Test & Training

Test & Training is the quality assurance and training-support service provided by Gloucestershire Hospitals NHS Foundation Trust through the Gloucestershire Retinal Education Group.

Frequently asked questions:

About Test & Training
Who is it for?
How does it work?
What does it look like?
What are the Key Features?
What are the Advantages?
How much does it cost?


About 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 was devised and is provided by the Gloucestershire Retinal Education Group and is owned by Gloucestershire Hospitals NHS Foundation Trust.

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).

The International version is currently being supplied to diabetic retinopathy screening programmes in China and the Republic of Ireland and also to Bangladesh, Botswana and Indonesia via charitable grant funding from Standard Chartered Bank through the Seeing is Believing project. Gloucestershire Hospitals has very recently received extension SiB funding to offer iTAT and educational support to staff in other countries including Malawi, Tanzania, Uganda and Zambia and we are grateful to Standard Chartered for this grant.

More information on our Seeing is Believing projects can be found on our research project pages.

If you are interested in accessing the International Test & Training system and services, please contact us via ghn-tr.drsadministrator@nhs.net to enquire.

How does it work?
Each month, graders access 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.

What does it look like?
For examples of various pages and functions within TAT and iTAT, please see the "Test and Training Samples" section under Test & Training on the main page header bar.

What are the Key Features?

  • 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 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)

What are the Advantages?

  • Standardised test environment
  • Available 24/7
  • Entirely feature-based lesion recording
  • Common diabetic retinopathy lesions with enriched ‘sight-threatening features' bias
  • All cases previously ‘ground-truth' graded by expert panel
  • Identifies high- and low-performing staff
  • Supports sensitivity & specificity 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 results and feedback

How much does it cost?
The cost is £100 (approximately USD150 or €140) per registered grading user for the first 12 months, thereafter £60 per user per year. Programmes initially registering fewer than 15 graders (excluding administration staff) would also be charged a one-off set-up fee of £1000 (approximately USD1500 or €1400).

International students who successfully complete either the Certificate of Higher Education in Diabetic Retinopathy Screening or the University Certificate in Grading for Diabetic Retinopathy Screening through the UoG, have one-year free access to iTAT included in the cost of their qualification and no set-up fee. Annual fees would be applicable thereafter.


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Site last updated 12/09/2018