Bowen Hills Histopathology

Histology s Bowen Hills Challenges Relocate and amalgamate Taringa and Indooroopilly Labs into a single complex histology laboratory Change workflow, staff structure, install new equipment, commission, integrate with existing equipment Move - scheduled for the busiest period of the year Major changes to be implemented: Lab Tracking Module especially Skin Lab Rapid Processing / Auto Embedding Automated microtomy - Skin Lab

Preparation Assess new equipment, purchase, supply to new lab Estimate solvent usage/storage for new lab Assess and coordinate equipment relocation, servicing required for installs of equipment not covered by removalists Map IT equipment to particular positions in new lab Everything had to be identified with specific floor, room and position location and labelled accordingly At new lab all items had to be mapped to their required location and these positions clearly labelled.

Moving Day Each Laboratory Labs operated as normal on Friday up to 03:00 Saturday Saturday Packing completed by 07:00 Move completed by 15:00 Taringa Histology moved 22/10/2016 Bowen Hills operational by 12:00 Sunday Indooroopilly Skin Lab moved 29/10/2016 Pathologists were reporting by 06:00 Monday

Infrastructure Coordination 136 Workstations with PCs 74 Laboratory Lab Tracking, dual touch-screens barcode reader, cassette writer, label printer 43 Pathologists/Registrars, dual head microscope, barcode reader, digital dictation microphone, camera 22 Managers, Supervisors, Support, Typists 10 accession, 22 Dissection, 8 Embedding, 16 Microtomy, 3 Allocation IHC/SS 12 Staining Machines, 4 Microtomy, 3 Workflow

SNP Histology Laboratory - Bowen Hills The Largest Histology Laboratory in Australia State-of-the-art equipment First Microwave Assisted Rapid Tissue Processors First Automated Embedding Systems Integrated LIS Tracking System Electronic Archive First Integrated Whole Slide Imaging - remote access All Microtomes motorised LIS integrated H&E stainer/coverslippers LIS integrated IHC & Special Stains Instruments Remote Flammables Storage All Departments

SNP Histology Reporting - Bowen Hills Cameras on all pathologist s microscope All pathologists Voice Recognition enabled Macrophotography all complex specimens Electronic ordering IHC/SS/Recuts IHC/SS control section on every slide Extensive range of Ab for IHC high level of QC 2 Multihead Microscopes with Visual Displays WSI MDT, Consults, remote reporting IHC/SS

Workloads and Productivity Weekday Variation Blocks Monday 3155 Tuesday 4024 Wednesday 4836 Thursday 3790 Friday 3825 Workloads Low High Record Specimens 2000 2800 3749 Blocks 3000 4800 6161 Slides 6000 9000 11724 Productivity 30 Blocks/FTE/Day FTE FTE FTE 100 160 205

Pre- commissioning

SRA and Dissection - Operational

SRA, Dissection, Specimen Storage, Waste Management Work Stations - 12 SRA, 8 Complex Dissection, 16 Non Complex Dissection

AutoTEC XPress AutoTEC XPress Future AutoTEC XPress 9 Peloris, 3 Xpress, 2 AutoTEC, 2 Xylene Recyclers - Reticulated Formalin, Ethanol, 70% Ethanol, Xylene, Recycled Xylene, Xylene Dump

Waste Management Blocks Specimen Storage Specimens in L R Specimen Storage/Waste Management, SRA Dissection, Tissue Processing and Reagent Management Linear Workflow

Xpress are xylene free, 2 X 3.8 litres of processing reagent 1500 blocks

L R Processing, Embedding/Microtomy/Allocation, Archives, IHC/SS/IF, WSI, Laboratory Management

8 Embedding Stations 16 Microtomy Stations all Leica 2255 Automated Microtomes, slide label print on demand 3 Prisma Stainer/Film Coverslippers LIS tracking enabled All Embedding, Microtomy, Allocation Stations have LIS tracking for samples and operators. Prisma Coverslippers will be LIS integrated

As AutoTEC is further commissioned, embedding stations will be replaced with microtomes. 1 Xpress + 1 AutoTEC supports 3 Microtomists

Basic Histology Process Map Specimens received H&E Special Stains IHC ISH Cassettes identified Request slip L I Tissue grossed Tissue processed Tissue embedded Tissue dried Filter reagents Rotate solutions Select program Load slides Tissue dried Slides sorted Depar tissue Prepare reagents Slides stained Tissue dried Slides sorted Depar tissue Verify slides Prepare reagents Tissue dried Slides sorted Tissue depar Prepare reagents Pretreatment Apply probe Denature Request entered S Slides identified Blocks sorted Slides stained Dehydrate slides Dehydrate slides Pretreatment Slides rinsed Slides stained Dehydrate slides Hybridize Stringency wash Detection Stain slides Dehydrate slides Image Tissue cut Slides sorted Recuts IHC Special Stains Pathology review Slides transported Slides sorted Slides labeled Slides coverslipped Sign out

Cutup Workflow Start Display Batch Scan Form Display Patient Demographics Finish Is Batch Complete Set to Scan Specimen Are All Specimens for Episode Scanned? Troubleshoot Display Patient Demographics Warning Scan First Specimen Scanned Specimen Matches Request? Set Focus in no. of Pieces Next Block Troubleshoot Troubleshoot Warning All Blocks from Previous Specimen Completed? Warning Require option to delete 1 or more blocks from batch, fix, decal, other process Display Block Table for Scanned Specimen Set Focus in no. of Pieces 1 st Block Table needs to be editable at cutup or can be updated from Accessioning Are All Blocks for Specimen Scanned? Edit no. of Pieces Default no. of pieces defined No. of Pieces = 0 Delete Current and Subsequent Blocks Instruction Required? Scan Block Scanned Block Specimen Match? Add comments from Dropdown Menu

Staff Accountability - Specimen Tracking Comprehensive Sample and Operator Audit Trail Traceability - Specimen audit trail Accountability Each operator recorded at every step

Sakura AutoTec 2015 AutoTEC Internationally USA - 20+; Europe 80+ 2015 Visited 3 Japanese labs quality results 2017-137 first generation AutoTEC internationally 2017 - Europe 60 AutoTEC A120 since June 2016 Italy 20 France 19 Denmark 13 Sweden 13 Germany 10 U.K. 6 Norway 5 Belgium 2 Holland 1 Ireland 1

Dermatopathology, Dallas, Texas - Average 1,400 blocks per day - Peak volume 1,600 - Dallas Laboratory has 2 Xpress, 2 AutoTEC A120 - Process >95% blocks on two Xpress - <5% of blocks are larger, use Sakura VIP 6 - Two AutoTEC's for virtually 100% of blocks - One integrated Prisma Stainer- Coverslipper - One back-up Tissue TEC 5 for manual embedding

Dallas July 2015

July 2015 Using a self aligning semi-automated microtome with blocks processed on Xpress and embedded on AutoTEC Location: Sakura design and development laboratory, Torrens, LA Note: High profile blade Serial sections ribbons No impact on sections from tissue supports in cassettes

Sakura Finetek Europe Biggest operation of Xpress and AutoTEC is in Denmark, a public hospital They have 2 x Xpress and 2 x AutoTEC Process 1,500 blocks per day

Copenhagen October 2015

Compact snap freeze apparatus for FS Eliminates Liq. N 2 transport, handling, delivery and storage

Fully motorized self aligning microtome Reduced risk of tissue loss from core and small biopsies Application: IHC/SS from regional labs

HE 600 on site at Bowen Hills. The HE 600 has been processing 500-600 slides per day since March 2017

2015-2017 Sakura Smart Section β Test in 10 Japanese laboratories Release to USA & Europe - Q3/4, 2018 Capability Section 20 blocks per hour At release - suitable for large tissues Anticipate increased throughput and range within 12 months

Joint PCL/Sakura project print on demand - sections mounted directly on slide no floatation - moving heated platform - robotically loads slide in rack Benefits no pre-stain incubation time and labour savings

Auto Slide Preparation System AS-410 Auto Slide Preparation System AS-410 In addition to being equipped with conventional microtome functions, our AS-410 Auto Slide Preparation System completely automates the entire sectioning process, including block feeding. Features Auto Blade Changer : Comes standard with an automatic blade replacement function to ensure safety. Automatic Orientation Function : Comes standard with an automatic tilting function. Section Residue Vacuuming Function : Vacuums and collects paraffin residue. Sample identification Function : Automatic sample management reduces human error. (optional) Automatic Surface Detection : Automatic facing function automatically recognizes the tissue surface. (optional) Expansion Units Available : Expansion units offer high scalability. (optional) Block Surface Temperature Detection Function : Monitors the surface temperature of the paraffin block during sectioning. (optional) Specifications Dimensions:W1,280 D700 H1,980mm (Standard configuration) Weight:800kg (Standard configuration) Power source:ac100v, 50/60Hz, 15A 2 systems

Philips Ultra Fast Slide Scanners for Whole Slide Imaging (WSI) Currently scanning all IHC/SS/Recuts for regional laboratories 250/day @ 2 min ea In use for multidisciplinary meetings and for some image enhanced reports