Options for Flow Cytometry Training - FloCyte Review

Flow Cytometry (FCM) isn't the easiest technique to learn.  It actually takes quite a while to master both the hardware and software components to sample acquisition and data analysis - let alone the applications utilizing the aforementioned instrumentation.  For many users of flow (in an academic setting) their first encounter with FCM is likely through a core facility, whereby they'll receive some instruction on how to operate an instrument and then how to analyze the data they collected.  The type and quality of this training varies greatly.  Some institutions I'm familiar with have multi-day courses with wet lab sessions and hands-on instrument time, while others attempt to provide a theoretical base and then do a bit of hand-holding for a few sessions.  The success a user may achieve greatly depends on his or her resourcefulness and overall aptitude for technology.  Some people pick it up quickly; others struggle for years.  I will say that training users in a busy core facility is a huge drain of time and resources.  In our core, for example we basically have an entire F.T.E. just providing training and consultation, so I'm sure that in smaller cores, where it's just one or two people, training has to be an even greater burden.  The question then becomes, how are we to provide the necessary training and attention our users require with the limited time and personnel resources characteristic of a core facility?

There aren't too many options.  Before I jump into an assessment of the FloCyte courses (which is the whole point of this post) let me briefly highlight other possibilities.  FYI, I've personally attended all 3 types of training sessions and have viewed all the resources in #4.  

1.  The Annual Course in Flow Cytometry - This weeklong course alternates between Los Alamos National Labs (or the University of New Mexico) and Bowdoin College in Brunswick, ME.  It is really geared towards users of the technology who already have a basic understanding of the technology.  Also, it focuses on the applications of flow cytometry rather than operation of a flow cytometer, however numerous sections also delve into the hardware components.  There's a pretty cool lab where you can assemble your very own (fairly crude) cytometer.  The cost of the course is about $1800, which includes dorm-style accommodations and meals (transportation is not included).   

2.  Vendor-specific instrument/software training - Most vendors will provide training for their hardware and associated software.  When you purchase an instrument, you might get some free training included with the purchase, but additional training is going to cost you.  As you'd expect, the training is geared towards the operation of that vendor's hardware.  If you were using multiple cytometers from different vendors, this obviously wouldn't be ideal, but if you were using a single platform it might be a good option.  The vendor training will also include some of the basics of cytometry, but again, it will be skewed towards their instruments, their reagents, and their idea of the technology.  It's also pretty expensive, sometimes as much as $2500 per person.

3. Training courses at meeting - Typically when you go to some of the bigger conferences they'll have some workshops on FCM.  Certainly at the CYTO meetings you'll have the opportunity to attend training sessions on various topics.  Also, some of the immunology focused scientific meetings will have some FCM training associated with them (for example, the AIC meeting in Chicago).  Cost for this training is variable, however it's usually limited to conference attendees, so unless you were already planning to attend the conference, it might be really expensive. 

4.  Online utilities - There is quite a lot of information freely available on the web.  You can certainly start at the Purdue University Cytometry Laboratory web site, where there are a bunch of powerpoint slides, movies, and resources freely available.  In addition, companies such as Becton Dickinson, Life Technologies, and Beckman Coulter offer overviews of flow cytometry and flow cytometer technology.  Note that the above links are linked directly to the company's training/support page with the intended materials.  Although these online utilities are readily available and free, you lose the benefit of asking questions and interacting with people who can tailor the training to your specific needs.  

So now, I'll walk you through my experience with the FloCyte Training course offered by FloCyte Services.  I attended the Comprehensive Training Course from 11/15/11 - 11/17/11 held at Spherotech, Inc.  I won't bother taking up space here to give you the rundown of the company and the mission of the training courses.  You can read all about it here.  However, I will note that I attended the Comprehensive training course, which is designed for novice users of flow.  You can see the course curriculum here.

Day 1, as you'd expect, goes over the basic components of flow cytometry.  This is done is a pretty common fashion, and anyone who's gone through the powerpoint slides on the Purdue University Cytometry Laboratory web site will recognize the format.  4-components, Fluidics, Optics, Electronics, and Data Analysis.  All the standard material you'd expect to be here is here.  There was however at least one pretty critical omission - multi-laser systems, laser delays, and how fluorescence emission is spatially separated.  I know this was briefly mentioned during one of the sections, but there was no figure, no reiteration of how it's possible to look at two colors with the exact same emission simultaneously because they're excited by spatially separated laser beams (e.g. PECy7 and APCCy7).  When we broke into small groups to take a look at some of the hardware, I spent most of the time explaining to my other group members how this works.  They were very confused.  The graphics used to talk about emission filtering where all systems like a FACScan or FACSCalibur, which don't have spatially separated beams, and all the light goes through the same "pinhole".  Also on day 1, we finished up with a mathematical explanation of compensation, which went horribly wrong.  The math is complicated and it's probably not something basic users need to understand in order to compensate their data correctly (or, should I say, let FlowJo compensate their data correctly).  Lastly, there was no mention of 1 very critical component to flow cytometry, Quality Assurance and Quality Control.  In all, the basics were handled just fine.  I will say, though, that it seemed to move pretty slow.  I think for the amount of information covered in that first day, it could've have been condensed into a half day.  For example, I feel like the flow basics class given at UCFlow is comparable in it's scope but is completed in about 1.5 -2 hours.  

Day 2 brought in a plethora of applications and tried to reinforce some of the concepts from day 1 while explaining how those concepts effect how you think about the applications.  I think this way of presenting the information is really good.  When we're talking about immunophenotyping, we're also talking about compensation, background due to fluorescence overlap, non-specific binding, etc...   When we're talking about cell cycle, we're also looking at doublet discrimination, coincidence, sample core size, etc...  Here we also start tackling the necessity of controls, including comp controls and the always popular FMO controls.  My big issues with this section solely revolved around the figures.  Many of the figures were at best poor representations of the idea being put forth and at worst blatantly misleading.  This was especially noteworthy in regards to an explanation of biexponential display transformation.  In another instance, the instructors were driving home the idea of how we are to never use quadrants to perform gating on our plots and the very next slide describing FMO controls was filled with quadrants used as gating.  A bit contradictory.

Day 3 was all about stats and panel design.  The stats part was very straight-forward and pretty easy to follow.  The panel design section was good, and covered many of the issues that arise when trying to put together a multicolor panel.  There was an introduction to a utility from Treestar called Fluorish (which I'm not going to complain about because I like it)  however there wasn't any real mention or demonstration of other available utilities like Chromocyte and CytoGenie.  Also, we spent some time going through some data analysis strategies using FlowJo.

The cost for the 3-day Comprehensive course is $700.  The beauty of the course is that it's brought to you (either your institution can host it, or it is hosted nearby) so you don't have to factor in airfare or hotel costs.  But, you'll have to remember that you're getting a comprehensive theoretical overview of flow cytometry, you are not learning how to operate your specific cytometer.  So, if you didn't have a core facility around to show you how to open up FACSDiVa and adjust voltages on your LSRII, you'd still be pretty clueless on how to run your first FCM experiment.  Another positive about the training is that it is modular such that you can attend just days 1 and 2, or just 2 and 3, or even just day 3.  That way if you have some basic knowledge already, you can skip day 1 and just attend days 2 and 3. Lastly, I'll mention that there are a bunch of other, more advanced courses available outside the comprehensive course, including a multicolor compensation course, a course on "phosflow" assays, and even clinical flow cytometry.  

The instructors are well-respected flow cytometry professionals with years of experience under their belts.  They presented most of the material in a clear and concise way.  There was, at times, some confusion regarding what a figure was trying to describe, but this was due to the fact that the slides were recently re-done and the instructors were not 100% comfortable with them.  I feel like I want to give them a pass on that, but then again, I did pay $700 on this course and expected a very polished delivery.  All things considered, they did an excellent job.

I could see this working in a couple of ways.  1.  You get some initial training on how to operate your cytometer from your core facility and then attend days 2 and 3 of the comprehensive course.  2.  You could attend the entire comprehensive course and then go through the specific instrument training given by your core facility.  3.  Get trained by your core, start running experiments, and then jump in on one of the advanced courses offered by FloCyte.  If you're not fortunate enough to have the support of a core facility, then this makes the FloCyte courses even more attractive.  Relying on them for the basic theoretical training, and then the instrument vendor for training on the actual equipment is probably your best bet. 

Cytometer Service Contract or Self Insure: the Wal-Mart effect.

Instrument maintenance and repair is typically not a huge factor when deciding on a piece of equipment to purchase.  People are much more concerned with the practical things like how many lasers can I put on, how fast can I run my samples, or more simply, can it handle the applications I plan to run?  Even after we have the instrument installed in the lab we're not really thinking about maintenance and repair because we're on the "full-warranty high."  If something breaks, what does it matter?  The company will come out the next day and repair it at no cost.  Right about the halfway point through the warranty period the thought hits you - I'm going to have to start paying for service on this thing.  Herein lies the dilemma.

Although there are many variations, in general there are two schools of thought here.  The first involves some level of service agreement (full, partial, lasers only, instrument minus lasers, etc...) and the second is akin to an "insurance" plan.  By the way, before I go on, I should state that I'm writing this from the standpoint of a private academic institution (namely the University of Chicago), however private companies, public institutions, or individuals may have a vastly different experience.  Let me briefly explain these two systems of instrument maintenance.

Service agreements.  About 6-8 months into your warranty period, a friendly company representative will contact you to try and sell you on a full service contract.  This basically extends the type of service experienced during the warranty period.  Labor and parts will be covered under the service contract costs you pay annually.  Be sure to get a list of what are typically called 'consumable parts'.  These items are parts that will not be covered under the service contract.  Consumables are commodities that are intended to be used up quickly and therefore are not parts that could undergo some type of failure.  It is this failure of a part that is covered by the service contract.  Consumables can be expensive; sometimes as much as $1000 - $2000 for a single item that may only last 6-12 months.  You'll need to be sure to add these costs to your total cost of ownership.  Full service contracts are fantastic.  You get rapid response times, an endless supply of new parts, and generally I find the quality of service is of a higher standard.  The downside is the expense.  You can plan on spending about 10% of the original purchase price yearly on a full service contract, which means that after 10 years, you'll have bought the instrument twice.  You can also look into service contracts that cover only parts of the instrument, such as a 'lasers-only' contract.  This may cover some of the major expenses that might hit, but some of the routine fluidics issues or electronics issues would still need to be paid out-of-pocket.  Lastly, you don't need to rely solely on the Original Equipment Manufacturer (OEM) for service.  In some cases, third party companies will either provide the service agreement (serve as a middle man between you and the OEM) or there are companies that can actually come out and fix some of your older generation instruments.

Insurance.  If you pass on the service agreement route, either with the OEM or a 3rd party company, you'll need to carefully make a plan on how you will pay for problems that pop up.  This can be done by including a line item on your budget and simply inserting the cost of the service contract.  Then you'd need to pay for any repairs using those available funds.  If you don't use all the funds then you have a surplus and possibly a way to do some upgrades or save it for a rainy day.  If, however, you end up paying out-of-pocket more than you have put away as insurance then you could have some trouble with your institution.  The insurance method also has some unintended consequences including the possibility that your service calls may be bumped to the bottom of the list if the OEM services customers on service contract first.  Secondly, I've noticed that the field service engineers tend to do the minimum to get the instrument functional again.  This is not to say they're lazy or anything, they're actually doing you a favor by not replacing non-essential parts, and performing the work quickly so the hourly labor charge is not too high.  However, this sometimes leads to more frequent trips to a site to fix a related part that breaks shortly after the instrument was put back into service.

So, what do we do at UCFlow?  Well, a hybrid, of course.  If you can anticipate which instruments will likely have more problems over the years, then you can keep your instruments running for many years without hassel for a lot less money.  Seems impossible, but here are a few tricks.  Obviously, the first thing you're going to do is monitor performance very carefully during the warranty period.  If odd things are happening monthly, or even quarterly, it may be a good idea to consider a service contract.  If you can find out from current owners of the same model instrument whether they have many service calls, that might help make the decision.  Also, if you or your lab is familiar with the innards of the cytometer and aren't afraid to do things like replace valves, regulators, or even lasers then you should be less likely to buy a service contract.  Lastly, the more instruments you have, the more money you'll be wasting on service contracts.  Let's say you have 6 instruments, and the service contract is $15,000 each ($90K total).  It's unlikely that all 6 cytometers will have multiple issues in a given year, so let's say you have 2 instruments with major problems (multiple service calls with big ticket items totaling $30K).  The other 4 run pretty smoothly, and maybe require another couple of service calls for minor issues ($15K).  If you pay out-of-pocket then you'll basically be paying 50% of the cost of a full service contract.  This might be a good year; some other years might not be so favorable.  However, it's likely that many years you'll be under budget and a couple of years you might be over budget.

As an example, I'll share a few stories of my experience.  We had multiple 1st generation FACSCantos that were breaking down monthly.  We were actually paying more out-of-pocket than the cost of a full service contract, so we went ahead and put them on contract.  This was a no brainer.  We also had an old LSRII that, over the course of 6 years had not had a single service call placed on it.  All we've had to do is perform the standard Preventative Maintenance (PM).  We never had a contract on this instrument.  After 6 years of spending nothing on this instrument, we had 2 lasers die at the same time, which required replacement at the cost of $50K.  The service contract cost was $22K per year, so 6 years times $22K = $132K, and actual costs were $50K, a 62% savings.   It is a situation like this that tells us to err on the side of NOT getting a service contract until an instrument proves to be unreliable.  Once it is deemed unreliable we either place it under service contract, or get rid of it and find a more reliable alternative.  It sometimes seems like a gamble, and if I only had 1 or 2 instruments, I'd likely have them on service contracts, but since I have the luxury of duplicate technology and the power of numbers, I'm able to take that gamble and the odds are usually in my favor.

By the way, of the 16 instruments we have in the lab, 3 are on service contract (only the aforementioned early generation FACSCanto-A).  We're able to save money by having a high number of instruments.  We can also negotiate better contracts if desired.  Larger volumes typically lead to better prices per unit.  This is what we call the Wal-Mart effect.  If that's not your case, then you'll likely want to lean more towards the service contract route.