[Histonet] Re: Slide quality

[Tony Henwood]

A good histotechnologists must be able to recognise tissue types. They
must know when a section is adequate (nay should I say perfect?) for
diagnosis. In my laboratories, my staff hate it when a medico tells them
that a section is inadequate. Hey we know more about the science of
Histopathology than a medico, that's why we are scientists or
technicians.

Granted some things slip through since we can only check a sample of the
days work but without basic histology knowledge how can one
differentiate a trichrome, or elastc stain?

Solving problems is our job. Take the GI Bx problem. We have used a
Lieca caroussel-type processor for many years to process these. It is a
lot gentler on the tissue but for placenta and large thick tissue blocks
we use a Shandon enclosed processor (more umph!). 

Train your staff to recognise good sections, give them spot quizzes on
unknown tissues. More importantly when a problem is noted and you know
how to solve it, don't. Let your staff knuckle it out.
Eg, the eosin staining tray in the automatic stainer was low and only
part of the section stained, yet the previous run with a full rack of
slides was OK. Why? You will be surprised at some of the answers. Here
is where you show your staff how to solve the problems. It gets them
thinking. It provides a work environment that is interesting since to
learn something new everyday, especially when they don't realise they
are doing it, really can induce a productive and responsive workforce.

Interesting I even wonder at some of our own ?experts in our External
QAP. An assessment of a Perl's stain (stained in a coplin jar, not on a
rack) stated that staining was uneven across the section. On review, it
was noted that the slide stained (supplied by the QAP) was of uneven
thickness. Couldn't the assessors pick this up? Anyway enough flamming
before I get into real trouble!!

Regards

Tony Henwood JP, MSc, BAppSc, GradDipSysAnalys, CT(ASC)
Laboratory Manager & Senior Scientist
The Children's Hospital at Westmead,
Locked Bag 4001, Westmead, 2145, AUSTRALIA.
Tel: 612 9845 3306
Fax: 612 9845 3318




-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Kemlo
Rogerson
Sent: Thursday, 6 December 2007 8:59 PM
To: Robert Richmond; histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Re: Slide quality


You couldn't get the average pathologist, definitely including this one,
to even notice most of the folds and wrinkles that occur in sections.
We've become so used to ignoring them that when we teach
photomicrography to residents, we have to remind them not to photograph
areas in the slide with wrinkles in them - they look like hell when
they're projected.

I think that asking the pathologist to document wrinkles and folds is
unreasonable.

In the various labs I do pathology in, the recurrent problem is GI
biopsies with shatter and "window-blind" artifact. My requests to
address the problem are usually ignored. Very few pathology services do
separate processor runs for small specimens, and I've never been able to
get a laboratory to even consider it.

If I ran the zoo, I'd have a double headed microscope (not permitted for
pathologists in small pathology services), and I'd look at the day's run
of slides with a senior histotechnologist nearly every day. That to my
mind might launch an effective quality assurance program.

I agree with you (before you argue with me!) that most pathologists in
this circumstance would be so abusive that the exercise would be quite
unendurable for the technologist. Robert



I'm surprised that you don't look at the slides with the Tech; how does
he/ she know if they are doing a good job. In my experience when my
Pathologist was kind enough to teach me some smatterings of
Dermatopathology it was stunningly powerful in showing me the error of
my ways. I don't understand why Techs/ BMSs don't look at slides before
they go to the Pathologist and even take a crack at the diagnosis. On
one or two occasions I remember I've spotted CIN3 on a Lletz that wasn't
spotted by the Pathologist but then I was a Cytologist; wouldn't be any
good at anything non- cervical; but I could learn!!!

Kemlo Rogerson
Pathology Manager
DD   01934 647057 or extension 3311
Mob 07749 754194; Pager 07659 597107;
The road to success is dotted with many tempting parking places.
--Author Unknown 

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