Improve Laboratory Efficiency Research Articles

Development of a Test Tube Automatic Sorting Storage Device After Completion of Inspection.

To develop an automatic test tube classification and storage device that sorts test tube boxes by detecting the box height and test tube cap color, improving laboratory efficiency and accuracy. An upper computer uses a No. 1 push rod to allocate test tube boxes to specific branch conveyor belts based on initial sorting criteria. Further sorting is done by the No. 2 push rod, which places boxes into adjustable slots within a seven-layer elevating storage system, categorizing them by day through height adjustment to match the conveyor belt. This invention automates test tube sorting and storage, aiding medical staff in quickly and accurately locating test tubes post-inspection.

A software to calibrate low-current meters in the range of picoamperes to microamperes

Among the main pillars of industry 4.0 are big data, artificial intelligence, and the industrial internet of things (IIoT) which, together with industrial automation, allow for significant operational advances. In the field of calibration, where processes and procedures must be standardized, automation diminishes the variability caused by human intervention. In addition, the process is no longer limited to the time the technician is present, speeding up deliveries and improving laboratory efficiency and productivity. In this work, a software for the calibration of low current meters is presented. Also, a mathematical model and uncertainty analysis related to the adopted calibration method is presented. It was possible to calibrate an electrometer in a fully automated way, with minimal intervention by the technician. This software was successfully validated through an intralaboratory comparison.

B-028 Clinical Performance of a Fully-Automated Fecal Calprotectin Chemiluminescence Immunoassay (CLIA)

Abstract Background Fecal calprotectin is a noninvasive marker for inflammatory bowel disease (IBD). Traditionally, calprotectin is measured by the well-established enzyme linked immunosorbent assay (ELISA) method. More recently, advances in fully automated platforms allow for comparable performance and diagnostic accuracy whilst improving laboratory efficiency. In this study, we assessed the diagnostic performance of the fully automated ALPCO calprotectin chemiluminescence immunoassay (CLIA), and compared it to the predicate, ALPCO’s 510(k) cleared manual calprotectin chemiluminescence ELISA. Methods Fecal calprotectin levels were measured with the ALPCO Calprotectin Chemiluminescence ELISA and the recently developed ALPCO Calprotectin CLIA, utilizing glow and flash chemiluminescence, respectively. An IRB approved study included over 400 individuals with clinical suspicion of IBD. The estimates of clinical sensitivity, and clinical specificity of the ALPCO Calprotectin Chemiluminescence ELISA and the ALPCO Calprotectin CLIA were determined by comparing analytical test results of the prospectively collected stool specimens against the clinical diagnosis made by the clinical investigator/gastroenterologist with ileocolonoscopic and histopathological sampling (reference standard). Results When distinguishing IBD from irritable bowel syndrome (IBS) and healthy persons, the sensitivity (70/76) and specificity (322/348), at a fecal calprotectin cut-off level of 50 µg/g, were 92.1% and 92.5%, respectively for the ALPCO Calprotectin Chemiluminescence ELISA. Sensitivity (73/78) and specificity (319/342), at a fecal calprotectin cut-off level of 50 µg/g, were 93.6% and 93.3%, respectively for the ALPCO Calprotectin CLIA. Conclusion The ALPCO Calprotectin CLIA showed comparable clinical performance for detection of IBD compared to the predicate 510(k) cleared ALPCO Calprotectin Chemiluminescence ELISA. The automation of the ALPCO calprotectin immunoassay allows for increased laboratory efficiency without sacrificing diagnostic accuracy.

Development of a Rapid and High-Throughput Multiplex Real-Time PCR Assay for Mycoplasma hominis and Ureaplasma Species

Bacterial commensals of the human genitourinary tract, Mycoplasma hominis and Ureaplasma species (parvum and urealyticum) can be sexually transmitted, and may cause nongonococcal urethritis, pelvic inflammatory disease, and infertility. Mycoplasma hominis and Ureaplasma species may also cause severe invasive infections in immunocompromised patients. Current culture-based methods for Mycoplasma/Ureaplasma identification are costly and laborious, with a turnaround time between 1 and 2 weeks. We developed a high-throughput, real-time multiplex PCR assay for the rapid detection of M. hominis and Ureaplasma species in urine, genital swab, body fluid, and tissue. In total, 282 specimens were tested by PCR and compared with historic culture results; a molecular reference method was used to moderate discrepancies. Overall result agreement was 99% for M. hominis (97% positive percentage agreement and 100% negative percentage agreement) and 96% for Ureaplasma species (96% positive percentage agreement and 97% negative percentage agreement). Specimen stability was validated for up to 7 days at room temperature. This multiplex molecular assay was designed for implementation in a high-complexity clinical microbiology laboratory. With this method, >90 samples can be tested in one run, with a turnaround time of 4 to 5 hours from specimen extraction to reporting of results. This PCR test is also more labor effective and cheaper than the conventional culture-based test, thus improving laboratory efficiency and alleviating labor shortages.

Characterization of Laboratory Flow and Performance for Process Improvements via Application of Process Mining.

The rising level of laboratory automation provides an increasing number of logged events that can be used for the characterization of laboratory performance and process improvements. This abundance of data is often underutilized for improving laboratory efficiency. The first aim of this descriptive study is to provide a structured approach for transforming raw laboratory data to data that is suitable for process mining. The second aim is to describe a process mining approach for mapping and characterizing the sample flow in a clinical chemistry laboratory to identify areas for improvement in the testing process. Data were extracted from instrument log files and the middleware between laboratory instruments and information technology infrastructure. Process mining was used for automated process discovery and analysis. Laboratory performance was quantified in terms of relevant key performance indicators (KPIs): turnaround time, timeliness, workload, work-in-process, and machine downtime. The method was applied to two Dutch university hospital clinical chemistry laboratories. We identified areas where alternative routes might increase laboratory efficiency and observed the negative effects of machine downtime on laboratory performance. This encourages the laboratory to review sample routes in its analyzer lines, the routes of high priority samples during instrument downtime, as well as the preventive maintenance policy. This article provides the first application of process mining to event data from a medical diagnostic laboratory for automated process model discovery. Our study shows that process mining, with the use of relevant KPIs, provides valuable insights for laboratories that motivates the disclosure and increased utilization of laboratory event data, which in turn drive the analytical staff to intervene in the process to achieve the set performance goals. Our approach is vendor independent and widely applicable for all medical diagnostic laboratories.

Current Developments of Artificial Intelligence in Digital Pathology and Its Future Clinical Applications in Gastrointestinal Cancers.

Simple SummaryThe rapid development of technology has enabled numerous applications of artificial intelligence (AI), especially in medical science. Histopathological assessment of tissues remains the gold standard for diagnosis of gastrointestinal (GI) cancers for subsequent management. In a traditional anatomical pathology (AP) laboratory, histopathologists are required to manually assess, quantify and classify diseases under a microscope in a semiquantitative or qualitative manner. The conversion of analogue-to-digital pathology is on the rise, conforming with trends toward digitalization. The rapid adoption of digital pathology (DP) is driven by factors such as the worldwide shortage of pathologists and medical technologists, the increasing incidence of cancer and the critical need to improve laboratory efficiency. In this review, we aim to provide a comprehensive summary of algorithms for AI detection and classification of GI cancer. We will also provide critical insight into the application of algorithms for routine care in clinical practice.The implementation of DP will revolutionize current practice by providing pathologists with additional tools and algorithms to improve workflow. Furthermore, DP will open up opportunities for development of AI-based tools for more precise and reproducible diagnosis through computational pathology. One of the key features of AI is its capability to generate perceptions and recognize patterns beyond the human senses. Thus, the incorporation of AI into DP can reveal additional morphological features and information. At the current rate of AI development and adoption of DP, the interest in computational pathology is expected to rise in tandem. There have already been promising developments related to AI-based solutions in prostate cancer detection; however, in the GI tract, development of more sophisticated algorithms is required to facilitate histological assessment of GI specimens for early and accurate diagnosis. In this review, we aim to provide an overview of the current histological practices in AP laboratories with respect to challenges faced in image preprocessing, present the existing AI-based algorithms, discuss their limitations and present clinical insight with respect to the application of AI in early detection and diagnosis of GI cancer.

The Use Of E-Reservation Open-Source Software (OSS) On Web-Based Laboratory Scheduling Information Systems In Order To Support Education Laboratory Management

Good laboratory management is needed to improve laboratory efficiency and effectiveness; one component of laboratory management is the use of laboratories. Laboratory use problems arise when there is a schedule change or a schedule conflict occurs since the management is still done manually, causing long automation and the lack of information on the laboratory’s availability, this can certainly hamper teaching and learning activities in the laboratory. To overcome this, it is necessary to have a system which can provide information on the availability of an effective laboratory and faster automation, one of which is by using the open-source software e-Reservation Meeting Room Booking System. It is a PHP and MySQL-based room reservation information system that can be used for laboratory scheduling and providing information on laboratory availability.

Kappa free light chains: Diagnostic performance in multiple sclerosis and utility in a clinical laboratory

BackgroundAutomated, technically simple analytical methods offering objective results are highly valued in clinical laboratories. Kappa free light chains (KFLC) in cerebrospinal fluid (CSF) are promising multiple sclerosis (MS) biomarkers, particularly kappa (K) index. MethodsKFLC were determined in CSF and serum samples of patients diagnosed with MS, clinically/radiologically isolated syndrome (N, 39), and controls (N, 152; inflammatory and non-inflammatory neurological disorders). Diagnostic performance of several KFLC parameters, previously determined oligoclonal band (OCB) testing, and IgG index, was assessed. A K index decision threshold for sample screening was identified and reduction in performed OCB analyses estimated accordingly. ResultsHigher KFLC parameters were detected in the MS group and K index performed best among them (AUC 0.92). At a 7.25 cut-off it showed better sensitivity (85% vs. 77%) though less specificity (88% vs. 91%) than OCBs. Comparatively, IgG index’s performance was inferior (AUC 0.83). A decision K index threshold of 2.55 (97% sensitivity) would reduce OCB testing by 52% in the studied population. ConclusionsThe proposed 7.25 cut-off could assist MS diagnostics and identify some false negative cases from OCB studies. Sequential algorithms using K index for the decision to perform OCB detection would improve laboratory efficiency and substantially reduce costs.

Diagnostic performance of the Abbott RealTime MTB assay for tuberculosis diagnosis in people living with HIV

Strengthening tuberculosis diagnosis is an international priority and the advocacy for multi-disease testing devices raises the possibility of improving laboratory efficiency. However, the advantages of centralized platforms might not translate into real improvements under operational conditions. This study aimed to evaluate the field use of the Abbott RealTime MTB (RT-MTB) and Xpert MTB/RIF assays, in a large cohort of HIV-positive and TB presumptive cases in Southern Mozambique. Over a 6-month period, 255 HIV-positive TB presumptive cases were consecutively recruited in the high TB/HIV burden district of Manhiça. The diagnostic performance of both assays was evaluated against two different reference standards: a microbiological gold standard (MGS) and a composite reference standard (CRS). Results from the primary analysis (MGS) showed improved sensitivity (Se) and reduced specificity (Sp) for the Abbott RT-MTB assay compared to the Xpert MTB/RIF (RT-MTB Se: 0.92 (95% CI: 0.75;0.99) vs Xpert Se: 0.73 (95% CI: 0.52;0.88) p value = 0.06; RT-MTB Sp: 0.80 (0.72;0.86) vs Xpert Sp: 0.96 (0.92;0.99) p value < 0.001). The lower specificity may be due to cross-reactivity with non-tuberculous mycobacteria (NTMs), the detection of non-viable MTBC, or the identification of true TB cases missed by the gold standard.

Comparison of electronic versus manual witnessing of procedures within the in vitro fertilization laboratory: impact on timing and efficiency

ObjectiveTo evaluate the impact of an electronic witnessing system (EWS) on witnessing standard operating procedures and to assess embryologist perceptions of the EWS.DesignProspective cohort study.SettingPrivate in vitro fertilization laboratory network.Patient(s)None.Intervention(s)NoneMain Outcome Measure(s)The time difference between manual and electronic double-witnessing procedures, and embryologist perceptions of the EWS.Result(s)From 342 witnessing times analyzed (114 EWS, 114 manual, and 114 interruptions to witnesses), the EWS reduced mean (SD) total witnessing time (in seconds) by 91.5 (23.6) for intracytoplasmic sperm injection, 62.0 (17.9) for Day 3 embryo assessment, 58.3 (18.9) for fresh embryo transfer, and 59.4 (13.3) for frozen embryo transfer. This time reduction significantly decreased the overall time required for double-witnessing by 3.1- to 5.2-fold. A survey with 50 embryologists within the laboratory network indicated that most embryologists considered the EWS to improve sample traceability (78.3%), reduce errors in labeling issues (80.4%), and reduce the risk of sample mismatch errors by minimizing disruptions (60.9%). Furthermore, 82.6% thought that visual completion of the EWS dashboard provided peace of mind when leaving work and 84.8% were more confident knowing that all procedures were completed according to the EWS.Conclusion(s)An EWS can improve laboratory efficiency by significantly decreasing the time required for witnessing procedures and by minimizing interruptions. The EWS was well perceived by embryologists and laboratory managers and enhanced their confidence and peace of mind with regard to witnessing compliance and safety/accuracy.

Biochemical and Culture-Based Approaches to Identification in the Diagnostic Microbiology Laboratory

The late 1800s through the early 1900s saw the rapid development of growth media containing various substrates, i.e. carbohydrates, to identify and differentiate microbes isolated from clinical specimens. However, during the 1950s, an evolution of diagnostic services occurred created by a growing population with access to health insurance and the subsequent requirement for quality healthcare. The utilization of miniaturized, multi-test kits provided the first significant advancement of the biochemical, growth-based approach needed to handle the increased demand for clinical services. These testing kits provided reductions in labor and material costs associated with making, maintaining, inoculating, and reading tubed and plated media, while also reducing the time required to identify microbial isolates. The trend to improve laboratory efficiency and quality continued with the incorporation of automation and computers throughout the 1970s. Automated systems greatly increased the testing capacity of laboratories by allowing the simultaneous determination of identification and antimicrobial susceptibilities from one inoculum, and by further reducing the time to identification to hours instead of days. Within just the last 10-15 years, development and integration of a new growth-based approach for identification has occurred in the form of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The mass spectrometric approach provides the lowest cost per analysis and fastest time to identification after isolation of any current technique available in the microbiology laboratory. As healthcare costs and demand continue to increase, and more hospitals look to consolidate laboratories, fully automated facilities incorporating mass spectrometry for identification, along with molecular methods, will become commonplace.

Clinical impact of cerebrospinal fluid Gram stain and culture testing: A retrospective cohort study.

Stewardship of microbiological tests can improve laboratory efficiency. One indicator of appropriate test stewardship is test impact on patient management decisions. We sought to assess the impact of cerebrospinal fluid (CSF) Gram stain and culture results on treatment decisions. Our hypothesis was that CSF Gram stain and culture have low impact on patient management. CSF specimens received at a tertiary microbiology laboratory between January 1, 2013, and December 31, 2013, were included. Clinical information and data on antibiotic treatment before CSF collection, antibiotic treatment after CSF Gram stain results, and antibiotic treatment after CSF culture results were collected. Ethics approval for secondary use of data was obtained. We received 242 CSF specimens for Gram stain and culture during the study period; 120 were excluded (84 from children, 2 from indwelling ventricular drains, 12 collected at outside hospitals, 21 data missing, 1 duplicate). No Gram stains or cultures were positive among patients not already treated empirically. The number needed to test to influence treatment was 17 for Gram stain (11 for abnormal cytochemistry, 29 for normal cytochemistry) and 6 for culture (3 for abnormal cytochemistry, 6 for normal cytochemistry). CSF Gram stain and culture are rarely positive and are being performed on inappropriate specimens. CSF results never prompt physicians to start treatment, so results are affecting not outcome but antibiotic stewardship. Negative CSF culture often leads to discontinuation of antibiotics. Labs could consider rejecting CSF Gram stain if cytochemistry is normal.

Validation and Implementation of an Ordering Alert to Improve the Efficiency of Monoclonal Gammopathy Evaluation.

To evaluate the use of a provider ordering alert to improve laboratory efficiency and reduce costs. We conducted a retrospective study to assess the use of an institutional reflex panel for monoclonal gammopathy evaluation. We then created a clinical decision support (CDS) alert to educate and encourage providers to change their less-efficient orders to the reflex panel. Our retrospective analysis demonstrated that an institutional reflex panel could be safely substituted for a less-efficient and higher-cost panel. The implemented CDS alert resulted in 79% of providers changing their high-cost order panel to an order panel based on the reflex algorithm. The validated decision support alert demonstrated high levels of provider acceptance and directly led to operational and cost savings within the laboratory. Furthermore, these studies highlight the value of laboratory involvement with CDS efforts to provide agile and targeted provider ordering assistance.

Biochemical and Culture-based Approaches to Identification in the Diagnostic Microbiology Laboratory

<h3>ABSTRACT</h3> The late 1800s through the early 1900s saw the rapid development of growth media containing various substrates, that is, carbohydrates, to identify and differentiate microbes isolated from clinical specimens. However, during the 1950s, an evolution of diagnostic services occurred created by a growing population with access to health insurance and the subsequent requirement for quality health care. The utilization of miniaturized, multitest kits provided the first significant advancement of the biochemical, growth-based approach needed to handle the increased demand for clinical services. These testing kits provided reductions in labor and material costs associated with making, maintaining, inoculating, and reading tubed and plated media while also reducing the time required to identify microbial isolates. The trend to improve laboratory efficiency and quality continued with the incorporation of automation and computers throughout the 1970s. Automated systems greatly increased the testing capacity of laboratories by allowing the simultaneous determination of identification and antimicrobial susceptibilities from 1 inoculum and by further reducing the time to identification to hours instead of days. Within just the last 10–15 years, development and integration of a new growth-based approach for identification have occurred in the form of matrix-assisted laser desorption ionization time-of-flight mass spectrometry. The mass spectrometric approach provides the lowest cost per analysis and fastest time to identification after isolation of any current technique available in the microbiology laboratory. As health care costs and demand continue to increase and more hospitals look to consolidate laboratories, fully automated facilities incorporating mass spectrometry for identification, along with molecular methods, will become commonplace.

Evaluation of Forward Laser Light Scatter Technology as a Preculture Screen of Unpreserved Urine Specimens

Abstract Introduction Urine cultures are standard of care for the diagnosis of urinary tract infections. Reflexively culturing specimens only after an effective screening test could minimize the number of samples cultured, improving laboratory efficiency. We evaluated a commercial forward laser light scatter system as a screening tool for urine cultures. Methods One hundred ninety (190) consecutive unpreserved urine specimens were screened by the BacterioScan 216Dx system (BacterioScan) prior to urine culture. Performance characteristics were compared against traditional culture methods. Results Urine specimens from 40 men and 150 women were evaluated. In total, 182 specimens were obtained by clean-catch, 7 by catheter, and 1 via nephrostomy; 134 specimens were negative by urine culture (70%). Fifty-six were positive, with the most commonly identified organism being E coli (35 specimens, 62.5%). Compared to urine culture, forward laser light scatter identified 132 positives and 58 negatives (31%) for a sensitivity of 98%, specificity of 42%, positive predictive value of 42%, negative predictive value of 98%, and an overall accuracy of 59%. Average time from collection to result for light scatter analysis was 25 hours and 28 minutes (95% CI, ±74 minutes) versus 52:37 (±280 minutes) for urine culture (P &lt; .01). Time to negative results was 25:51 (±77 minutes) for light scatter versus 53:17 (±320 minutes) for culture (P &lt; .01). Time to positive results was 26:36 (±66 minutes) versus 51:02 (±146 minutes) for culture (P &lt; .01). Conclusions Time to negative result and assay sensitivity showed an improvement over direct urine culture and could reduce number of cultures by ~30%; however, low positive predictive value and accuracy would lead to reflexive culture in the majority of specimens tested, limiting overall utility. Cost analyses may prove the modest efficiency gains do not outweigh the additional expense.

Using Machine Learning to Aid the Interpretation of Urine Steroid Profiles.

Urine steroid profiles are used in clinical practice for the diagnosis and monitoring of disorders of steroidogenesis and adrenal pathologies. Machine learning (ML) algorithms are powerful computational tools used extensively for the recognition of patterns in large data sets. Here, we investigated the utility of various ML algorithms for the automated biochemical interpretation of urine steroid profiles to support current clinical practices. Data from 4619 urine steroid profiles processed between June 2012 and October 2016 were retrospectively collected. Of these, 1314 profiles were used to train and test various ML classifiers' abilities to differentiate between "No significant abnormality" and "?Abnormal" profiles. Further classifiers were trained and tested for their ability to predict the specific biochemical interpretation of the profiles. The best performing binary classifier could predict the interpretation of No significant abnormality and ?Abnormal profiles with a mean area under the ROC curve of 0.955 (95% CI, 0.949-0.961). In addition, the best performing multiclass classifier could predict the individual abnormal profile interpretation with a mean balanced accuracy of 0.873 (0.865-0.880). Here we have described the application of ML algorithms to the automated interpretation of urine steroid profiles. This provides a proof-of-concept application of ML algorithms to complex clinical laboratory data that has the potential to improve laboratory efficiency in a setting of limited staff resources.

Quantification of nitrated-polycyclic aromatic hydrocarbons in atmospheric aerosol samples with in-injection port thermal desorption-gas chromatography/ negative chemical ionization mass spectrometry method

In-injection port thermal desorption (TD) was extended in determination of particulate phase nitrated-polycyclic aromatic hydrocarbons (N-PAHs) on filter samples coupled with a gas chromatography/negative ion chemical ionization-mass spectrometry (GC/NCI-MS). The experimental and analytical parameters were optimized with standard testing and ambient samples. Fourteen of the most abundant N-PAHs in ambient airs were included for their quantification. A desorption temperature of 280 °C for 10 min was sufficient to transfer entire target compounds from injection port to the analytical system. Good linearity (R2 >0.995) on the calibrations for each analyte was achieved. The limit of detections (LODs) ranged from 46.5 to 152.3 pg per filter sample, which were 4–66% better than solvent extraction (SE) approach. Method precision, repeatability and reproducibility, determined by replicate analyses of calibration standards and ambient samples, were less than 6% for target compounds. Validation of the method were conducted with two batches of a total of 30 ambient aerosol-loaded filters using our TD and the traditional SE approaches. Reasonably good agreement (R2 = 0.98) by the two methods was demonstrated for most of N-PAHs, except for 9-nitrophenanthrene and 6-nitrobenzo(a)pyrene. The in-injection port TD can improve laboratory efficiency and reduce solvent-based costs for the measurement of N-PAHs.

Quantification of oxygenated polycyclic aromatic hydrocarbons in ambient aerosol samples using in-injection port thermal desorption-gas chromatography/mass spectrometry: Method exploration and validation

In-injection port thermal desorption (TD) was evaluated for determination of particulate phase oxygenated-polycyclic aromatic hydrocarbons (O-PAHs) collected on filters coupled with a gas chromatography/mass spectrometry (GC/MS). The analytical parameters were optimized with standard testing and ambient samples. Ten of the most abundant O-PAHs in ambient air were included in the demonstration. A desorption temperature of 275 °C for 9 min was sufficient to transfer entire target compounds to the analytical system. Good linearity (R2 >0.99) on the calibrations for each analyte was achieved. The limit of detection (LOD) ranged from 21 to 269 pg per loading. Method precisions, determined by replicate analyses of calibration standards and ambient samples, was less than 10% for target compounds. Comparisons were conducted on batches of 28 ambient aerosol filter samples using our TD and the traditional SE methods. Reasonably good agreement (R2 = 0.98) by the two methods was demonstrated for most of O-PAHs. The in-injection port TD can improve laboratory efficiency and reduce solvent-based costs for the measurement of O-PAHs.

Changing Antinuclear Antibody Screening Methods: Also Consider Medical Specialists Whose Primary Diagnostic Concern is Not Connective Tissue Disease.

To the Editor: In conjunction with institutional rheumatologists, Tacker and Perrotta (1) described in commendable detail their success in optimizing antinuclear antibody (ANA)1 testing. Their goals were to improve laboratory efficiency, i.e., reduce the number of manually performed ANA testing by immunofluorescent assay (IFA) as well as the diagnostic accuracy for connective tissue disease (CTD). Central to Tacker and Perrotta's success was the ability to access patient records and to consult with their …

Left Atrium and Left Atrial Appendage Screening Prior to Atrial Fibrillation Ablation: A Comprehensive Review of the Literature.

In the past decade, certain patient groups have been observed to have a presumptive lower incidence of left atrial (LA)/LA appendage (LAA) thrombus, particularly those who have no or minimal comorbidities. This has led to the question of whether a preprocedural evaluation of the LA/LAA is necessary in every patient, or if it can be avoided in certain patient populations. The answer to this is further complicated by the possibility of newer anticoagulation approaches affecting the incidence of intracardiac thrombus, including uninterrupted warfarin therapy and uninterrupted novel oral anticoagulant (NOAC) therapy, both of which are becoming more common. In this study, we conducted a comprehensive review of the literature addressing these questions in an attempt to summarize current approaches to evaluating the LA/LAA prior to ablation in order to elucidate the strategies that are currently being employed, to determine which strategies are becoming more favorable for use, and to identify what topics can or should be targeted for future study. In addition, this paper seeks to address the following specific questions: is ruling out LA/LAA thrombus necessary in all patients prior to atrial fibrillation (AF) ablation? Are there any identifiable patient populations at reliably lower risk who could potentially avoid LA/LAA thrombus screening prior to AF ablation? What are the current strategies being employed by electrophysiologists in the published literature? What is the opinion of the current literature on warfarin and NOAC drugs as they pertain to the incidence of LA/LAA thrombus prior to AF ablation, and how does each fit into the current treatment strategies for the prevention of procedural thromboembolism? Finally, what is the future of preprocedural intracardiac thrombus evaluation prior to AF ablation, and what steps can be taken to ensure that the risk to the patient is minimized while improving laboratory efficiency and avoiding unnecessary costs?