FCS Express: Low Testing Volume

Laboratory Profile - Low Testing Volume

Quick Summary

Laboratory: University of Florida & Shands Hospital
Lab Contact: Dr. Raul Braylan,
Former Professor and Chief, Hematopathology Section
Patient Testing Volume: Approximately 300 samples per month
Cytometers: (2) FACSCaliburs, (1) FACSScan,
(1) FACSAria 
Staffing: 6 Technologists, 5 Staff Pathologists and 1 Trainee plus Residents
Testing Menu: Assessment of Hematological and Lymphoid Tissue Neoplasms 
Prior Analysis Software: Cell Quest, ModFit, Lysis
Major Concerns: Ease of Use, Networking, Macintosh Support

Laboratory Overview

Shands Hospital at the University of Florida is a private, not-for-profit hospital that specializes in tertiary care for critically ill patients.  Shands at UF continually receives recognition as one of the best hospitals in the nation by U.S. News and World Report because of its dedication to patient care, education and research.  It is also the primary teaching hospital for the UF College of Medicine. 

The Hematopathology Laboratory serves as a major consulting center for the various Shands Hospitals along with a number of other institutions and clinics in the Southeast.  The analysis of clinical samples is one of the main sources of data for UFs clinical research and educational activities.  Data access and networking capabilities are critical to this lab to allow for teaching and collaboration. 

Dr. Raul Braylan

Lab Concerns

The Hematopathology lab was Macintosh based because of their choice of cytometry instrument platforms, but was now being lead into a PC environment due to lack of institutional support for Macintosh computers.  The lab also desperately needed a better way to share data amongst the various cytometry users.  The routine clinical casework is analyzed and reviewed by several laboratory technologists and pathologists.  In addition, many residents also need to analyze data during their rotations through the department. The lab only had two workstations for data analysis which all these people had to share, causing serious scheduling conflicts.  Waiting for your turn decreased turn-around -time for the lab and added to the already labor intensive process.  Dr. Braylan publishes many journal articles and books; and is well known for his Clinical Cytometry Lectures and Training courses.  This aspect of his job also required him to look for a better way to provide high quality graphics. Creating presentations was a time-consuming process because it required him to make many adjustments in photo editing software before his images were ready for publishing. 

Additionally, Dr. Braylan was looking for an analysis program that would allow him to perform the multiple gating strategies that he required and that was intuitive and easy to train his staff to use. He had found himself struggling with limited gating features; finding it difficult to do basic functions such as replacing or renaming gates, deleting gates, and creating gating hierarchy.

Benefits of FCS Express

Dr. Braylan was first introduced to FCS Express while attending a cytometry meeting in Europe .  He was impressed with many of the features that he saw during a brief demonstration and decided to give FCS Express a try.  He initially used FCS Express primarily for non-clinical use (teaching, publishing articles).  However, he soon saw the value FCS Express could provide for the clinical laboratory.  He purchased a network version of FCS Express so his staff would be able to analyze their cases from their own PCs.  Previously analysis was a labor intensive process with many people having to share workstations.  Now they can perform their analysis on any available computer in the lab which has greatly improved the quality of their work as well as their efficiency.

The pathologists use the program routinely for clinical purposes. In addition, many residents (post-docs) use it during their rotations through the department.  FCS Express not only provides a solution to the networking requirement but also allows each doctor the flexibility to create exactly the layout needed for their cases.

Using FCS Express

Dr. Braylan describes their workflow like this: “We use several layouts. Two standard ones are utilized to analyze tissues and blood/bone marrows, respectively. These are the ones that are used for most routine cases. Other templates are used for T-cell clonality, DNA analysis and other specialized applications with smaller number of reagents. Also, each one of us has a "personal" layout (or layouts) that we prefer for certain situations. Layouts are the starting point in our analysis. In most instances, the analysis goes beyond the initial template and consists of interactive observation of the data and appropriate gating strategies applied to the specific situation using something like the "paint-a-gate" approach to recognize abnormal populations and characterized them.” 

Since FCS Express uses a familiar Power Point like interface, training the lab staff to use the program was easy. The staff made use of the ability to create and label multiple gates, inserted tokens into their layouts to extract needed statistics and keywords from the data files, edited fonts and annotations, and utilized the multiple undo function, along with the networking capabilities. They send their acquired data files onto a server so they can access data from multiple computers. They also receive better support from their IT department on the PC platform. In addition, many cases are reviewed in a group setting on a giant 42” monitor located in the lab. Because of the simplicity of FCS Express, even new residents can immediately participate and perform an analysis in front of his/her peers.

The ease of use and benefits of FCS Express has certainly saved them time in their daily work which translates into other gains for the lab.  Although saving time and labor is a major concern for most laboratories including this one, Dr. Braylan feels that using FCS Express also means a higher quality analysis which is the number one concern for this lab.