A Two-Year Study of Microscopic Urinalysis Competency Using the Urinalysis-Review Computer Program

Abstract

Background: The microscopic examination of urine sediment is one of the most commonly performed microscope-based laboratory tests, but despite its widespread use, there has been no detailed study of the competency of medical technologists in performing this test. One reason for this is the lack of an effective competency assessment tool that can be applied uniformly across an institution. Methods: This study describes the development and implementation of a computer program, Urinalysis-ReviewTM, which periodically tests competency in microscopic urinalysis and then summarizes individual and group test results. In this study, eight Urinalysis-Review exams were administered over 2 years to medical technologists (mean, 58 technologists per exam; range, 44–77) at our academic medical center. The eight exams contained 80 test questions, consisting of 72 structure identification questions and 8 quantification questions. The 72 structure questions required the identification of 134 urine sediment structures consisting of 63 examples of cells, 25 of casts, 18 of normal crystals, 8 of abnormal crystals, and 20 of organisms or artifacts. Results: Overall, the medical technologists correctly identified 84% of cells, 72% of casts, 79% of normal crystals, 65% of abnormal crystals, and 81% of organisms and artifacts, and correctly answered 89% of the quantification questions. The results are probably a slight underestimate of competency because the images were analyzed without the knowledge of urine chemistry results. Conclusions: The study shows the feasibility of using a computer program for competency assessment in the clinical laboratory. In addition, the study establishes baseline measurements of competency that other laboratories can use for comparison, and which we will use in future studies that measure the effect of continuing education efforts in microscopic urinalysis.

Urine Crystals Classification Using Image Matching Method

“…Urine is considered as one of the body fluids, which is extracted by the kidneys from the human blood, and then excreted through the ureter to reach the bladder to be later casted out of the body via urethra [4]. This process helps get rid of excess salts and water in the body.…”

“…-Calcium Oxalate: they are crystals that appear in colorless diuresis in many forms. They are of two types [4]:  Monohydrate: the shape of the crystal is close to Dumbbells.  Dihydrate: octahedral (form of envelope letters) that is the most common.…”

“…Human Urine Samples were preparation of glass slides were done in medical laboratories. A digital image by slides was obtained under an optical microscope and of appropriate resolution as it was taken using a digital camera directly connected to the computer, as shown in Figure (4). Fig.…”