Test & Training

Test & Training

Test & Training (TAT) and the international version iTAT are the Internet-served monthly quality assurance and training-support system for readers (graders) of diabetic retinopathy who work in systematic Diabetic Eye Screening Programmes. It is equally useful to new or experienced screening staff and to staff wishing to improve their skills in the detection of diabetic retinopathy from ophthalmic images.

The system provides graders with access to sets of retinal images from 20 eyes and identify and classify the retinopathy features present in the ‘ground-truthed' images. Each set of 20 cases is randomised at the point of delivery, so no two people see cases in exactly the same order. After each month-end, graders compare their responses and feature-list with the system results and the results of their local and national peers.

There are also over 40 training sets that graders have unlimited access to. The guide grades for these are immediately available allowing graders to review and compare their answers straight away, to increase and enhance their grading knowledge and skills.

Quality Improvement in Laser Training tool (QUILT)

The QUILT simulator presents images of validated fundus photographs (DME, PDR, and retinal vein occlusion) displayed with optical coherence tomography scans (when appropriate) to plan laser treatments.

For more information visit www.quiltsystem.com or contact us through our Enquire Now section.

Who is it for?

Test & Training is utilised as the mandated on-going monthly external quality assurance testing environment for all grading staff who work in the English NHS Diabetic Eye Screening Programme (NHS-DESP) and is currently used by over 1000 NHS-DESP users each month.

An international version of Test & Training (iTAT) is available to users from outside England. The iTAT system can be easily translated into almost any language (a Chinese Mandarin version is already available). This version is currently supplied to graders in China, the Republic of Ireland, Bangladesh, United Arab Emirates, Jamaica, Iceland, eSwatini plus many others.

Key features and advantages

  • Internet-served secure testing system
  • Password protected authorised multi-role access
  • Works with multiple web-browsers
  • Available 24/7 (no Time Zone issues)
  • 12 monthly test sets of 20 cases/eyes (240 cases per year)
  • Cases previously ‘ground-truthed’ by panel
  • Feature-based ‘lesion’ recording
  • Randomised case presentation order to users (reduces sharing in Tests)
  • Image viewer tools: auto ETDRS grid, red-free, magnification, contrast etc.
  • Results:
  • Secure pseudonymised data
  • Scores against panel & peer grades
  • Full lesion list per case
  • Lesion-annotated results images
  • My history monthly historic results
  • Manager’s detailed reports
  • Can be tailored to different levels/schemes (chargeable)



  • Standardised test environment
  • Available 24/7
  • Entirely feature-based lesion recording
  • Common diabetic retinopathy lesions with enriched ‘sight-threatening features’ bias
  • Identifies high and low performing staff
  • Supports sensitivity and specifity calculations
  • Test result comparisons against system & peers after each month-end
  • Post-test training library supports new staff, MDT meetings and case discussions
  • Test and re-test through the training library with immediate

Click here to view Test & Training samples

Further information and costs

If you are interested in accessing the International Test & Training system and services, please contact us at ghn-tr.drsadministrator@nhs.net for further information regarding registration and set-up fees.