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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
**
**
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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