Dawn H. Grohs

Impact of automated technology on the cervical cytologic smear. A comparison of cost.

The cervical cytologic screening test for cervical cancer is the largest-volume cancer screening test currently conducted predominantly without the advantage of process automation. Much attention has been directed toward commercial application of automated technology to support both quality enhancement and productivity gain in cervical cytology screening. Several systems are now available for clinical application that address various aspects of cervical cytologic screening automation. These include specimen-preparation devices and image-based automated screeners. Each system provides a different mix of benefits and impacts cost differently as well. This, coupled with the fact that few systems are in broad clinical use as yet, makes it difficult to conduct parallel cost-benefit analysis. A comparison is presented on the impact of system use on the laboratorys cost to conduct the test. Although there is a demand for technology that can support improvements in quality and/or productivity of cervical cytologic screening, there is also a responsibility for fiscal prudence in technology implementation. Products that dramatically increase the cost of service, and thus perhaps limit access to care for some patients, may have an impact on patient outcomes quite apart from that intended.

The AcCell Series 2000 as a Support System for Training and Evaluation in Educational and Clinical Settings

Providing effective training, retraining and evaluation programs, including proficiency testing programs, for cytoprofessionals is a challenge shared by many academic and clinical educators internationally. In cytopathology the quality of training has immediately transferable and critically important impacts on satisfactory performance in the clinical setting. Well-designed interactive computer-assisted instruction and testing programs have been shown to enhance initial learning and to reinforce factual and conceptual knowledge. Computer systems designed not only to promote diagnostic accuracy but to integrate and streamline work flow in clinical service settings are candidates for educational adaptation. The AcCell 2000 system, designed as a diagnostic screening support system, offers technology that is adaptable to educational needs during basic and in-service training as well as testing of screening proficiency in both locator and identification skills. We describe the considerations, approaches and applications of the AcCell 2000 system in education programs for both training and evaluation of gynecologic diagnostic screening proficiency.

Utility of the TracCell System in Mapping Papanicolaou-Stained Cytologic Material

BACKGROUND Much attention has been directed toward commercial application of automation technology to support both quality and productivity enhancement in cervical cytology screening. The introduction of a fully automated precision microscopy workstation, the AcCell Series 2000, (Accu-Med International, Inc., Chicago, Illinois, U.S.A.) has made it possible to effectively incorporate automated prescreening systems that support the human screener. SYSTEM DESIGN The TracCell 2000 slide mapping system (AccuMed) is a fully automated, stand-alone prescreening device for Papani-colaou-stained cytologic material, such as cervical cytology specimens. The system locates the areas of the slide that do not require review and maps material in the remaining areas; it finds the optimal focal plane, calculates a preferred routing path for human review and determines speed adjustment relative to material density variation. Through slide bar coding identification, this information is transmitted to the AcCell precision microscopy workstation for presentation of the specimen to the human screener. DISCUSSION By making it possible to automatically guide the human screener to the material of interest, the TracCell system eliminates the need to review empty space and irrelevant areas of the slide. This has the immediate advantage of improved productivity. In addition, by reducing the need to review neutral background material, the system increases the signal-to-noise ratio, thus contributing to a sustained level of vigilance in the screener. The system also addresses operator fatigue through computer-assisted focus and speed variation. This instrument is for investigational use only. The performance characteristics of the device have not been established.