Digital Morphology Imaging Aim of Project

Digital Morphology Imaging

Aim of ProjectTo develop Web based technology in EQA for digital

morphological examination

Brereton M, Burthem J, Wells E, Serrant A, Ardern J,

Hickman L, Seal L, Hutchinson C, Parker-Williams J,

De La Salle B, McTaggart P, Hyde K

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Web Based Morphology Exercises

2001• 2 cases, 5 digital images each• Limited response n = 30 – more images per case

2003• 1 case, 12 images with expert opinion• Same case with educational element• Same case ‘Stitched Image’ of 12 images• Response n = 128 – positive feedback

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Priorities for 2004

Web Page Utilisation• Archive / education record• Images from each survey with results and feedback.

Electronic slide• Develop larger field of view• Maintain resolution• Virtual slide• Precious material• All see the same cells

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CPD Image Library

Image Library• Multiple images with expert opinion and top five

features from original survey.• All surveys presented from end 2002• On going – image review process - surveys

added.• Preview available at manlab.co.uk (department

morphology); Link via web pilot.• January 2005 available via the NEQAS(H) site.

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0301 BF1

The five most commonly reported features were:Nucleated red cellsBlast cellsMacrocytic plateletsMyelocytesMegakaryocyte fragments.

Patient DetailsAge (yrs)SexHb(g/l) WBC(x109/l) Platelets (x109/l)

55f8.776.7 114

Expert Comment (Dr J Parker-Williams, Scheme Director, UK NEQAS)

This film was prepared from a blood specimen taken from a fifty-five-year-old-lady, who was diagnosed with myelofibrosis in 1992.

This is a film with complex morphological abnormalities - too many to score as many stated! Myelofibrosis was diagnosed in 1992; a splenectomy was performed in 1996 for increasing splenomegaly; twenty percent of participants recorded features of hyposplenism. The majority felt that the features were those of a myeloproliferative/myelodysplastic disorder with transformation to AML-M7.

Myeloblasts and megakaryoblasts were present, many of the latter being micromegakaryoblasts; on immunophenotyping 50% of the blasts were CD61 positive. Many large and abnormal platelets/megakaryocyte fragments were present. Thirty-five percent of participants declined to offer a diagnosis.Click here to go to No 2 : Morphology Tutorial

Priorities for 2004

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

feedback.

Electronic slide• Develop larger field of view• Maintain resolution• Virtual slide• Precious material• All see the same cells

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20042001

Electronic Slide

• Response to feedback

• Individual images taken at high magnification consecutively then stitched together

• 12 images “stitched” together in 2003 compared to 40 images “stitched” together in 2004

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Use + and - to zoom in/outclick and hold left mouse button over image, then drag to pan.

0301 BF1The five most commonly reported features were:Nucleated red cellsBlast cellsMacrocytic plateletsMyelocytesMegakaryocyte fragments.

Patient Details 

Age (yrs) 55

Sex f

Hb(g/l) 8.7

WBC (x109/l) 76.7

Platelets (x109/l) 114

0301bf1.mov

Stitched Image (2003)

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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Exercise for 2004

Dr. John Burthem

Manchester Royal Infirmary.

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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

4.5

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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Panel C. WP4

0

10

20

30

40

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60

70

80

90

Myelocytes Blast cells Nucleated RBCs Promyelocytes Thrombocytosis Left shift

reported morphological feature

digital

glass

0001BF2 (HbSS)

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

Panel A WP1

0

10

20

30

40

50

60

70

80

90

100

NucleatedRBCs

Polychromaticcells

Target cells Sickle cells Howell JollyBodies

Spherocytes

reported morpological feature

digital

glass

0002BF1 (Bcell PLL)

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

Panel B WP2

0

10

20

30

40

50

60

70

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90

100

Thrombocytopenia Spherocytes Lymphocytosis Polychromasia Prolymphocytes Blast cells

reported morphological feature

digital

glass

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**

0403PA1 (P.Ovale)

Panel D. WP5

0

10

20

30

40

50

60

70

80

90

100

Plasmodium vivax Plasmodium ovale Plasmodium malariae Plasmodium falciparum

reported parasite

digital

glass

Future developments

(Go here to the BM stitch)

Future Developments

Introducing CPD, maintain and develop image library.

Incorporation of stitched images.

Driven by participants, cases from users.

Exploring education.

Getting feedback to participants.

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Acknowledgements

All respondents of exercisesStaff at UK NEQAS(H).www.ukneqas-haem.org.uk

Staff in Haematology at Manchester Royal Infirmary.www.manlab.co.uk (department morphology).

Universities of Salford & Manchester Metropolitan.

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