Integración de sistemas de

trazabilidad y escáneres de

preparaciones

Marcial García Rojo Hospital General Universitario de

Ciudad Real. Spain. marcial@seis.es

Tracking and scanning systems integration

Emerging solutions

• Complete traceability

• Digital slides

Why are we so late with tracking systems?

• Automatic staining systems improvements

Can we make both systems (total traceability and digital image) work together?

Anatomic Pathology Information

Systems-SIAP (I)

Efficient management of data and images to generate final pathology report. Classic functions: • Patient identification and management • Accessioning and specimen management • Gross and microscopic descriptions • Management of special techniques requests…. New functions: • Tracking systems and workflow control • Integration with digital image • Telepathology, ….

Tracking in pathology

• Correct Identification

• Workflow management

• Time management (LEAN)

• Bottlenecks identification

• Where is located each object

Slide and cassettes labelling:

interpretation errors

SOS

50S

505

5O5

S05

1405

1705

1905

14OS

17OS

84

B4

89

B7

87

BY

Fuente: Dako y Leica

Possible scenarios

• AP study request: Electronic, paper based or mixed

• Specimen accession number: does it come from clinical information system or from pathology I.S.

• Accessioning secretary technicians

• Tracking systems: Part of the SIAP or special software

• Laboratory workflow: Batch mode, continuous workflow or mixed

• Digital slides: Partial or total scanning

• Autostainers: Integrated or not

Identificación de objetos

•Documentos

•Envases

•Casetes

•Portaobjetos

•Códigos de barras

–Impresión directa: Leica / Sakura (2D: datamatrix)

–Etiquetas (resistentes)

•Radiofrecuencia (RFID): Bloques parafina y portas

Petición electrónica

Día 1 09:15

Circuito de trabajo RECEPCIÓN Y REGISTRO DE MUESTRAS

Petición electrónica Registro Macro y

fijación Inclusión

Microtomía y H&E

Micro IHQ, SS,

ISH Diagnóstic

o Informe

Fuente: Dako

Ventana Vantage Dako TruePositiveId

Leica Cerebro

Vitro VTS

ESTACIÓN 2:

Macro/Sala de Tallado. Impresión y verificación de casetes

Escanear etiqueta de

informe de petición.

Seleccionar color

cassette desde

Patwin.

Imprimir y verificar

Fuente: Dako

Etiquetar portas

• Sin código de barras: Escasa trazabilidad (posible OCR – Hologic). Se traminte muy poca información. Requiere más trabajo manual

• Doble etiquetado: Queda muy poco espacio para datos como nombre paciente, hospital, nombre patólogo, etc.

• Re-Etiquetado: Añadir 8,5 sec/porta manipulación para colocar etiqueta. Son muchas horas y posibles errores

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Sin código de

barras, sólo datos

Sitio solo para

3 líneas

Solo código de

barras del

instrumento

Identificación portaobjetos

LIS/TPID – DakoLink – TPID: affects the

whole pathology laboratory workflow

Case information entered into LIS or TPID. Labeling of specimens.

Accessioning

Grossing of the case. Cassettes produced.

Grossing

Processing of cassettes. Tracking of case and cassettes.

Processing

Embedding of cassettes. Tracking of case and blocks.

Embedding

Tracking of blocks. Slide labeling.

Cutting

Tracking of archived blocks and slides.

Archiving

Processing of slides through staining process with Dako Link.

IHC/SS Staining laboratory From

Microtome to

Microscope

Use the same

label! Slide scanning

Slide reading and reporting

Control de preparaciones. Estado

Preparaciones digitales

Tres fases:

1. Digitalización: Escáner capaz de leer código de barras y aceptar lista de trabajo

2. Gestión de imágenes (almacenamiento, consultas)

3. Visualización: Interfaz usuario

– Visor (software). Mostrar información etiqueta

– Agrupar preparaciones del mismo caso

Escáneres de preparaciones

Más de 25 sistemas disponibles:

• 3DHistech Panoramic (4) • Aperio ScanScope (6) • Olympus VS (3) • Hamamatsu Nanozoomer (2) • Claro (2) • Leica SCN400 (2) • Menarini D.Sight(2) • Omnyx (2) • Philips (1) • Roche Ventana (2)

Aperio Scanscope AT / XT / CS

3D Histech

Hamamatsu

Nanozoomer 2 Olympus

VS800, VS120, VS110

.slide Philips

Leica SCN400 Omnyx VL4

Menarini

D.Signt

Supplement 122 in DICOM

• Attributes for the identification and description of specimens:

– (1) identify the specimen (within a given institution and across institutions)

– (2) identify and describe the container in which the specimen resides

– (3) describe specimen collection, sampling, and processing

– (4) describe the specimen or its ancestors when these descriptions help with the interpretation of the image.

Antes de TPID

Con TPID

Conclusions

• Tracking systems are designed to improve laboratory workflow ( “prediagnosis phase”), but not department workflow, but we must learn to use them in diagnosis phase (pathologist and cytotechnician)

• An integrated tracking solution improves workflows and response time.

• Integrated solutions in digital pathology with electronic health record, tracking and central image repository, will improve collaborative work between technicians and pathologists to improve security for patients and quality in health providing.

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¡Muchas gracias!

marcial@seis.es