchy. Specific aspects of microscopic images can be added to well known communication standards such as DICOM 3, HL 7, or HTTP. Image quality standards have to include parameters that describe accuracy of object segmentation, correct image illumination or shading, and equalize the gray value distribution. Additional standards have to give regulations for image display (size and resolution of image display systems), minimum number, size, and magnifications of transmitted image compartments, and color distributions. Simple questions, for example which color space is appropriate for which color distribution, have also to be answered in an unequivocal manner.

Preliminary investigations

Preliminary experiences derived from trials to perform automated diagnosis on digitized slides demonstrate that a standardization of image quality includes at least measures of vignette (shading), maximum gray value height, and homogenous gray value distribution. The minimum number of potential segmentation thresholds related to the derived diagnosis as well as image entropy and compression modes are additional features that have to be defined in quantitative measures. The use of fixed image sizes is prerequisite for any texture analysis including area dependent image transformations.

Perspectives: The development and implementation of image standards focussing on specific needs of virtual microscopy is an issue that has to (and certainly will) become of significant attention in human and automated application.


  1. Mireskandari M, Kayser G, Hufnagl P, Schrader T, Kayser K: Teleconsultation in diagnostic pathology: experience from Iran and Germany with the use of two European telepathology servers. J Telemed Telecare. 2004, 10: 99-103. 10.1258/135763304773391549.

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  2. Kayser K, Gortler J, Goldmann T, Vollmer E, Hufnagl P, Kayser G: Image standards in Tissue-Based Diagnosis (Diagnostic Surgical Pathology). Diagn Pathol. 2008, 3: 17-10.1186/1746-1596-3-17.

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Financially supported by International Academy of Telepathology, and the Verein zur Förderung des biologisch – technologischen Fortschritts in der Medizin e.V.

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Correspondence to Klaus Kayser.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Kayser, K., Borkenfeld, S., Görtler, J. et al. Image standardization in tissue – based diagnosis. Diagn Pathol 5 (Suppl 1), S13 (2010).

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