Introducing Digital Pathology to the Air Force: A Preview of Intra-facility QA Studies

Transcription

1 Introducing Digital Pathology to the Air Force: A Preview of Intra-facility QA Studies

2 Authors Russell Silowash, BS Evaluation Team Research Analyst Leslie Anthony, MA UPMC Digital Pathology Informatics Project Manager Robb Wilson, MA Evaluation Team Project Manager Dana Grzybicki, MD, PhD Evaluation Team Principal Investigator

3 Funding This work was supported by funding from the U.S. Air Force administered by the U.S. Army Medical Research Acquisition Activity, Fort Detrick, Maryland (Award No. W8XWH and Contract No. DAMD ). The content of the information does not imply U.S. Air Force or Government endorsement of factual accuracy or opinion.

4 Introduction Quality Assurance (QA) is an important component to pathology practices in order to provide the best patient care possible Raab et al found a multi-institutional discrepancy frequency of 6.7% 2 Previous QA studies conducted at UPMC with 24 genitourinary cases yielded promising results regarding diagnostic concordance and confidence The purpose of this study is to determine the feasibility and utility of inter- and intra-facility WSIbased Quality Assurance in the Air Force and UPMC

5 Sites

6 IRB Process Other Air Force Bases (Total of 5) Lackland Air Force Base Keesler Air Force Base Air Force Surgeon General Pitt IRB IMITS Evaluation Project

7 Case Selection 30 random cases QA team at UPMC pulled the cases from a pool representing 5% of the cases seen in the months of February, April, and September 2004 Patient reports de-identified and used for background information

8 Case Breakdown 67 parts to be assessed 202 total slides Case Type Number of Cases Case Type Number of Cases Gastrointestinal Biopsy 6 Ostiomeatal Excision Biopsy Bladder Biopsy 3 Hernia Repair Mitral Valve Replacement Skin Biopsy Hepatic Polypectomy Thyroid Lobectomy Face Lesion Excision Thoracotomy Abdominal Aortic Aneurysm Lymph Node Biopsy Finger Partial Amputation

9 Study Design There are 3 parts to this project. Pre-implementation Questionnaire 2. Case/Slide Surveys 3. Post-implementation Questionnaire Question: Since this study is pretty expansive (8 sites across the country), how do you plan to collect the data?

10 Data Collection Solution: We build an electronic data collection system! Users can download it from a website System is a Microsoft Access Database that has many features Allows for seamless data entry and data collection At-ready data reporting

11 Features Automatic ID Generator Easy Access to Surveys / Questionnaires Automatic Data Exportation

12 Pre-Questionnaire Completed before case surveys can be viewed Evaluates WSI and professional experience Records perceptions and attitudes

13 Case Navigation Command buttons access case surveys Check boxes keep track of participant progress Tells participants how many slides are in each case Allows participants to access edit features

14 Case Surveys Automatically calculates screen resolution Provides patient and procedure information to participant Records QA Agreement by biopsy part Command buttons access slide surveys!

15 Slide Surveys Records many variables Image quality Image artifact presence & severity Focus quality for multiple cell properties Time spent on slide Database automatically opens image on internet Zooming features enabled

16 Post-Questionnaire Records attitudes, perceptions, and satisfaction Strengths of WSI Weaknesses of WSI Suggestions for improvement UPMC and Air Force support Comfort in diagnosis using WSI

17 Data Exportation The database is a large file Can t it back and forth between participant and honest broker Database function exports relevant data to excel spreadsheets Spreadsheet files can be ed to honest broker Honest broker s de-identified data to data manager for analysis / reporting

18 Does It Work? To test the feasibility and function of the database, 5 pathologists were recruited for a pilot study 4 UPMC pathologists outside pathologist

19 Pilot Results

20 Next Steps Make necessary programming changes Distribute data collection system to Air Force Sites via Air Force Knowledge Now and UPMC Collect data Develop dynamic reporting system and display results to investigators

21 References. Ho, J., A.V. Parwani, et al. (2006). Use of whole slide imaging in surgical pathology quality assurance: design and pilot validation studies. Human Pathology 37(3): Raab, S.S, R.E Nakhleh, et al (2005). Patient safety in anatomic pathology: Measuring discrepancy frequencies and causes. Archives of Pathology and Laboratory Medicine 29: