1. Digital Morphology and EQA Michelle Brereton, John Burthem,
Keith Hyde.
Manchester Royal Infirmary.
UK NEQAS(H)

2. 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

3. >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.

4. 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

6. 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

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

8. 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)

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

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

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

12. 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

13.                    
                                                                                                                                                                             
Image Library.

14. 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

15. Photograph single “high power” images

16. Take multiple “overlapping” fields

17. Computer software matches fields

19. And “stitches” a composite image

20. Assemble many fields to make image larger….

21. And larger…….

22. Etc…..

23. While still retaining
details that can be
viewed at high power

25. Stitched “digital slide” 2001
Department of Morphology

26. “stitched” digital slide for 2004
morphology

27. 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)

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

29. Was the image of adequate size to allow an opinion?

30. (H)
Rate the Exercise

31. 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

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

33. (H)
0403BF1 (CGL)

34. (H)
0403BF1 (CGL)

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

36. 0002BF1 (Bcell PLL) ** ** ** (H)
Diagnosis virtual: CLL (33); LPD (26) PLL (25) lymphoma (11) AL (9) CMML (2) viral (2)

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

38. 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.

39. Future developments

41. 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.

42. 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.

43. 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).

44. 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)
Paul McTaggart. Barbara De La Salle. John Parker-Williams.
Participants of the NEQAS morphology scheme.