-
National and International Quality Standards in the Pulmonary
Function
LaboratoryCarl Mottram, RRT RPFT FAARC
Director - Pulmonary Function Labs & RehabilitationAssociate
Professor of Medicine - Mayo Clinic College of
Medicine
-
Case Presentation• 31 y.o. female • History of present
illness
• Non-specific cough, tightness in throat and episodic shortness
of breath following URI
• No wheezing noted by patient or on exam• Exam normal other
than obesity (BMI 38)
• LMD orders CXR and spirometry with diffusing capacity
-
Case Presentation
• CXR• Spirometry & DLCO
Pre Post %Pred
FVC 2.10 2.11 62%
FEV1 0.89 1.36 31%
Ratio 42.4 64.5
DLCO 8.0 30%
Impression: Severe obstruction with a severe reduction in DLCO.
Some improvement with BD
External Pulmonary Laboratory
0
2
4
6
8
10
12
0 1 2 3 4 5 6 7 8Volume L
Flow
L/s
ControlPost AlbuterolPredicted
Chart3
000
0.040.040.505
0.080.080.843
0.120.121.685
0.160.172.528
0.210.213.37
0.250.25
0.290.29
0.330.33
0.370.37
0.410.41
0.450.46
0.490.5
0.540.54
0.580.58
0.620.62
0.660.66
0.70.7
0.740.74
0.780.79
0.820.83
0.860.87
0.910.91
0.950.95
0.990.99
1.031.03
1.071.08
1.111.12
1.151.16
1.191.2
1.241.24
1.281.28
1.321.32
1.361.37
1.41.41
1.441.45
1.481.49
1.521.53
1.561.57
1.611.61
1.651.65
1.691.7
1.731.74
1.771.78
1.811.82
1.851.86
1.891.9
1.941.94
1.981.99
2.022.03
2.062.07
2.12.11
Control
Post Albuterol
Predicted
Volume L
Flow L/s
External Pulmonary Laboratory
0
0
0
0.64
0.22
5.69
1.17
0.3
5.37
1.37
0.72
3.56
1.45
1.13
1.66
1.46
1.36
0
1.44
1.52
1.37
1.66
1.4
1.77
1.48
1.81
1.53
1.85
1.49
1.89
1.37
1.91
1.21
1.91
1.03
1.85
0.84
1.79
0.67
1.72
0.64
1.65
0.58
1.59
0.49
1.55
0.45
1.52
0.37
1.5
0.35
1.49
0.49
1.44
0.52
1.37
0.36
1.28
0.34
1.17
0.54
1.04
0.47
0.95
0.42
0.85
0.41
0.74
0.37
0.63
0.27
0.55
0.17
0.47
0.55
0.43
0.81
0.34
0.81
0.29
0.77
0.28
0.71
0.29
0.64
0.29
0.53
0.27
0.41
0.21
0.31
0.15
0.25
0.29
0.21
0.28
0.46
0.21
0.42
0.11
0.33
0.07
0.14
0.12
0.15
0.14
0.13
0.12
0
0
MPLOT
0599C0000599B0000599N000
0599C0.640.040.640599B0.220.040.220599N5.690.5055.69
0599C1.170.081.170599B0.30.080.30599N5.370.8435.37
0599C1.370.121.370599B0.720.120.720599N3.561.6853.56
0599C1.450.161.450599B1.130.171.130599N1.662.5281.66
0599C1.460.211.460599B1.360.211.360599N03.370
0599C1.440.251.440599B1.520.251.52
0599C1.370.291.370599B1.660.291.66
0599C1.40.331.40599B1.770.331.77
0599C1.480.371.480599B1.810.371.81
0599C1.530.411.530599B1.850.411.85
0599C1.490.451.490599B1.890.461.89
0599C1.370.491.370599B1.910.51.91
0599C1.210.541.210599B1.910.541.91
0599C1.030.581.030599B1.850.581.85
0599C0.840.620.840599B1.790.621.79
0599C0.670.660.670599B1.720.661.72
0599C0.640.70.640599B1.650.71.65
0599C0.580.740.580599B1.590.741.59
0599C0.490.780.490599B1.550.791.55
0599C0.450.820.450599B1.520.831.52
0599C0.370.860.370599B1.50.871.5
0599C0.350.910.350599B1.490.911.49
0599C0.490.950.490599B1.440.951.44
0599C0.520.990.520599B1.370.991.37
0599C0.361.030.360599B1.281.031.28
0599C0.341.070.340599B1.171.081.17
0599C0.541.110.540599B1.041.121.04
0599C0.471.150.470599B0.951.160.95
0599C0.421.190.420599B0.851.20.85
0599C0.411.240.410599B0.741.240.74
0599C0.371.280.370599B0.631.280.63
0599C0.271.320.270599B0.551.320.55
0599C0.171.360.170599B0.471.370.47
0599C0.551.40.550599B0.431.410.43
0599C0.811.440.810599B0.341.450.34
0599C0.811.480.810599B0.291.490.29
0599C0.771.520.770599B0.281.530.28
0599C0.711.560.710599B0.291.570.29
0599C0.641.610.640599B0.291.610.29
0599C0.531.650.530599B0.271.650.27
0599C0.411.690.410599B0.211.70.21
0599C0.311.730.310599B0.151.740.15
0599C0.251.770.250599B0.291.780.29
0599C0.211.810.210599B0.281.820.28
0599C0.461.850.460599B0.211.860.21
0599C0.421.890.420599B0.111.90.11
0599C0.331.940.330599B0.071.940.07
0599C0.141.980.140599B0.121.990.12
0599C0.152.020.150599B0.142.030.14
0599C0.132.060.130599B0.122.070.12
0599C02.100599B02.110
0799C00.740
0799C-0.390.73-0.39
0799C-0.750.71-0.75
0799C-0.880.7-0.88
0799C-0.910.68-0.91
0799C-0.930.67-0.93
0799C-0.930.65-0.93
0799C-0.910.64-0.91
0799C-0.880.62-0.88
0799C-0.840.61-0.84
0799C-0.790.59-0.79
0799C-0.750.58-0.75
0799C-0.690.57-0.69
0799C-0.630.55-0.63
0799C-0.560.54-0.56
0799C-0.510.52-0.51
0799C-0.50.51-0.5
0799C-0.520.49-0.52
0799C-0.570.48-0.57
0799C-0.640.46-0.64
0799C-0.720.45-0.72
0799C-0.790.44-0.79
0799C-0.830.42-0.83
0799C-0.860.41-0.86
0799C-0.890.39-0.89
0799C-0.90.38-0.9
0799C-0.90.36-0.9
0799C-0.910.35-0.91
0799C-0.90.33-0.9
0799C-0.90.32-0.9
0799C-0.90.3-0.9
0799C-0.860.29-0.86
0799C-0.830.28-0.83
0799C-0.770.26-0.77
0799C-0.710.25-0.71
0799C-0.630.23-0.63
0799C-0.540.22-0.54
0799C-0.460.2-0.46
0799C-0.420.19-0.42
0799C-0.410.17-0.41
0799C-0.420.16-0.42
0799C-0.410.15-0.41
0799C-0.390.13-0.39
0799C-0.290.12-0.29
0799C-0.120.1-0.12
0799C-0.070.09-0.07
0799C-0.090.07-0.09
0799C-0.140.06-0.14
0799C-0.170.04-0.17
0799C-0.210.03-0.21
0799C-0.10.01-0.1
0799C000
MPLOT
Control
Post Albuterol
Predicted
Volume L
Flow L/s
External Pulmonary Laboratory
-
Case Presentation• LMD Action Plan
• Orders a CT scan• Referred to Mayo Clinic for further
evaluation
http://www.google.com/url?url=http://www.philipsctscanner.com/&rct=j&frm=1&q=&esrc=s&sa=U&ei=a4mfU9LYFMOlyASq34CoAw&ved=0CBwQ9QEwAw&sig2=V-nQQjkQGsYZYRWQOjCNuw&usg=AFQjCNGCAm39PLOat_Dp5TS9H7a4mXNDng
-
Case Presentation• Outside CT negative• Pulmonary, ENT, and GI
consults
scheduled
• Pulmonary physician• Negative exam• Lungs clear, patient had
coughing spell
during exam, no wheezing or stridor noted• Questioned outside
spirometry results and
orders PFT’s
-
Case Presentation
• Spirometry & DLCOPre Post %Pred
FVC 2.55 2.48 75%
FEV1 2.27 2.25 79%
Ratio 89 90.7
DLCO 24.2 99%
Impression: Borderline restriction most likely 2° to obesity
with no evidence of airflow obstruction or BD response
Mayo Pulmonary Function Laboratory
0
2
4
6
8
10
12
0 1 2 3 4 5 6 7 8Volume L
Flo
w L
/s
ControlPost AlbuterolPredicted
Chart1
000
0.050.050.507
0.10.10.845
0.150.151.69
0.20.192.535
0.250.243.38
0.30.29
0.350.34
0.40.39
0.450.44
0.50.49
0.550.53
0.60.58
0.650.63
0.70.68
0.750.73
0.80.78
0.850.83
0.90.88
0.950.92
10.97
1.051.02
1.11.07
1.151.12
1.21.17
1.251.22
1.31.26
1.351.31
1.41.36
1.451.41
1.51.46
1.551.51
1.61.56
1.651.6
1.71.65
1.751.7
1.81.75
1.851.8
1.91.85
1.951.9
21.95
2.051.99
2.12.04
2.152.09
2.22.14
2.252.19
2.32.24
2.352.29
2.42.33
2.452.38
2.52.43
2.552.48
Control
Post Albuterol
Predicted
Volume L
Flow L/s
Mayo Pulmonary Function Laboratory
0
0
0
0.72
1.2
5.7
2.19
2.64
5.38
3.3
3.43
3.57
4.17
4.04
1.65
4.75
4.48
0
5.08
4.82
5.71
5.06
5.86
5.21
5.79
5.33
5.29
5.41
5.62
5.34
6.17
5.35
5.92
5.3
5.97
5.19
5.69
5.18
5.84
5.08
5.65
4.89
5.56
4.73
5.4
4.73
5.13
4.51
5.15
4.37
4.8
4.33
4.69
4.15
4.58
3.94
4.05
3.84
4.17
3.71
3.73
3.64
3.76
3.49
3.65
3.35
3.1
3.15
3.14
3.03
2.97
2.75
2.68
2.65
2.39
2.39
2.3
2.14
1.98
1.89
1.82
1.61
1.54
1.33
1.28
1.12
1.08
1.03
0.88
1.03
0.73
0.94
0.55
0.72
0.4
0.63
0.29
0.52
0.17
0.34
0.14
0.2
0.09
0.11
0.08
0.06
0.05
0.11
0
0
MPLOT
0599C000599B000599N00
0599C0.050.720599B0.051.20599N0.5075.7
0599C0.12.190599B0.12.640599N0.8455.38
0599C0.153.30599B0.153.430599N1.693.57
0599C0.24.170599B0.194.040599N2.5351.65
0599C0.254.750599B0.244.480599N3.380
0599C0.35.080599B0.294.82
0599C0.355.710599B0.345.06
0599C0.45.860599B0.395.21
0599C0.455.790599B0.445.33
0599C0.55.290599B0.495.41
0599C0.555.620599B0.535.34
0599C0.66.170599B0.585.35
0599C0.655.920599B0.635.3
0599C0.75.970599B0.685.19
0599C0.755.690599B0.735.18
0599C0.85.840599B0.785.08
0599C0.855.650599B0.834.89
0599C0.95.560599B0.884.73
0599C0.955.40599B0.924.73
0599C15.130599B0.974.51
0599C1.055.150599B1.024.37
0599C1.14.80599B1.074.33
0599C1.154.690599B1.124.15
0599C1.24.580599B1.173.94
0599C1.254.050599B1.223.84
0599C1.34.170599B1.263.71
0599C1.353.730599B1.313.64
0599C1.43.760599B1.363.49
0599C1.453.650599B1.413.35
0599C1.53.10599B1.463.15
0599C1.553.140599B1.513.03
0599C1.62.970599B1.562.75
0599C1.652.680599B1.62.65
0599C1.72.390599B1.652.39
0599C1.752.30599B1.72.14
0599C1.81.980599B1.751.89
0599C1.851.820599B1.81.61
0599C1.91.540599B1.851.33
0599C1.951.280599B1.91.12
0599C21.080599B1.951.03
0599C2.050.880599B1.991.03
0599C2.10.730599B2.040.94
0599C2.150.550599B2.090.72
0599C2.20.40599B2.140.63
0599C2.250.290599B2.190.52
0599C2.30.170599B2.240.34
0599C2.350.140599B2.290.2
0599C2.40.090599B2.330.11
0599C2.450.080599B2.380.06
0599C2.50.050599B2.430.11
0599C2.5500599B2.480
MPLOT
Control
Post Albuterol
Predicted
Volume L
Flow L/s
Mayo Pulmonary Function Laboratory
-
• Further testing• Labeling (COPD,
Asthma, etc)
• Medicine• Disability• Clinical trial data
PFT results affect people!!!
-
• Spirometry in Primary Care Practice*• 30 primary care clinics,
15 trained group
/15 usual group• 3.4% in usual group and 13.5% in
trained group met ATS acceptability and reproducibility
criteria
• 1,012 pt. tests, 2,928 blows (2.89) • * Eaton et al, Chest
1999; 116:416-423
Evidence of Quality Testing
-
Evidence of Quality Testing
• Improving the Quality of Bedside Spirometry
• Audit of testing outside the PF lab -Cleveland Clinic
• 15% - ATS acceptability/reproducibility criteria
• CI Project - 63.5% acceptability/reproducibility
• Stoller JK. Orens DK. Hoisington E. McCarthy K. Bedside
spirometry in a tertiary care hospital: The Cleveland Clinic
experience. Respiratory Care. 47(5):578-82, 2002 May
-
Evidence of Quality TestingCertification of DLCO Measurements
for
Clinical Trials
• Results of the initial DLco simulation tests from 125
pulmonary laboratories
• 94 (75.2%) Passed with coaching; no hardware • 24 (19.2%)
Failed. Passed after servicing• 6 (4.8%) Failed. Passed with new
equipment • 1 (0.8%) Site dropped 1
Jensen, R, Leyk, M, Crapo R, Muchmore D, Berclaz PY. Quality
control of DLCO instruments in global clinical trials. Eur Respir J
2009; 33:1-7.
-
• All DLCO simulations were completed by one individual from DAP
using the same simulation device from May 2009 to March 2011.
• 24 instruments were tested at the 13 sites. • 24 instruments,
17 (70.8%) met the target range and 7
(29.2%) were outside the 10% target range.
• lack of routine instrument maintenance, medical gases,
defective demand valve, defective electronic components, defective
flow sensor, defective sample pump, defective carbon monoxide gas
analyzer.
• Post intervention, all instruments met the expected target
range.
2012 ATS 27384
-
• Diagnostic Accreditation Program (DAP) of British
Columbia.
• 23 sites and 40 instruments• Instruments represented four
venders and
multiple software versions
2012 ATS 27584
-
Evidence of Quality Testing
Results from a surveyof PFT labs in Europe and Latin America
Enright, Blonshine, Harris 2007 ERS abstract
-
Guidelines and Standards
• American Thoracic Society•1987 Revised Spirometry
Standards•1994 Revised Spirometry Standards•1995 Diffusing
Capacity• 1999 Guidelines for Methacholine and Exercise Challenge
Testing•ATS/ERS 2005 Series:
• General Laboratory, Spirometry, Diffusing Capacity, Lung
volumes, and Interpretation
•2017 ERS/ATS Diffusion of the lung
-
Resources for Success
• American Thoracic Society• ATS Pulmonary Function
Laboratory
Management and Procedure Manual• 3rd Edition 2016
• www.thoracic.org• Education• Education Products
-
Resources for Success• Clinical and Laboratory Standards
Institute “Quality Systems and Laboratory Practice
Committee”
• Professionals• Government – FDA, CDC, CMS• Industry
-
CLSI’s Quality Systems • QMS01-A4: Quality Management Systems
A
Model for Laboratory Services
• QMS04-A2: Quality Systems in Respiratory Care
Patientassessment
ClinicalinterpretationapplicationPath of workflow
QSE
Patient
-
Quality Systems in the PFLQuality Assurance
CLSI’s “Path of workflow” Model
-
Quality Systems in the PFLPre-test
• Pre-test instructions• Appropriate order• Questionnaire •
Height* and weight• Equipment quality
assurance program
-
Quality Systems in the PFLPre-test
• Subject preparation• Activities that should preferably be
avoided
prior to lung function testing.• Smoking within 1 hours of
testing• Consuming alcohol within 4 hours of testing• Performing
vigorous exercise within 30
minutes of testing• Wearing clothing that substantially
restricts
full chest and abdominal expansion• Eating a large meal within 2
hours of testing
• Deviations recorded 2005 ATS/ERS Standards General
Laboratory
-
Quality Systems in the PFLPre-test
• Height and weight•Measured in indoor clothes without
shoes•Patients with deformities of the thoracic cage should have
their arm span measured
•Regression equations•Ht = arm span/1.06
2005 ATS/ERS Standards General Laboratory
-
Quality Systems in the PFLPre-test
• Equipment quality assurance
•Validation/Verification•Preventive maintenance•Documentation
and records (logbooks)
• Mechanical models
• Biological models
-
Quality Systems in the PFLPre-test
• Mechanical Model•3-liter syringe – Daily and weekly
• 0.5, 1-2, 6 second flows•Leak checked •Stored and used in such
a way as to maintain the same temperature and humidity of the
testing site•Validated based on manufacturer recommendations
2005 ATS/ERS Standards Standardization of Spirometry
-
Quality Systems in the PFLPre-test
Mechanical Model -Plethysmography
• Validation using a known volume should be performed
periodically
• Model lung with thermal mass to simulate isothermal conditions
of the lung.
• Accuracy 50 ml or 3%
2005 ATS/ERS Standards Standardization of Lung Volumes
-
Quality Systems in the PFLPre-test
• Mechanical Model –Dilution techniques
• Analyzer accuracy and linearity
• N2 washout: Monthly, exhalation volumes should be checked with
the syringe filled with room air, and inhalation volumes with the
syringe filled with 100% O2.
2005 ATS/ERS Standards Standardization of Lung Volumes
-
Quality Systems in the PFLPre-test
• Mechanical Models – DLCO• 2.5% volume acceptability
range • Syringe DLCO weekly or
whenever problems occur•VA,VC BTPS ~ 3.2- 3.3L
• DLCO Simulator or BioQC
2017 ERS/ATS Standardization of DLCO
-
Quality Systems in the PFLPre-test
• Biological Model• Normal laboratory subjects• Two individuals
(16)• Establish mean and SD
(minimum 20 samples)
2005 ATS/ERS Standards General Laboratory
-
Quality Systems in the PFLPre-test
Biological Control – Lung volume• At least monthly or whenever
errors are suspect 2 reference
subjects (biologic controls) should be tested
2005 ATS/ERS Standards - Standardization of Lung Volumes
Sheet1
bioqc_keybioqc_idbioqc_nametesttimetestdateroomcodebioqc_fvcbioqc_fev1bioqc_pefbioqc_tlcPbioqc_tlcHbioqc_tgvPbioqc_tgvHbioqc_vcLVbioqc_HeVCbioqc_srawbioqc_dlcobioqc_vabioqc_vcD
_JQM_BIOB_LAB_1200302100728RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:28 AM2/10/0317.0564.1034.8965.13660623.907936.329564.5325
_JQM_BIOB_LAB_1200407120739RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:39 AM7/12/0417.10254.0124.635.13590722.7596.3809614.402
_JQM_BIOB_LAB_1200409130741RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:41 AM9/13/0417.0724.3154.7545.44843122.859836.3759574.548
_JQM_BIOB_LAB_1200405100728RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:28 AM5/10/0417.234.1794.8585.45320522.782326.3475844.4035
_JQM_BIOB_LAB_1200411241411RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 12:11
PM11/24/0417.1443.9726674.7115.25327923.617966.4166544.527
_JQM_BIOB_LAB_1200302240728RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:28 AM2/24/0317.0014.11054.8515.41057323.537586.285574.568
_JQM_BIOB_LAB_1200403080717RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:17 AM3/8/0417.0814.05054.835.1832923.17466.3261214.5
_JQM_BIOB_LAB_1200203110726RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:26
AM3/11/0214.5163.376.8567.26854.1755.0356.74806122.50666.2219644.6065
_JQM_BIOB_LAB_1200212160729RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:29
AM12/16/0216.96953.93054.7386.69923122.09686.3831954.44
_JQM_BIOB_LAB_1200304280734RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:34 AM4/28/0317.1013.80254.975.9306422.02586.4206524.6515
_JQM_BIOB_LAB_1200205200727RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:27
AM5/20/0217.18454.2584.7854.90120523.817986.3955464.6555
_JQM_BIOB_LAB_1200207150726RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:26
AM7/15/0216.9934.39054.7916.37396322.734826.1999014.4895
_JQM_BIOB_LAB_1200401050722RCH1_JQM_BIOB_LAB_1BIO SWANTKO, CRIS
RM 17:22
AM1/5/0414.7513.4637.1357.13253.93154.9865.06913522.74416.4451944.59
_JQM_BIOB_LAB_2200409270729RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:29
AM9/27/0427.00656.6340654.1032.9940654.7744.7895.99002321.578936.1060244.528
_JQM_BIOB_LAB_2200311100725RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:25
AM11/10/0326.9926.2148573.89252.8518574.7744.6315.73189524.549846.0931994.52
_JQM_BIOB_LAB_2200211040751RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:51 AM11/4/02221.687116.0630064.451
_JQM_BIOB_LAB_2200210070954RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 29:54 AM10/7/0224.4173.3946.6086.0486743.3346744.417
_JQM_BIOB_LAB_2200208260731RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:31
AM8/26/0227.09756.6646653.8422.9386654.8834.8715.34343322.210546.5325464.6695
_JQM_BIOB_LAB_2200407190737RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:37
AM7/19/0426.84156.5592343.8913.2032344.7554.2915.56582922.674456.0021454.327
_JQM_BIOB_LAB_2200212230735RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:35
AM12/23/0226.9696.1233353.91652.6263354.8284.566.23018323.531776.1670384.742
_JQM_BIOB_LAB_2200204150804RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 28:04 AM4/15/0227.2193624.1073624.882
_JQM_BIOB_LAB_2200208050737RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:37
AM8/5/0224.7363.4476.8417.03057.0841543.76553.6001544.9964.776.33660821.805686.3495274.7045
_JQM_BIOB_LAB_2200410280907RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 29:07 AM10/28/0426.987253.8744.857
_JQM_BIOB_LAB_2200210140728RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:28
AM10/14/0226.7586.0538763.80452.6448764.6084.5855.91547221.467315.872734.3265
_JQM_BIOB_LAB_2200203180723RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:23
AM3/18/0224.8743.5976.6036.5796677.5880093.7496674.892014.9874.6386.48279620.8715.9786794.552
_JQM_BIOB_LAB_2200210210752RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:52 AM10/21/0225.9313142.7103144.519
_JQM_BIOB_LAB_2200401120720RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:20
AM1/12/0427.07256.433583.88353.053584.9414.6725.65512322.791656.0019824.529
_JQM_BIOB_LAB_2200309080737RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:37
AM9/8/0326.9476.8020213.9892.901024.7614.7175.34402222.94575.9444644.547
_JQM_BIOB_LAB_2200303051208RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 212:08 PM3/5/0324.8023.6126.7086.4505212.7985224.832
_JQM_BIOB_LAB_2200303310740RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:40
AM3/31/0326.99556.2362164.06152.6612164.9754.7566.12859423.382696.1600684.662
_JQM_BIOB_LAB_2200403150727RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:27
AM3/15/0427.0946.4297054.1813.0137054.8614.616.15586222.33736.0079394.612
_JQM_BIOB_LAB_2200303030730RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:30
AM3/3/0324.8383.6266.7376.98556.7175063.9813.3945064.9044.8385.72192723.19716.1087414.716
_JQM_BIOB_LAB_2200405170726RCH2_JQM_BIOB_LAB_2BIO SWANTKO, CRIS
RM 27:26
AM5/17/0427.02056.6868164.01553.2578164.7444.6376.49437422.773915.9138424.471
_JQM_BIOB_LAB_3200304210858RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 38:58
AM4/21/0334.8083.5856.9286.99856.8161383.8523.6191384.8484.7246.16649823.734956.1733294.695
_JQM_BIOB_LAB_3200303100724RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:24
AM3/10/0337.10956.7547124.1093.2227124.9554.7565.68408322.828876.1384084.724
_JQM_BIOB_LAB_3200212300724RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:24
AM12/30/0237.04956.537653.93653.126654.7754.6676.02861823.558956.1007064.52
_JQM_BIOB_LAB_3200309150726RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:26
AM9/15/0337.0676.7173034.28953.3393034.7554.6515.82959422.420916.2998464.507
_JQM_BIOB_LAB_3200210210730RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:30
AM10/21/0236.96456.5442373.9773.4742364.6314.5686.47976522.383886.0890144.4035
_JQM_BIOB_LAB_3200311170724RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:24
AM11/17/0337.12356.6136284.0573.1266284.8984.7555.48139323.076816.1277714.627
_JQM_BIOB_LAB_3200305190728RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:28
AM5/19/0337.09256.4968284.25353.8578284.8694.6176.22475823.171426.1300254.616
_JQM_BIOB_LAB_3200208120726RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:26
AM8/12/0237.2026.9903864.0363.8513864.9654.6846.30969820.898135.9656414.612
_JQM_BIOB_LAB_3200203250733RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:33
AM3/25/0234.7593.3486.5437.27756.9925994.1533.3925995.0094.738.17894519.857886.3385364.5625
_JQM_BIOB_LAB_3200305120736RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:36
AM5/12/0337.1596.8437483.743.1767484.8764.7285.31038222.67056.1263914.587
_JQM_BIOB_LAB_3200204290811RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 38:11 AM4/29/02322.867496.4044494.718
_JQM_BIOB_LAB_3200205130758RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:58 AM5/13/02321.856336.0722254.625
_JQM_BIOB_LAB_3200206030729RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:29
AM6/3/0234.7513.476.8847.2676.1145114.1264.6905114.9443.2456.92847920.69616.4725834.7505
_JQM_BIOB_LAB_3200407260722RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:22
AM7/26/0437.0096.2231974.23852.7561964.8014.5575.94545723.855986.2179524.551
_JQM_BIOB_LAB_3200405240730RCH3_JQM_BIOB_LAB_3BIO SWANTKO, CRIS
RM 37:30
AM5/24/0437.016.5956474.20253.2626474.7234.6176.830622.497826.1631654.3775
_JQM_BIOB_LAB_4200210280724RCH4_JQM_BIOB_LAB_4BIO SWANTKO, CRIS
RM 47:24
AM10/28/0246.83253.9524.8815.6546322.580636.1875024.402
_JQM_BIOB_LAB_4200401260725RCH4_JQM_BIOB_LAB_4BIO SWANTKO, CRIS
RM 47:25
AM1/26/0447.0854.11254.8855.46816823.345466.198814.4585
_JQM_BIOB_LAB_4200208190724RCH4_JQM_BIOB_LAB_4BIO SWANTKO, CRIS
RM 47:24
AM8/19/0246.83253.7884.8328.43715423.216276.3933754.4685
_JQM_BIOB_LAB_4200406010726RCH4_JQM_BIOB_LAB_4BIO SWANTKO, CRIS
RM 47:26
AM6/1/0444.6613.417.3697.194.2114.8095.11524122.086196.2373134.5405
_JQM_BIOB_LAB_4200204010732RCH4_JQM_BIOB_LAB_4BIO SWANTKO, CRIS
RM 47:32
AM4/1/0244.3563.3997.6557.21954.18855.0438.14752122.746696.3054644.611
_JQM_BIOB_LAB_4200309220722RCH4_JQM_BIOB_LAB_4BIO SWANTKO, CRIS
RM 47:22
AM9/22/0347.09053.9254.5725.51363923.174786.305114.3035
_JQM_BIOB_LAB_4200303170733RCH4_JQM_BIOB_LAB_4BIO SWANTKO, CRIS
RM 47:33
AM3/17/0347.19854.20455.0475.89296723.167966.3087564.517
_JQM_BIOB_LAB_4200311240720RCH4_JQM_BIOB_LAB_4BIO SWANTKO, CRIS
RM 47:20
AM11/24/0347.18154.0684.8656.48275123.956696.3115194.469
_JQM_BIOB_LAB_4200301060729RCH4_JQM_BIOB_LAB_4BIO SWANTKO, CRIS
RM 47:29
AM1/6/0344.683.4317.0496.88154.0224.8586.52844523.485866.3205044.6095
_JQM_BIOB_LAB_5200210140752RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:52 AM10/14/02521.831286.0593584.375
_JQM_BIOB_LAB_5200208260721RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:21
AM8/26/0257.18654.2574.9275.68716422.512536.1891384.5365
_JQM_BIOB_LAB_5200402020722RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:22
AM2/2/0454.7843.5097.2337.20854.12254.9725.6773422.203856.3490644.6205
_JQM_BIOB_LAB_5200211040719RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:19
AM11/4/0254.6713.5096.7367.00154.23754.7635.8057122.509866.3083494.536
_JQM_BIOB_LAB_5200408090716RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:16 AM8/9/0457.12754.4494.7194.90422422.656926.3432344.488
_JQM_BIOB_LAB_5200410040722RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:22
AM10/4/0454.7443.5027.3967.2694.2624.8225.52840522.164476.5065264.635
_JQM_BIOB_LAB_5200301130726RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:26 AM1/13/0357.08754.11654.855.62158522.475836.2933544.54
_JQM_BIOB_LAB_5200309290720RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:20
AM9/29/0357.1734.30854.7676.30910824.006616.2515264.435
_JQM_BIOB_LAB_5200406070729RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:29 AM6/7/0457.1163.9744.6725.3576922.950666.3530934.5465
_JQM_BIOB_LAB_5200203131026RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 510:26 AM3/13/02521.68366.1057024.56375
_JQM_BIOB_LAB_5200204080727RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:27
AM4/8/0254.8123.5497.7737.1284.2115.1046.14301121.592186.3350314.6525
_JQM_BIOB_LAB_5200208120714RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:14 AM8/12/0257.11453.98754.955.8010123.157536.2572224.745
_JQM_BIOB_LAB_5200208190746RCH5_JQM_BIOB_LAB_5BIO SWANTKO, CRIS
RM 57:46 AM8/19/0256.8894.4973.9327.114714
_JQM_BIOB_LAB_6200202250722RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:22 AM2/25/0260.248.094648
_JQM_BIOB_LAB_6200406140713RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:13 AM6/14/0467.044.1454.625.68711922.268336.4145054.505
_JQM_BIOB_LAB_6200410121047RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 610:47
AM10/12/0467.1324.24454.8295.53531623.789536.4030374.61
_JQM_BIOB_LAB_6200209030732RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:32
AM9/3/0264.5443.4237.0636.9334.00854.9036.11807222.275616.4184114.5425
_JQM_BIOB_LAB_6200402090722RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:22 AM2/9/0466.90354.2234.645.78206322.321146.2286964.448
_JQM_BIOB_LAB_6200211110725RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:25 AM11/11/0266.93.97854.7825.26477322.873676.2744044.489
_JQM_BIOB_LAB_6200301200717RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:17 AM1/20/0367.01754.0964.8454.57095923.45986.0742754.426
_JQM_BIOB_LAB_6200310060715RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:15
AM10/6/0364.7023.3877.1427.2414.16654.9447.28543922.19056.3976424.566
_JQM_BIOB_LAB_6200206240715RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:15
AM6/24/0267.1824.10154.9935.48223922.922626.373494.7345
_JQM_BIOB_LAB_6200204150727RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:27
AM4/15/0264.9113.6977.6087.1364.15755.096.19428823.370826.3355544.658
_JQM_BIOB_LAB_6200408090721RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:21 AM8/9/0467.1063.99854.8025.92693121.479156.1697094.551
_JQM_BIOB_LAB_6200408160728RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:28
AM8/16/0467.0874.45054.8255.99189922.664356.2967654.491
_JQM_BIOB_LAB_6200203141352RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 61:52 PM3/14/02622.412016.1636124.5135
_JQM_BIOB_LAB_6200312080716RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:16
AM12/8/0367.0714.11154.9425.51229522.347426.1991064.478
_JQM_BIOB_LAB_6200404120716RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:16
AM4/12/0466.90453.92954.7356.18427322.349186.1853474.3605
_JQM_BIOB_LAB_6200301130712RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:12 AM1/13/0367.03354.034.9645.1945124.104166.3122624.542
_JQM_BIOB_LAB_6200309220745RCH6_JQM_BIOB_LAB_6BIO SWANTKO, CRIS
RM 67:45 AM9/22/03623.935596.4024634.413
_JQM_BIOB_LAB_7200203140953RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 79:53 AM3/14/02723.343096.2796174.426
_JQM_BIOB_LAB_7200209030800RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 78:00 AM9/3/0270.5056.652844
_JQM_BIOB_LAB_7200209090730RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:30 AM9/9/0277.0664.0414.8465.60428822.909516.3944884.59
_JQM_BIOB_LAB_7200202110720RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:20
AM2/11/0274.7713.5426.1987.0853.98055.0535.93122420.370176.110824.4355
_JQM_BIOB_LAB_7200310130727RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:27
AM10/13/0374.7253.5527.0167.0744.1764.7315.75813222.061466.3303854.454
_JQM_BIOB_LAB_7200204220729RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:29
AM4/22/0274.7913.5336.7066.99454.0935.0056.56216621.436786.2622324.625
_JQM_BIOB_LAB_7200209030750RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:50 AM9/3/0279.998298
_JQM_BIOB_LAB_7200205130721RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:21 AM5/13/02724.032396.2752844.618
_JQM_BIOB_LAB_7200211180711RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:11
AM11/18/0277.0124.12854.794.95910122.842376.2715074.4595
_JQM_BIOB_LAB_7200406070737RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:37 AM6/7/0477.1914.01954.7895.8651522.096736.4031464.4335
_JQM_BIOB_LAB_7200302030740RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:40 AM2/3/03722.550776.3822114.474
_JQM_BIOB_LAB_7200404190707RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:07
AM4/19/0477.0674.00654.6845.97160121.693276.2753674.4665
_JQM_BIOB_LAB_7200408230715RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:15 AM8/23/0477.054.03254.5635.92399324.599356.421844.539
_JQM_BIOB_LAB_7200410221349RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 71:49
PM10/22/0477.1964.3174.8414.98225523.515766.4537834.7025
_JQM_BIOB_LAB_7200312150719RCH7_JQM_BIOB_LAB_7BIO SWANTKO, CRIS
RM 77:19
AM12/15/0377.1254.32654.9035.44362822.773796.3366344.634
_JQM_BIOB_LAB_8200302030730RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:30
AM2/3/0384.5343.3986.7077.12454.16054.7926.28427322.623926.2882184.5545
_JQM_BIOB_LAB_8200304140722RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:22
AM4/14/0387.18654.3324.9865.71276422.651256.3547134.5215
_JQM_BIOB_LAB_8200406280717RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:17 AM6/28/0487.12654.3724.5676.43232621.40376.2561434.45
_JQM_BIOB_LAB_8200402230717RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:17 AM2/23/0487.134.1344.7166.39663922.546756.1184214.42
_JQM_BIOB_LAB_8200212230720RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:20
AM12/23/0287.2264.11054.7456.5972323.391215.9527324.4105
_JQM_BIOB_LAB_8200211180731RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:31
AM11/18/0287.17354.1714.8995.08662921.812616.0283684.329667
_JQM_BIOB_LAB_8200310200708RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:08
AM10/20/0387.20454.0754.7435.23617622.580056.3102434.394
_JQM_BIOB_LAB_8200211250725RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:25
AM11/25/0287.17854.18854.7835.85397622.133376.3379854.5025
_JQM_BIOB_LAB_8200404260714RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:14 AM4/26/0487.1514.2244.7275.96175722.157655.947034.471
_JQM_BIOB_LAB_8200411050839RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 88:39
AM11/5/0487.16354.2384.7764.76490122.819016.4179224.664
_JQM_BIOB_LAB_8200202180733RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:33
AM2/18/0284.6263.5726.4157.1534.26654.875.58212921.502996.0537794.417
_JQM_BIOB_LAB_8200207080714RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:14 AM7/8/0287.17754.6714.9285.8624322.082726.2657814.6415
_JQM_BIOB_LAB_8200205170718RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:18 AM5/17/02824.263896.5055854.72
_JQM_BIOB_LAB_8200204290723RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:23
AM4/29/0284.7713.5826.7767.1064.4875.0026.88690923.608076.3434324.756
_JQM_BIOB_LAB_8200203040742RCH8_JQM_BIOB_LAB_8BIO SWANTKO, CRIS
RM 87:42
AM3/4/0284.783.5776.3997.29454.3745.0945.80170119.365456.0551414.4745
_JQM_BIOB_LAB_9200202250740RCH9_JQM_BIOB_LAB_9BIO SWANTKO, CRIS
RM 97:40 AM2/25/0294.8653.6086.534
_JQM_BIOB_LAB_9200201210732RCH9_JQM_BIOB_LAB_9BIO SWANTKO, CRIS
RM 97:32 AM1/21/0294.7663.5536.91
_JQM_BIOB_LAB_9200409070715RCH9_JQM_BIOB_LAB_9BIO SWANTKO, CRIS
RM 97:15 AM9/7/0494.4133.2936.863
_JQM_BIOB_LAB_9200212090730RCH9_JQM_BIOB_LAB_9BIO SWANTKO, CRIS
RM 97:30 AM12/9/0294.4983.2936.633
_JQM_BIOB_LAB_B200310270718RCHB_JQM_BIOB_LAB_BBIO SWANTKO, CRIS
RM B7:18
AM10/27/03B7.2424.2244.8045.24012625.190986.5735774.806
_JQM_BIOB_LAB_B200403010714RCHB_JQM_BIOB_LAB_BBIO SWANTKO, CRIS
RM B7:14
AM3/1/04B4.7243.36.7037.24954.1554.94.83686424.129426.5736164.835
_JQM_BIOB_LAB_B200302170724RCHB_JQM_BIOB_LAB_BBIO SWANTKO, CRIS
RM B7:24 AM2/17/03B4.9213.6026.895
_JQM_BIOB_LAB_B200411190912RCHB_JQM_BIOB_LAB_BBIO SWANTKO, CRIS
RM B9:12
AM11/19/04B7.19354.22854.7444.7391325.155986.659724.756
_JQM_BIOB_LAB_B200308250716RCHB_JQM_BIOB_LAB_BBIO SWANTKO, CRIS
RM B7:16 AM8/25/03B7.14054.5024.684.6318724.749286.4957894.588
_JQM_BIOB_LAB_B200409070734RCHB_JQM_BIOB_LAB_BBIO SWANTKO, CRIS
RM B7:34
AM9/7/04B4.7273.437.8077.2844.1464.9235.07869924.032066.7089584.801
_JQM_BIOB_LAB_B200407060716RCHB_JQM_BIOB_LAB_BBIO SWANTKO, CRIS
RM B7:16
AM7/6/04B4.5873.436.9697.19854.15354.7765.50186624.283736.3001364.777
_JQM_BIOB_LAB_B200302240731RCHB_JQM_BIOB_LAB_BBIO SWANTKO, CRIS
RM B7:31 AM2/24/03B7.18954.19954.822
_JQM_BIOB_LAB_B200302100730RCHB_JQM_BIOB_LAB_BBIO SWANTKO, CRIS
RM B7:30 AM2/10/03B7.2034.1154.7386.9027524.373916.5749614.662
_JQM_BIOB_LAB_B200312290714RCHB_JQM_BIOB_LAB_BBIO SWANTKO, CRIS
RM B7:14
AM12/29/03B7.23854.20354.7314.31328524.166916.153724.665
Chart1
7.0564.103
7.10254.012
7.0724.315
7.234.179
7.1443.972667
7.0014.1105
7.0814.0505
7.26854.175
6.96953.9305
7.1013.8025
7.18454.258
6.9934.3905
7.13253.9315
7.00654.103
6.9923.8925
7.09753.842
6.84153.891
6.9693.9165
7.03053.7655
6.987253.874
6.7583.8045
6.5796673.749667
7.07253.8835
6.9473.989
6.99554.0615
7.0944.181
6.98553.981
7.02054.0155
6.99853.852
7.10954.109
7.04953.9365
7.0674.2895
6.96453.977
7.12354.057
7.09254.2535
7.2024.036
7.27754.153
7.1593.74
7.2674.126
7.0094.2385
7.014.2025
6.83253.952
7.0854.1125
6.83253.788
7.194.211
7.21954.1885
7.09053.925
7.19854.2045
7.18154.068
6.88154.022
7.18654.257
7.20854.1225
7.00154.2375
7.12754.449
7.2694.262
7.08754.1165
7.1734.3085
7.1163.974
7.1284.211
7.11453.9875
6.8894.497
7.044.145
7.1324.2445
6.9334.0085
6.90354.223
6.93.9785
7.01754.096
7.2414.1665
7.1824.1015
7.1364.1575
7.1063.9985
7.0874.4505
7.0714.1115
6.90453.9295
7.03354.03
7.0664.041
7.0853.9805
7.0744.176
6.99454.093
7.0124.1285
7.1914.0195
7.0674.0065
7.054.0325
7.1964.317
7.1254.3265
7.12454.1605
7.18654.332
7.12654.372
7.134.134
7.2264.1105
7.17354.171
7.20454.075
7.17854.1885
7.1514.224
7.16354.238
7.1534.2665
7.17754.671
7.1064.487
7.29454.374
7.2424.224
7.24954.155
7.19354.2285
7.14054.502
7.2844.146
7.19854.1535
7.18954.1995
7.2034.115
7.23854.2035
TLC-Pleth
FRC-Pleth
Measurement Number
Volume in Liters
TLC and FRC from PlethysmographyBioQC Technologist #2
Chart2
2.9940656.634065
2.8518576.214857
3.3346746.048674
2.9386656.664665
3.2032346.559234
2.6263356.123335
4.1073627.219362
3.6001547.084154
2.6448766.053876
4.892017.588009
2.7103145.931314
3.053586.43358
2.901026.802021
2.7985226.450521
2.6612166.236216
3.0137056.429705
3.3945066.717506
3.2578166.686816
3.6191386.816138
3.2227126.754712
3.126656.53765
3.3393036.717303
3.4742366.544237
3.1266286.613628
3.8578286.496828
3.8513866.990386
3.3925996.992599
3.1767486.843748
4.6905116.114511
2.7561966.223197
3.2626476.595647
TLC-He Dilution
FRC-He Dilution
Measurement Number
Volume in Liters
TLC and FRC in He DilutionBioQC Technoligist #2
Chart3
6.32.88
6.012.55
6.172.65
6.032.38
6.152.78
6.362.85
6.072.46
6.012.61
6.132.73
6.062.49
6.152.46
6.182.65
6.292.68
6.263.03
6.142.86
6.222.87
6.392.88
6.212.87
6.473.42
6.322.95
6.372.99
6.42.93
6.172.78
6.32.59
5.942.41
6.322.64
6.362.72
6.342.65
6.222.63
6.343.01
6.342.96
6.372.69
6.172.68
6.242.78
TLC-Nitrogen Washout
FRC-Nitrogen Washout
Measurement Number
Volume in Liters
TLC and FRC in Nitrogen WashoutBioQC Technologist #2
Sheet2
bioqc_tlcPbioqc_tgvPbioqc_tgvHbioqc_tlcHTLC-N2FRC-N2
7.0564.1032.9940656.6340656.32.88
7.10254.0122.8518576.2148576.012.55
7.0724.3153.3346746.0486746.172.65
7.234.1792.9386656.6646656.032.38
7.1443.9726673.2032346.5592346.152.78
7.0014.11052.6263356.1233356.362.85
7.0814.05054.1073627.2193626.072.46
7.26854.1753.6001547.0841546.012.61
6.96953.93052.6448766.0538766.132.73
7.1013.80254.892017.5880096.062.49
7.18454.2582.7103145.9313146.152.46
6.9934.39053.053586.433586.182.65
7.13253.93152.901026.8020216.292.68
7.00654.1032.7985226.4505216.263.03
6.9923.89252.6612166.2362166.142.86
7.09753.8423.0137056.4297056.222.87
6.84153.8913.3945066.7175066.392.88
6.9693.91653.2578166.6868166.212.87
7.03053.76553.6191386.8161386.473.42
6.987253.8743.2227126.7547126.322.95
6.7583.80453.126656.537656.372.99
6.5796673.7496673.3393036.7173036.42.93
7.07253.88353.4742366.5442376.172.78
6.9473.9893.1266286.6136286.32.59
6.99554.06153.8578286.4968285.942.41
7.0944.1813.8513866.9903866.322.64
6.98553.9813.3925996.9925996.362.72
7.02054.01553.1767486.8437486.342.65
6.99853.8524.6905116.1145116.222.63
7.10954.1092.7561966.2231976.343.01
7.04953.93653.2626476.5956476.342.96
7.0674.28956.372.69
6.96453.9776.172.68
7.12354.0576.242.78
7.09254.2535
7.2024.036
7.27754.153
7.1593.74
7.2674.126
7.0094.2385
7.014.2025
6.83253.952
7.0854.1125
6.83253.788
7.194.211
7.21954.1885
7.09053.925
7.19854.2045
7.18154.068
6.88154.022
7.18654.257
7.20854.1225
7.00154.2375
7.12754.449
7.2694.262
7.08754.1165
7.1734.3085
7.1163.974
7.1284.211
7.11453.9875
6.8894.497
7.044.145
7.1324.2445
6.9334.0085
6.90354.223
6.93.9785
7.01754.096
7.2414.1665
7.1824.1015
7.1364.1575
7.1063.9985
7.0874.4505
7.0714.1115
6.90453.9295
7.03354.03
7.0664.041
7.0853.9805
7.0744.176
6.99454.093
7.0124.1285
7.1914.0195
7.0674.0065
7.054.0325
7.1964.317
7.1254.3265
7.12454.1605
7.18654.332
7.12654.372
7.134.134
7.2264.1105
7.17354.171
7.20454.075
7.17854.1885
7.1514.224
7.16354.238
7.1534.2665
7.17754.671
7.1064.487
7.29454.374
7.2424.224
7.24954.155
7.19354.2285
7.14054.502
7.2844.146
7.19854.1535
7.18954.1995
7.2034.115
7.23854.2035
Sheet3
-
Quality Systems in the PFLPre-test
Biologic Control – Diffusing Capacity• At least weekly• Or
whenever errors are suspect• Or whenever a calibration tank is
replaced
DLCO and VA from Diffusing Capacity BioQC Technologist #3
0
5
10
15
20
25
1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85
89 93 97 101 105 109 113 117
Measurement Number
DLC
O U
nits
/Lite
rs
DLCO
VA
2017 ERS/ATS - Standardization of DLCO
Chart1
22.457425.579083
21.886545.526704
21.522685.455055
19.705065.068124
22.279335.258265
22.460025.241067
22.872195.318152
20.901765.487248
20.784545.42036
21.031135.346184
22.1335.411172
20.804335.432315
21.927445.471178
21.164185.233736
22.318365.288573
21.50355.250048
21.601415.641555
21.808425.288092
21.558865.154362
21.697275.414671
22.198835.594488
21.924555.391812
21.92035.488445
23.027485.690065
21.387175.496735
21.783515.336338
21.775765.412809
22.037495.385263
21.325965.080881
21.516895.070127
21.148295.176807
23.255385.570961
21.087725.195387
21.029375.24528
20.66025.156411
20.96075.113388
20.378195.355091
20.661775.43146
21.081145.01596
20.484955.02829
21.17575.137232
20.242845.268423
21.102995.341953
22.733095.541206
20.534195.081621
20.126425.150063
20.211825.329634
20.974335.414106
20.029945.019048
19.869085.037608
19.750015.032855
22.238865.405356
19.891335.021911
20.983445.211291
19.694045.013781
19.868545.344282
20.056385.304243
19.785665.174265
19.603425.21764
20.337735.21157
19.654585.255809
21.664095.288022
20.368235.273021
20.177924.955153
20.781295.013676
19.747854.88236
20.005585.160966
19.932625.244716
20.089735.028169
19.402215.098633
20.06274.977845
21.317115.375932
20.370455.293208
19.670425.042727
20.316555.164653
21.552555.401068
20.539935.343596
21.175565.110169
21.504035.094612
21.073575.343829
19.750885.059638
19.398415.020131
19.858375.03138
20.463725.271163
22.469695.270149
20.505995.281406
19.93414.954821
20.798525.170086
19.129715.019513
19.448934.932442
18.934585.050352
19.461445.059314
19.95255.212954
20.780765.488127
20.043615.331093
20.094885.005692
19.145465.222089
19.03814.917673
18.966715.151113
19.737045.219888
19.442695.36117
20.610465.344718
19.977525.289449
20.761984.992064
20.432695.133034
19.732425.193201
19.536485.016115
19.013995.130635
19.308535.074565
20.55485.380139
21.730565.295375
20.420495.215432
18.891584.818534
19.442645.000786
19.829255.369992
20.527855.175196
19.14525.147583
19.027314.8764
18.260364.986724
DLCO
VA
Measurement Number
DLCO Units/Liters
DLCO and VA from Diffusing Capacity BioQC Technologist #3
Query1
bioqc_keybioqc_dlcobioqc_vabioqc_vcD
_JQM_BIO3_LAB_6200208190740RCH622.457425.5790833.7075
_JQM_BIO3_LAB_8200204150734RCH821.886545.5267043.7675
_JQM_BIO3_LAB_8200206240740RCH821.522685.4550553.7165
_JQM_BIO3_LAB_1200202250742RCH119.705065.0681243.612333
_JQM_BIO3_LAB_1200203121529RCH122.279335.2582653.59375
_JQM_BIO3_LAB_1200203131106RCH122.460025.2410673.5925
_JQM_BIO3_LAB_1200205060737RCH122.872195.3181523.672
_JQM_BIO3_LAB_2200201210743RCH220.901765.4872483.8565
_JQM_BIO3_LAB_2200203040731RCH220.784545.420363.723
_JQM_BIO3_LAB_2200204110942RCH221.031135.3461843.846
_JQM_BIO3_LAB_2200205130732RCH222.1335.4111723.8165
_JQM_BIO3_LAB_2200206030752RCH220.804335.4323153.7345
_JQM_BIO3_LAB_2200207220733RCH221.927445.4711783.761
_JQM_BIO3_LAB_3200203040814RCH321.164185.2337363.7295
_JQM_BIO3_LAB_3200203110743RCH322.318365.2885733.7675
_JQM_BIO3_LAB_3200205200741RCH321.50355.2500483.8445
_JQM_BIO3_LAB_3200207290734RCH321.601415.6415553.7955
_JQM_BIO3_LAB_4200203180737RCH421.808425.2880923.6785
_JQM_BIO3_LAB_4200204010759RCH421.558865.1543623.692667
_JQM_BIO3_LAB_4200205280740RCH421.697275.4146713.7005
_JQM_BIO3_LAB_5200203250735RCH522.198835.5944883.8415
_JQM_BIO3_LAB_5200206030743RCH521.924555.3918123.6325
_JQM_BIO3_LAB_6200204010731RCH621.92035.4884453.827
_JQM_BIO3_LAB_6200206100740RCH623.027485.6900653.774
_JQM_BIO3_LAB_7200204080741RCH721.387175.4967353.797
_JQM_BIO3_LAB_7200206170737RCH721.783515.3363383.691
_JQM_BIO3_LAB_7200207010743RCH721.775765.4128093.722667
_JQM_BIO3_LAB_7200207011117RCH722.037495.3852633.7155
_JQM_BIO3_LAB_7200207011530RCH721.325965.0808813.59225
_JQM_BIO3_LAB_7200208260742RCH721.516895.0701273.627
_JQM_BIO3_LAB_8200209030739RCH821.148295.1768073.629
_JQM_BIO3_LAB_B200209090743RCHB23.255385.5709613.9255
_JQM_BIO3_LAB_1200209230736RCH121.087725.1953873.539
_JQM_BIO3_LAB_1200209300734RCH121.029375.245283.734
_JQM_BIO3_LAB_2200209300741RCH220.66025.1564113.7855
_JQM_BIO3_LAB_3200210070739RCH320.96075.1133883.6835
_JQM_BIO3_LAB_8200210140740RCH820.378195.3550913.762
_JQM_BIO3_LAB_4200210140815RCH420.661775.431463.683
_JQM_BIO3_LAB_5200210210746RCH521.081145.015963.646
_JQM_BIO3_LAB_5200210280742RCH520.484955.028293.597
_JQM_BIO3_LAB_6200210281209RCH621.17575.1372323.5515
_JQM_BIO3_LAB_7200211040737RCH720.242845.2684233.647
_JQM_BIO3_LAB_8200211110742RCH821.102995.3419533.6945
_JQM_BIO3_LAB_B200211180901RCHB22.733095.5412063.76
_JQM_BIO3_LAB_2200212090740RCH220.534195.0816213.695
_JQM_BIO3_LAB_3200212160735RCH320.126425.1500633.611
_JQM_BIO3_LAB_4200212230746RCH420.211825.3296343.657
_JQM_BIO3_LAB_5200212300744RCH520.974335.4141063.71
_JQM_BIO3_LAB_6200301060739RCH620.029945.0190483.575
_JQM_BIO3_LAB_7200301130741RCH719.869085.0376083.6645
_JQM_BIO3_LAB_8200301270735RCH819.750015.0328553.6015
_JQM_BIO3_LAB_B200302030736RCHB22.238865.4053563.7945
_JQM_BIO3_LAB_2200302030753RCH219.891335.0219113.703
_JQM_BIO3_LAB_2200302170748RCH220.983445.2112913.779
_JQM_BIO3_LAB_3200302240731RCH319.694045.0137813.645
_JQM_BIO3_LAB_4200303030752RCH419.868545.3442823.6115
_JQM_BIO3_LAB_5200303100744RCH520.056385.3042433.5285
_JQM_BIO3_LAB_6200303170736RCH619.785665.1742653.5455
_JQM_BIO3_LAB_6200303240738RCH619.603425.217643.525
_JQM_BIO3_LAB_7200303240756RCH720.337735.211573.507
_JQM_BIO3_LAB_8200303310745RCH819.654585.2558093.5615
_JQM_BIO3_LAB_B200304070740RCHB21.664095.2880223.679
_JQM_BIO3_LAB_1200304140744RCH120.368235.2730213.702
_JQM_BIO3_LAB_3200304140747RCH320.177924.9551533.776
_JQM_BIO3_LAB_2200304210747RCH220.781295.0136763.716
_JQM_BIO3_LAB_3200304280746RCH319.747854.882363.692
_JQM_BIO3_LAB_5200305120746RCH520.005585.1609663.5
_JQM_BIO3_LAB_5200305190745RCH519.932625.2447163.526
_JQM_BIO3_LAB_2200308250750RCH220.089735.0281693.609
_JQM_BIO3_LAB_6200308250752RCH619.402215.0986333.5705
_JQM_BIO3_LAB_3200309020739RCH320.06274.9778453.608
_JQM_BIO3_LAB_4200309080738RCH421.317115.3759323.7055
_JQM_BIO3_LAB_5200309150747RCH520.370455.2932083.6195
_JQM_BIO3_LAB_7200309290739RCH719.670425.0427273.51
_JQM_BIO3_LAB_8200310060735RCH820.316555.1646533.5055
_JQM_BIO3_LAB_B200310130741RCHB21.552555.4010683.54
_JQM_BIO3_LAB_1200310200754RCH120.539935.3435963.626
_JQM_BIO3_LAB_2200310270752RCH221.175565.1101693.694
_JQM_BIO3_LAB_3200311030738RCH321.504035.0946123.834
_JQM_BIO3_LAB_4200311100736RCH421.073575.3438293.528
_JQM_BIO3_LAB_5200311170736RCH519.750885.0596383.496
_JQM_BIO3_LAB_6200311240734RCH619.398415.0201313.619
_JQM_BIO3_LAB_7200312010729RCH719.858375.031383.5645
_JQM_BIO3_LAB_8200312080736RCH820.463725.2711633.5065
_JQM_BIO3_LAB_B200312150740RCHB22.469695.2701493.7915
_JQM_BIO3_LAB_1200312220733RCH120.505995.2814063.605
_JQM_BIO3_LAB_2200312290740RCH219.93414.9548213.544
_JQM_BIO3_LAB_3200401050754RCH320.798525.1700863.6785
_JQM_BIO3_LAB_4200401120739RCH419.129715.0195133.4885
_JQM_BIO3_LAB_5200401190744RCH519.448934.9324423.4925
_JQM_BIO3_LAB_6200401260801RCH618.934585.0503523.492
_JQM_BIO3_LAB_7200402020759RCH719.461445.0593143.466
_JQM_BIO3_LAB_8200402090741RCH819.95255.2129543.5885
_JQM_BIO3_LAB_B200402160737RCHB20.780765.4881273.68
_JQM_BIO3_LAB_1200402230748RCH120.043615.3310933.5895
_JQM_BIO3_LAB_2200403010741RCH220.094885.0056923.703
_JQM_BIO3_LAB_5200403220740RCH519.145465.2220893.5395
_JQM_BIO3_LAB_6200403290739RCH619.03814.9176733.3845
_JQM_BIO3_LAB_5200403290754RCH518.966715.1511133.471
_JQM_BIO3_LAB_7200404050739RCH719.737045.2198883.5295
_JQM_BIO3_LAB_8200404120737RCH819.442695.361173.598
_JQM_BIO3_LAB_B200404190744RCHB20.610465.3447183.643
_JQM_BIO3_LAB_1200404260742RCH119.977525.2894493.538
_JQM_BIO3_LAB_2200405030736RCH220.761984.9920643.734
_JQM_BIO3_LAB_3200405100742RCH320.432695.1330343.649
_JQM_BIO3_LAB_4200405170739RCH419.732425.1932013.497
_JQM_BIO3_LAB_3200407120736RCH319.536485.0161153.6335
_JQM_BIO3_LAB_4200407190737RCH419.013995.1306353.479
_JQM_BIO3_LAB_8200407190741RCH819.308535.0745653.581
_JQM_BIO3_LAB_8200408160741RCH820.55485.3801393.587
_JQM_BIO3_LAB_B200408230737RCHB21.730565.2953753.6135
_JQM_BIO3_LAB_7200408300740RCH720.420495.2154323.369
_JQM_BIO3_LAB_2200409070736RCH218.891584.8185343.493
_JQM_BIO3_LAB_3200409130738RCH319.442645.0007863.5335
_JQM_BIO3_LAB_5200409200739RCH519.829255.3699923.5735
_JQM_BIO3_LAB_4200409270742RCH420.527855.1751963.473
_JQM_BIO3_LAB_7200410040735RCH719.14525.1475833.325
_JQM_BIO3_LAB_5200410110741RCH519.027314.87643.434
_JQM_BIO3_LAB_6200410260919RCH618.260364.9867243.425
-
Quality Systems in the PFLBiological Quality Control - PF
Lab
• Results “Out of range”• Repeat with another technologist•
Second tech is within limits - record out of range data• Second
tech out of range - trouble-shoot and
document
Mottram ERS 2013 Abstract
-
0
2
4
6
8
10
12
0 1 2 3 4 5 6 7 8Volume, L
Flow, L/sPredictedControlPost Dilator
Abnormal Study: Mild airway obstruction with a significant
response to bronchodilator. Lung volumes suggest hyperinflation.
DLCO is within normal limits.
-
BioQC - Quality CountsBioQC Anderson
0
1
2
3
4
5
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Date
TLC
- He
Lite
rs
BioQC data-2 SD+2 SD
Changed Sodasorb
Test performed
Chart1
386373863738637
386583865838658
386663866638666
386773867738677
386863868638686
386933869338693
387003870038700
387083870838708
387153871538715
387303873038730
387433874338743
388203882038820
388353883538835
388603886038860
388743887438874
389193891938919
390163901639016
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394933949339493
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395123951239512
395203952039520
395323953239532
395333953339533
395503955039550
5.76.58
Changed Sodasorb
BioQC data
-2 SD
+2 SD
Date
TLC - He Liters
BioQC Anderson
6.2296571732
5.7
6.58
5.9861741066
5.7
6.58
6.0827178955
5.7
6.58
6.2651128769
5.7
6.58
5.8570008278
5.7
6.58
6.0238871574
5.7
6.58
5.8880391121
5.7
6.58
6.3213210106
5.7
6.58
6.1918749809
5.7
6.58
6.1808900833
5.7
6.58
6.3779788017
5.7
6.58
6.1891241074
5.7
6.58
6.0722408295
5.7
6.58
5.7448611259
5.7
6.58
5.8148908615
5.7
6.58
6.1548819542
5.7
6.58
6.3595671654
5.7
6.58
5.8375067711
5.7
6.58
6.2996149063
5.7
6.58
5.9684791565
5.7
6.58
6.4059181213
5.7
6.58
6.45
5.7
6.58
6.52
5.7
6.58
6.75
5.7
6.58
7.24
5.7
6.58
7.1
5.7
6.58
7.28
5.7
6.58
6.2820529938
5.7
6.58
7.55
5.7
6.58
7.76
5.7
6.58
8.07
5.7
6.58
8.56
5.7
6.58
8.42
5.7
6.58
8.22
5.7
6.58
8.58
5.7
6.58
9
5.7
6.58
8.87
5.7
6.58
8.37
5.7
6.58
8.92
5.7
6.58
6.1829819679
5.7
6.58
5.7
6.58
JaegerBioQC
bioqc_keybioqc_idbioqc_nametesttimetestdateroomcodebioqc_fvcbioqc_fev1bioqc_pefbioqc_tlcPbioqc_tlcHbioqc_tgvPbioqc_tgvHbioqc_vcLVbioqc_HeVCbioqc_srawbioqc_dlcobioqc_vabioqc_vcD
_JQM_BIOR_LAB_A200509200751RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/999/20/055.706.58A4.69999980933.723000049610.02200031282.176945924831.53941917425.98523521424.4899997711
_JQM_BIOR_LAB_A200510121045RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/9910/12/055.706.58A4.58400011063.691999912310.21599960336.22965717321.98665702344.744999885633.8034400945.99605512624.4714999199
_JQM_BIOR_LAB_A200511021243RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/9911/2/055.706.58A4.65000009543.697999954210.02200031285.98617410662.19117403034.670000076332.55702972415.66370105744.5830001831
_JQM_BIOR_LAB_A200511100838RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/9911/10/055.706.58A4.5060000423.66599988949.7360000616.08271789552.03371810914.653999805534.86259841925.92903709414.5539999008
_JQM_BIOR_LAB_A200511210738RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/9911/21/055.706.58A4.75699996953.80800008779.81200027476.26511287692.3591129784.836999893234.68238067635.90915584564.5085000992
_JQM_BIOR_LAB_A200511300947RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/9911/30/055.706.58A4.58199977873.68899989139.75100040445.85700082781.96900105484.689000129731.79752922065.40606403354.4035000801
_JQM_BIOR_LAB_A200512071251RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/9912/7/055.706.58A4.52400016783.58100008969.86400032046.02388715742.11088705064.613999843634.40058898935.78639888764.4720001221
_JQM_BIOR_LAB_A200512140739RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/9912/14/055.706.58A4.72499990463.58200001729.15400028235.88803911212.72903895384.596000194533.69829177865.54671001434.4664998055
_JQM_BIOR_LAB_A200512221252RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/9912/22/055.706.58A4.51999998093.59699988379.81999969486.32132101062.00532102584.836999893232.16445922855.60001420974.4505000114
_JQM_BIOR_LAB_A200512290800RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/9912/29/055.706.58A4.26300001143.27699995049.5299997336.19187498092.00587606434.706999778731.16506958015.51708602914.4035000801
_JQM_BIOR_LAB_A200601131251RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/991/13/065.706.58A4.50299978263.56999993329.78499984746.18089008332.39588999754.528999805530.96500015265.44574689874.4260001183
_JQM_BIOR_LAB_A200601260735RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/991/26/065.706.58A4.69299983983.60299992569.45699977876.37797880172.34197902684.800000190727.46545982365.46601390844.4124999046
_JQM_BIOR_LAB_A200604131118RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/994/13/065.706.58A4.44199991233.53299999249.72599983226.18912410742.00512294.703999996231.0978698735.57510805134.6560001373
_JQM_BIOR_LAB_A200604281334RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/994/28/065.706.58A4.50299978263.47000002869.78100013736.07224082952.0522410874.73400020629.39509010315.4962577824.4994997978
_JQM_BIOR_LAB_A200605230813RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/995/23/065.706.58A4.44899988173.60899996769.69999980935.74486112592.26586103444.613999843628.57822990425.54937505724.5289998055
_JQM_BIOR_LAB_A200606060644RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/996/6/065.706.58A4.30100011833.33999991429.02099990845.81489086151.80289196974.645999908429.87949943546.13594484334.5599999428
_JQM_BIOR_LAB_A200607210803RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/997/21/065.706.58A4.44000005723.27300000199.0950002676.15488195422.28488206864.613999843629.53709030155.68474388124.5615000725
_JQM_BIOR_LAB_A200610260940RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/9910/26/065.706.58A4.40000009543.53099989899.55000019076.35956716542.67056703574.725999832229.91411018375.54219198234.4724998474
_JQM_BIOR_LAB_A200704300740RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/994/30/075.706.58A4.1269998553.21700000768.45300006875.83750677112.31050705913.980999946629.23959922795.48879194264.3074998856
_JQM_BIOR_LAB_A200705151235RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/995/15/075.706.58A4.29899978643.33599996579.55399990086.29961490632.38761496544.526999950428.98314094545.37199592594.243999958
_JQM_BIOR_LAB_A200706131235RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/996/13/075.706.58A4.253.34200000769.77200031285.96847915651.82847905164.520999908429.49142074585.31449317934.2239999771
_JQM_BIOR_LAB_A200708011245RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/998/1/075.706.58A4.29500007633.22399997719.47700023656.40591812132.2639179234.551000118329.50806999215.34747219094.4485001564
8/6/075.706.586.45
8/14/075.706.586.52
9/4/075.706.586.75
9/17/075.706.587.24
9/25/075.706.587.1
10/4/075.706.587.28
_JQM_BIOR_LAB_A200710110917RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/9910/11/075.706.58A4.45800018313.565999984710.2320003516.28205299382.51705193524.504000186930.92536926275.56849908834.5265002251
10/25/075.706.587.55
11/14/075.706.587.76
11/23/075.706.588.07
12/6/075.706.588.56
1/7/085.706.588.42
1/29/085.706.588.22
2/15/085.706.588.58
2/26/085.706.589
3/5/085.706.588.87
3/13/085.706.588.37
3/25/085.706.588.92
_JQM_BIOR_LAB_A200803261343RCHA_JQM_BIOR_LAB_ABIO ANDERSON, GREG
RM
A12/31/993/26/085.706.58A4.3530001643.40000009549.53600025186.18298196792.30298209194.63100004232.31864166265.66447877884.4310002327
4/12/085.706.58
0.221199385
6.1400756098
6.5824743799
5.6976768397
&A
Page &P
-
BioQC Quotes from Diagnostic Listserv
• “In my experience, it's easier to correct a QC failure on an
ABG analyzer than on PFT equipment. The conflict in my experience
has been with justifying the closure of a PFT lab because of a QC
issue that I have difficulty resolving,…”
• “I've had weeks of headaches with DLCO results that were
questioned by a physician, and did seem to be a bit high, but which
were not resolved although flow sensors, analyzers, and circuits
and tubings were replaced. What caused the problem?”
• “I have yet to find someone with stable values plus we are so
busy it is almost impossible to schedule staff to do these
studies.”
• “We need a subject to be the National Human PFT Biocontrol,who
will travel the country subjecting himself/herself to testing so
the results can be compared to the National Reference Lab (Mayo
?).”
-
National BioQC Subject!
-
“This is fine as far as it goes. From here on, it’s who you
know.”
-
Quality Systems in the PFLTest
• Testing room environment• Environmental interference
• Technologist’s performance & training - QSE: Personnel
• Second technologist• Meeting ATS/ERS acceptability and
repeatability criteria
-
Quality Systems in the PFLTest - QSE: Personnel
• Technologists• Job qualifications• Job descriptions•
Orientation• Training• Competency assessment• Continuing education•
Performance appraisal
-
Quality Systems in the PFLTest - QSE: Personnel
• Competence Assessment• Training and on-going
performance evaluations• NIOSH Spirometry Training
Course• cdc.gov/NIOSH/topics/spirometry
• AARC’s Spirometry Training
• National Board for Respiratory Care• PFT exams
-
Quality Systems in the PFLTest - QSE: Personnel
• Harmonizing Education in Respiratory Medicine for European
Specialists
Eur Respir J 2011; 37: 479–481
-
Quality Systems in the PFLTest - Reference equations
• NHANES III• Spirometry only• ATS/ERS recommended• ERS GLI
Taskforce “All-Age
Approach”
• Diffusing capacity• Many choices, none recommended
• Lung volumes - limited
-
http://www.lungfunction.org/
ERS Task Force founded in 2008
http://www.lungfunction.org/
-
Eur Respir J 2012; 40: 1324–1343“All-Age Approach”
-
• 160,000 data pts from 72 centers in 33 countries
• 97,759 records of healthy nonsmokers (55.3% females) aged
2.5–95 yrs.
• Reference equations were derived for healthy individuals aged
3–95 yrs for Caucasians (n=57,395), African–Americans (n=3,545),
and North (n=4,992) and South East Asians (n=8,255).
-
Quality Systems in the PFLPost-Test
• Maneuver selection• Quality review by second technologist•
“While in-house training may achieve the
desired goals, laboratory directors should strongly consider the
benefits of formal training programs from outside providers.”
• Feedback to the technicians concerning their performance
should be provided on a routine basis 2005 ATS/ERS Standards
General Laboratory
-
Quality Systems in the PFLPost-Test
• Consistent Interpretation (ATS/ERS Guideline)
• Turn-around time• Average TRT: 7 d (3%)• ATS PFL Registry
Abstract AARC 2005, OF-
05-037• Mayo’s PFL: ½ day to Electronic Medical
Record
-
Quality Systems in the PFLDoes it Work?
• Retrospective review of 18,000 consecutive pts. at Mayo
Clinic
• Ninety percent of the patients were able to repeat FEV1 within
120 ml (6.1%), FVC within 150 ml (5.3%), and PEF within 0.80 L
(12%).
American Journal of Respiratory & Critical Care Medicine.
169(2):235-8, 2004 Jan 15.
-
Accreditation Models
-
• How many have had JCAHO come into your lab and actually
perform an inspection?
-
• Self-assessment questionnaire• Submission of the application
forms, along with
the laboratory procedure and policy manuals
• Site visit by the accreditation assessment panel
-
• Submission of BioQC and mechanical model data for
review/feedback
• Checklist for self and on-site inspections based on the
ATS-ERS recommendations
-
US Based Pulmonary Function Laboratory Accreditation
• American Thoracic Society• Appointed an Expert Panel to
discuss accreditation
model.
-
Accreditation in PF Labs
• Integrate new QA recommendations into your lab practice
now!
•Questions??
National and International Quality Standards in the Pulmonary
Function LaboratoryCase PresentationCase PresentationCase
PresentationCase PresentationCase PresentationPFT results affect
people!!!Evidence of Quality TestingEvidence of Quality
TestingEvidence of Quality Testing Slide Number 11Slide Number
12Evidence of Quality Testing Guidelines and StandardsResources for
SuccessResources for SuccessCLSI’s Quality Systems Quality Systems
in the PFL�Quality AssuranceQuality Systems in the PFL
�Pre-testQuality Systems in the PFL �Pre-testQuality Systems in the
PFL �Pre-testQuality Systems in the PFL �Pre-test Quality Systems
in the PFL �Pre-test Quality Systems in the PFL �Pre-test Quality
Systems in the PFL �Pre-test Quality Systems in the PFL �Pre-test
Quality Systems in the PFL �Pre-testQuality Systems in the PFL
�Pre-test Quality Systems in the PFL �Pre-testQuality Systems in
the PFL �Biological Quality Control - PF LabSlide Number 31BioQC -
Quality CountsBioQC Quotes from Diagnostic ListservNational BioQC
Subject!Slide Number 35Quality Systems in the PFL �Test Quality
Systems in the PFL �Test - QSE: PersonnelQuality Systems in the PFL
�Test - QSE: PersonnelQuality Systems in the PFL �Test - QSE:
PersonnelQuality Systems in the PFL �Test - Reference
equationsSlide Number 41Slide Number 42Slide Number 43Quality
Systems in the PFL �Post-Test Quality Systems in the PFL
�Post-TestQuality Systems in the PFL �Does it Work?Accreditation
Models Slide Number 48Slide Number 49Slide Number 50US Based
Pulmonary Function Laboratory AccreditationSlide Number 52
