FCS Express: Medium Testing Volume

Laboratory Profile - Medium Testing Volume

Quick Summary


Laboratory: Cincinnati Children's Hospital Medical Center,
Diagnostic Immunology Laboratory,
Division of Hematology / Oncology
Website: http://www.cincinnatichildrens.org/dchi
Lab Contact: Dan Marmer, M.S., MT (ASCP),
Manager Core Flow Cytometry Facility
Patient Testing Volume: Total workload = 4500 cases per month (Leukemia/Lymphoma 3-4 per week)
Cytometers: (2) FACSCaliburs and (1) FACSCanto; (2) FACSVantages for research use
Staffing: 12 Technologists
Testing Menu: Leukemia / Lymphoma, Lymphocyte Subsets, CD34 Enumeration.
The Lab performs about 15 other esoteric flow cytometric assays such as: Autoimmune Lymphoproliferative Syndrome (ALPS) panel, Perforin/Granzyme B Panel, CD107a mobilization, Foxp3, CD154 (CD40L, Fas L) expression for HIgM Syndrome, SAP protein to R/O XLP, TCR alpha-beta / gamma-delta, Wiskott-Aldrich Syndrome Protein (WASP), B Cell Panel, and Neutrophil oxidative burst.
Prior Analysis Software: CellQuest Pro, DiVa
Major Concerns: Ease of Use, Training, Automation

Laboratory Overview

Cincinnati Children’s Hospital Medical Center is nationally recognized as a leader in pediatric health care, with a reputation for excellence in patient care, research and medical education.  CCHMC is a full-service, not-for-profit pediatric academic medical center.

The Diagnostic Immunology Laboratory is integrated in a comprehensive Immunodeficiencies and Histiocytosis Program at CCHMC.  It interfaces with the Molecular Genetics Lab as part of the Diagnostic Center for Heritable Immunodeficiencies, as well as with the Blood and Marrow Transplantation Program. 

The Flow Cytometry laboratory is equipped with two FACSCaliburs, two FACSVantage SE high speed cell sorters, and a FACSCanto system.  The lab performs a vast number of Cytometry based assays for immunodeficiency detection and monitoring, oncology related, and transplantations.  The Core Flow Cytometry Facility is managed by Daniel Marmer under the direction of Dr. Alexandra Filipovich.

Carol, Carrie, Allison
Carol Moore, Allison Prchlik, and Carrie Koenig enjoy using FCS Express to analyze their cases.


Lab Concerns

The primary concern was that the lab felt they were wasting a lot of unnecessary time analyzing cases and generating their reports manually.  Report generation consisted of a several step process.  Using the CellQuest Pro™ software that accompanied the purchase of their FACS instruments, they first needed to acquire the data and then import these data files into analysis templates.  During analysis, it was necessary to separately change the file on each individual plot if multiple data files were required for the case.  If the data required overlays for interpretation, that required yet another manual step to create the overlay plot from the individual histograms.  Final steps required manually typing the results into the LIS or a report form. 

Another major problem to overcome involved the computer systems within the laboratory.  The hospitals IT policy required them to update their computers every two years; however, the lab could not comply as the instrument vendor was unable to support the use of newer operating systems such as those utilized on a newer Mac based computer.  This situation developed into a constant struggle for support from their internal IT department who did not want to deal with obsolete hardware and became a driving force for them to consider other platforms and options for analysis and report generation.

Additionally, Dan recognized that he needed to take into consideration the ease of training staff on any new analysis program brought into the laboratory.  This was an important point as the staff consists of two very different experience levels.  One group is very versed in computer technology and is highly proficient in Microsoft applications such as Word, PowerPoint and Excel and a second group that is relatively new to computer use in general.  He realized that he needed to be able to train and support both types of employee and yet still be able to get the daily workload completed.

Benefits of FCS Express

Dan Marmer first heard about FCS Express at one of the Clinical Cytometry Meetings.  He was able to try the program during the meeting and was pleased at how user friendly he found FCS Express.  The fact that FCS Express V3 Clinical Edition was listed with the FDA for IVD use was also a very important factor to their CAP approved laboratory.  Dan is always concerned about introducing change to the staff technologists but even this normally difficult process was addressed with flying colors.  “At first, there were the usual complaints about having to learn something new, but the group picked up FCS Express in no time.  And now they absolutely love using it!”  His initial concerns regarding training the various staff members were also dismissed during their lab validations.  They decided to form a team including some of the more computer proficient staff members to develop their templates one assay at a time.  The team made minor adjustments to the layouts as needed and then introduced them to the other staff members to use for the validation process.  They decided to analyze patient samples side by side in their current Cell Quest program and also in FCS Express allowing all the staff members time to become familiar and proficient in the new software in a timely manner.

Using FCS Express has allowed them to automate the lengthy reporting process as well as provide standardized reports and report templates for their clients.  They have created tokens to extract needed statistics from the data files and automatically perform needed calculations.  In addition, they have taken advantage of using FCS Express to create a number of custom tokens to further increase efficiency analyzing their data.  These custom tokens use logical equations and calculations to generate different normal ranges and scoring of results automatically, calculate percents and absolute counts, and provide information to assist in interpretation for their Leukemia/Lymphoma panels.  Histogram overlays are also created automatically using panels to load the selected data files in FCS Express, eliminating another manual reporting step and provides more accurate results via histogram subtraction to remove background staining.  FCS Express also allows them to do overlays of 2D plots for activation markers (positives over isotypes) which previously could not be done at all.

Not only did FCS Express improve their productivity, having QC alerts and tokens built right into their templates also provided better quality results.  They have completely automated the old manual analysis process into a single step process.  Multiple patient files are automatically loaded into the analysis layouts via the panel function, overlays and calculations are automatically performed, and the desired results are generated and exported with a single click.  They can also use FCS Express’s compensation feature to correct cases with obvious post acquisition issues reducing the need for repeat testing.  Originally they created their own LIS integration and designed reports which mimicked the ones created in FCS Express for standardization.  Dan is happy that FCS Express also provides them with flexibility for the future growth since now that they have completed the entire migration to FCS Express for analysis, their IT department has plans to upgrade the LIS to Cerner Millennium soon.  "That will enable us to import statistics from the FCS 3.0 data files directly into the new system and to further improve our processes.  We’re already upgrading our reports in FCS Express to prepare for this now”.