The Application of Digital Morphology in Haematology Education. Barbara De la Salle Deputy Director UK NEQAS General Haematology

Transcription

1 The Application of Digital Morphology in Haematology Education Barbara De la Salle Deputy Director UK NEQAS General Haematology

2 8 November, 2011 UK National External Quality Assessment Service comprises a network of 144 schemes operating from 24 centres based at major hospitals, research institutions and universities throughout the UK

3 West Herts Hospitals Trust

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5 Digital Slides All view the same cell(s) Microscopy vs morphology skills Direct annotation: education/training Relatively low cost Viewable by limitless numbers Easy to store

6 Hutchinson CV et al Clin Lab Haem (2005)

7 Patient Details Age (yrs) Sex Hb(g/l) WBC(x10 9 /l) Platelets (x10 9 /l) 55 f 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 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. The five most commonly reported features were: Nucleated red cells Blast cells Macrocytic platelets Myelocytes Megakaryocyte fragments.

8 2004 Exercise: stitched images

9 2004: Rate the Exercise With thanks to Michelle Brereton, Manchester Royal Infirmary

10 Feedback 2004: High quality, large scale, stitched slides Easy to use software Educational content Access for more participants

11 Photograph single high power images

12 Take multiple overlapping fields

13 Computer software matches fields

14 While still retaining details that can be viewed at high power

15 2007: UK NEQAS / SlidePath not for profit collaboration UK NEQAS images Digital Slidebox software Secure, on-line, individual participation

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17 Digital Morphology CPD Scheme Launched April 2008 Individual participation Educational in purpose 6 cases per year 2000 individual licenses returns per case Laboratory manager admin pages 2011 Additional educational content for 2012

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34 Feedback from users It is a relatively effortless way for my staff to create evidence of CPD This strengthens the knowledge of all of my staff and improves their validation knowledge It s more personal and removes some of the pressure of similar schemes. It is more comfortable for less experienced staff to participate

35 Cases issued

36 First Case DM1 Previous UK NEQAS 0507BF2 37 year old, female, SE Asia Hepatosplenomegaly, transfused Hb 7.2 g/dl, RBC 4.36, MCV 55, MCH 17 DIAGNOSIS Complex haemoglobinopathy: Hb A + Hb E + Hb Barts Disease

37 Top 5 Features 0801DM1 Glass slide Digital slide 1 Target cells Target cells 2 Hypochromic RBC Punctate basophilia 3 Tear drop poikilocytes Tear drop poikilocytes 4 Punctate basophilia RBC fragments etc 5 Poikilocytes Hypochromic RBC

38 Second Case DM1 Previous UK NEQAS 0505BF1 83 year old, female Transient ischaemic attack, angina, hypertension Hb 11.2 g/dl, WBC 138, Platelets 7 DIAGNOSIS Lymphoproliferative disorder: T-PLL

39 Top 5 Features 0802DM1 Glass slide Digital slide 1 Thrombocytopenia Thrombocytopenia 2 Lymphocytosis Lymphocytosis 3 Smear/smudge cells Smear/smudge cells 4 Prolymphocytes Cleft nuclei 5 Cleft nuclei Neutropenia

40 Questionnaire completed survey Overall feedback was positive with several good suggestions on improvement

41 Participant groups surveyed 2% 14% 2% 11% Laboratory Manager Chief or Senior BMS Specialist BMS 36% Basic grade BMS Generic/ non Specialist BMS. Trainee BMS 35% Other (please specify)

42 Type of organisation 2% 6% 26% Teaching District General Private Other (please specify) 66%

43 Background Haematology 37.7% Haematology/Transfusion 50.5% Blood transfusion 5.5% Combined Blood Sciences 4.5% Others 1.8% Leukaemia diagnosis Stem Cell Laboratory Haemato-Oncology

44 Morphology Experience How much morphology experience do you have? 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Report under supervision Regularly issue reports Issue reports out of hours Occasionally report films Not currently practising Series1 6.0% 59.3% 13.7% 16.2% 4.7%

45 Quality of DM Process Very good/good (%) Very poor/poor (%) 120 Good/Very Good (%) Poor/Very Poor(%) Range of cases Quality of images Stain quality Case questions Range of cases Quality of images Stain quality Case questions

46 Cases: viewed / completed 30.0% How many cases completed % How many cases viewed % 25.0% 20.0% 15.0% 10.0% 5.0% How many cases completed % 0.0% How many cases viewed % None >7 3.9% 17.6% 23.0% 19.1% 17.9% 18.5% 1.5% 15.7% 20.5% 19.3% 18.4% 24.5%

47 Lab Managers: 87% - Registration is easy 70% - Want on-line management and to track staff participation

48 UK NEQAS Digital Morphology Workshop participants, all DM users 95% rated the educative morphology narrative as useful 76% liked comparison of their results against others 70% felt the programme met their expectations

49 Collaborative Activities British Society for Haematology slide sessions Institute of Biomedical Science slide sessions International Society for Laboratory Haematology morphology workshop 2008 World Health Organisation photo-gallery

50 Conclusions Novel educational programme for laboratory scientists High level of satisfaction with quality and case mix Demonstrated increased confidence amongst participants: % offered a diagnosis % offered a diagnosis

51 Finally.. I have just completed the first module of the scheme and I must say that I have found it very informative and instructive, even for someone with my experience. The website was very clear to navigate around and the quality of the images was excellent. The teaching input was very comprehensive and has proved to be of great benefit and interest to all my staff taking part. Many thanks for what promises to be an innovative and instructive scheme. A participant s comment

52 Acknowledgements Manchester Royal Infirmary, UK Michelle Brereton, John Burthem, John Ardern UK NEQAS General Haematology staff and advisors Zuotimi Eke, John Parker-Williams, Keith Patterson, Paul McTaggart, Mary West, Keith Hyde Manchester Universities, UK Len Seal, Laura Tatum UK NEQAS participants

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