NSH Poster Podcast: P06/ P15 (2024)

P06-Understanding the Quality of your Electron Microscopy Provider in this Era of Outsourcing of Services- Tracey de Haro MSc, FIBMS, UK NEQAS CPT TEM Scheme Coordinator Specialist Scientific Lead for Electron Microscopy University Hospitals Of Leicester NHS Trust, UK 

Background
Electron Microscopy (EM) remains vital to the diagnostic repertoire for the diagnosis of pathologies. Surveys of diagnostic TEM units in the UK were carried out in 2012, in 2019 (unpublished) and is currently being repeated. These surveys showed that a large amount of EM is now outsourced to units away from the originating trust.

Whether UK or globally, when pathology departments are looking for a supplier of diagnostic EM services, the only
questions they ask of the EM units are “how much does it cost” and “what is your turnaround time?” Are these the only relevant questions to ask?
Considerations

The following relevant issues should be considered alongside cost and speed;
The technical quality of an electron microscopy service;

Can the EM unit produce good quality sections and images that maximizes the chances of observing relevant pathologies?
Data from UK NEQAS CPT show that only 50% of EM units participating in the diagnostic TEM scheme
achieve excellent scores of 9 or 10 out of 102 not achieving excellent quality could potentially compromise a diagnosis.
The knowledge the staff have of ultrastructural pathology
• Do the staff assessing your samples know what to look for? Having proof of EM staff’s knowledge in ultrastructural
pathology is essential when relying on them to provide relevant images and a considered report on features seen
or not seen.

Questions to Ask Your EM Provider
To ensure that the EM service you are sending your samples to is ‘fit for purpose’, you should not only consider the speed and cost of the service but also;
• Ensure that your potential provider is accredited to ISO 15189 standards.
• Ask for evidence of participation in an EQA scheme specifically for technical TEM.
• Ask for TEM EQA results over the past 12 months and ensure they are consistently achieving excellent marks.
• Do the EM staff participate in regular knowledge and competence competency review specifically for TEM
and ultrastructural assessment?
• How much experience of ultrastructural pathology do the members of staff examining your samples have
and do they have any qualifications in this area?
• Get endorsements from other users of the EM service to evidence the quality of work offered.

Summary

Access to EM services remains vital across the globe, but in the UK is increasingly being outsourced to units remote from the originating trust. In this case, the pathologist is reliant on the images and ultrastructural report being accurate to inform diagnosis.
To ensure accuracy, the EM unit, whether they be UK based or part of our international community, all should participate in a quality EQA scheme and all staff should be experienced and have access to training to ensure
they are educated to a high level in ultrastructural pathology.
Without this, the referring trust cannot be guaranteed the service they are paying for is fit for purpose.

P15-Understanding the Quality of your Electron Microscopy Provider in this Era of Outsourcing of Services: How does a Technical EQA Scheme Add Value? -Tracey de Haro MSc, FIBMS, UK NEQAS CPT TEM Scheme Coordinator Specialist Scientific Lead for Electron Microscopy University Hospitals Of Leicester NHS Trust, UK

Background
Benefit of Participation in an EQA Scheme 
Summary
The Transmission Electron Microscopy (TEM) Scheme was developed in 2018 as a means of assessing the quality of the final output of diagnostic TEM Units against a defined assessment standard. The aim of this EQA scheme is to allow EM units to have their work regularly assessed and measured against other TEM units in an anonymous and supportive manner. This ensures that results are reliable and comparable no matter where
they are performed. Education in technical aspects of the TEM process is also offered as a knowledge and competence exercise as part of each EQA assessment.

EQY Scheme Organization

TEM scheme Participants are asked to submit 4 digital images from each of 2 contrasted TEM cases. There are 6 EQA assessment runs per year. Specific tissue types for each case are requested for each assessment run. Renal cases are requested for each run as case 1 and muscle or nerve are requested in rotation for case 2. However alternative tissue types can be submitted for either case if participants do not
examine those tissue types.

Details of technical fixation, processing and imaging for each case are required to be submitted as part of Data Entry. This allows generation of ‘best method’ reports for high achieving EQA scores to be issued to Participants. Each image is anonymously assessed against the defined assessment  criteria by a pair of expert peer assessors. Each assessor will award a score out of 5 giving a total score for each image out of 10.

Participants receive the following for each run;

• EM Individualized report detailing the scores awarded for each image, along with information about where marks were lost and why
• EM best method report detailing methods that achieved high scores
• EM image report giving examples of images that achieved a range of scores from the maximum score to low scoring images, along with why those scores were allocated 

Summary
Participation in a technical TEM EQA scheme provides factual information that can also be used to advertise and promote an EM unit as providing a proven quality service.  Whilst being participating in an educational exercise within each EQA assessment, allows individual and laboratory knowledge and competence to be assess and demonstrated.

Evidencing your EM unit provides a high quality, gold standard service is vital when diagnostic electron microscopy is often being outsourced to external EM units. Cost of service and turn round times for results are often asked, but quality of work for diagnostic results
should also be considered. Consistency of technical quality is important to ensure pathologists receive high quality diagnostic information.
This mitigates against misinterpretation from poor quality images, assuring a safe, accurate diagnosis. This is good
news for the participating EM units, good news for the diagnostic process and ultimately, good news for patients.