I write a slide management platform that doesn't convert images to a single format and it mostly works. From time to time you do get issues though (cause you see millions of slides). Sometimes vendor's own libraries fail to open the slides (cough Phillips cough). Or there is a new version of firmware that sets some flag that wasn't used before.

We support DICOM supp 145 too, but it's no panacea. There are still vendor specific quirks. The "surface" is larger (cause you expect all the metadata to be there in the standard format) so you still sometimes see differences.