6 minute read
The Digital Cell
CellaVision Remote Review Software (CRRS)
Most modern laboratories have a ‘quiet space’ for the examination of blood films – this could be a quiet corner, or even a separate room. So, when a lab has an automated track system with a DI-60 attached, it can be an issue for the morphologists who don’t want to stand in front of the analyser track to perform their smear examination. We have a solution to this problem that could help in more ways than one.
Working in collaboration with CellaVision, laboratories can use CellaVision Remote Review Software (CRRS) to enable authorised users to log in to the software (using secure VPN) from other locations and access the results from the DI-60. CRRS makes it possible to review and verify cell differentials from anywhere, at any time, which removes the need to be by the analyser, or even in the laboratory itself. CRRS allows users to step away from the analyser and review films in an area of their choice. It is very flexible and can be implemented to suit your own laboratories requirements. Some hospitals have it set up for a single site with a few users who perform morphology on a regular basis. Some will expand the CRRS to include the clinicians so that they have access in their office, in the clinic, and even have networked access for laptops so they can assist easily on call. Larger hospital networks use CRRS to connect multiple sites together. CRRS allows external users from labs to remotely access CellaVision results. Films can be remotely reviewed, differentials can be performed and comments can be added using CRRS. This enhances a workflow efficiency, by removing geographical constraints; allowing an experienced morphologist to work remotely without travelling. Consultants can review films easily without having to travel between sites and can also assist on-call/shift staff within the network. This is beneficial to the patients’ treatment, as cases can be reviewed quicker and allows for diagnosis to be made earlier. COVID-19 has highlighted a greater need for products like CRRS, and its usefulness will continue to benefit the lab when faced with staff shortages, by allowing staff to work remotely and to support one another during tough times. CRRS comes in two varieties, either a dongle-based licence which is placed into the PC it is to be used on, or as a concurrent licence package that can be loaded onto a number of PCs. The benefit to the license package is that there are no physical dongles which can be lost when transferring the licence from one location to another. The Royal Preston Hospital has a Sysmex XN-9000 track with a DI-60 incorporated which has been validated for use by Steve Hambridge (Lead BMS Haematology), Nicola Peacock (BMS Team Leader Haematology) and Brittany Houghton (Haematology STP) with the support of the laboratory staff. The DI-60 uses version 6 software and the Advanced Red Cell Application, along with 5 remote review licence dongles. The laboratory uses digital morphology for smear examination during routine working hours with the long term aim to roll this out to 24-hour working. Steve, can you briefly describe how the lab ran before you had digital imaging and what were the main limitations?
We have a dual site so we run principally from Royal Preston and our sister site is at Chorley hospital which is a smaller ESL. All of the blood films were sent across to Preston for manual analysis prior to the introduction of digital morphology. Realistically the main problems with blood film analysis is obviously the training aspect having the experienced personnel within the department to perform this labour intensive process. How does your digital morphology set up fulfil the needs of morphology within your laboratory?
We tend to work on the days digitalised images, cutting through arguably the easier elements to clear and focus on the ones that are urgent following that. Going forwards if this is done throughout a 24-hour period it will certainly improve things no end because literally you could be reviewing the film almost as it's been through the DI-60 in the future and picking it out if it needed to be reviewed manually or releasing those results fairly swiftly after generation. Are there any users that utilise the remote review access for cross site working or from a remote location?
The concept has been proved by the use of the laptop at home but cross sites we’ve just got a few little internal IT things to resolve before we can introduce the licences properly in Chorley. Once we've got those licences in operation across at our sister site then that will happen. The fact that we can have access via a laptop as well means arguably people can do this from home which with COVID has been a bit of a bonus as well.
Are there any features of the system you feel shine through for you?
I would say absolutely the quality of the image is exceptional and the actual categorisation again is usually very very good. With the additional advanced red cell parameters it does tend to suggest some of the features occurring a little bit more frequently than our eyes would see but that's for us to adjust the limitations of it and adjust the gateway's accordingly. I would say that's one of the shining lights, the other one realistically is the training because that really really helps, particularly with junior staff. They can sit with somebody a little bit more experienced, more senior and they can review images together and go through them. It's a good training tool in that respect and that is very very helpful as it's always probably one of the more difficult skills to pick up within the lab and certainly this has helped us no end.
How do the staff feel about using the digital morphology?
All staff have been impressed by the system but I would say certainly the younger ones have been like a duck to water with this, they've really embraced it easily. There's been a big buy-in, I would say the staff understand the methodology, it has stimulated their interest and it started them on the pathway to attaining good competencies in this area.
Picture: Steve Hambridge (Lead BMS Haematology) and Tuli Panchal (BMS Haematology) in front of DI-60 in the Royal Preston haematology laboratory. Nicola Peacock (BMS Team Leader Haematology) looking at remote review software in the morphology room at Royal Preston Hospital.
What advice would you give to anyone who was about to begin the process of implementing digital morphology?
Don't expect 100% compliance with digital to start with and use it as a tool in your armoury. It is a machine, it's not human and you've got to work within said limitations and it's important to realise that at the outset there are limitations with this and as long as you work within those boundaries you're not going to fall far short. Do a bit of background work with the guys at Sysmex and CellaVision, lean on their expertise, find out as much information as possible. If you can get the staff on board early doors and see some benefits then ultimately it makes it easier to bring into more routine use for sure and there are plenty of benefits there. As a training tool it's absolutely essential, it's brilliant, it really is good. We'd like to thank Kate at Wolverhampton for facilitating a visit there which really helped us make some plans moving forward and obviously Sysmex and CellaVision for the support that you provided.
