1

Cell Imaging Analysis: Our journey to Hematology Productivitygy y

Kelly T. Yoder MT(ASCP)SH

Lab Manager, Excela Health Westmoreland Hospital

Greensburg, PA

J 18 2012January 18, 2012

Disclosure

• Receiving an honorarium for this educational presentation

2

Objectives

• Identify reasons for choosing Cell Imaging to• Identify reasons for choosing Cell Imaging to streamline Hematology processes

• Compare manual differential to old/new Automated Differential Imaging systems

• Evaluate case studies using the CellaVision® Automated Differential Imaging System

Fast Facts

• 4,800 employees (region’s third-largest health system)

600 l h i i i 35 i lti• 600-plus physicians in 35 specialties

• 654 licensed beds

• 800 volunteers and auxiliary members

Budgeted for FY 2011

• 1,945 births

• 31,000 inpatient admissions

• 122,682 emergency department visits

3

Our HospitalsWestmoreland Hospital

Greensburg

Latrobe HospitalLatrobe

Frick HospitalMount Pleasant

Catchment areapopulation:

400,000Our reach of care covers Westmoreland County and parts of Allegheny, Fayette and Indiana Counties.

Hematology

• Annual CBC’s• Annual CBC s

• Annual Manual Differential Rate

• Annual Body Fluid Rate

• 2 CellaVision Imaging Systems– Westmoreland

– Latrobe

4

Cell Imaging

• CellaVision DM96– Up to 35 slides/h

• CellaVision DM1200– Up to 20 slides/h

• CellaVision DM8 (discontinued by manufacturer 12/2010)– Loading capacity of 8 slides

– No body fluid application

• MEDICA EasyCell assistant– 5.5 min/slide

– No body fluid application

Cell Imaging Overview

• Locate cells on a glass slideP l if WBC l• Pre-classify WBC classes using an artificial neural network

• Cells grouped, sorted and displayed for Tech

• Historical archiving of all imagesimages

• Access to images through lab network

5

• Starts at a fixed point in the thick area of the

Cell Imaging Technology

smear (33mm from end)

• Moves stepwise towards the thinner part of smear, continously grabbing 10x image until the start and end points have been determined

Start scanning

10x images

determined

Center line

• Analyze the number of RBC contours and the average size of them

Cell Imaging Technology

• When certain criterias are fulfilled, the end point is defined

• Move towards the thinner part and calculate the parameters continously until the critereas for theuntil the critereas for the start point is full fillled

6

• Once the start and end points are determined, the mono layer is then

d (10 ) f ll

Cell Imaging Technology

scanned (10x) for cells according to the Battlement track pattern and the coordinates are stored

• When 3 x (number of cells ordered) objects have been found, or the

End

Start

end point is reached, it stops. (remember this!)12 mm

• Using the 100x objective, the system returns to the previous coordinates and starts focusing

Cell Image Technology

End

Start

and grabbing 100x images of the cells.

• The scan direction is from thin to thick area.

: . . : ¨Start

12 mm

. : .

: ¨ . . ¨Cell coordinates

7

Cell Image Technology

When the cell is in focus, a classification algorithm is performed based upon cell features and characteristics.

EasyCell assistant by MEDICA

8

EasyCell assistant Overview

Designed with the smaller laboratory in mind– Easy to use

– Compact

– Optimized for less than 50 slides per day

– Has virtually no maintenance

Flexibility to fit workflow practices– Accepts up to 30 slides at a time for unattended operation

• Capable of accepting a single slide, e.g. STAT capable

– Performs either 100 or 200 cell analysesy• Displays images for RBC Morphology

• Qualitative Platelet Estimate

– Bi-directional LIS communication

– Archives Images for long term Image storage

– Able to connect to remote network workstations

CellaVision DM96

9

DM-Series Overview• Pre-classifies 18 WBC cell

classes • Pre-classifies 6 RBC

Morphology characterizationsMorphology characterizations• Reads bar-coded slide labels• Windows OS• Large Database • Archiving of Images• Integrates with existing

Network• Bi-directional LIS support,

ASTMASTM• Email transmission of images

CellaVision Software

• Peripheral Smear Imaging

B d Fl id A li ti• Body Fluid Applications– Access to a patient’s historical images and real-time

collaboration

– Ensures the accuracy and standardization of the analysis.

• Competency Software– Comparison to lab expert with statistics

Dynamic education opportunities– Dynamic education opportunities

– Decreases recordkeeping for QA

• Remote Review Software– Full functionality from other network connected PC’s

10

Cell Imaging Implementation

• Customizable software• Customizable software– WBC reportable cell lines

– RBC morphology cell lines

– PLT morphology comments

– WBC morphology comments

• LIS interface• LIS interface– Autofiling

– Exceptions are blast cells and sickle cells

Peripheral Smear SoftwareSettings

11

Peripheral Smear SoftwareSettings

Peripheral Smear SoftwareCustomizable WBC Classifications

12

Peripheral Smear SoftwareCustomizable RBC Classification

Peripheral Smear SoftwareFull Screen WBC

13

Peripheral Smear SoftwareRBC Morphology Tab

Peripheral Smear SoftwarePLT Estimate Tab

14

Peripheral Smear SoftwareSign Out Tab

Peripheral Smear SoftwareLIS Acceptance WBC and RBC

15

Peripheral Smear SoftwareLIS Acceptance WBC/PLT Morph

Hematology Value

• Increased quality and consistency– Ability to review smears easily and cells classedAbility to review smears easily and cells classed

– Identify issues with technicians and ability to educate

• Aging technician population– Better ergonomics

– Cell Image adjustments

• Competency and EducationStudents– Students

– Slide Review

– Multiple Databases

• Decreases tech time

16

Technician Time Comparison

Table 4 Comparison of time taken to complete the 30 differentials onTable 4. Comparison of time taken to complete the 30 differentials on the CellaVision DM96 including reclassification of cells with time taken to perform the same differentials manually

Operator Time for analysis on DM96 Time for manual differential

1 1 h 5 min 1 h 45 min

2 1 h 10 min 1 h 40 min

3 1 h 30 min 3 h 45 min

4 1 h 40 min 4 h 10 min

5 1 h 14 min 3 h 10 min

Reference: Kratz A., Bengtsson H., Casey J.E., Keefe J.M., Beatrice G.H., GrzbekD.Y.,Lewandrowski K.B. & Van Cott E.M. (2006) Performance evaluation of the CellaVision DM96 system. American Journal of Pathology 124, 770–781.

Technician Time Savings

“Th ti d h i th DM96 i t t• “The time saved when using the DM96 is greatest for the less experienced laboratory scientists. With increased instrument familiarity with the instrument there may be potential for even more time saved”

Reference:Briggs C., Longhair I., Slavik M., Thwaite K., Mills R., ThavarajaV., Foster A., Romanin D., Machin S.J. (2009) Can automated blood film analysis replace the manual differential? An evaluation of the CellaVision DM96 automated image analysis system. Jnl. Lab. Hem. 31, 48–60

17

Hematology Value

“The DM96 is reliable and certainly has a place inThe DM96 is reliable and certainly has a place in the haematology laboratory where it should improve workflow, make more efficient use of experienced laboratory scientists’ time and make training and monitoring of staff in blood cell morphology skills easier and more efficient.”

Reference:Briggs C., Longhair I., Slavik M., Thwaite K., Mills R., ThavarajaV., Foster A., Romanin D., Machin S.J. (2009) Can automated blood film analysis replace the manual differential? An evaluation of the CellaVision DM96 automated image analysis system. Jnl. Lab. Hem. 31, 48–60

Pathologists Benefits• Pathologists

– Email cell images for reviewEmail cell images for review

• Specific cells emailed

• Decrease time to search for abnormal cells

• Electronic record of abnormalities– Remote review software

• Pathologist complete review– Real time consultations

• No need for microscope or oil lenses

18

Hematology ValuePathologist Review via Email

CellaVision Body Fluid

• Prepare Cystospin slide

• Uses Blue magazines/cartridges to identify smear• Uses Blue magazines/cartridges to identify smear as a Body Fluid

• Same classification principle as peripheral blood software

19

CellaVision Body Fluid

Operational Benefits

• LEAN approach

• Barcoded specimen ID increases quality• Barcoded specimen ID increases quality

• Multiple stations reading differentials without the need of a microscope

• Odd shifts increase productivity with remote review software

• Competency and education improve quality results

20

HST Line

HST Line

21

CellaVision Workstation

Financial Benefits

• Time savingsTime savings

• Techs can perform other duties

• Decrease pathologists time on slide review

• Time available for new assays for additional revenue

22

Conclusion

• Cell Imaging provides• Cell Imaging provides – Increases in quality

– LEAN approach

– Education opportunities

– Tech time savings

– Accuracy and precision

– CompetencyCompetency

– Pathologist real time review

– Pathologists time savings

References

Briggs C., Longhair I., Slavik M., Thwaite K., Mills R., ThavarajaV., Foster A., Romanin D., Machin S.J. (2009) Can automated blood film analysis replace the manual differential? An evaluation of the CellaVision DM96 automated image analysis system. Jnl. Lab. Hem. 31, 48–60

Kratz A., Bengtsson H., Casey J.E., Keefe J.M., Beatrice G.H., Grzbek D.Y., Lewandrowski

K.B. & Van Cott E.M. (2006) Performance evaluation of the CellaVision DM96 system. American Journal of Pathology 124, 770–781.

23

Question and Answers

Kelly T. Yoder MT(ASCP)SH

kyoder@excelahealth.org

Work: 724-832-4353

Cell: 724-972-7950