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Virtual Microscopy Pilot Survey Report by qza17959

VIEWS: 15 PAGES: 14

									                                            Virtual Microscopy
                                          Pilot Survey Report

                                                                       prepared by

                                            Susan Neville, Alan Bateman
                                           John Sioufi, Katherine Marsden
                                             & the Haematology QAP



                                                        RCPA Haematology QAP
                                                       PO Box 50, Westmead. 2145
                                                          Sydney. AUSTRALIA.

                                                 Date of issue: 27 November 2007

                 NATA ACCREDITED PROFICIENCY TESTING SCHEME PROVIDER NUMBER: 14863
                 THIS FACILITY IS ACCREDITED BY THE NATIONAL ASSOCIATION OF TESTING AUTHORITIES,
                 AUSTRALIA AND COMPLIES WITH THE REQUIREMENTS OF ILAC G13, SITE NUMBER: 15363




This material is copyright and may not be used in any form for advertising, sales promotion or publicity. The
material may not be reproduced in whole or in part for any purpose whatsoever (including presentations at
meetings and conferences), without the prior written permission of the RCPA Quality Assurance Programs Pty
Limited. Permission must be sought in writing from the Program Chair but will not be unreasonably refused.
                                Virtual Microscopy Pilot Survey

Introduction:

A pilot Virtual Microscopy survey was sent to laboratories who had expressed interest in participating
in a preliminary questionnaire earlier in the year. 114 of 120 laboratories who were sent the pilot
survey returned results and we thank them for their participation.

Purpose:

To evaluate two Virtual Systems, namely the Aperio System, using Aperio software from Scanscope
and the .slide system, using the OlyVIA software from Olympus. Images for each system are
produced from scanning the peripheral blood smears at magnification x60 oil.

Laboratories were asked to evaluate both systems and to indicate their preference.

Three case studies were selected from previous Morphology Surveys (stained peripheral blood are
issued to subscribers that participate in the Morphology Program). These peripheral blood smears
were scanned by the Aperio system and .slide (OlyVIA) system and the scanned images and software
systems were sent on DVD to participating laboratories.

The participating laboratories were asked to load the software and attempt to make a diagnostic
interpretation as well as describe the morphological features in each case. Laboratories were also
asked to assess the individual cell lines from both systems using a grading system of 1 to 5 (1 = poor,
5 = excellent).

A questionnaire was also provided to obtain an overall assessment of both systems, with a series of
questions about both systems using the same grading system as above. We also asked laboratories
about the potential uses they see for the virtual microscope in the future.

Results:

PART A: The first part of the exercise compared the virtual microscope survey results with the results
from the same slides in the previous surveys. As only 114 laboratories participated in this exercise
compared to over 500 laboratories in previous surveys, the numbers have been converted to
percentages.

PART B: The second part of the exercise was an overall assessment of both systems in relation to
image quality and loading and ease of use of the software.




                                                                                                     2
                                                                                                                                                                                                                        PART A

CASE STUDY 1

86 year old male. Rapidly rising WCC.
                                                                9                                                                                                                                                                                                                                                                                                                                                     9
WCC = 59.1 x 10 /L                                                                                                                             Hb = 124 g/L                                                                                                  MCV = 87 fL                                                                                       PLT = 117 x 10 /L



                                                                                                                                               Case 1 - Virtual Microscopy Diagnoses

                  35%
                                                                                                                                                                                                                                                                                                                                                                                  n = 114
                                                                                                                                                                                                                                                                                                                                                                                                                          Acceptable
                  30%


                  25%                                                                                                                                                                                                                                                                                                                                                                                                     Unacceptable
  Responses (%)




                  20%


                  15%


                  10%


                  5%


                  0%




                                                                                                                                                                                                                                                                                                                                                                                                    Sezary Syndrome
                        PLL




                                                                                                                                               MCL




                                                                                                                                                                                                                                                   AML-M3v




                                                                                                                                                                                                                                                                                                                                                         CLL
                                            ALL-L2

                                                                    ALL-L1




                                                                                                                                                                                                            AML-M0

                                                                                                                                                                                                                          AML-M1

                                                                                                                                                                                                                                   AML-M2




                                                                                                                                                                                                                                                             AML-M4

                                                                                                                                                                                                                                                                      AML-M5




                                                                                                                                                                                                                                                                                                                                              NHL




                                                                                                                                                                                                                                                                                                                                                                                  CMML
                                                                                                                                                                                                                                                                                  AML-M5a
                                    T PLL




                                                                              ATLL




                                                                                                                                                                    CLL in trans

                                                                                                                                                                                      High grade Lymphoma
                                                                                                                               Precursor TLL




                                                                                                                                                                                                                                                                                                                        Follicular Lymphoma
                                                                                     T cell lymphoma




                                                                                                                                                                                                                                                                                            Lymphoma Leuk phase




                                                                                                                                                                                                                                                                                                                                                                AL ambiguous
                                                                                                                                               Case 1 (MP5-02c) - Survey Diagnoses

                  35%
                                                                                                                                                                                                                                                                                                                                                                                  n = 514


                  30%


                  25%
  Responses (%)




                  20%


                  15%


                  10%


                  5%


                  0%
                              PLL




                                                                             ALL




                                                                                                                                                                                   Mantle Cell




                                                                                                                                                                                                                                                               AML




                                                                                                                                                                                                                                                                                                                                                                                         CMML +/- trans
                                                                                                                                                                                                                     CLL/PL




                                                                                                                                                                                                                                                                                                                                                CLL/PL
                                             Good Description




                                                                                                                                                                                                                                                                                                                  LPD
                                                                                                                                                                                                                                      Lymphoma




                                                                                                                                                                                                                                                                               Lymphoma
                                                                                                                                                                                   Lympohma




                                                                                                                                                                                                                                      High grade
                                                                                                       PLL in transformation




                                                                                                                                                                                                                                                                                                                                                                Acute Leukaemia
                                                                                                                                               leukaemia/lymphoma
                                                                                                                                                      T cell




The actual diagnosis for case study 1 was Prolymphocytic Leukaemia (PLL) and this had been case
MP5-02c in the 2005 Morphology Program. The actual diagnosis of PLL was returned by
approximately 30% of participants in both submissions. A wider variety of responses from the virtual
exercise were submitted compared to the original exercise (MP5-02c) as diagnoses were grouped by
QAP for reporting of that survey. Of note, the various AML responses in the virtual exercise add up to
15-20%, similar to the results from the original exercise in the 2005 survey.



                                                                                                                                                                                                                                                                                                                                                                                                                           3
                                          Number of responses                                                                                               Number of Responses                                                                                             Number of responses




                            0
                                10
                                     20
                                            30
                                                  40
                                                          50
                                                                60
                                                                     70
                                                                          80
                                                                                                                                              0
                                                                                                                                                  10
                                                                                                                                                       20
                                                                                                                                                              30
                                                                                                                                                                    40
                                                                                                                                                                            50
                                                                                                                                                                                  60
                                                                                                                                                                                       70
                                                                                                                                                                                            80
                                                                                                                                                                                                                                                              0
                                                                                                                                                                                                                                                                  10
                                                                                                                                                                                                                                                                       20
                                                                                                                                                                                                                                                                              30
                                                                                                                                                                                                                                                                                    40
                                                                                                                                                                                                                                                                                            50
                                                                                                                                                                                                                                                                                                  60
                                                                                                                                                                                                                                                                                                       70
                                                                                                                                                                                                                                                                                                            80




                                                                                                                    Atypical Lymphocytes                                                                                                     Acanthocytes

                                                                                                                Atypical mononuclear cells                                                                                                       Burr Cells
                 Clumps
                                                                                                                      Band forms/left shift                                                                                         Correct WCC for NRBC

                                                                                                                                Blast cells
                                                                                                                                                                                                                                            Crenated cells

                                                                                                                               Cleft nuclei
                                                                                                                                                                                                                                           Dimorphic RBC

          Giant platelets                                                                                         Cytoplasmic vacuolation
                                                                                                                                                                                                                                               Elliptocytes

                                                                                                                       Dysplastic changes
                                                                                                                                                                                                                                    Fragments/Schistocytes
                                                                                                                             Folded nuclei
                                                                                                                                                                                                                                                      HJB
                                                                                                                            High N:C ratio
                                                                                                                                                                                                                                         Hypochromic cells
        Megakaryocytes
                                                                                                                           Lymphocytosis
                                                                                                                                                                                                                                                Microcytes
                                                                                                                          Metamyelocytes
                                                                                                                                                                                                                                         Microspherocytes
                                                                                                                             Monocytosis
                                                                                                                                                                                                                                                    NRBC
                                                                                                                               Myelocytes
                    NAD
                                                                                                                                                                                                                                                Ovalocytes
                                                                                                                              Neutropenia




                                                                               CASE 1 - Platelet descriptions
                                                                                                                                                                                                                                                                                                                 CASE 1 - Red cell descriptions




                                                                                                                                                                                                                                              Pencil forms
                                                                                                                                                                                                 CASE 1 - White cell descriptions




                                                                                                                          Prolymphocytes

                                                                                                                                                                                                                                               Poikilocytes
                                                                                                                       Prominent nucleoli

                                                                                                                                                                                                                                        Polychromatic cells
    Platelet anisocytosis                                                                                                  Promyelocytes

                                                                                                                    Reactive lymphocytes                                                                                                         Rouleaux


                                                                                                                              Sezary cells                                                                                                    Spherocytes


                                                                                                                     Smear/smudge cells                                                                                                          Spur cells

     Thrombocytopenia
                                                                                                                         Toxic granulation                                                                                                     Target cells

                                                                                                                            Twisted nuclei                                                                                           Tear drop Poikilocytes




                                                 Aperio
                                                                                                                                                                   Aperio




                                                 OlyVIA
                                                                                                                                                                   OlyVIA
                                                                                                                                                                                                                                                                                   Aperio
                                                                                                                                                                                                                                                                                   OlyVIA




4
CASE 2

19 year old female. Bone pain.
                                          9                                                                                                                                                                                                          9
WCC = 8.9 x 10 /L                                                           Hb = 78 g/L                                                     MCV = 89 fL                                          PLT = 548 x 10 /L

                                                                             Case 2 - Virtual Microscopy Diagnoses
                                                                                                                                                                                                                                                         Acceptable
                  60%
                                                                                                                                                                                                                                     n = 114

                                                                                                                                                                                                                                                         Partially
                  50%                                                                                                                                                                                                                                    acceptable

                                                                                                                                                                                                                                                         Unacceptable
                  40%
  Responses (%)




                  30%



                  20%



                  10%



                  0%




                                                                                                                                                                                                 PK deficiency
                                                                                                                                               Fe deficiency




                                                                                                                                                                                  Oxidative HA
                        Splenectomy




                                             Splenectomy




                                                           Splenectomy



                                                                          HbSS




                                                                                                                              Haemolysis
                                                                                                           HbS trait
                                                                                                  HbSC




                                                                                                                                                               Drug induced HA




                                                                                                                                                                                                                                       Plasma Cell
                                                                                                                              HbS trait +
                                                            HbS trait +




                                                                                                                                                                                                                                        Myeloma
                                               HbSC +
                          HbSS +




                                                                                                Case 2 (MP6-05c) - Diagnoses

                  60%
                                                                                                                                                                                                                                      n = 489


                  50%



                  40%
  Responses (%)




                  30%



                  20%



                  10%



                  0%
                                                                                                                                                                                                                 Haemoglobinopathy
                                      Splenectomy




                                                                                                                                                               Post Splenectomy
                                                                             Good Description




                                                                                                                       HbSS
                                        HbSS +




The actual diagnosis for case study 2 was Hb SS + Splenectomy and it was previously used as MP6-
05c, in 2006. The actual diagnosis of Hb SS + Splenectomy was returned by approximately 50% of
participants in both submissions. Again a wider variety of responses from the virtual exercise are
listed compared to the original exercise (MP6-05c) as diagnoses in the latter were pre-grouped for
reporting. Similar percentages of acceptable, partially acceptable and unacceptable results were
returned in both exercises.



                                                                                                                                                                                                                                                            5
                                      Number of responses                                                                                         Number of responses                                                                                          Number of responses




                                                                                                                                    0
                                                                                                                                        10
                                                                                                                                             20
                                                                                                                                                    30
                                                                                                                                                          40
                                                                                                                                                                  50
                                                                                                                                                                        60
                                                                                                                                                                             70
                                                                                                                                                                                  80




                        0
                            10
                                 20
                                        30
                                              40
                                                      50
                                                            60
                                                                 70
                                                                      80
                                                                                                                                                                                                                                                      0
                                                                                                                                                                                                                                                          20
                                                                                                                                                                                                                                                               40
                                                                                                                                                                                                                                                                       60
                                                                                                                                                                                                                                                                               80
                                                                                                                                                                                                                                                                                     100
                                                                                                                                                                                                                                                                                           120




                                                                                                    Abnormal eosinophil                                                                                                            Acanthocytes
                                                                                                          gran
                                                                                                                                                                                                                                    Agglutination
             Clumps
                                                                                                                                                                                                                              Basophilic stippling
                                                                                                            Band forms/left shift

                                                                                                                                                                                                                                        Bite cells


                                                                                                                      Basophilia                                                                                                      Blister cells

                                                                                                                                                                                                                          Correct WCC for NRBC

                                                                                                                      Blast cells                                                                                                Dimorphic RBC
      Giant platelets
                                                                                                                                                                                                                              Dysplastic changes

                                                                                                                    Cytoplasmic
                                                                                                                                                                                                                                      Elliptocytes
                                                                                                                    vacuolation

                                                                                                                                                                                                                          Fragments/Schistocytes

                                                                                                                    Eosinophilia                                                                                                     Helmet cells

                NAD                                                                                                                                                                                                                           HJB

                                                                                                                     Myelocytes                                                                                                Hypochromic cells

                                                                                                                                                                                                                                     Macrocytes

                                                                                                                    Neutropenia
                                                                                                                                                                                                                               Microspherocytes
                                                                                                                                                                                                                                                                                                 CASE 2 - Red cell descriptions




                                                                           CASE 2 - Platelet descriptions
                                                                                                                                                                                       CASE 2 - White cell descriptions




                                                                                                                                                                                                                                           NRBC
Platelet anisocytosis                                                                                               Neutrophilia
                                                                                                                                                                                                                                      Ovalocytes

                                                                                                                                                                                                                           Pappenheimer bodies
                                                                                                                            NAD
                                                                                                                                                                                                                                    Pencil forms

                                                                                                                                                                                                                                     Poikilocytes
                                                                                                                      Reactive
                                                                                                                    lymphocytes                                                                                               Polychromatic cells
    Thrombocytosis
                                                                                                                                                                                                                                        Rouleaux
                                                                                                               Toxic granulation
                                                                                                                                                                                                                                      Sickle cells
                                                                                                                                                         Aperio
                                                                                                                                                                                                                                                                      Aperio




                                                                                                                                                         OlyVIA
                                                                                                                                                                                                                                                                      OlyVIA




                                             Aperio
                                             OlyVIA




6
                                                                                                                                                         Responses (%)                                                                                                                            Responses (%)




                                                                                                                                     0%
                                                                                                                                          2%
                                                                                                                                               4%
                                                                                                                                                    6%
                                                                                                                                                         8%
                                                                                                                                                              10%
                                                                                                                                                                    12%
                                                                                                                                                                          14%
                                                                                                                                                                                16%
                                                                                                                                                                                      18%
                                                                                                                                                                                                  20%
                                                                                                                                                                                                                                                                              0%
                                                                                                                                                                                                                                                                                   2%
                                                                                                                                                                                                                                                                                        4%
                                                                                                                                                                                                                                                                                             6%
                                                                                                                                                                                                                                                                                                   8%
                                                                                                                                                                                                                                                                                                        10%
                                                                                                                                                                                                                                                                                                                    12%
                                                                                                                                                                                                                                                                                                                             14%
                                                                                                                                                                                                                                                                                                                                      16%
                                                                                                                                                                                                                                                                                                                                                18%
                                                                                                                                                                                                                                                                                                                                                            20%
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           CASE 3



                                                                                                            MPD + Splenectomy                                                                                                                         MPD + Splenectomy

                                                                                                                                                                                                                                        CML-Chronic phase + Splenectomy
                                                                                                               Good Description
                                                                                                                                                                                                                                          CML-Accelerated + Splenectomy




    original survey.
                                                                                                            CML + Splenectomy                                                                                                             CML-Blast phase + Splenectomy
                                                                                                                                                                                                                                                                                                                                                                                                                                9




                                                                                                                                                                                                                                              Myelofibrosis + Splenectomy
                                                                                                                                                                                                                                                                                                                                                                                                                     WCC = 90.2 x 10 /L



                                                                                                                  Myelofibrosis +
                                                                                                                   Splenectomy                                                                                                         Myelofibrosis in trans + Splenectomy
                                                                                                                    MPD trans +
                                                                                                                    Splenectomy                                                                                                                MPD in trans + Splenectomy

                                                                                                                    CML trans +                                                                                                          MDS/MPD unclass + Splenectomy
                                                                                                                    Splenectomy
                                                                                                                                                                                                                                               MDS in trans + Splenectomy
                                                                                                            MDS/MPD unclass +
                                                                                                              Splenectomy                                                                                                              Chronic MPD unclass + Splenectomy

                                                                                                                    MDS/MPD +                                                                                                                    ET in trans + Splenectomy
                                                                                                                    Splenectomy
                                                                                                                                                                                                                                                        ET + Splenectomy
                                                                                                          Myelofibrosis in trans +
                                                                                                              Splenectomy                                                                                                                              CML-Chronic phase
                                                                                                                    ET in trans +                                                                                                                                     MPD
                                                                                                                    Splenectomy
                                                                                                                                                                                                                                                                                                                                                                                                                     Hb = 87 g/L




                                                                                                                                                                                                                                                         CML-Accelerated
                                                                                                                                                                                                                                                                                                                                                                                                                                          58 year old male in ICU for marrow transplant.




                                                                                                                             CML
                                                                                                                                                                                                                                                              Myelofibrosis

                                                                                                                            MPD                                                                                                                         MDS/MPD unclass

                                                                                                                                                                                                                                                              MDS in trans
                                                                                                              CML in trans to AL
                                                                                                                                                                                                                                                       ET in trans + Sepsis
                                                                                                                    Myelofibrosis




                                                                                                                                                                                                        Case 3 (MP6-02b) - Diagnoses
                                                                                                                                                                                                                                                                  AML-M7

                                                                                                                                                                                                                                                   AML-M7 + Splenectomy
                                                                                                                                                                                                                                                                                                                                                                             Case 3 - Virtual Microscopy Diagnoses




                                                                                                                       MDS/MPD
                                                                                                                                                                                                                                                    AML-M7 + Haemolysis
                                                                                                              MDS/MPD unclass
                                                                                                                                                                                                                                                                    G-CSF

                                                                                                                    MPD in trans                                                                                                                          AML multilineage
                                                                                                                                                                                                                                                                                                                                                                                                                     MCV = 83 fL




                                                                                                                                                                                                                                                            AL ambiguous
                                                                                                            Myelofibrosis in trans
                                                                                                                                                                                                                                                      CNL post transfusion

                                                                                                               Acute Leukaemia                                                                                                                       RAEB + Splenectomy

                                                                                                                                                                                                                                             RARS in trans + Splenectomy
                                                                                                            Leukaemoid reaction
                                                                                                                                                                                                                                                                    Sepsis
                                                                                                                            MDS                                                                                                                      Sepsis+ Splenectomy

                                                                                                                                                                                                                                                              Splenectomy
                                                                                                                    MDS in trans
                                                                                                                                                                                                                                                                Thal major
                                                                                                                                                                                            n = 519
                                                                                                                                                                                                                                                                                                                                                      n = 114




                                                                                                            CMML in trans to AL
                                                                                                                                                                                                                                                       Thal major + Sepsis
                                                                                                                                                                                                                                                                                                                                                                                                                                9
                                                                                                                                                                                                                                                                                                                                                                                                                     PLT = 220 x 10 /L




    MP6-02b in 2006. Although a wide variety of diagnoses were submitted, the range was similar in both
    the original survey and the virtual exercise, given that diagnoses had been grouped together in the
    The actual diagnosis for case study 3 was MDS/MPD + Splenectomy and this was previously case




7
                                                                                                                                                                                                                                                                                                                                   Partially
                                                                                                                                                                                                                                                                                                                                   acceptable
                                                                                                                                                                                                                                                                                                                                                                Acceptable




                                                                                                                                                                                                                                                                                                              Unacceptable
                                     Number of responses                                                                                             Number of responses                                                                                         Number of responses




                                                                                                                                       0
                                                                                                                                           10
                                                                                                                                                20
                                                                                                                                                     30
                                                                                                                                                           40
                                                                                                                                                                 50
                                                                                                                                                                      60
                                                                                                                                                                           70
                                                                                                                                                                                80
                                                                                                                                                                                     90




                            0
                                20
                                     40
                                             60
                                                      80
                                                           100
                                                                 120
                                                                                                                                                                                                                                                        0
                                                                                                                                                                                                                                                            20
                                                                                                                                                                                                                                                                 40
                                                                                                                                                                                                                                                                         60
                                                                                                                                                                                                                                                                                 80
                                                                                                                                                                                                                                                                                       100
                                                                                                                                                                                                                                                                                             120




                                                                                                          Abnormal eosinophil gran
                                                                                                                                                                                                                                      Acanthocytes
    Dysplastic changes
                                                                                                               Band forms/left shift
                                                                                                                                                                                                                                       Agglutination
                                                                                                                         Basophilia
                                                                                                                                                                                                                                 Basophilic stippling
          Giant platelets                                                                                                Blast cells
                                                                                                                                                                                                                                           Burr cells
                                                                                                            Cytoplasmic granulation
                                                                                                                                                                                                                             Correct WCC for NRBC
           Hypogranular                                                                                     Cytoplasmic vacuolation
             platelets                                                                                                                                                                                                               Crenated cells
                                                                                                                      Dőhle bodies

                                                                                                                                                                                                                                    Dimorphic RBC
                                                                                                                Dysplastic changes
     Inaccurate platelet
           count                                                                                                       Eosinophilia                                                                                              Dysplastic changes


                                                                                                                      Folded nuclei                                                                                          Fragments/Schistocytes

       Megakaryoblasts                                                                                  Hypersegmented neutrophils                                                                                                              HJB

                                                                                                            Hypogranular cytoplasm                                                                                                Hypochromic cells

                                                                                                                   Metamyelocytes
        Megakaryocytes                                                                                                                                                                                                                  Macrocytes

                                                                                                                       Monocytosis
                                                                                                                                                                                                                                         Microcytes
                                                                                                                        Myelocytes




                                                                       CASE 3 - Platelet descriptions
                                                                                                                                                                                                                                                                                                   CASE 3 - Red cell descriptions




         Megakaryocyte                                                                                                                                                                                                                        NRBC
                                                                                                                                                                                          CASE 3 - White cell descriptions




           fragments
                                                                                                                       Neutrophilia
                                                                                                                                                                                                                              Pappenheimer bodies
                                                                                                                               NAD
                                                                                                                                                                                                                                        Poikilocytes
Micromegakaryocytes                                                                                               Pelger Huet cells
                                                                                                                                                                                                                                 Polychromatic cells
                                                                                                                      Plasma cells
                                                                                                                                                                                                                                           Rouleaux
    Platelet anisocytosis                                                                                            Promyelocytes

                                                                                                                                                                                                                                       Spherocytes
                                                                                                              Reactive lymphocytes

                                                                                                               Smear/smudge cells                                                                                                       Target cells
        Thrombocytosis
                                                                                                                  Toxic granulation                                                                                           Tear drop Poikilocytes
                                                                                                                                                            Aperio
                                                                                                                                                                                                                                                                        Aperio




                                            Aperio
                                                                                                                                                            OlyVIA
                                                                                                                                                                                                                                                                        OlyVIA




                                            OlyVIA




8
                                                                    PART B

Participants were asked to rate the two virtual systems using a worst to best grading system (1 = poor,
5 = excellent). The majority of participants rated each system from 3 to 5, with higher proportions
scoring Aperio as 4 or 5. It should be noted that it is possible that the scoring for ease of use and
loading of the software may have been biased towards Aperio if some participants were already
familiar with it through the Anatomical Pathology QAP. Data on this was not collected.
The evaluations were graphed as follows.

                                           Q1. How did the images compare to viewing glass slides?

                          60
                                                                                                             Aperio Mean: 3.7
                                                                                              55             OlyVIA Mean: 3.4


                          50

                                                                              44


                          40
    No. of Participants




                                                                                                       34

                                                                                                                                 Aperio
                          30
                                                                                                                                 OlyVIA

                                                                     23

                          20                                                                                       18

                                            13
                                                     11
                                                                                                                            10
                          10


                                       2
                               1
                          0
                                   1             2                        3                        4                    5
                                                          Grading (1 = Poor, 5 = Excellent)




                                             Q2. How would you assess the quality of the images?

                          60
                                                                                              57            Aperio Mean: 3.9
                                                                                                            OlyVIA Mean: 3.5


                          50

                                                                                                       44

                                                                              40
                          40
    No. of Participants




                                                                                                                                 Aperio
                          30
                                                                                                                                 OlyVIA
                                                                                                                   24
                                                                     22

                          20




                          10                         8                                                                      8
                                             7


                                       1
                               0
                          0
                                   1             2                        3                        4                    5
                                                          Grading (1 = Poor, 5 = Excellent)




                                                                                                                                          9
                                           Q3. How easy was the viewing software to load?

                      60
                                                                                                      Aperio Mean: 3.8
                                                                                                      OlyVIA Mean: 3.2


                      50

                                                                                        43

                      40
No. of Participants




                                                                        32                                      32
                                                                                                                              Aperio
                      30
                                                                                                                              OlyVIA
                                                               25
                                                                                                 24

                                               20
                      20
                                                                                                                         17




                      10           8
                           5           5


                      0
                               1           2                        3                        4                       5
                                                    Grading (1 = Poor, 5 = Excellent)




                                       Q4. How easy was the viewing software to navigate?

                      60
                                                                                                         Aperio Mean: 4.0
                                                                                                         OlyVIA Mean: 3.4


                      50
                                                                                        46


                                                                                                                40
                      40
                                                                        37
No. of Partcipants




                                                                                                 31
                                                                                                                              Aperio
                      30
                                                                                                                              OlyVIA



                      20
                                                                                                                         17
                                                               15
                                               12

                      10
                                       6
                                   4
                           3

                      0
                               1           2                        3                        4                       5
                                                    Grading (1 = Poor, 5 = Excellent)




                                                                                                                                   10
                                   Aperio - Overall Grading


                      70
                                                                                    n = 114

                                                                                Mean = 4.0
                      60



                      50
No. of Participants




                      40



                      30



                      20



                      10



                      0
                           1   2      3                       4        5   Unable to access
                                   Grading (1 = Poor, 5 = Excellent)




                                   OlyVIA - Overall Grading


                      60
                                                                                   n = 114

                                                                                Mean = 3.3

                      50




                      40
No. of Participants




                      30




                      20




                      10




                      0
                           1   2      3                       4        5   Unable to access
                                   Grading (1 = Poor, 5 = Excellent)




                                                                                              11
The RCPA Haematology QAP was also interested in feedback from participants about other potential
uses of Virtual Microscopy. Reponses are listed below.
                                                      Q1a. Assess the potential of VM in replacing glass slides in EQA

                                       80



                                       70



                                       60



                                       50
            No. of Participants




                                       40



                                       30



                                       20



                                       10



                                        0
                                            1                     2                         3                       4               5
                                                                             Grading (1 = Poor, 5 = Excellent)



                                                         Q1b. Assess the potential of VM for use as a teaching aide

                                       80



                                       70



                                       60



                                       50
          No. of Participants




                                       40



                                       30



                                       20



                                       10



                                       0
                                            1                     2                         3                       4               5
                                                                             Grading (1 = Poor, 5 = Excellent)



                                                Q1c. Assess the potential of VM for images of difficult to collect or rare slides

                                       80



                                       70



                                       60



                                       50
                 No. of Participants




                                       40



                                       30



                                       20



                                       10



                                        0
                                            1                     2                         3                       4               5
                                                                             Grading (1 = Poor, 5 = Excellent)




                                                                                                                                        12
                               Q2. Are you now more or less enthusiastic about the applications of VM in EQA?

                      80



                      70



                      60



                      50
No. of Participants




                      40



                      30



                      20



                      10



                      0
                           1                      2                         3                     4                5
                                                               Grading (1 = Less, 5 = More)




                                       Q3. Do you consider the addition of a VM Program worthwhile?

                      80



                      70



                      60



                      50
No. of Participants




                      40



                      30



                      20



                      10



                      0
                           1                      2                         3                     4                5
                                                               Grading (1 = Less, 5 = More)




                               Q4. Would your laboratory be interested in the offer of individual subscriptions?

                      80



                      70



                      60



                      50
No. of Participants




                      40



                      30



                      20



                      10



                      0
                                           NO                                                         YES


                                                                                                                       13
Discussion:

PART A:

The results returned by the Virtual Microscopy pilot survey compared well with those previously
obtained in the original Morphology surveys with glass slides. In case studies 2 and 3, laboratories
were able to see the inclusions in the red cells and ascertain hyposplenism in both cases.


The proportions of diagnoses which were acceptable, partially acceptable and unacceptable were
similar in all three cases with the virtual microscopy and previous glass slide surveys. However, it is
possible that some familiarity had developed from the previous exposure to the slides in the 2005 and
2006 surveys.


PART B:

The evaluation of both systems was positive from the majority of laboratories, with the Aperio
Scanscope (OS model) obtaining a slightly higher rating in the questions asked. However, this was
not unanimous and some participants preferred the Olympus .slide system over the Aperio system,
indicating a degree of individual personal preference.

There was a positive response from the majority of participants with an average score of 3.4
(Olympus) & 3.7 (Aperio) out of 5.0 to the question “How did the images compare to viewing glass
slides?” The remaining 3 questions were similar, with all questions averaging a score of 3.2 - 4.0 for
both systems, which implies that participants welcome the advances that Virtual Microscopy has to
offer.

The responses received from participants with regards to the different applications that may be
available were positive. There was positive feedback overall with regards to the different potential
uses for virtual microscopy for blood film morphology. The RCPA does not plan to replace the current
surveys which use glass slides with Virtual Microscopy but the scope can be broadened with virtual
images of difficult to obtain samples including bone marrow smears.

The majority of laboratories that participated in this study also welcomed Virtual Microscopy as a
teaching aide, with an average score of 4.5. With the majority being enthusiastic about Virtual
Microscopy applications in external quality assurance schemes, there appears to be a good interest in
a Virtual Microscopy program. However, only 50% are interested in an individual subscription for a
virtual microscopy program.

Conclusion:

From the pilot survey results, there appears to be an overall positive reaction to Virtual Microscopy
with favourable responses to image quality, ease of use and potential applications. The RCPA
Haematology QAP hope to introduce a Virtual Microscopy program as part of the range offered to
subscribing laboratories. We will also be investigating the variety of applications that the Virtual
system has to offer for educational purposes.




                                                                                                    14

								
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