NY · NJ · PA · OH · New England — research basis, September 2026

Northeast Imaging Map

Which hospitals and academic centers in the Northeast and Ohio already move digital images across scanners, PACS and institutions, what estates they run, and which funding routes reach them without a hospital IT capital request. Prepared for Tiger Health Software as a vendor-neutral orchestration layer entering the US as non-diagnostic infrastructure.

Status limited to public documentation [S] sourced · [D] derived · [I] inference
Framing

What the research supports, and what it does not

The formats are already fragmented, and that is the job

The multi-site pathology programs in this region that publish their infrastructure do not agree on a format. NCI's Imaging Data Commons converts whole slide images to DICOM Slide Microscopy on Google Cloud and AWS. The Cancer Imaging Archive's histopathology portal stores native SVS, NDPI and TIFF. HTAN's primary format is OME-TIFF with SVS accepted, on Synapse over S3 and GCS. The cooperative-group biobanks in Ohio and Pennsylvania that scan at volume disclose no format at all.

A layer whose function is to move images between those systems without committing the institution to one of them has a defined place in that landscape. That is a description of the problem, not evidence that any institution has budgeted to solve it.

Non-diagnostic entry sidesteps the two slowest gates

Primary-diagnosis pathology software in the US sits behind FDA clearance and, at the hospital, behind the value analysis committee, which is triggered by PHI and LIS integration rather than by dollar value and takes three to twelve months. Research, archive, tumor-board and cross-site collaboration use cases avoid both.

The cost of that entry point is that it lands in research budgets rather than clinical ones, which are smaller, grant-cycled, and controlled by cancer-center and department leadership rather than by hospital operations. The funding instruments below are sized accordingly. This research treats a $30K ARR as a vice-president-level decision by assumption, not by verification: no institution's director-level signature threshold was confirmed, and no public benchmark for US hospitals exists. The gate map's own inferred director ranges reach $100K at the largest systems, so a director-level close at $30K is possible at some of them and unverified at all of them.

Digital pathology is additive cost. The lab still cuts and stains glass. The 43 Category III CPT codes carry no national RVUs and are packaged under OPPS. US lab adoption is roughly 10% (CAP, 2024). UPMC's own published all-in figure is $12–15 per slide, split evenly across hardware, software, technician labor and storage. That is why the capital committee declines, and why every route on this page runs around it.
Institutions

Institutions, by evidence of adoption

Pathology is what is publicly documented for whole slide imaging. Imaging estate is the radiology PACS and archive stack where it could be found; "undisclosed" means the viewer contract is public but the archive vendor is not. Greenfield means a search found no deployment, pilot or program. Revenue is the most recent published fiscal year; NIH is FY2025; CCSG is the FY2025 P30 obligation from HHS TAGGS. Systems under roughly $1.5B in revenue appear only when they are among the largest in their state.

State
Pathology status
Signal
Search
Institution St Pathology Imaging estate Signals Revenue NIH FY25 CCSG FY25 Funding route
Deployed production clinical use Partial live but narrow Intent named priority or active procurement Research core or lab only Greenfield no evidence found
Multi-vendor imaging estate confirmed or likely multi-vendor Multi-site research lead or member in a cross-institution image program AI investment named AI center, compute or partnership with figures Timing procurement, migration or grant cycle live in the next 12 months Fujifilm Fujifilm product or project documented; mentions highlighted in the row

Fujifilm on this page

  • Hackensack Meridian Health (NJ). Synapse Radiology PACS (Synapse 5) with Synapse VNA and Synchronicity, Synapse Mobility viewer and Synapse Cloud Services purchased 2017; network-wide Synapse Cardiology PACS across 18 hospitals announced March 4, 2025, described as cloud-ready. The only confirmed end-to-end single-vendor Fujifilm estate in the region.
  • OhioHealth (OH). Synapse PACS since 2003 and Synapse Mobility from 2011; no newer public record, so whether the estate is current or overdue could not be established.
  • Capital Health (NJ), not in the table. Synapse PACS replacement, August 2017, one of seven systems in a single Fujifilm announcement.
  • Market position (KLAS). Synapse VNA was Best in KLAS for VNA in 2024 at 86.7 against Merative iConnect at 80.3. In KLAS's 2025 large-PACS scores Fujifilm sits third at 84.9, behind Sectra 91.0 and Agfa 87.2. KLAS's Nov 2023 report notes VNA adoption is strongest when bundled with the PACS vendor, naming Fujifilm as the example.
  • Not Fujifilm. "Synapse" in the HTAN row and the Dana-Farber note is Sage Bionetworks' Synapse research data platform, unrelated to Fujifilm Synapse. Those mentions are deliberately not highlighted.
  • Not found. No Fujifilm digital pathology deployment at any institution in the region, and no Fujifilm reference at any of the 34 institutions whose radiology stack could not be established.
Cross-institution image programs

Where images already move between institutions

Programs with a lead or member in the geography that share pathology or radiology images across sites. The infrastructure column is the point: it is what an orchestration layer would have to interoperate with, and most programs do not disclose it.

ProgramRegional institutionsFundingImage infrastructure
NCI Imaging Data CommonsBrigham and Women's (co-PIs Fedorov, Kikinis); MGHNCI via Cancer Moonshot, contract through Leidos Biomed; amount not disclosedDICOM Slide Microscopy for all WSI; Google Cloud and AWS public buckets; open-source SliM viewer
Cancer Imaging Archive, histopathology portalStony Brook (Saltz group contributes TIL maps, 13 cancer types); managed at Frederick National LabNCI Cancer Imaging Program; since 2010Native SVS, NDPI, TIFF; IDC is the DICOM front end
Human Tumor Atlas NetworkData coordinating center at Dana-Farber and MSK; Phase 2 precancer atlases launched fall 2024NCI U24CA233243; amounts not publishedOME-TIFF primary, SVS accepted; Synapse over S3 and GCS; DICOM subset to IDC; 8,425 biospecimens as of Sept 2024
Cancer AI AllianceMSK and Dana-Farber, with Fred Hutch and Johns Hopkins$40M pooled; AWS, Google, Microsoft, NVIDIA as partners; platform live Oct 2025; wider application process planned 2026Federated learning with a centralized orchestration layer on AWS; framework unnamed; pathology WSI not publicly listed as a modality
NRG Oncology Biospecimen BankColumbus (Nationwide Children's) and Pittsburgh sitesNCI U24CA19606751,333 slides scanned across 32 trials through Dec 2022; scanner and platform not disclosed
Alliance Biorepository SystemOhio State and Brigham and Women's, with WashU and MayoNCI NCTNImage-analysis committee exists; infrastructure not disclosed
Children's Oncology Group Biopathology CenterNationwide Children'sNCIDigital pathology review with slide-scanning robots; vendor and volumes not disclosed
MSK Warren Alpert CenterMSKWarren Alpert Foundation, est. 2017In-house "HoBBiT" honest-broker de-identification and transfer tool; dedicated compute; ~7M slides licensed to Paige, now Tempus, on Azure
FL4M federated consortiumMGH lead; LaheyNot disclosedRhino Health platform; radiology (aneurysm), not pathology
Aidoc Diagnostic AI ConsortiumNorthwell, Mount Sinai, University Hospitals Cleveland, WellSpan among 12 systems (Aug 2026)Vendor-ledAidoc aiOS; radiology; not an image archive

Not found: TCGA/GDC slide-image infrastructure, any Labcorp or Quest digital consortium, Owkin or NVIDIA FLARE pathology pilots with sites in the region, and the 2025 DICOM WSI Connectathon participant list (article blocked).

The instruments

Funding routes that reach an infrastructure purchase

Ranked by fit for a non-diagnostic software layer. None of these passes through a hospital IT capital committee.

Massachusetts · nonprofit AMCs and research institutes

MLSC Research Infrastructure

$1.5M – $5M
  • Funds equipment, hardware and software, service contracts and renovation over one to three years.
  • Current round open August 17 through November 6, 2026.
  • Repeat awardees: MGH ($3.379M Living Tissue Repository, Dec 2025), BIDMC ($1.807M MassNano), MIT (auto-stainer for a tissue and spatial imaging core, Jul 2026).
  • Over $638M invested to date.
Pennsylvania · NIH/NCI-funded institutions

CURE formula grants

~$36.5M/yr
  • Up to 50% may be spent on infrastructure, stated in the program's own annual report.
  • Allocated non-competitively by formula; no proposal contest.
  • SFY2021-22: Penn $6.56M, Pitt $6.56M, Penn State $5.58M, CHOP $5.58M. Current-cycle allocations are not published.
All states · NCI-designated centers

CCSG shared resource

$2.1M – $13.5M
  • Roswell Park's Aperio AT2 and image analysis platform are stated on its own page as funded by P30CA16056 and a C06 instrumentation award.
  • Most tractable at competing renewal. Live windows: Wistar's period ended 2/28/2026; Mount Sinai Tisch became Comprehensive 10/2025; Columbia in competing continuation; Wilmot newly designated 3/2025.
  • 19 NCI-designated centers across the region.
New York · medical schools

NYFIRST

Up to $1.0M
  • Capital equipment explicitly allowable, alongside lab establishment and upgrades.
  • Round 7 open 7/15/2026 through 7/16/2027, rolling review.
  • Requires a recruited or retained translational researcher and a 2:1 institutional match.
National · informatics tools

NCI ITCR

$300K – $600K/yr
  • Cancer informatics tools including imaging and pathology platforms. RFA-CA-27-019 U01 early-stage at $300K direct per year for three years; RFA-CA-27-020 and -021 U24 at $600K direct per year for five years.
  • Pre-application webinar September 15, 2026. Due dates not yet posted.
  • Institution-held, not vendor-held; a commercial layer participates as a subcontractor or in-kind partner.
Ohio · research institutions

Third Frontier TVSF Phase 1

$200K – $1.0M
  • Ohio research institutions are directly eligible. Institutional match required.
  • 300+ grants, ~$57M since 2012. FY2025 cycle: proposals due February, awards April.
  • Fits only where the purchase can be framed as validating an institution-owned technology.

Secondary routes, in order of size

  • Foundation and philanthropy. Dana-Farber took $779.2M in contributions in FY2024, Boston Children's $646.4M, Cleveland Clinic Foundation $459.2M, CHOP Foundation $163.7M, NewYork-Presbyterian Fund $186.1M. Historically 12.9% of hospital philanthropy goes to capital equipment (FY2012, the last public breakdown). Slow: six to eighteen months and a named donor attached to a clinical use case.
  • Internally adjudicated pools. Cleveland Clinic's VeloSano raised $14.5M in 2025 and distributes it by internal peer review. Nationwide Foundation's $10M Pediatric Innovation Fund (Oct 2025) names Biomedical Data Sciences, including cloud support for research and AI, as a pillar. MaineHealth's innovation program funds Ignite awards to $20K and Bonfire awards to $100K; external consulting is permitted, staff time is not.
  • CTSA hubs. Cincinnati Children's and University of Cincinnati renewed at $37.2M over seven years in Oct 2025, more than $65M with match, explicitly funding research infrastructure. Tufts CTSI $78.4M over seven years (2023); Rutgers-led NJ ACTS $47.5M; Yale $63.7M (2021); Buffalo $28.4M (2025).
  • Indirect cost recovery and residual funds. UVA's published policy returns 29.4% of indirect cost recovery to the clinical department that generated it; several institutions let departments keep the full residual on fixed-price awards. Mechanism is documented; magnitudes are not.
  • State AI compute. Empire AI (New York, more than $500M public and private, Mount Sinai and Rochester members), Massachusetts AI Hub ($31M state, $120M expected over five years, no hospital members named), Yale's $150M five-year AI commitment. These buy compute, not orchestration software, and are noted as signals of where AI budgets sit rather than as routes.
  • Departmental operating spend. 86% of healthcare IT executives report unsanctioned software purchasing in their system (symplr with CHIME, 2025). It exists and it is being actively consolidated (the share of systems running more than 50 applications fell from 60% to 51% over two years). Whether $30K clears at a director's signature at a given institution is unverified.
Gate map

What clears without a committee

The structure of these gates is documented. The dollar values are not: hospital delegation-of-authority matrices are internal and essentially none are published. Every figure in this table is inference [I]. The working assumption for this research is that a $30K ARR lands at the service-line/VP row; the director row's inferred upper ranges overlap $30K at $7B+ systems, and neither has been verified at any named institution.

Gate$1.3–7B system$7–12B$12–23B$23B+Cost
Capitalization linecommonly $5,000; below it, expense rather than capitalNone. Subscription software is expensed; perpetual licenses and hardware are not.
Department director$5K–25K$10K–50K$25K–75K$25K–100KA purchase order. Overlaps $30K at $7B+ systems on the inferred range; unverified.
Service line / VP$25K–100K$50K–250K$75K–500K$100K–1MLegal review. Weeks. Working assumption for $30K, not a verified threshold.
Value analysis / IT governancetriggered by PHI, LIS or EHR integration, or clinical workflow change, not by dollars aloneThree to six months, up to a year. Committees meet monthly or quarterly. Non-diagnostic scope avoids it.
Capital committee / CFOannual cycle; 39% of systems budget 2–5% of revenue to capital, 35% budget 5–10%12–18 months, ranked against every other request.
Approach by status

What each status implies for a vendor-neutral layer

Deployed  Interoperate, do not displace

UPMC, Ohio State, NYU Langone, Mount Sinai, MSK, Cleveland Clinic, HNL Lab Medicine. The image management system is chosen and, at several, contractually locked for years. The open question at each is the archive and the cross-site or cross-modality movement of images, which the IMS vendor does not always own. Where the archive vendor is undisclosed, that is the first thing to establish.

  • UPMC's published state is roughly 5% prospective scanning at academic sites against a five-year goal of 100%; the multi-year ramp is where an orchestration layer would sit.
  • Mount Sinai, Ohio State and NYU are single-vendor Philips in pathology and, at OSU and NYU, Visage in radiology with the archive undisclosed.

Partial  Expansion is already funded or planned

University Hospitals Cleveland, Nationwide Children's, Columbia/NYP, MetroHealth, Yale, Brown University Health, Mass General Brigham. Live but narrow, and several have said publicly what comes next.

  • Brown University Health runs Philips, two Leica models and three Grundium units in one pathology informatics group; that is the clearest multi-vendor pathology scanner estate found in the region.
  • Nationwide Children's names incomplete LIMS integration, scanner failures and limited informatics bandwidth as its constraints, and is a cooperative-group biobank scanning at volume with an undisclosed platform.
  • Yale reads about 10% of caseload digitally with an unnamed scanner vendor and a Visage radiology contract whose 2017 seven-year term has run.

Intent  Procurement is live

Beth Israel Lahey Health, Penn Medicine, Rutgers Cancer Institute.

  • BILH ran a nine-month evaluation of nine image management platforms, has three finalists, and expects an eight-site launch in November 2026. In the same window it signed a seven-year A$90M Visage full-stack radiology contract with a Q1 2027 go-live and a migration off unnamed legacy PACS archives. Two migrations, two vendors, one year.
  • Penn's chair has named LIS harmonization across Penn Medicine entities as a goal; Penn is single-vendor Sectra in radiology and has already extended Sectra to genomics.

Greenfield  No evidence of a program

All of New Jersey, Northwell, Montefiore, Jefferson, Geisinger, most of New England outside Boston and New Haven, and most Ohio community systems.

  • For a non-diagnostic layer, greenfield in pathology is not by itself an opening; it means there are no images to orchestrate yet. The relevant greenfield accounts are those with a documented multi-vendor radiology estate or a live migration: WellSpan and Allegheny Health Network (Visage viewer over a separate VNA), Hackensack Meridian (single-vendor Fujifilm, network-wide Synapse Cardiology PACS 2025), Northwell (Nuvance integration, imaging plan undocumented).
  • Several are in financial distress and are noted as such in the table; those are deprioritized, not excluded.
Conditions

What changed recently

CMS and CAP diverge on computational pathology

In July 2026 CMS proposed removing computational pathology from the Clinical Laboratory Fee Schedule in both the OPPS and PFS rules, reclassifying ten algorithmic-analysis codes as "Software as a Medical Service" on the position that analysis of whole slide images does not require CLIA-regulated laboratory services. CAP opposes, citing checklist items GEN.50630 and GEN.52860. A non-diagnostic layer is not directly in scope, but every pathology informatics buyer is watching it.

Vendor consolidation

Tempus acquired Paige in September 2025 for $81.25M, with the ~7M MSK-licensed slides and Paige's Azure commitment. AstraZeneca acquired Modella AI, the Brigham Mahmood Lab spinout, in January 2026. Sectra completed its first US cloud migration (Emory) in June 2026. In KLAS's 2025 data Sectra is considered in nearly 60% of PACS decisions and most often selected; Philips, Optum/Change and GE customer bases are the ones most frequently evaluating options.

CAP inspects digital pathology directly

In 2025 CAP added a Laboratory General Checklist section, "Digital Pathology Including Remote Data Assessment": validation records, reports generated through digital analysis, scan-failure rates, image-quality criteria and QMS integration. The 2022 validation guideline still governs at 60 cases and greater than 95% concordance. This applies to diagnostic use and is one reason a non-diagnostic entry is faster.

Financial distress in the region

Jefferson −$196M FY2025 and −2.3% in H1 FY2026; UC Health $256M cumulative losses with 56 days cash; Yale New Haven −$196.8M FY2025 with no permanent CFO; Tufts −2.0%, fourth straight loss year; UMass Memorial −3.4%; Boston Medical Center −$240M with $129M from ex-Steward hospitals; UVM Health Network under a required $300M three-year cut; Mass General Brigham's largest layoffs in its history (Feb 2025); MSK −$47.9M with $177M of Epic go-live cost. Massachusetts' median hospital operating margin was −2% in FY2024. Against that: RWJBarnabas 6.4%, Cleveland Clinic 5.0%, MaineHealth 4.9%, ProMedica 8.1%, NYU Langone 3.1%.

Evidence gaps

What is not sourced

  • Radiology PACS and archive vendors for roughly half of the 69 institutions. Not found for Mount Sinai, Northwell, Montefiore, NYC H+H, Albany Med, all of New Jersey except Hackensack and Cooper, UPMC, Jefferson, Geisinger, Penn State Health, Main Line, Tower, Bon Secours Mercy, Summa, TriHealth, Kettering, Premier, UC Health, Dana-Farber, Boston Children's, BMC, Tufts, UMass, Baystate, Brown, Dartmouth, and most of Maine and Vermont. Job postings and KLAS decision records are the likeliest way to fill these.
  • Every departmental and service-line signature threshold in the gate map. No public benchmark for US hospitals exists.
  • Image infrastructure inside the cooperative-group biobanks (NRG, Alliance, COG) and inside CAIA. They scan or federate at volume and disclose neither scanner nor platform.
  • Mass General Brigham's current pathology vendor and primary-diagnosis status. The 2018 Philips partnership is documented; enterprise go-live is not.
  • AI dollar figures for MGB, Dana-Farber, Penn, Cleveland Clinic's IBM program, Northwell, Boston Children's, Dartmouth and Broad.
  • Current-cycle PA CURE allocations (public lists stop at SFY2021-22), CTSA amounts for most hubs, and the restricted share of hospital philanthropy (AHP member-paywalled).
  • Whether Case Comprehensive Cancer Center offers whole-slide scanning. Its shared-resources page does not say.
  • Connecticut Bioscience Innovation Fund's academic track terms (page unavailable), and state programs in RI, NH, VT.
  • Definitive Healthcare and Becker's bed counts do not reconcile; use one dataset per account.
Sources

Where the numbers came from

Becker's — health systems ranked by annual revenue, FY2025
GEN — Top 50 NIH-funded institutions, FY2025
ScienceDex — NIH RePORTER institutional totals
HHS TAGGS — P30 Cancer Center Support Grant obligations
NCI — Find a Cancer Center
Roswell Park — Pathology Network shared resource
Ohio State — Digital and Computational Pathology
Pitt/UPMC — Computational Pathology and Informatics
Laboratory Economics, Sept 2024 — UPMC per-slide cost
Executive War College — NYU Langone fully digital in one year
CAP Today, Aug 2026 — BILH digital pathology platform evaluation
Pro Medicus ASX filing, May 2026 — BILH Visage contract
Pro Medicus FY26 results — OSU, AHN renewals
KLAS, Aug 2025 — PACS market competitiveness
Brown University Health — Pathology Informatics scanner estate
Yale Medicine Magazine — digital pathology at Yale
NCI Imaging Data Commons — team and infrastructure
Nature Methods 2025 — HTAN data infrastructure
MSK — Cancer AI Alliance
NRG Oncology — biospecimen bank U24 report
Massachusetts Life Sciences Center — Research Infrastructure program
PA Department of Health — CURE grants
Empire State Development — NYFIRST
NCI — ITCR funding opportunities
Ohio Development — Third Frontier TVSF
NY Governor — Empire AI Beta online, Aug 2026
Yale — $150M AI commitment
Mass.gov — Massachusetts AI Hub
Pitt — Leidos $10M for CPACE
Cincinnati Children's — AI Imaging Research Center
Healthcare IT Today — Tempus acquires Paige
CAP — digital pathology CPT codes
Discoveries in Health Policy, Aug 2026 — CMS and CAP diverge
Becker's — Mass General Brigham FY2025
Becker's — Yale New Haven Health FY2025
Boston Globe — BMC and ex-Steward losses
symplr 2025 Compass Survey with CHIME
Advisory Board / Optum — capital spending trends
AHA Trustee Services — AHP philanthropy medians
philanthropy.org — Form 990 data