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(H). Digital Morphology Imaging Aim of Project To 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. (H). - PowerPoint PPT Presentation
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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
50
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
80
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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