The Implementation of Cloud-Based Telemedical Applications for External Quality Control Purposes in the Field of Cytopathology

The Implementation of Cloud-Based Telemedical Applications for External Quality Control Purposes in the Field of Cytopathology

Stavros Archondakis (Cytopathology Department 401 Military Hospital, Athens, Greece), Abraham Pouliakis (Department of Cytopathology, University of Athens, “ATTIKON” University Hospital, Athens, Greece), Niki Margari (Department of Cytopathology, University of Athens, “ATTIKON” University Hospital, Athens, Greece) and Petros Karakitsos (Department of Cytopathology, University of Athens, “ATTIKON” University Hospital, Athens, Greece)
Copyright: © 2014 |Pages: 15
DOI: 10.4018/ijrqeh.2014070102

Abstract

The aim of this study was to analyze in details the implementation of an accredited proficiency testing scheme by cytopathology labs wishing to establish external quality control measures according to ISO 15189:2012. The proficiency testing scheme was based on simple Cloud-based telemedical applications and was enthusiastically accepted by all colleagues due to its simplicity and its low cost. Six major cytopathology laboratories contributed fifty conventional pap smears with histological confirmation from their registries voluntarily. Twenty board-certified cytopathologists reviewed the smears voluntarily and recorded their diagnoses. Four major diagnostic categories of cytological reports were used for statistical purposes. In addition to diagnosis, reviewers also commented on overall smears quality. Ten smears in which diagnostic interobserver accordance was almost perfect were selected for further study. A characteristic video from each one of the 10 selected smears was transferred via a simple cloud application to password-protected accounts for remote review by independent cytopathologists. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. The statistical evaluation of each participation' s results were a valuable external quality control tool for each participating laboratory and its members.
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Background

Proficiency testing (PT) is a well-recognized method for evaluating actual laboratory performance, usually, by means of interlaboratory comparisons (Cramer et al., 1991; Woodhouse et al., 1999). Proficiency testing results can be used as an independent indication of a laboratory’s diagnostic competence and can be integrated in the ordinary process of the laboratory’s assessment and accreditation (Cramer et al., 1991; Woodhouse et al., 1999). According to ISO 15189:2007, all accredited laboratories must conduct proficiency tests in accordance with their regular patient testing and reporting procedures (Pantanowitz et al., 2009). A recent revision of ISO 15189, published in 2012 proposes the additional use of alternative methods for the evaluation of laboratories technical competence, where accredited PT schemes are not available. The practice of diagnostic cytopathology performed on digital images is a process by which remote laboratories can obtain expert opinions on difficult cases (telecytology) (Archondakis et al., 2009). Telecytological diagnosis can be achieved either with the use of cytological images viewed in real time from the microscope (dynamic telecytological systems), or with the use of cytological pictures that are first captured in a digital format and then transmitted to distant observers (static telecytological systems) (Archondakis et al., 2009; Stamataki et al., 2008) or combinatorially (Della Mea et al., 2000) . Hybrid systems have also been developed. However, the majority of relevant articles have focused on the possible use of telecytology for diagnostic and consultation purposes (Archondakis et al., 2009).

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