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WC-6 Superiority of immunoradiometric assay for serum thyrotropin (TSH) over free thyroxine index (FTI) in the evaluation of thyroid function
CCLM/CSCC POSTER ABSTRACTS conventional typewriter, computer generated forms provide an additional graphic dimension and great f l e x i b i l i t y . At the same time, use of a simple system for this purpose encourages interest and development of expertise applicable to future computer applications. A variety of labora¢ory forms such as {}C charts, worklists and requisitions wi]l be displayed. Emphasis will be placed on report forms for "special" tests such as the "triple bolus', protein eIectrophoresJs and glucose tolerance. Well designed reports improve communication of interpretive information to physicians and thus increase tho profo¢~Jnnal
Jnmgo n f t b o l a h n r a t n r y _
Microcomputer approaches to problem solving in the clinical laboratory. P.M. Keane, Doris Schuh, Laboratory Medicine, Foothills Medical Centre, Calgary, Alberta. The interpretation of complex batteries of diagnostic tests, ~ut of control assays or malfunctioning instruments all represent problems in "pattern recognition" which are most frequently solved by "in house" experts using rule of thumb approaches. We have investigated the application of microcomputer based approaches to problem solving in these areas~ The key being the establishment of a data base of relevant facts plus access and retrieval systems which allow answers to queries. The "string" searching abilities (up to 80 alphanumeric characters) of small memory resident programs may be used to match test results and diagnoses and viceversa. The knowledge base may be placed in an "expert system" shell allowing more formal reasoning to be used. The use of '%ypertext" allows multidimensional search with the inclusion of graphics were appropriate. "Fuzzy logic" and confidence factors may be incorporated by using a declarative language such as Prolog. The application of these approaches to two model systems: laboratory diagnosis of thyroid disease and lipid abnormalities will be presented. The availability of relevant inexpensive software for both MS-DOS and A~ple Macintosh systems will be discussed as will the educational potential of these approaches.
ON-LINE COST ACCOUNTING OF NONLABOUR COSTS BY A LABORATORY COMPU'IER ~ Melvvn Bernsteim Sheila Armstrong.
(Department of Laboratory Medicine, Health Sciences Centre Hospital, 2211 Wesbrook Mall, Vancouv~, B.C, V6T 2BS) We have developed a method for on-line capture of the costs of laboratory tests within the laboratory computer system. The system consists of two components. 1) A data base system developed using the EPIC Analyst Software. 2) A reporting program ~;m;l~r to the Statistics Canada reporting system which uses the actual cost per individual test instead of units. This is a module of the Meditcch Clinical Laboratory System. The individual test costs were determined within the data base by using the costs of each of the component parts of the test. This included the cost of all disposables ('mcluding labels), reagents, and the detneclation mad maintenance of equipment. These are calculated based on empeeted equipment life and average supply costs during the reporting period. Whenever supply c o ~ change these can be entered in the data base and appfied to all tests ,t~i,g t h ~ suppfies. The reporting system gives the costs per bench area broken down into the individual tests and into the categories: inpatleuts, outpatients, referred in, standards and icoutrols, as well as stats. The system has been in use now for three years and the cost estimate at the end of the fiscal year has proved to be within 3% of the actual e.~imnditure. The advantages of this system in managing a clinical laboratory has become significant in this day of cost containment and restraint
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•
AN ARTIFICIAL INTELLIGENCE SOFTWARE PROGRAMFOR PRETATION OF MATERNAL SERUM AFP RESULTS, FOR BOTH OPEN NTD AND DOWN'S SYNDROME. A.R. MacRae and K.B. McEvoy, Benetech Medical Systems, Toronto, Ontario, Canada.
A software program u t i l i z i n g an a r t i f i c i a l intelligence (AI) expert system has been developed to i n t e r p r e t maternal serum a l p h a - f e t o p r o t e i n (MSAFP) screen r e s u l t s . The 386
hardware requirements are an IBM-XT* or compatible computer f i t t e d with a standard I0 MB hard d r i v e . AI is ideally suited f o r making medical diagnoses, because i t can process m u l t i p l e complex f a c t o r s and yet demonstrate the logic that was used in the diagnosis. The complexities of MSAFP screening are t h e r e f o r e handled with an ideal security and absolute consistency not a v a i l a b l e through conventional programming. In the MSAFP program, p a t i e n t data is error checked, and the m u l t i p l e of the median (MoM) is calculated based on the p a t i e n t ' s gestational age in completed weeks, and the p a t i e n t ' s r a c i a l o r i g i n . The MoM is adjusted i f appropriate f o r the IDDM population, and weight corrected i f the maternal weight is provided. The p r o b a b i l i t i e s of an open NTD and Down's sydrome are calculated. One of approximately I00 d i f f e r e n t interpretive messages is provided. Other f a c t o r s t h a t are considered include: gestational age over 18 weeks, the method of determining gestational age, previous high or low r e s u l t s , and the degree of abnormality of the MSAFP r e s u l t . Approximately 60,000 patient data sets can be stored on a 20 MB disk, and the program calculates medians selected by gestational age, racial o r i g i n and assay date, on request. Data sets can also be transmitted to and from other s i t e s using a modem. *IBM registered Trade Mark
i we-5 ITSH REFERENCE VALUES STRATIFIED ACCORDINGTO AGE M.L. Givner (Div. of Clin. Chem., Dept. o f Path., Victoria General Hosp. and Dalhousie Univ., H a l i f a x , N.S., B3H IVS) The purpose of our study was to determine i f there were any age-related d i f f e r e n c e s in TSH values as determined on normal subjects with the novel and u l t r a s e n s i t i v e Delfia hTSH Kit (LKB-Pharmacia). Serum samples from 203 female and male presumably normal subjects were assayed f o r the hTSH with the above kit. Range f o r a l l subjects was 0.I to 8.6 mlU/L with a mean 1.38±1.15 (S.D.). Values o f subjects under 40 yrs (0.23 to 5.8 mlU/L, mean 1.22±0.90 (S.D.) were s i g n i f i c a n t l y lower (p
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SUPERIORITY OF IMMUNORADIOMETRIC ASSAY FOR SERUM THYEOTROPIN (TSR) OVER FREE THYROXINE INDEX (FTI) IN THE EVALUATION OF THYROID FUNCTION. J. Kalra, K.L. Massey and V.A. Laxdal (Dept.Path.,Univ.of Saskatchewan and Univ. Hospital, Saskatoon, Sask., S7N OXO)
A number of strategic approaches to the investigation of thyroid function have been suggested. Recently the immunoradiometric assay (IRMA) for serum Thyrotropin (TSH) has been suggested as the initial screening test for evaluating thyroid status. We compared and assessed the diagnostic efficiency of free thyroxine index [serum thyroxine (T4) x T 3 uptake~ with a sensitive IRMA for TSH [Bis-Rad Echoclonal@ hTSHJ. Patients studied were divided into different groups on the basis of their clinical findings and the results for FTI and IRMA-TSH were compared in making the correct diagnosis. In the hyperthyroid group (n=18) all the patients were correctly diagnosed using FTI and IRMA-TSH except one, in whom FTI was within normal range. The values of serum IRMA-TSH and FTI in patients with primary hypothyroidism (n=16) were compatible with the diagnosis and were correctly diagnosed. All the patients who were clinically euthyroid (n=31), pregnant (n=3) and on oral contraceptives (n=2) were correctly diagnosed using IRMA-TSH and FTI. In those patients who had nonthyroidal illness (n=l~) seven were correctly diagnosed and four showed discrepancies using FTI. However, using IRMA-TSR all these patients were correctly diagnosed. These results indicate that IRMA-TSH provided better diagnostic efficiency and was superior to FTI in making the correct diagnosis. CLINICAL
BIOCHEMISTRY,
VOLUME
21, D E C E M B E R
1988
Jnmgo n f t b o l a h n r a t n r y _
Microcomputer approaches to problem solving in the clinical laboratory. P.M. Keane, Doris Schuh, Laboratory Medicine, Foothills Medical Centre, Calgary, Alberta. The interpretation of complex batteries of diagnostic tests, ~ut of control assays or malfunctioning instruments all represent problems in "pattern recognition" which are most frequently solved by "in house" experts using rule of thumb approaches. We have investigated the application of microcomputer based approaches to problem solving in these areas~ The key being the establishment of a data base of relevant facts plus access and retrieval systems which allow answers to queries. The "string" searching abilities (up to 80 alphanumeric characters) of small memory resident programs may be used to match test results and diagnoses and viceversa. The knowledge base may be placed in an "expert system" shell allowing more formal reasoning to be used. The use of '%ypertext" allows multidimensional search with the inclusion of graphics were appropriate. "Fuzzy logic" and confidence factors may be incorporated by using a declarative language such as Prolog. The application of these approaches to two model systems: laboratory diagnosis of thyroid disease and lipid abnormalities will be presented. The availability of relevant inexpensive software for both MS-DOS and A~ple Macintosh systems will be discussed as will the educational potential of these approaches.
ON-LINE COST ACCOUNTING OF NONLABOUR COSTS BY A LABORATORY COMPU'IER ~ Melvvn Bernsteim Sheila Armstrong.
(Department of Laboratory Medicine, Health Sciences Centre Hospital, 2211 Wesbrook Mall, Vancouv~, B.C, V6T 2BS) We have developed a method for on-line capture of the costs of laboratory tests within the laboratory computer system. The system consists of two components. 1) A data base system developed using the EPIC Analyst Software. 2) A reporting program ~;m;l~r to the Statistics Canada reporting system which uses the actual cost per individual test instead of units. This is a module of the Meditcch Clinical Laboratory System. The individual test costs were determined within the data base by using the costs of each of the component parts of the test. This included the cost of all disposables ('mcluding labels), reagents, and the detneclation mad maintenance of equipment. These are calculated based on empeeted equipment life and average supply costs during the reporting period. Whenever supply c o ~ change these can be entered in the data base and appfied to all tests ,t~i,g t h ~ suppfies. The reporting system gives the costs per bench area broken down into the individual tests and into the categories: inpatleuts, outpatients, referred in, standards and icoutrols, as well as stats. The system has been in use now for three years and the cost estimate at the end of the fiscal year has proved to be within 3% of the actual e.~imnditure. The advantages of this system in managing a clinical laboratory has become significant in this day of cost containment and restraint
W
C
•
AN ARTIFICIAL INTELLIGENCE SOFTWARE PROGRAMFOR PRETATION OF MATERNAL SERUM AFP RESULTS, FOR BOTH OPEN NTD AND DOWN'S SYNDROME. A.R. MacRae and K.B. McEvoy, Benetech Medical Systems, Toronto, Ontario, Canada.
A software program u t i l i z i n g an a r t i f i c i a l intelligence (AI) expert system has been developed to i n t e r p r e t maternal serum a l p h a - f e t o p r o t e i n (MSAFP) screen r e s u l t s . The 386
hardware requirements are an IBM-XT* or compatible computer f i t t e d with a standard I0 MB hard d r i v e . AI is ideally suited f o r making medical diagnoses, because i t can process m u l t i p l e complex f a c t o r s and yet demonstrate the logic that was used in the diagnosis. The complexities of MSAFP screening are t h e r e f o r e handled with an ideal security and absolute consistency not a v a i l a b l e through conventional programming. In the MSAFP program, p a t i e n t data is error checked, and the m u l t i p l e of the median (MoM) is calculated based on the p a t i e n t ' s gestational age in completed weeks, and the p a t i e n t ' s r a c i a l o r i g i n . The MoM is adjusted i f appropriate f o r the IDDM population, and weight corrected i f the maternal weight is provided. The p r o b a b i l i t i e s of an open NTD and Down's sydrome are calculated. One of approximately I00 d i f f e r e n t interpretive messages is provided. Other f a c t o r s t h a t are considered include: gestational age over 18 weeks, the method of determining gestational age, previous high or low r e s u l t s , and the degree of abnormality of the MSAFP r e s u l t . Approximately 60,000 patient data sets can be stored on a 20 MB disk, and the program calculates medians selected by gestational age, racial o r i g i n and assay date, on request. Data sets can also be transmitted to and from other s i t e s using a modem. *IBM registered Trade Mark
i we-5 ITSH REFERENCE VALUES STRATIFIED ACCORDINGTO AGE M.L. Givner (Div. of Clin. Chem., Dept. o f Path., Victoria General Hosp. and Dalhousie Univ., H a l i f a x , N.S., B3H IVS) The purpose of our study was to determine i f there were any age-related d i f f e r e n c e s in TSH values as determined on normal subjects with the novel and u l t r a s e n s i t i v e Delfia hTSH Kit (LKB-Pharmacia). Serum samples from 203 female and male presumably normal subjects were assayed f o r the hTSH with the above kit. Range f o r a l l subjects was 0.I to 8.6 mlU/L with a mean 1.38±1.15 (S.D.). Values o f subjects under 40 yrs (0.23 to 5.8 mlU/L, mean 1.22±0.90 (S.D.) were s i g n i f i c a n t l y lower (p
iW C - " [
SUPERIORITY OF IMMUNORADIOMETRIC ASSAY FOR SERUM THYEOTROPIN (TSR) OVER FREE THYROXINE INDEX (FTI) IN THE EVALUATION OF THYROID FUNCTION. J. Kalra, K.L. Massey and V.A. Laxdal (Dept.Path.,Univ.of Saskatchewan and Univ. Hospital, Saskatoon, Sask., S7N OXO)
A number of strategic approaches to the investigation of thyroid function have been suggested. Recently the immunoradiometric assay (IRMA) for serum Thyrotropin (TSH) has been suggested as the initial screening test for evaluating thyroid status. We compared and assessed the diagnostic efficiency of free thyroxine index [serum thyroxine (T4) x T 3 uptake~ with a sensitive IRMA for TSH [Bis-Rad Echoclonal@ hTSHJ. Patients studied were divided into different groups on the basis of their clinical findings and the results for FTI and IRMA-TSH were compared in making the correct diagnosis. In the hyperthyroid group (n=18) all the patients were correctly diagnosed using FTI and IRMA-TSH except one, in whom FTI was within normal range. The values of serum IRMA-TSH and FTI in patients with primary hypothyroidism (n=16) were compatible with the diagnosis and were correctly diagnosed. All the patients who were clinically euthyroid (n=31), pregnant (n=3) and on oral contraceptives (n=2) were correctly diagnosed using IRMA-TSH and FTI. In those patients who had nonthyroidal illness (n=l~) seven were correctly diagnosed and four showed discrepancies using FTI. However, using IRMA-TSR all these patients were correctly diagnosed. These results indicate that IRMA-TSH provided better diagnostic efficiency and was superior to FTI in making the correct diagnosis. CLINICAL
BIOCHEMISTRY,
VOLUME
21, D E C E M B E R
1988