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Decision criteria for the selectionof analytical instruments usedin clinical chemistryIII Non-monetary criteriaH. BiittnerInstitute for Clinical Chemistry, Medical School, Hannover, West Germany.
THE selection of analytical instruments is a very complexproblem for a clinical chemical laboratory. The reason forthis is that medical, methodological and practical organisa-tional aspects must all be considered simultaneously. It isnecessary to develop criteria for these aspects which relate tocharacteristic and relevant features of the instrumentsconcerned, which can be verified, and which may be quanti-fied, wherever possible.
At present, there is no consensus agreement on criteria ofthis kind, but there are, however, some recommendationsfrom international scientific associations relating to particularproblem areas 1,21.
After the objectives have been defined as already outlined,the examination of the data for selection should be carriedout in the following order of priority:(1) Applicability to the intended purpose.(2) Performance of the instrument.(3) Practicability.
Applicability to the intended purposeClinical chemical analyses are not only required for diagnosticbut also for prognostic purposes, for follow-up and above all,for decisions relating to therapy. There is therefore a widerange of requirements which the analytical instruments mustsatisfy. These are listed in Table 1.
Table 1" Decision criteriaSingle or multiple testingfixed programpossibility of selecting tests according to requestpossibility of selecting clinically orientated groups of tests
Analytical mode-analytical principle (photometric, others)endpoint or reaction rate measurement
Sample size (volume)use for paediatric departments
Degree of mechanisation-expected number of patient specimensfully mechanised (or automated) system neededelectronic data processing needed
Possibility of performing statistical emergency tests
The requirements will also vary with the type of hospital tobe served, i.e. whether general, small, paediatric, intensive care (1)unit, etc. (2)
Frequently, instrument manufacturers claim ’universal’ (3)
applicability as a significant advantage of their analytical (4)instruments. However, practical experience shows that this (5)is rarely the case a simple instrument designed for a specific (6)purpose is often to be preferred to a more sophisticated so-called ’universal’ instrument.
Performance of the instrumentOnce the type of analytical instrument has been determinedusing the clinical requirements to provide the basic data,suitable criteria must be applied to determinethe performance
of the individual instrument. Examples of these criteria areshown in Table 2.
Table 2: Decision criteria for instrument performanceAnalytical reliability of the measuring part of the instrumentprecisionaccuracyspecificitydetection limit
Speed criteriaspecimens/samples per time unit (frequency)analysis timethroughput time
Correction of interferencesautomated detection and correction of interferences such astwo wave lengths’ turbidity
Contaminationcarry-over between samples
Stabilitytemperaturemeasurement process (drift, noise)
The analytical reliability is a predominant feature, and forthe assessment of this element suitable criteria already exist.The factors to be considered are precision and accuracy anddetection limit, both for the final measuring elements of theinstrument and for clinical chemical techniques of analysisused on the instrument. The testing protocols of, for example,the recommendations of the IFCC Expert Panel on QualityControl (Approved Recommendation (1978) on QualityControl in Clinical Chemistry; part 2. Assessment of Analy-tical Methods for Routine Use) may be used in the appropriatecontext to obtain comparable data.
At present no universally acceptable testing protocolshave been established for the other criteria mentioned.
Practicability of the instrumentUnder this heading it is necessary to take into considerationthe specific requirements of the laboratory concerned,including the number of suitable personnel available, theirqualifications, the space allocated, financial resources
Table 3: Decision criteria for the practicability of theinstrument
(7)(8)(9)
Space requiredEnergy consumption, other services requiredEase of operationOperation by unskilled personnelAdaptability and changeover of analysis methodsPossibility of introducing urgent samples into routine proceduresNo restrictions in terms of selection of reagents which can beusedSafe operationFault detection and signalling, e.g. using microprocessorsEasy maintenance
(10) Operating instructions(11) Safety for the operating personnel(12) Environmental aspects, e.g. production of effluent, waste
Volume 2 No. January 1980 25
Decision criteria- Buttner
available, and many other factors. The list in Table 3 isby no means exhaustive and has been designed to facilitatethe decision as to whether a given instrument is practicableunder the conditions prevailing in the laboratory concerned.
These criteria cannot be assessed as objectively as thosegiven previously.
ConclusionsConsideration of the above criteria should make it possible toarrive at an objective decision at all times. However, it isessential that the following conditions are satisfied: (1) thatsuitable, quantifiable test parameters exist for these criteria;(2) that requirements are laid down for these test parameters,e.g. optimum values; and (3) that suitable data and informationare available to cover the range of instruments from whichselection is to be made. The conditions are far from satisfiedand for this reason the IFCC Expert Panel on Instrumentationhas a most important task the evaluation and drafting ofappropriate recommendations and standards.
REFERENCES1. Commission on Automation, IUPAC Section of Clinical Chemistry.
Characteristics and attributes of instruments intended for auto-
2a.
mated analysis in clinical chemistry. IUPAC Information Bulletin1978, No. 3,234-240.Btittner, J., Borth, R., Boutwell, J. H., and Broughton, P. M. G.(1978 b) Approved Recommendation on Quality Control inClinical Chemistry. Part 1. General Principles and Terminology.Clin, Chim. Acta, to be published. Provisional Recommendationwas published Clin. Chim. Acta 63, F25 F38 (1975).
b. Buttner, J., Borth, R., Boutwell, J. H., Broughton, P. M. G., andBowyer, R. C. (1978 c). Approved Recommendation on QualityControl in Clinical Chemistry. Part 2. Assessment of AnalyticalMethods for Routine Use. Clin. Chim. Acta, to be published.Provisional Recommdendation was published Clino Chim. Acta69, F1 F7 (1976).
c. Buttner, J., Borth, R., Boutwell, J. H., Broughton, P. M. G., andBowyer, R. C. (1977) Provisional Recommendation on QualityControl in Clinical Chemistry. Part 3. Calibration and ControlMaterials. Clin. Chim. Acta 75, F11 F20.
d. Buttner, J., Borth, R., Boutwell, J. H., Broughton, P. M. G., andBowyer, R. C. (1978 a) Provisional Recommendation on QualityControl in Clinical Chemistry. Part 5. External Quality Control.Clin. Chim. Acta 83, 191F-202F.
e. Buttner, J., Borth, R., Boutwell, J. H., Broughton, P. M. G., andBowyer, R. C. (1977) Provisional Recommendation on QualityControl in Clinical Chemistry. Part 6. Quality Requirementsfrom the Point of View of Health Care. Clin. Chim. Acta 74,F1 F9.
Decision criteria for the selectionof analytical instruments usedin clinical chemistry|V External and internal evaluation of analyticalinstruments in clinical laboratory sciences
M. HjelmDepartment of Clinical Chemistry, University Hospital, DK-5000 Odense, Denmark
and T.D.GearyDivision of Clinical Chemistry, Institute ofMedical and Veterinary Science, Adelaide, South Australia
THE performance and final choice of an analytical instrumentare usually judged on two criteria, external and internal. Theformer are dependent on the experience of others, especiallyif the evaluation was carried out under conditions comparableto those in the purchaser’s own laboratory. The latter relateto the purchaser’s own assessment.
The clinical requirementsThere are, as yet, no "objective" rules for establishing clinicalperformance criteria for a particular biomedical analysis.Instead, it is frequently necessary to use allowable limits oferror which are based upon present knowledge of the clinicalrequirements for systematic and random errors, while awaitingmore accurate data arising from conferences. That held atAspen in 1976 by the College of American Pathologists [1]forms a suitable guideline for these.
External evaluationsThese may take the form of published papers, reports givenat regional, national and international meetings, or documentsproduced on behalf of or by various national, professional andgovernmental organisations. This information may be available
from the manufacturer, but a list of evaluations has beenpublished in the British Association of Clinical Biochemists’Newsletter, [2] and a revised list in a WHO Newsletter. It isthe intention of the IFCC Expert Panel on Instrumentationto publish a revised list on a regular basis.
The Instrumentation Commission of the Clinical BiologySociety of France produced a multi-centre evaluationprotocol with which they assessed various enzyme rateanalysers. This was based upon the National Comittee ofClinical Laboratory Standards Proposed Standard EvaluationProtocol 1,3 and work by Broughton et al [4 ]. A workinggroup of the German Society for Clinical Chemistry has takenthis document and on behalf of the Expert Panel on Instru-mentation of the IFCC, intend to prepare an evaluationprocedure which should either be, or provide the basis for, aninternational standard. The final report prepared from datasupplied by more than one laboratory will be less affected bythe work patterns of each testing laboratory. It will thereforeprovide a strong basis for comparison.
Multi-centre trialThe proposed procedure will take the form of a multi-centre
26 Journal of Automatic Chemistry
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