Digital bone marrow morphology: your questions, answered

Our recent webinar with Dr. Mattias Hofmans from Ghent University Hospital drew over 200 hematology professionals from 28 countries. During the session, attendees raised a range of clinical, technical, and operational questions - from AI performance and staining protocols to regulatory status and remote review.

We’ve compiled the most frequently asked questions along with detailed responses from our clinical team.

How does the system achieve 100x resolution? Is it upscaled from lower magnification?

The system scans each slide using a 20x objective lens, then applies proprietary computational photography algorithms to produce images at 100x oil immersion equivalent resolution. This isn’t generative upscaling - the technology reconstructs high-resolution detail from multiple low-resolution captures taken under varying illumination conditions. The image quality and its comparability to 100x on a manual microscope was validated in multi-site clinical trials for both peripheral blood smear and bone marrow aspirate applications, on the basis of which the peripheral blood smear application received FDA clearance and CE-IVDR certification, and the bone marrow aspirate application received CE-IVDR certification and is currently pending FDA clearance.

Can the system alert us when clinically significant cells are detected - for example, a high blast percentage?

Yes. The system automatically flags cases where clinically relevant cell populations are detected. By default, cases are flagged when blast percentage reaches 20% or above, plasma cell percentage reaches 10% or above, no particles are detected, or no bone marrow precursor cells are detected. Lab administrators can configure additional morphology alerts based on their clinical needs.

Does Scopio propose a diagnosis?

No. Scopio provides AI-powered decision support, not a diagnosis. The system automatically locates and pre-classifies hematopoietic cells across 17 categories, but the qualified user reviews the pre-classifications, makes any adjustments, and issues the final report at their own discretion.

Does the AI calculate M:E ratios?

Yes. The AI-powered decision support provides an automated myeloid-to-erythroid (M:E) ratio calculation based on the classified cell populations, along with evaluations of erythropoiesis and myelopoiesis states, specimen quality assessment, and a full nucleated cell differential.

Can multiple users review the same case? How does remote review work?

Multiple users can access and review the same case simultaneously. The application is browser-based - anyone on the secure hospital network can open a case from any workstation using Google Chrome or Microsoft Edge, without dedicated software. Remote review has full functionality: the same tools, navigation, annotation, and classification capabilities are available whether you’re on-site or accessing the case remotely.

How many slides can be loaded, and is additional staff needed?

Only one operator is needed to load slides. The X100 holds up to three slides at a time and requires manual oil application and coverslipping. The X100HT holds up to 30 slides at a time and handles oil and coverslipping automatically - a load-and-walk-away workflow. Scan times vary by scan mode and sample complexity, with the X100HT processing up to nine slides per hour.

How does long-term image storage work?

All data - scans, reports, annotations - is stored on the on-premises system, with capacity of up to 500 cases and 15,000 reports on the X100 and 1,500 cases and 45,000 reports on the X100HT. For long-term archiving, images can be exported in DICOM format to external imaging systems such as IMS and PACS, integrating with your existing enterprise imaging infrastructure. Scopio is the first bone marrow aspirate application to support native DICOM image export.

What staining protocols are supported?

The bone marrow aspirate application supports all Romanowsky stains. The latest software release includes two new color configurations: a warm color setting aligned with MGG staining, and a cold color setting aligned with Wright-Giemsa or Modified Wright-Giemsa staining. Users can further fine-tune images using built-in filters for brightness, exposure, contrast, saturation, gamma, and hue. Labs that wish to adjust their staining protocols to optimize the digital experience can work with our clinical team to support that process.

Is the platform licensed for clinical use in Europe? What about the US?

Yes. In Europe, the platform is regulated under the EU In Vitro Diagnostic Regulation (IVDR). Both the Full-Field Peripheral Blood Smear and Full-Field Bone Marrow Aspirate applications, running on the X100 and X100HT platforms, are CE-IVDR certified for clinical use. In the US, the Full-Field Peripheral Blood Smear application is FDA cleared on both platforms. The Full-Field Bone Marrow Aspirate application is currently pending FDA clearance.

Didn’t find your question here? Reach out to us at info@scopiolabs.com - we’re happy to help.

You can also watch the full webinar recording featuring Dr. Hofmans’ presentation and download our 2026 industry survey on the state of blood sample review in hematology laboratories.

*Scopio’s Full-Field Peripheral Blood Smear application is FDA cleared and CE-IVDR certified. *Scopio’s Full-Field Bone Marrow Aspirate application is CE-IVDR certified and pending FDA clearance. Not commercially available in the US for in vitro diagnostic procedures.