Occupational and environmental laboratory medicine: A network of EQAS organisers

Most people in any community come into contact with chemicals that are potentially harmful to their health. Some elements are essential to health and inadequate amounts in food may also lead to ill health. Measurement of chemicals in blood, urine or other specimens is a fundamental feature of studies undertaken in the field of Occupational and Environmental Laboratory Medicine (OELM). Results are used to assess the risk for either overexposure or deficiency of essential nutrients. External Quality Assessment Schemes (EQAS) aid laboratories to achieve accurate and consistent data and 11 organisers of EQAS in Europe and North America are working to improve the effectiveness of their activities.The aims of the Network of EQAS Organisers in OELM are to stimulate improvements in analytical results, establish equivalence of assessment among Schemes, collaborate to enhance the practice of EQA including whenever possible to warrant traceability of EQAS to primary standards.Presented at the Eurachem PT Workshop September 2005, Portorož, Slovenia.     

A survey of workload, facilities and awareness of uncertainty of measurement among Italian laboratories performing analyses in occupational and environmental medicine

Biological monitoring is essential for risk assessment in the presence of exposure of workers or the general population to harmful chemical agents. Besides the choice of analytical methods which are fit for purpose and the skills of the analysts, the performance of laboratories, including those working in the field of environmental and occupational medicine, also depends on other technical factors such as frequency of testing, the use of well maintained and properly functioning equipment and the implementation of quality control procedures including the participation in External Quality Assessment Schemes (EQAS). Surveys of laboratory workload have been organized periodically since 1997 within the MeTos Project, an Italian national EQAS for biomarkers of environmental and occupational exposure to chemical agents. In 2001, a more extensive survey, including specific technical issues, was organized as part of the activities of the Thematic Network of European Organizers of External Quality Assessment/Proficiency Testing Schemes Related to Occupational and Environmental Medicine (Network survey). In addition, information on the awareness and implementation of the new requirement for laboratories to estimate the uncertainty of their measurements was collected since 2000. The results of these surveys are reported and compared here. In all surveys, Pb in blood was the biomarker most frequently determined. As for biomarkers of exposure to organic compounds, the data collected in the Network survey indicate that methylhippuric acid, hippuric acid and mandelic acid in urine were the assays most commonly performed. About a third of the participants stated that they estimate the uncertainty of at least some of their measurements. Preliminary analysis of data, limited to Pb in blood, showed that analytical performance improved with continuous participation in EQAS and was positively influenced by a high workload.     

Evaluation of sample processing and sub-sampling performance

A methodology for the estimation of sample processing and sub-sampling performance based on the comparison of the global method experimental dispersion of results with the uncertainty estimated from developed models for the subsequent analytical steps is presented. This approach is a valuable alternative to the evaluation of adequate experimental information using a classical ANOVA, since the significance of the sample processing and sub-sampling is evaluated with a higher number of degrees of freedom for the same number of experimental assays, due to the high number of degrees of freedom associated with the uncertainty estimated for the subsequent analytical steps from the combination of the involved sources of uncertainty.Considering the construction of a model to describe the performance of the analytical steps following sample processing and sub-sampling over a broad concentration range, the experimental assays involved at the evaluation of the sample processing and sub-sampling can be performed at any concentration meeting the previously validated range and several months after the development of that model once its adequacy has been proven over time.This approach, which also allows the construction of a detailed performance model for the global analytical method over a broad concentration range, was applied to the determination of pesticide residues in apples by gas-chromatography with electron capture detector.Considering that no information was available regarding the samples heterogeneity, sub-sampling performance was evaluated considering a sample representing the worst expectable homogeneity. This was accomplished by spiking just one out of the 10 halves of apples processed in each sample.The developed model for the performance of the analytical method was successfully and easily applied to routine analysis through an automated link between the information generated by the chromatograph software with a file containing the model.     

Development of a proficiency testing scheme for a limited number of participants in the field of natural water analysis

A proficiency testing (PT) scheme was developed for a limited number of analytical laboratories participating in the analysis of natural water in Israel. Three fit-for-intended-use reference materials (RMs) were prepared for a pilot PT from natural water: RM-blank and two in-house reference materials (IHRMs) with seven analytes fortified to achieve different levels of analyte concentrations. The measurands for the PT participants were the traceable spike values certified in the IHRMs, i.e., added mass concentrations of the analytes. The RM-blank and IHRMs were found to be homogeneous and stable over 11 days, the time necessary for the experimental part of the PT. The RMs were distributed to the PT participants as unknown test items similar to routine samples. The test results were evaluated using their deviations from the IHRM-certified values. Eight Israeli laboratories took part in the interlaboratory comparison. Individual laboratory performance and metrological compatibility of the PT results of the participants, as a local group of laboratories, were evaluated for every analyte.     

Local comparability of proficiency testing results: determination of concrete slump and compressive strength values

A proficiency testing (PT) scheme is developed for comparability assessment of results of concrete slump and compressive strength determination. The scheme is based on preparing of a test portion/sample of a concrete in-house reference material (IHRM) at a reference laboratory (RL) in the same conditions for every PT participant. Therefore, in this scheme IHRM instability is not relevant as a source of measurement/test uncertainty, while intra- and between-samples inhomogeneity parameters are evaluated using the results of RL testing of the samples taken at the beginning, the middle and the end of the PT experiment. The IHRM assigned slump and compressive strength values are calculated as averaged RL results. Their uncertainties include the measurement/test uncertainty components and the components arising from the material inhomogeneity. The test results of 25 PT participants were compared with the IHRM assigned values taking into account both the uncertainties of the assigned values and the measurement/test uncertainties of the participants. Since traceability of the IHRM assigned values to the international measurement standards and SI units cannot be stated, local comparability of the results is assessed. It is shown, that comparability of the slump and compressive strength determination results is satisfactory, while uncertainty evaluation for slump results requires additional efforts.     

Measurement traceability and US IVD manufacturers: the impact of metrology

A goal of clinical laboratory science is to produce accurate and comparable patient test results for a specimen independent of analytical methodology. The In Vitro Diagnostics Directive in Europe has provided the impetus for the U.S. in vitro diagnostic (IVD) industry to adapt the concepts of Metrology, the science of measurement, including measurement traceability and measurement uncertainty. The joint committee for traceability in laboratory medicine has provided a valuable database of internationally recognized reference materials and methods and reference laboratories. Much of the responsibility for measurement traceability falls on IVD manufacturers, but all global stakeholders, including the clinical laboratory profession, government Regulatory bodies, metrology institutes, and the providers of EQA/PT surveys, must cooperate to progress toward this goal. The adaptation of the concepts of Metrology to the clinical laboratory is an appropriate and logical development and it will continue in the twenty-first century.     

Proficiency testing in analytical chemistry, microbiology, and laboratory medicine – working group discussions on current status, problems, and future directions

Working group (WG) discussions on proficiency testing (PT) held at the joint Eurachem/ EQALM workshop, Borås, Sweden, 24–26 September 2000 are summarized. The discussions focused on aspects of PT and accreditation (WG 1), general aspects of PT in analytical chemistry (WG 2), microbiology (WG 3), and laboratory medicine (WG 4), incorporation of measurement uncertainty into PT schemes (WG 5), international harmonization of PT schemes (WG 6), and the role of PT in the international structure of chemical measurement (WG 7). Current status, problems and future directions are identified. Each WG contained a majority of participants experienced in the subject being covered by that WG, and a few participants with different expertise. This was done to promote cross-fertilization of ideas between sectors, a key objective of the workshop. The WG issues reflected the content of the keynote lectures and some issues were covered from different perspectives by more than one group.     

Quality specifications for evaluation and comparison of performance among external quality assessment schemes in occupational and environmental laboratory medicine

Quality specifications (QS) are proposed for lead in blood and for aluminium, copper, selenium and zinc in serum as part of the aim to set standards of performance for laboratories so that results can be demonstrated to be fit for the purpose to which they are applied. The QS were established taking account of the analytical state-of-the-art, physiological variations in the concentrations of the analyte and the clinical purpose for which the assay is to be used. A procedure was devised that uses these QS to give equivalence of assessment among external quality assessment schemes (EQAS), thus avoiding conflicting information which has been demonstrated in the past. Advantages of this procedure are: to provide direct comparison of performance of laboratories taking part in different schemes, to provide equivalence of assessment of laboratory performance necessary to establish mutual recognition agreements, and to demonstrate the fitness for purpose of results from participants.Presented at the Eurachem PT Workshop September 2005, Portorož, Slovenia     

Preparation of in-house reference material of benzylpenicillin in milk and results of a Brazilian proficiency testing scheme

Two milk test materials containing benzylpenicillin and a benzylpenicillin-free material were prepared and used for the operation of a Brazilian proficiency testing (PT) scheme according to the requirements of ISO/IEC 17043. The PT scheme was designed to include laboratories in charge of confirmatory analysis as well as screening analysis. Sets of sample vials, benzylpenicillin-free and spiked items containing 0.2 g of lyophilized milk, were distributed to each participant. Of 20 participants who reported screening data, 18 accomplished satisfying results, providing evidence of the capability of Brazilian laboratories to produce reliable qualitative information. The assigned value (robust average calculated from 6 results) and its uncertainty were (8.28 ± 0.52) μg/L. Participants’ performance was evaluated using z-scores. A small number of participants were able to report quantitative benzylpenicillin results, and consequently care should be taken in the interpretation of the laboratory’s performance, considering the statistical nature of z-scores. Long-term stability testing on remaining PT items showed that a stable benzylpenicillin quality control material was produced and can be used for internal quality control or validation purposes.     

Key metrological issues in proficiency testing––response to “Metrological compatibility-a key issue in further accreditation” by K. Heydorn

A discussion of proficiency testing (PT) topics started by Heydorn (Accred Qual Assur 15:643–645, 2010) is continued in the present paper. The role of PT in the accreditation of testing/analytical laboratories, the use of consensus values (average or weighted average, median, observed standard deviation, etc.) and a metrological background of PT schemes are discussed. It is shown that metrological traceability, comparability, and compatibility, as well as commutability of a reference material, are the key issues of any PT scheme that applies certified reference material as test items. Metrological compatibility of PT results in such schemes is a property demonstrating the closeness of the PT results to the certified value in comparison with the measurement uncertainty of their difference. The metrological background is especially important for the selection and use of PT schemes for a limited number of participants (fewer than 30) as detailed in IUPAC/CITAC Guide on the topic published in 2010 in Pure Appl Chem 82(5):1099–1135.     

Uncertainty due to the quantification step in analytical methods

The quantification step is an important source of uncertainty in analytical methods, but it is frequently misunderstood and disregarded. In this paper, it is shown how this uncertainty is closely related to the linear response range of a method, and to the Pearson correlation coefficient of the calibration line. So, if there is a need for a pre-fixed quantification uncertainty, the linear response range will be affected. Some practical cases are given showing the quantification uncertainty significance. The theoretical equation giving the value of the quantification uncertainty is deduced from which new conclusions can be taken out. Because of that, the quantification uncertainty can easily be calculated and the parameters that really affect its value are shown along the paper. Some final considerations about detection limits and two-point calibration lines are also given. The paper can also be considered a reflection on uncertainty owed to calibration and on their consequences on the analytical methodology.     

Interlaboratory study of a liquid chromatography method for erythromycin: determination of uncertainty

Erythromycin is a mixture of macrolide antibiotics produced by Saccharopolyspora erythreas during fermentation. A new method for the analysis of erythromycin by liquid chromatography has previously been developed. It makes use of an Astec C18 polymeric column. After validation in one laboratory, the method was now validated in an interlaboratory study. Validation studies are commonly used to test the fitness of the analytical method prior to its use for routine quality testing. The data derived in the interlaboratory study can be used to make an uncertainty statement as well. The relationship between validation and uncertainty statement is not clear for many analysts and there is a need to show how the existing data, derived during validation, can be used in practice. Eight laboratories participated in this interlaboratory study. The set-up allowed the determination of the repeatability variance, s(2)r and the between-laboratory variance, s(2)L. Combination of s(2)r and s(2)L results in the reproducibility variance s(2)R. It has been shown how these data can be used in future by a single laboratory that wants to make an uncertainty statement concerning the same analysis.     

A new terminology for the approaches to the quantification of the measurement uncertainty

A new terminology for the approaches to the quantification of the measurement uncertainty is presented, with a view to a better understanding of the available methodologies for the estimation of the measurement quality and differences among them. The knowledge of the merits, disadvantages and differences in the estimation process, of the available approaches, is essential for the production of metrologically correct and fit-to-purpose uncertainty estimations. The presented terminology is based on the level of the analytical information used to estimate the measurement uncertainty (e.g., supralaboratory or intralaboratory information), instead of the direction of information flow (“bottom-up” or “top-down”) towards the level of information where the test is performed, avoiding the use of the same designation for significantly different approaches. The proposed terminology is applied to the approaches considered on 19 examples of the quantification of the measurement uncertainty presented at the Eurachem/CITAC CG4 Guide, Eurolab Technical Report 1/2002 and Nordtest Technical Report 537. Additionally, differences of magnitude in the measurement uncertainty estimated by various approaches are discussed.     

Establishment of an assigned value and its uncertainty for tumour markers in proficiency testing in China

Proficiency testing (PT) is an important aspect of clinical laboratory quality control for tumour markers. To evaluate the performance of an individual laboratory, the assigned value and the standard uncertainty of each tumour marker must be determined. However, no data about the standard uncertainty of the assigned value of any analyte in PT is available in China. The aim of this paper is to introduce a new approach for establishment of assigned value and its standard uncertainty for tumour markers. Five sets of control materials at different concentrations were assigned to each laboratory that participated in PT for tumour markers in 2012. We collected the data from each laboratory using the Clinet-EQA reporting system V1.5 and Clinet-EQA evaluation system V1.0 and developed a software program to calculate the assigned value and its uncertainty according to ISO 13528 (Statistical methods for use in proficiency testing by interlaboratory comparisons. ISO 13528. International Standards Organisation, Geneva, 2005). The assigned value and inter-laboratory CV calculated by the new approach was compared with that obtained by the current approach used in PT in our country. No significant difference between the two outcomes was found in our study. Most assigned values had a standard uncertainty that can meet the criterion: $ u_{X} \le \, 0.3\hat{\sigma } $ u X ≤ 0.3 σ ? , which meant the new approach for establishment of the assigned value was acceptable. It is expected that the new approach to determination of the assigned value and its standard uncertainty for PT for tumour markers in China will enable participants to evaluate their measurement uncertainty.     

Estimation of sample processing uncertainty for chlorpyrifos residue in cucumber

Sample processing is a very important component of uncertainty in analytical results. In order to have reliable results, the laboratory sample should be properly processed to obtain statistically homogenous matrix—before the representative test portions are withdrawn for analysis. The use of ¹⁴C-labeled compound is preferable because the analyte can be quantified without cleanup. The method is based on surface treatment of cucumber with ¹⁴C-chlorpyrifos, determination of ¹⁴C-chlorpyrifos activity in the replicate test portions of different size, and determination of the uncertainty of sample processing.     

Proficiency testing in analytical chemistry, microbiology and laboratory medicine: working group discussions on current practice and future directions

A summary of the working group (WG) discussions on proficiency testing (PT) and external quality assessment (EQA) held at the joint EURACHEM/CITAC/EQALM workshop, Bracknell, UK, 16–18 February 2003 is provided. The nine WGs covered a range of issues concerned with current practice and future directions; PT/EQA as a tool for regulators (WG1); PT/EQA as a tool for accreditation (WG2); evaluation of performance and uncertainty (WG3); frequency of PT/EQA participation (WG4); selection of appropriate PT/EQA schemes (WG5); added value of PT/EQA and cost benefit evaluation (WG6); global harmonisation and rationalisation (WG7); new technical areas and challenges in PT/EQA (WG8); and accreditation of PT/EQA providers (WG9). Participants with different backgrounds were on each WG in order to capture a range of views and experience from different sectors. The discussions reflected on the keynote lectures and built, in many cases, on discussions at previous workshops in 2000 and 2002.     

Measurement uncertainty of food carotenoid determination

For consistent interpretation of an analytical method result it is necessary to evaluate the confidence that can be placed in it, in the form of a measurement uncertainty estimate. The Guide to the expression of Uncertainty in Measurement issued by ISO establishes rules for evaluating and expressing uncertainty. Carotenoid determination in food is a complex analytical process involving several mass transfer steps (extraction, evaporation, saponification, etc.), making difficult the application of these guidelines. The ISO guide was interpreted for analytical chemistry by EURACHEM, which includes the possibility of using intra- and interlaboratory information. Measurement uncertainty was estimated based on laboratory validation data, including precision and method performance studies, and also, based on laboratory participation in proficiency tests. These methods of uncertainty estimation were applied to analytical results of different food matrices of fruits and vegetables. Measurement uncertainty of food carotenoid determination was 10–30% of the composition value in the great majority of cases. Higher values were found for measurements near instrumental quantification limits (e.g. 75% for β-cryptoxanthin, and 99% for lutein, in pear) or when sample chromatograms presented interferences with the analyte peak (e.g. 44% for α-carotene in orange). Lower relative expanded measurement uncertainty values (3–13%) were obtained for food matrices/analytes not requiring the saponification step. Based on these results, the saponification step should be avoided if food carotenoids are not present in the ester form. Food carotenoid content should be expressed taking into account the measurement uncertainty; therefore the maximum number of significant figures of a result should be 2.     

Identification of possible technical problems in determination of the major inorganic constituents of brown-rice flour by evaluating proficiency test results

To support skill upgrading in analysis of inorganic constituents of environmental and food samples, the National Metrology Institute of Japan (NMIJ) and the National Food Research Institute (NFRI) have organized a proficiency test (PT) of determination of Mn, Fe, Cu, Zn, As, and Cd in brown-rice flour based on the international standard (ISO/IEC 17043:2010). One hundred and thirty-three sets of reports were assessed by use of the E _n -number and z-score approaches in accordance with ISO/IEC 17043 and the international harmonized protocol for PT. The PT results and analytical procedures, reported in detail, were reviewed, and possible technical reasons for questionable or unsatisfactory results are discussed.

Do we need to consider metrological meanings of different measurement uncertainty estimations?

Along the years, several approaches for measurement uncertainty estimation have been suggested. Emphasis has been put on the general metrological interpretation of measurement uncertainty, but not on its different meanings when it is associated to given conditions of measurement where analytical work is performed and errors are originated. Three different definitions for uncertainty are proposed for reproducibility and intermediate precision conditions of measurement. These definitions inherit features from the VIM 3 definition of measurement uncertainty. It is argued that if a high performance laboratory keeps errors under control with proper validation and quality assurance programs, measurement uncertainty from intermediate precision condition of measurement is justified as a suitable estimation of its capability to attribute values to a measurand. Alternatively, a laboratory that does not keep errors under control should use uncertainty from reproducibility condition of measurement as the cost of its imperfections. Selection of information sources for measurement uncertainty estimation should be in harmony with its metrological meaning.     

The effect of the choice of method for determining assigned value on the assessment of performance in melting point analysis

The determination of melting point is a fundamental test in the Pharmaceutical industry, since it is one of the simplest techniques for the identification of a chemical substance. The melting point provides information on both identity and purity of a chemical substance and for that reason is a key test in the PHARMASSURE proficiency testing (PT) scheme. The PT scheme assesses participant??s determination of melting point, using chemicals of high purity and basing the assigned value on the robust consensus mean (median). In recent rounds, melting point reference standards have been provided as the test material and a reference value used as the assigned value for PT assessment. Comparison of the PT results over a number of rounds, using test materials with a wide range of melting points, shows the overall performance of the participant group is worse in rounds where a reference material and associated reference assigned value are used for performance assessment. When participants were assessed against the reference assigned value, a positive bias was observed in the participant??s results. Detailed information regarding the methodology used demonstrated that the majority of participants use the same analytical method, EU.Ph.2.2.14 (Council of Europe, Strasbourg, 2011), for the determination of melting point although this procedure allows flexibility in key methodological parameters, such as heating ramp rate, which may fail to ensure consistent performance across the group of participant laboratories.