digital morphology and eqa michelle brereton, john burthem, keith hyde

Digital Morphology and EQA

Michelle Brereton, John Burthem,

Keith Hyde.

Manchester Royal Infirmary.

www.manlab.co.uk

UK NEQAS(H) www.ukneqas-haem.org.uk

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Digital Morphology Imaging

Aim of ProjectTo assess the emerging role of digital imaging and web-based technology in morphological education,

EQA and CPD

NEQAS participant driven – questionnaire feedback

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United Kingdom External Quality Assessment Service

Haematology - UK NEQAS (H) Morphology Scheme

Started in 1968 – updated in 1979• >500 participant centres UK (80 non UK labs)• 8 surveys per year - 2 cases per survey. • Age, Sex, Hb and WBC.• Choose 5 morphological features – offer a diagnosis.• Glass slides via post.

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United Kingdom External Quality Assessment Service

Haematology - UK NEQAS (H) Morphology Scheme

Returns and Reports via post:• Histogram of morphological features (coded)• List of 5 most commonly reported features• Brief case history / medical features/ additional

laboratory results• Diagnosis and Expert opinion

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Web Based Morphology Exercises

2001• 2 cases from previous surveys.• 5 digital images on each case.• Participants view via web site.• Limited response n = 30

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Digital Image 2001

More Images per case.

Improve picture quality.

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Web Based Morphology Exercises

20031. Survey Report:

A single case, 12 images with expert opinion and consensus results.

2. Pilot exercise:

Educational element, participant involvement.

(Response n = 128)

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Feature 3119 giant platelet3 megakaryocyte fragment

Tutorial: Slide 4

Feature 8101 megakaryocytic fragment15 giant platelet4 smear cell

Tutorial: Slide 4

Feature 6

67/128 acanthocyte

40/128 echinocyte

11/128 spherocyte

Tutorial: Slide 4

Priorities for 2004 (1)

Survey Report - Multiple Images with Expert Opinion: via Web

• Archive / education record• Images from each survey with results and

feedback• Image Library of NEQAS surveys since

2002• Moving to CPD

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www.manlab.co.uk

Image Library.

Priorities for 2004 (2)

Electronic slide• Develop larger field of view• Maintain resolution• Use computer software to change field of view• Precious material• All see the same cells

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Photograph single “high power” images

Take multiple “overlapping” fields

Computer software matches fields

And “stitches” a composite image

Assemble many fields to make image larger….

And larger…….

Etc…..

While still retainingdetails that can beviewed at high power

Stitched “digital slide” 2001

www.manlab.co.ukDepartment of Morphology

“stitched” digital slide for 2004

www.ukneqas-haem.org.uk

www.manlab.co.uk morphology

Exercise for 2004

4 cases from previous surveys• Participants not informed that images were actual

surveys.• Cases chosen were 0001BF2 (HbSS), 0002BF1 (Bcell

PLL),0403BF1 (CGL) and 0403PA1 (malaria)• 40 images “stitched” per case• Images presented with same basic information given

with standard surveys (age, sex, WBC, Hb).• Participants asked to give 5 comments per case

Result sheets and questionnaire returned to UK NEQAS(H)

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166 returned completed coded morphology forms.

162 also completed questionnaire

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Response

Was the image of adequate size to allow an opinion?

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0

20

40

60

80

100

120

1(SS) 2(PLL) 4(CGL) 5(MP)

YES

NO

Rate the Exercise

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0

20

40

60

80

100

120

Comparisonwith survey

Follow up teaching

1

2

3

4

5

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Download time

CPD

Comparison to glass

Follow-up

Archive

Teaching aid

“Rare” Image

2.7

3.5

3.8

4.1

4.2

4.6

4.6

Rate the Exercise (overview)

Poor ExcellentOK

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The cases:

0403BF1 (CGL)0001BF2 (HbSS)

0002BF1 (Bcell PLL) 0403PA1 (P.Ovale)

0403BF1 (CGL)

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0

10

20

30

40

50

60

70

80

90

glass slide

electronic

0403BF1 (CGL)

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0

10

20

30

40

50

60

70

80

90

glass slide

electronic

0001BF2 (HbSS)

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0

10

20

30

40

50

60

70

80

90

100

glass slide

electronic

**

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Responses: Sickle disorder: 84% HA: 4% Splenectomy: 5%

0002BF1 (Bcell PLL)

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0

10

20

30

40

50

60

70

80

Survey

Image

Diagnosis virtual: CLL (33); LPD (26) PLL (25) lymphoma (11) AL (9) CMML (2) viral (2)

**

**

**

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0

5

10

15

20

25

30

35

40

45

50

glass slide electronic

vivaxovalemalariaefalciparum

**

0403PA1 (P.Ovale)

Summary

Digital Imaging for Morphology in EQA

• Participant Driven from digital web exercises.• ???s with survey feedback and expert opinion.

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Future developments

UK NEQAS (H)

EQA and Education

Continuing Professional Development

• Participant Driven from digital web exercises.• Image Library - Multiple images with survey

feedback and expert opinion.• UK NEQAS registered with IBMS executive for

CPD scheme 2005.• Individuals, rather than centres, react to images

of morphology.

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UK NEQAS (H)

CPD Scheme – Pilot via Web

• Participant centres asked to nominate and register an individual.

• View selected surveys via the web.• Comment on images and provide reflective

notes.• Return reports to UK NEQAS.• 250 participants currently registered for phased

trial.• First 50 start18th April 2005.

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UK NEQAS (H)

CPD Pilot – Process

• Register with UK NEQAS(H) nationally• 2 CPD points for registration• 1 point per case reviewed• Accumulate 18 points per year• Complete Reflective Form, Specific to Pilot.• CPD credits awarded by UK NEQAS(H).

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Acknowledgements

Manchester Royal Infirmary www.manlab.co.uk John Ardern. Michelle Brereton. John Burthem. Lois Hickman. Claire Hutchinson. Keith Hyde.

Manchester Metropolitan and Salford Universities.Len Seal. Andrew Serrant. Emma Wells.

UK NEQAS (H) www.ukneqas-haem.org.uk Paul McTaggart. Barbara De La Salle. John Parker-Williams.

Participants of the NEQAS morphology scheme.

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