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

Aim of Project Digital Morphology Imaging To assess the emerging role of digital imaging and web-based technology in morphological education, EQA and CPD NEQAS participant driven – questionnaire feedback

>500 participant centres UK (80 non UK labs) (H) 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.

Returns and Reports via post: (H) 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

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

(H) Digital Image 2001 More Images per case. Improve picture quality.

Web Based Morphology Exercises 2003 Survey Report: A single case, 12 images with expert opinion and consensus results. Pilot exercise: Educational element, participant involvement. (Response n = 128)

Tutorial: Slide 4 Feature 3 119 giant platelet 3 megakaryocyte fragment

Tutorial: Slide 4 Feature 8 101 megakaryocytic fragment 15 giant platelet 4 smear cell

Tutorial: Slide 4 Feature 6 67/128 acanthocyte 40/128 echinocyte 11/128 spherocyte

Survey Report - Multiple Images with Expert Opinion: via Web 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

                                                                                                                                                                                                    www.manlab.co.uk Image Library.  

Priorities for 2004 (2) Electronic slide Develop larger field of view (H) 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

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 retaining details that can be viewed at high power

Stitched “digital slide” 2001 www.manlab.co.uk Department of Morphology

“stitched” digital slide for 2004 www.ukneqas-haem.org.uk www.manlab.co.uk morphology

Result sheets and questionnaire returned to 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)

Response 166 returned completed coded morphology forms. 162 also completed questionnaire

Was the image of adequate size to allow an opinion?

(H) Rate the Exercise

Rate the Exercise (overview) 2.7 Comparison to glass 3.5 Download time 3.8 CPD 4.1 Follow-up 4.2 Archive 4.6 Teaching aid 4.6 “Rare” Image Poor OK Excellent

The cases: (H) 0001BF2 (HbSS) 0403BF1 (CGL) 0002BF1 (Bcell PLL) 0403PA1 (P.Ovale)

(H) 0403BF1 (CGL)

(H) 0403BF1 (CGL)

(H) 0001BF2 (HbSS) ** ** Responses: Sickle disorder: 84% HA: 4% Splenectomy: 5%

0002BF1 (Bcell PLL) ** ** ** (H) Diagnosis virtual: CLL (33); LPD (26) PLL (25) lymphoma (11) AL (9) CMML (2) viral (2)

(H) 0403PA1 (P.Ovale) ** 154 indicated malaria

Digital Imaging for Morphology in EQA Summary Digital Imaging for Morphology in EQA Participant Driven from digital web exercises. ???s with survey feedback and expert opinion.

Future developments

Continuing Professional Development (H) 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.

CPD Scheme – Pilot via Web 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.

CPD Pilot – Process UK NEQAS (H) 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).

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.