ADVIA® 2120i Hematology System Gains Online Training

Welcome to the ADVIA® 2120i Hematology System Gains online training course. During this course you will be able to: Define gains Identify gain parameters Perform steps for gain adjustment Select Next to continue. Define the term "gain" Differentiate between Sample and System Flags Identify the steps to perform gain adjustments Interpret the flags and results affected by improper gain adjustment Resolve common errors that may occur during Gain adjustments Upon successful completion of this course, you will be able to: Select Next to continue. Computers are required to have varying levels of performance depending on what they are used for and where they are located in the hospital – and this means varying requirements on the individual hardware components that are crucial for a computer's performance. For example, computers that are used for 3D image processing have far more powerful hardware components than computers that are used for documentation. But in the final analysis, all computers function in the same way and have the same hardware (this applies also to servers). Congratulations.  You have completed the ADVIA® 2120i Hematology System Gains online training course.  Listed below are the key points that have been presented.  Take time to review the material before you proceed to the final quiz.  Define the term "Gains" "Gains" is a software setting that is used by the system to correctly place the cells in cytograms. It is important that the cell populations are in the expected place on each cytogram so that flagging and counting are correct. As each cell is detected in the flowcell, its signal is amplified by the associated gain factor in order to place the cell on the cytogram in the correct position. Interpret the flags and results affected by improper gain adjustment The following channels are affected by gains: RBC/Platelet, Retic, Baso, Perox Morphology flagging can be affected gain settings. Percent Retic can be affected by gain settings. The differential can be affected by gain settings. Identify Sample versus System Flagging Causes Before adjusting gains it is important to identify system vs. sample related causes. Review sample results to help identify cause of flagging. If all samples are flagging with the same morphology, flagging the system may be the cause. Identify the steps to perform gain adjustments Gain adjustment is performed on an as-needed basis and in each of the following cases: On installation If there is a significant shift in control values after replacing a critical hydraulic or optical component Installing reagents with a different lot number When indicated by quality control data, or frequent false positive or false negative morphology flags The materials required are OPTIPoint for RBC, platelet and retic gains, calibrator for Perox gains, and five whole blood samples. Adjust gains by navigating with the Wizard and performing a verification run or without the Wizard and performing an optional verification run. Resolve common errors that may occur during Gain adjustments Errors may occur during the gain adjustment run or during review of the gain data. Common errors may include: Probe clog Flatness Insufficient number of data points Gain factor range Select Next to continue.   You are now familiar with the requirements for running software with the various hardware components and the operating system. However, before users can start working on a program, it first has to be installed on the computer. What exactly does installation mean? When installing software, program files or data from the new application are copied onto the computer's hard disk. The software is also registered with the operating system, so that the operating system allocates computer resources to the software.   Gains - software settings used by the system to correctly place the cells in cytograms. Cytograms - two dimensional displays that can be viewed on the Run Screen during cell counting and analysis.   A gain factor is used by the analyzer to process the cell signals seen by a detector. As each cell is detected: It is analyzed in the flowcell The signal is amplified by the associated gain factor It correctly places the cell on the cytogram Accurate morphology flagging and sample results are displayed   Cytogram Gains Learn about the individual cytogram gains. Slide NumberText BlocksCalloutsAudio ScriptImage File1RBC Cytogram Cells are distributed on the RBC cytogram based upon low angle and high angle scatter signals obtained in the laser optical assembly. The RBC X and RBC Y gain factors ensure the cells are located correctly on the RBC cytogram. Red blood cells display on this cytogram based on their volume and cellular hemoglobin concentration. Select Next to continue.  Select the number to review the corresponding text.Note: If audio does not automatically start, select the play arrow in the top left to begin.Callouts RBC Y RBC X Low angle and high angle light scatter signals are plotted on the cytogram and reflect red cell volume and hemoglobin concentration for red cells. The RBC X and RBC Y gain factors ensure the cells display correctly on the cytogram.2Platelet Cytogram Cells are distributed on the Platelet cytogram based upon amplified low angle and high angle scatter signals obtained in the laser optical assembly. The PLT X and PLT Y gain factors ensure the cells are located correctly on the RBC cytogram. Platelet volume and refractive index are displayed on this cytogram. Select Next to continue.Select the number to review the corresponding text.Callouts PLT Y PLT X Amplified low angle and high angle light scatter signals are plotted on the cytogram and reflect platelet volume and refractive index of platelets. The platelet X and platelet Y gain factors ensure the cells display correctly on the cytogram.3Retic Cytogram Cells are distributed on the Retic cytogram based upon low or high angle scatter and absorption signals in the laser optical assembly. The Retic Z gain factor related to absorption for the Retic channel only ensures the cells are located correctly on the Retic cytogram. Select Next to continue.Select the number to review the corresponding text.Callouts Retic Z Reticulocytes are stained and the absorption signal will determine the amount of stain in the reticulocytes. The Retic Z gain factor is used to adjust the threshold for reticulocyte percentage count.4 Baso Cytogram Cells are distributed on the Baso cytogram based upon their low and high angle scatter signals in the laser optical assembly. The Baso X and Baso Y gain factors ensure the cells are located correctly on the Baso cytogram. The cells displayed on this cytogram show white cells stripped of their cytoplasmic membranes and categorized as mononuclear or polymorphonuclear and intact basophils. Select Next to continue. Select the number to review the corresponding text.Callouts Baso Y Baso X The baso cytogram displays white blood cells based on their low and high angle light scatter signals. Baso X and Baso Y gain factors are adjusted to ensure the cells are displayed correctly on the cytogram.5 Perox Cytogram Cells are distributed on the Perox cytogram based upon light scatter and absorption in the Perox optical assembly. The Perox X and Perox Y gain factors ensure the cells are located correctly on the Perox cytogram.   When complete, select the X in the upper-right corner to close the window and continue. Select the number to review the corresponding text.Callouts Perox Y Perox X Cells are distributed on the Perox cytogram based upon light scatter and absorption. Here clusters of white cells are distributed and differentiated based on cell size and amount of peroxidase activity. The perox x and perox y gain factors are adjusted to make sure the cells are classified correctly. License models: Campus, procedure-based and pay-per-use license model Campus license model With this license model, the software is available to an unlimited number of employees in a hospital or department.  It is not attached to a particular workstation or specific group of users or number of users, in other words, with this license, all workstations can be used and an unlimited number of users can work in parallel on the software. Procedure-based license model This model corresponds to the campus license model. However with this model, the licenses are limited to a specific number of procedures (performed procedures according to the DICOM standard) per year. If the defined number of procedures per year is exceeded, further licenses must be purchased. Pay-per-use license model This model is also based on the campus license model, but with this model, payment is made each time the software is used. Unlike with the procedure-based license model where licenses are purchased all-in for a specific number of procedures, with this model the license is issued for the exact number of procedures performed (or data volume in terabytes) per year. The Open Source Model is often referred to in this context. This describes freely accessible software that is allowed to be copied, further developed, and re-distributed free of charge.   The ADVIA® 2120 Hematology System analyzes the cells using flow cytometry. During flow cytometry analysis: Cells are encased with sheath reagent Delivered and analyzed through in the flowcell Light scatter and absorption signals are measured Cell Analysis in the Flowcell Learn how cells are analyzed in the Flowcell.   Select the play arrow to begin the animation.  When complete, select the X in the upper-right corner to close the window and continue.      Databases: Managing & storing data Scan and treatment data on each individual patient has to be recorded in such a way that it can be quickly and specifically consulted at any time. Now just imagine that a hospital such as Munich Harlaching treats around 35,000 patients each year, and has to manage the corresponding volumes of patient data. This is done with the aid of databases. A database is an electronic system enabling data to be accessed rapidly and large data volumes to be stored with low space requirements.   The sample flagging and results affected by gains are unique for each channel. There are five channels on the ADVIA® 2120i Hematology System, the only channel not affected by gains is the hemoglobin channel. The following channels are affected by gains: RBC/Platelet Retic Baso Perox Select Next to continue.   Pre-fetching If a new scan is planned or performed for a patient, the radiologist often requires the patient's previous scans. If these previous scans are no longer available in the STS or online storage, they must be re-loaded from the archive (LTS) onto the STS, so that they can be displayed on the workstation. This process is usually automatically prompted by the newly planned scan and is also referred to as "pre-fetching". As there is always a certain time lag with pre-fetching, many clinics want to keep as much data as possible for as long as possible in the STS, so that data can be accessed immediately and directly. The STS or online storage permits a high level of performance, is cost-effective, and can be extended on demand. The scope and duration for which data is kept in the STS may vary from a few weeks, through several months to several years, depending on the hospital's requirements. Short-term and long-term storage systems are generally used in connection with a PACS system in the medical environment.   The RBC cytogram is a plot of RBC volume and hemoglobin concentration data intended for evaluating red cell morphology. The results affected by gains in the RBC channel include:   Hematocrit   MCV   MCHC   CHCM   CH   RDW   HDW   Impact of Gains on RBC Morphology Flags Learn how gains affect RBC morphology flags and results. Tab TitleTextCorrect gains The normal RBC cytogram displays RBC's with no morphology flags. With correct gain settings all normal sample results display without requiring further review.      RBC X Low A low RBC X gain factor shifts the population to the left and causes a HYPO flag even for normal samples. Low CHCM results may also display. Upon microscopic review of normal samples no hypochromia would be noted.   RBC X High A high RBC X gain factor shifts the population to the right. If the RBC X gain factor is too high a HYPER flag is displayed even for normal samples. The CHCM result may also be high. Upon microscopic review of normal samples no hyperchromia would be noted.   RBC Y Low A low RBC Y gain factor shifts the population down and causes a MICRO flag even for normal samples. Low MCV, high HCT, high MCHC may display. Upon microscopic review of normal samples no microcytosis would be noted.   RBC Y High A high RBC Y gain factor shifts the population up and causes a MACRO flag even on normal samples. High MCV, low hematocrit, and low MCHC may display. Upon microscopic review of normal samples no macrocytsis would be noted. When complete, select the X in the upper-right corner to close the window and continue.      LAN and WLAN A network is basically nothing more than a cluster of more than one computer and other devices (e.g. printers, router, and switch) for exchanging data. To function as a network, the computers and/or devices need a network card. A limited number of connected computers are referred to as a local area network (LAN). In our case, the modalities, diagnostic workstations, and servers belong to the LAN in radiology. It can be a highly complex task to set up such a network, extending across a number of stations, departments, and buildings. Instead of using cables, data can be transmitted via a radio connection. Such a wireless network with a limited range is referred to as a wireless LAN (WLAN).  Hospital staff has access via their laptops to the network via the WLAN, wherever they are within the hospital. In this way, a physician for example may access the lab report on a patient via the wireless network while on his or her rounds. But what roles do clients and servers assume within a network?   Platelet gains are affected by the RBC gains Adjusted at the same time PLT X gains are related to the RBC X gains PLT Y gains are related to the RBC Y gains RBC and Platelets are analyzed together in the same flowcell.   Impact of Gains on Platelet Morphology Flags Learn how gains affect platelet morphology flags and results. Tab TitleTextRBC/PLT X Low A low RBC X shifts both the RBC and platelet populations to the left. The Large PLT flag occurs because RBC's are pulled into the platelet counting area. An RBC Ghosts flag could also occur as cells move into this area. MPV could be increased.     RBC/PLT X High A high RBC X shifts the RBC's right and up on the RBC cytogram and causes distortion on the platelet cytogram. RBC Fragments or Ghosts flags could possibly occur. MPV may be low.   RBC/PLT Y Low A low RBC Y gain factor shifts the population down and right causing distortion on the platelet cytogram. RBC Ghosts or RBC Fragments morphology flagging may occur.   RBC/PLT Y High A high RBC Y gain factor shifts the platelet population up and right. Large platelets or RBC Ghosts flagging may occur. When complete, select the X in the upper-right corner to close the window and continue.        Peter, what do you think of thin client technology? Thin clients are a great option. After all, if applications run centrally on the server, then standard computers are sufficient to meet the needs of clinical users, such as radiologists. These standard computers are configured just like the computers we use in the sales department for our daily work. Physicians can access data and complex applications really quickly using these standard computers, e.g. for 3D or 4D image processing. Does this mean physicians can also use the applications at home on their normal laptops? Yes, this is possible under certain conditions, if they use a VPN connection. In this scenario, the physician sees the results displayed directly on his or her laptop screen. The memory-hungry calculations are performed by powerful servers. But there are also further benefits to this approach: The hospital can make these kinds of standard computers or thin clients, more available to its users than high-cost workstations. Physicians no longer have to wait for a workstation to be free or cover long distances between different workstations in order to use specific applications. They simply log on using any thin client in the network. A good argument. This means that staff can work more efficiently in overall terms, thus ensuring greater cost savings. This is a huge asset considering the present shortage of medical specialists. With so many benefits, it is not surprising that development is heading in the direction of thin client architectures. I completely agree with you. What's more, this concept also saves the IT administrator a lot of work, as they only have to install and manage one application on the central server. The retic cytogram displays both RBC and Reticulocytes.  As the cells pass through the flowcell, the signals measure: Cell size Hemoglobin concentration Absorption Reticulocytes are displayed on the cytogram in blue.   Impact of Gains on %Retic Learn how gains affect %Retic results. Tab TitleTextRetic Z Low When the Retic Z gain factor is too low an increase in the %Retic result may occur.     Retic Z High When the Retic Z gain factor is too high a decrease in the %Retic result may occur. When complete, select the X in the upper-right corner to close the window and continue.      Using interfaces to integrate systems Lets take a closer look at how the individual components in a network are interconnected. On the hardware side, every computer has ports, via the network card, connecting the computer to the network. These junctions between individual components are referred to as interfaces. The term is used for connecting two hardware components as well as for the logical connection between two applications (software). Interfaces are responsible for ensuring the smooth flow of data between different computers. To this end, data standards play an important role, ensuring that different applications can "understand" the various data formats.  DICOM (Digital Imaging and Communications in Medicine) is the standard for medical images, HL7 (Health Level 7) is the standard for data such as administrative information, lab values, billing data, etc. Integrated total solutions are built up on the basis of individual systems linked via intelligent interfaces.   The Baso cytogram displays white blood cells that have been stripped of their cytoplasm with the exception of Basophils.  Possible flags associated with the Baso channel are: WBCB %Baso Blast morphology flag Left Shift morphology flag Impact of Gains on Baso Learn how gains affect baso results. Tab TitleTextBaso X Low A low Baso X gain factor shifts the population to the left and may cause a Blast flag. A Left Shift flag may also occur if the PMN's fill the MN/PMN valley.     Baso X High A high Baso X gain factor shifts the population to the right and may cause a missed Blast flag. A Left Shift flag may also occur if the MN's fill the MN/PMN valley.   Baso Y Low A low Baso Y gain factor shifts the population down and may cause a Blast flag. A Left Shift flag may also occur if the PMN's fill the MN/PMN valley.   Baso Y High A high Baso Y gain factor shifts the population up and may cause a missed Blast flag. A Left Shift flag may also occur if the PMN's fill the MN/PMN valley. When complete, select the X in the upper-right corner to close the window and continue.      What does an IT service concept entail? To safeguard against risks while their IT systems are up and running, hospitals enter into service agreements with service providers. In addition to servicing hardware components, the agreements aim in particular to keep the software updated within the hospital. A comprehensive service concept therefore usually incorporates the following components: Software service agreement User support Hardware maintenance agreement Service Level Agreements (SLA) are drawn up to define in detail the scope of services and corresponding quality required from the service provider. For example, an SLA will detail how any faults will be escalated, how quickly a service provider is to commence work on clearing the fault (response times), and when the service is to be provided (e.g. Mondays to Fridays, from 8:00 to 18:00 hrs.). SLAs will also set out what role the customer (e.g. the IT administrator) has to assume in maintaining and supporting the IT systems. Let's take a closer look: What is a software service agreement required for and how does hardware servicing work using maintenance agreements?   The Peroxidase cytogram displays cell size and peroxidase staining for white blood cells.  Possible flags affected by gains in the perox channel are: WBCP %Neut %Lymph %Mono %Eos %LUC ATYPS NRBC IG PLT Clumps MPO Def Impact of Gains on Perox Learn how gains affect perox results. Tab TitleTextPerox X Low A low Perox X gain factor shifts the population to the left causing MPO (myeloperoxidase deficiency) and ATYP (atypical lymph) flags.   Perox X High A high Perox X gain factor shifts the population to the right.  Moving LUC's into the Mono area may be causing a missed ATYP flag.   Perox Y Low A low Perox Y gain factor shifts the population down. Mono and Lymph cells are pulled down into the Noise, NRBC and platelet clump areas. IG, Platelet Clumps and NRBC flags may occur.     Perox Y High A high Perox Y gain factor shifts the population up which may cause an ATYP flag because some Lymphs may be counted as LUC's, and an NRBC flag because noise is shifted into the NRBC area. When complete, select the X in the upper-right corner to close the window and continue.        From diagnosis to treatment Mr. Sommer is now settled in the ward. When his ward physician does his evening rounds, he consults the results on his laptop and at the same time makes the necessary arrangements to have the kidney stones removed the next day. The system also tells him whether the operating suite can fit in the surgery. When Mr. Sommer returns home two days later, his family doctor is also electronically notified of the diagnosis and treatment.   Morphology flags may occur due to sample or system related causes. A microscopic review of the sample will confirm if the morphology flag is sample or system related. Sample morphology flags could be due to: Abnormal sample Example: anemia(s) System morphology flags could be due to: Adjusting gains System mechanical issue Select Next to continue.   The gain adjustment procedure is used to adjust the amplification signals in a channel to properly position the cell signatures within a cytogram. Gain adjustment is performed on an as-needed basis and in each of the following cases: During installation If there is a significant shift in control values After replacing a major component Different lot number Frequent false positive or false negative morphology flags Select Next to continue.   Try to guess the percentage of myocardial infarctions that result in a fatal outcome. Perform the following before adjusting gains: Visually inspect the hydraulics during operation. Check pressure and vacuum in the Analyzer Status screen. Verify that the optical system is functioning properly by reviewing the cytograms shape. Clean the shear valve pathways. Set the probe clog stop criteria to 1 in the Alarm/Stop Criteria window. Select Next to continue. syngo Dynamics is a dynamic image review, archiving, and reporting system for cardiology. This Siemens solution allows efficient processing and evaluation of multi-modality images, e.g. echocardiography, coronary angiography, and nuclear medicine images. It provides access to all relevant imaging data and supports cardiology workflow with modality-specific report templates and tools. Siemens not only offers a complete spectrum of highly accurate cardiac imaging diagnostics, but laboratory diagnostics as well. Point of care (POC) testing makes it possible to conveniently carry out diagnostic procedures at the patient’s bedside. All these are impressive examples of Siemens Healthcare innovations: extremely patient-friendly solutions offering excellent diagnostic quality as well as opening up completely new applications.   Material required for adjusting gains: ADVIA OPTIpoint for the RBC X and RBC Y in the RBC channel and Retic Z in the Reticulocyte channel ADVIA SETpoint Calibrator (or the normal control if calibrator is not available) for the NEUT X and NEUT Y in the Peroxidase channel Whole blood for the MNx and MNy in the Basophol/lobularity channel Select Next to continue. The gain wizard will guide you through the gain adjusment procedure.  It is mandatory when using the gain wizard to rerun the samples before final acceptance of the new gain factors.   Using the Gain Wizard Learn how to use the gain wizard for gain adjustments. Instructions:If media does not automatically start, select the play arrow to begin.Flash File:/content/generator/Course_90005840/ADVIA2120GainsWizard_9_2/ADVIA2120GainsWizard_9_2.swfHTML5 File:/content/generator/Course_90005840/ADVIA2120GainsWizard_9_2/index.htmlPDF File: You have just learned how to perform a Gain Adjustment, now it is your turn to practice.    Select the link below to begin. Perform a Gain Adjustment Practice performing a gain adjustment using the Gain Wizard. Instructions:If media does not automatically start, select the play arrow to begin.Flash File:/content/generator/Course_90005840/ADVIA2120_GainsYourTurn_800x600_9/ADVIA2120_GainsYourTurn_800x600_9.swfHTML5 File:/content/generator/Course_90005840/ADVIA2120_GainsYourTurn_800x600_9/index.htmlPDF File: It is recommended that the Wizard is used to perform gain adjustments. Gain adjustments differs slightly when adjusting without the Wizard. Without the Wizard, each step in the process is accessed by selecting the side buttons in the Adjust Gains screen.   Adjusting Gains Without Using the Wizard Learn about adjusting gains without using the Wizard. Checklist TitleChecklist TypeChecklist ContentAdjust Gains IntroductionHTML The software screen necessary to perform a gain adjustment is located under the Procedures menu. To adjust gains without using the Wizard, select the Gains Definition button on the left.  Note: You can select Exit to leave the gain procedure at any time. If you exit before completing the adjust gain process, the system saves the data for the samples you have already processed.  When you next enter the Adjust Gains tab, the system asks you if you want to use or discard the data. Select each checkbox to learn more about adjusting gains without using the wizard. Select Gains ProcedureHTML Select the radio button for the gain procedure to be performed. The Perox and Baso gains can be performed with or without the autosampler. The Optipoint material for RBC gains is aspirated using the manual open tube sampler.   Reference DataHTML The Reference Data will automatically display the values for MNx and MNy. The OK button is selected before navigating to the next screen.   Run Reference MaterialHTML   Run the gain adjustment according to the directions displayed on this screen. As the results are processed the data appears on the Data Review screen.  Data ReviewHTML   Review the data after all samples have been processed.    Gain AcceptanceHTML View the status here. You must accept gain factors before they can be used. If the gains failed, click  the grey box to view the reason. The Help button in the lower right corner will provide useful information regarding gain acceptance. When performing gains without the Wizard, the software gives you a choice as to whether you need to perform a verification run. When complete, select the X in the upper-right corner to close the window and continue.   Errors may occur during the gain adjustment run or during review of the gain data. Common errors include: Probe Clog Precision Insufficient number of data points Gain factor range Handling Errors During Gains Adjustment Learn about handling errors that may occur when adjusting gains. Tab TitleTextProbe Clog If a Probe Clog message is received while you are running the Autosampler to adjust gains, you must exit the Adjust Gains tab, correct the probe clog, and then resume the gain procedure. The message typically appears due to a loose sample line fitting on the Autosampler. Pay attention to the prompts when re-entering the Wizard as it will ask if you want to resume the Gain Adjustment that was started. Select "Yes" to resume.  Flatness If Baso or Perox fails for flatness the problem is due to an irregular flow rate in the respective channel. Follow the troubleshooting information in the Operator's Guide for Baso Irregular Flow Rate or Perox Irregular Flow Rate and then return to the gain procedure.   Insufficient Number of data There are a minimum number of data points required for gains. When reviewing data do not omit more than the required number of data points or the gains will fail. The Wizard will not allow you to omit less than the required number of data points. Data points excluded by the software can be reinstated. Optional: If you need to aspirate additional samples to meet the required number of aspirations, select Run More to run additional samples. For example, if there was a probe clog during the run, you may need to run additional samples to meet the required minimum number.  IMPORTANT: Use the Run More button to aspirate additional samples using the manual open-tube sampler or the manual closed-tube sampler. If the autosampler is processing samples, wait until it has completed the run.  Gain Factor Range The gain factor range is 20 to 255. If the value falls outside this range the gains will fail. Make sure the Gain Reference Data is correct. Check the optical alignment for the affected channel. Check the vacuum and pressure readings and visually inspect the hydraulic lines and pathways. If the gains are too far off, the gain factor may be manually adjusted in the gain factor log. Then continue with the gain adjustment in the Procedures menu. When complete, select the X in the upper-right corner to close the window and continue.