2 History of Automation 1957 1970 1976-1978 1980-Present Technicon develops the first automated analyzerContinuous flowIssues: carryover and costly1970Dr Anderson(NASA) develops a centrifugal analyzerDuPont ACA revolutionized chemistry with a non-continuous flow, discrete analyzer with random access availabilityKodak Ektachem: dry slide technologySmall volumes of sampleReagents on slides for dry chemistry analysis1980-PresentDiscrete analyzer take over Chemistry“walk-away” capabilities
4 Drivers For Technology Advances Reduction in TAT’sStaff shortagesEconomic factorsIncrease throughputReduction in lab errorIncrease safety24/7 operationsFocus on automation of tasks rather than manual methods
5 Automated Chemistry Analyzers AdvantagesIncreased number of tests/technologisteach tech can perform more tests during a period of timeMinimizes variations in resultseliminates errors in pipetting, calculationsSmall sample size and reagent volumes
6 Automated Chemistry Analyzers DisadvantagesMethods vary with the instrument type, etc.Generally, cost of equipment, maintenance, amount of QCTechs must be kept knowledgeable & careful in set-up and operations
7 Basic Types of Instruments Continuous flowCentrifugal analysisDiscrete analysisBatch analyzerperform only test that is requestedcan perform many combinations of testsdo not consume reagents for tests not orderedContinuous flow, centrifugal and discrete analyzers can all use batch mode
8 Automated Chemistry Instruments Continuous flow analysisReagents are pumped continuously through the system.Samples are introduced sequentially at timed intervals and follow each other through the same network of tubing coils, heating baths and photometer / other detector.While economical for profiles of tests, not good for stats or single order tests.All samples get all tests, ordered or notCould not easily interrupt the process once initiated.*Also prone to “carryover”.Wasteful of reagentsExample: Chem 1 By Technicon
9 Automated Chemistry Instruments Centrifugal analysisA discrete system where the transfer of solutions is carried out by the use of centrifugal forceRuns multiple samples, one test at a timeExample:Cobas-Bio and IL Monarch
10 Automated Chemistry Instruments Discrete analysisEach sample is contained in a separate reaction vesselMake up the majority of modern chemistry analyzersRun multiple tests one sample at a time or multiple samples one test at a time called RANDOM samplingExamples:Dade Behring Dimension RXLKodak EktachemAlfa Wasserman Ace Alera
11 Automated Chemistry Systems Wet chemistry systemsReagents come ready to use or lyophilized and must be reconstitutedSystems include batch and profile analyzers or stat analyzersExamples: Beckman Coulter CX-7, Vitros, Dade, Advia, Roche Integra, Hitachi, Alfa Wasserman Ace Aleria, etc.
12 Automated Chemistry Systems Dry reagent systemsReagents can be tablets or found on cellulose fibers located on strips, cards, or layered on film.Reagents easy to handle, store well, and have fairly long shelf life.Examples: Vitros, Seralyzer, Kodak Ektachem, ChemPro, Dupont Analyst
13 Automated Chemistry Analyzers Concepts and definitions
14 Automated Chemistry: Terms ThroughputMax # samples that can be processed in 1 hourDwell timeminimum amount of time required to get test result after samplingvaries greatly with instrumentcan be important consideration when selecting instrument
15 Automated Chemistry:Terms Stat testingLatin statum = immediatea widely used (abused) word in the lab, used to prioritize workStat turn around time - within 1 hour after order entry
16 Costing of chemistry lab tests Things that are included in pricinglabor – processingequipment maintenancereagents - including a portion of start-upcalibration and QCconsumables - containers, papercapital - proportionate amt of life of instrumenthospital overhead - facility maintenance
17 Automated Chemistry Test repertoire What tests the instrument is capable of doingConsider cost analysisImmediate test repertoireWhat it can do without any changes (set- up or programmed for)Total test repertoireTotal number of tests that can be performed on the instrument, with a few changes, ie. reagents, filters or components.
19 Preanalytic Phase Specimen collection Specimen transport Right tube for right testsProper patient labelCorrect draw siteSpecimen transportPhlebotomistsVolunteersPneumatic-tube systems
20 Analytic Phase Sample handling Important to check the specimen for hemolysis, lipemia, clots or fibrinSome analyzers use closed-tube,some open-tubeMost instruments utilize a level-sensing probe to detect the amount of serum or plasma in a tube
21 Summary of Analyzer Operations Sample identification: bar code or manual readDetermination of tests to be performed: LIS can communicate this or operatorReagent systems and delivery: reagents dispensed into cuvetSpecimen measurement and delivery: sample aliquot in introduced into reaction cuvetChemical reaction phase: Sample and reagents mixed and incubatedMeasurement phase: Optical readingsSignal processing and data handling: Concentration is estimated from a calibration curve stored in analyzerSend results to LIS or read and entered off results tape
22 Postanalytical Phase Bidirectional communication Decreases opportunity for errorAuto-verification
23 Trends Total Laboratory Automation (TLA) Integrated work cells Specimen managerTrack systemImmunoassayChemistry
24 ReferencesBishop, M., Fody, E., & Schoeff, l. (2010). Clinical Chemistry: Techniques, principles, Correlations. Baltimore: Wolters Kluwer Lippincott Williams & WilkinsSunheimer, R., & Graves, L. (2010). Clinical Laboratory Chemistry. Upper Saddle River: Pearson .