UCL MEDICAL PHYSICS AND BIOENGINEERING Transforming technology into healthcare Medical Physics and Bioengineering Annual Newsletter 2013 1 Welcome Welcome to the second edition of the Newsletter of the UCL Department of Medical Physics AND Bioengineering Our Newsletter highlights some of the new and exciting research activity in the department, and includes various news items about the department which we hope will be of particular interest to former students and staff. We include reports on recent research including photoacoustic imaging and MRI, novel applications of x-ray imaging and radiotherapy, and an article from our new Biomedical Ultrasound Group. We also have a piece written by one of our undergraduate students, as an example of the type of student project we can offer. We are particularly pleased to include articles from our colleagues from Medical Physics and Bioengineering, and Radiotherapy Physics in UCLH. We hope you enjoy it. If you have any questions or comments, we would be delighted to hear from you, via medphys.newsletter@ucl.ac.uk. Jeremy C. Hebden | Head of Department ConTACTS Department of Medical Physics & Bioengineering University College London Gower Street London WC1E 6BT Web: www.ucl.ac.uk/medphys Tel: 020 7679 0200 Email: medphys.newsletter@ucl.ac.uk Twitter: @UCLMedphys 2 UCL Medical Physics and Bioengineering | Newsletter 2013 Departmental news new UNDERGRADUATE programmes in Biomedical Engineering The UCL Faculty of Engineering is introducing a common framework for its undergraduate degree provision across all nine departments, known as the Integrated Engineering Programme. As part of this initiative, our department is introducing new 3-year (BEng) and 4-year (MEng) degrees in Biomedical Engineering. The first cohort of students in expected to join us in September 2014. The programmes will cover core engineering subjects and skills development during the first two years, with an increased focus on medical physics and biomedical engineering topics during the third and fourth years, including an individual research project. The programmes will be given a unique flavour, drawing upon the distinctive expertise of the department and UCL’s broader biomedical engineering community. Sports Day Infrastructure changes The past two years have probably been the department’s most successful in its history in terms of generating research grant income. Accommodating the increase in our research activity has meant optimising the usage of all available space in the department. During the past year, our former small meeting room (Room 3.09) has been converted into a laboratory, as has a small storeroom on the second floor of the Malet Place Engineering Building (Room 2.23). We have also significantly increased the maximum occupancy of the student study room on the first floor (Room 1.18), while utilising the former study room next door (Room 1.17) to accommodate researchers in our radiation physics group. Meanwhile, plans are in progress to refurbish our seminar and teaching room (Room 1.19) with state-of-the-art electronic teaching equipment, and to redecorate and refurnish our common room (Room 3.14). Forty-five staff and students took part in an annual Departmental Sports Day in June 2012, held at Highgate Cricket & Tennis Club in north London. While some indulged in a broad range of sporting activities, such as tennis, football, and egg-and-spoon races, others just relaxed in the sun during one of the summer’s rare warm and sunny days. The event concluded with the traditional tug-of-war and a barbeque. 1 UCL Medical Physics and Bioengineering | Newsletter 2013 Departmental news Departmental Retreats first departmental Open Day In July 2012 we held our second Summer Retreat. Fifty-five members of staff spent a day-and-a-half at Pendley Manor Hotel in Hertfordshire. The event involved a mix of “formal” sessions intended to address different areas of work activity such as teaching and research, and team challenges intended to encourage greater communication and cooperation between department staff (of which most took place on the extensive hotel lawn among the native peacocks). The challenges were given an Olympic 2012 flavour, and members of teams finishing first, second and third were presented with gold, silver and bronze medals. Another Retreat was organised for, and by, the department’s PhD students. In November 2012, thirty-six students spent two nights at a youth hostel in the New Forest. They performed a variety of outdoor and indoor activities, including various team challenges and an expedition. The delicious home-cooked meals, unseasonably warm weather, and beautiful location also ensured that the Retreat was an unforgettable success. On 31 May 2013, we will be holding our first Departmental Open Day. The aim is to promote our research and encourage collaborations within UCL, UCLH and beyond. We will have 10 stands in the North Cloisters featuring hands-on demonstrations of our work. Joel Lecture The Joel Chair is the oldest chair in the world in the field of Medical Physics. It was established in 1920 following a large donation to the Middlesex Hospital Medical School by the Barnato-Joel family in 1913. An annual lecture to celebrate the importance of the Chair in Medical Physics was established in 2012 and the first Joel Lecture was given by Professor Steve Webb on the subject of Intensity Modulated Radiotherapy (IMRT) and its development. This year, Professor Peter Wells CBE FRS will present the Joel Lecture. Peter’s lecture will be on imaging with ultrasound and is entitled “Inside the human body: Seeing with ultrasound”. 2 Other news New Arrivals Jamie Harle – Coordinator of our Distance Learning MSc. Andy O’Reilly – Personal Assistant to the Head of Department. Liz Zuzikova – Departmental Receptionist. Promotions Sebastien Ourselin has been promoted to Professor of Medical Image Computing. Ben Cox is now a Senior Lecturer. Research highlights UCL Medical Physics and Bioengineering | Newsletter 2013 Explosive detection using X-ray diffraction Authors: Daniel O’Flynn, Christiana Christodoulou and Robert Speller Typical X-ray baggage scanners measure the amount of X-rays which pass through materials, giving an image of the items inside a bag or parcel based on their density and the types of atoms they are made from. This approach is effective for finding metal items such as guns and knives, but struggles when identifying plastic explosives since they absorb X-rays in a similar way to typical baggage items. X-ray diffraction (XRD) is an alternative scanning technique which probes molecular structure. Each material has a unique structure, and so XRD can effectively be used to fingerprint hidden items. In collaboration with the UK Home Office and Department for Transport, funded by the Innovative Research Call 2010, we are currently working at UCL to develop a system for scanning baggage and packages using XRD. Typically, XRD is a technique which is either too slow or too impractical for use in security applications. We aim to overcome these limitations by using a novel X-ray detector developed by the Rutherford Appleton Laboratory. The detector can simultaneously measure the position and energy of X-rays which have been scattered after hitting an object – these two characteristics previously could only be measured separately. It is possible to view snapshots at constant energies; for example the image above shows only X-rays with an energy of 20 keV which have been diffracted by the sample. The two distinctive arcs change size according to the energy window, and their behaviour, diffracted by a sample of caffeine is directly linked to the molecular structure of caffeine. A large challenge for this project was to untangle the vast quantities of data we measure in order to obtain meaningful information on the materials under study, which range from explosive materials to everyday items like sugar or toothpaste. We have devised a way of combining the patterns shown into a single overall picture of the sample, retaining the important diffraction features in space and energy – this is our diffraction fingerprint. With this technique we are able to show that even with data collected for just one second we can correctly identify explosive materials. 4 Image: The behaviour of X-rays diffracted by a caffeine sample What is X-ray diffraction? Waves passing through a small opening begin to spread out with a circular wavefront. If there are two such openings, two circular sets of waves are produced, which can then interact with each other. These waves will interfere either constructively (the waves get larger) or destructively (the waves get smaller, or vanish completely). This effect can be observed with water waves, sound waves or even light waves – including X-ray radiation. The positions at which the waves constructively interfere are related to the spacing between the openings, which in the case of X-ray diffraction is the space between the different layers of atoms in a material. Facing up to disfigurement Author: Clifford Ruff Facial disfigurement can have a dramatic effect on the way people see themselves and the way they are perceived by society, this is especially true for children. Reconstructive surgery can result in a significant improvement in quality of life, especially when preoperative counselling has provided the patient with realistic expectations of the surgical outcome. It is often impossible to achieve a perfect result following reconstructive surgery, however it is important to achieve the best result possible for the individual patient. Current surgical techniques allow augmentation of areas in the bony skeleton by using the patient’s own bone, or by using other materials such as titanium. It is also possible to augment the soft tissues by transplanting skin, muscle and fat from elsewhere on the patient’s body. To plan a reconstruction it is not enough to just know precisely where the deformity exists, it is also important to know how much tissue is required, where it is required, what shape it needs to be and what existing deformed tissues need restructuring. To answer these questions the Medical Graphics and Imaging Group at UCLH, has been mathematically modelling the facial features, both on the skin and underlying skeleton, of both the normal population and patients suffering from a range of congenital deformities. The second thread compares the deformity of an individual patient with the normal population to assist in planning the reconstruction, in order to achieve the most aesthetically pleasing solution that is achievable for that patient. The planned reconstruction has to be surgically achievable, with any implanted material matching the patients’ anatomy in the areas that are not being reconstructed. In some cases, physical models of the reconstruction are made on a rapid prototyper, to guide the surgeon when harvesting and shaping the patients tissues prior to transplantation. As part of this project the department has a 3D camera system that allows us to capture faces in high resolution in 3 dimensions. The camera is non-invasive and nonionising, allowing us to capture images of both patients and the general population. In 2012 the camera was set up in the London Science Museum for three months as part of the Live Science exhibition, where over 12,000 3D facial images of normal volunteers were captured. There are two main threads to the modelling work, the first looks at the facial features associated with various syndromes (Aperts, Crouzons, Treacher Collins, etc.) themselves in order to gain an understanding of the facial features characteristic of each syndrome. The resulting models are then compared to the models of the normal population, thus allowing the surgeon to assess and visualise the full extent and range of 3D deformations associated with each syndrome. 5 Biomedical Photoacoustic Imaging Author: PAUL BEARD Photoacoustic imaging is a new biomedical imaging modality based on the use of laser-generated ultrasound. It is widely viewed as one of the most exciting and promising imaging techniques to have emerged in recent years offering major opportunities for increasing our understanding of basic biological processes and improving the clinical diagnosis and treatment of cancer and other major diseases. The Photoacoustic Imaging Group has been at the forefront of the field since its foundation in 2003. Back then, when the technique was very much in its infancy, it tended to be viewed by the biomedical imaging community as something of a fringe activity involving interesting physics pursued by a small band of eccentrics with little prospect of ever getting it to work in any practical sense. In some respects, this pessimistic view was understandable given the formidable technical challenges involved in producing images from the extremely weak photoacoustic signals generated in tissue. Thankfully these challenges were largely overcome, the eccentrics prevailed and the pessimists were proved wrong. Since then the field has witnessed tremendous growth with more than 50 groups worldwide now active in the field, the appearance of the first commercial scanners and the first steps towards practical application in medicine and biology being taken. This expansion has been matched by the growth of our group which now comprises more than 20 researchers making it one of the largest worldwide devoted to the development of biomedical photoacoustic methods. Photoacoustic imaging works by irradiating the surface of the skin with low energy, nanosecond pulses of visible or nearinfrared laser light, typically in the 600-900nm wavelength range. Due to the relative optical transparency of soft tissues at these wavelengths, the light penetrates deeply (several cm) and is also strongly scattered, resulting in a relatively large tissue volume becoming “bathed” in diffuse light. Absorption of the laser light by molecules such as haemoglobin leads to a harmless temperature rise of a fraction of degree and the subsequent generation of acoustic pulses at ultrasonic frequencies. These acoustic pulses propagate to the tissue surface where they are detected by an array of ultrasound 6 detectors. By measuring the time-of-arrival of the pulses at the detectors relative to the firing of the laser pulses, it is possible to reconstruct a full three dimensional image of the internal tissue structure based upon its optical absorption properties. The fundamental advantage of the technique is that, by encoding optical absorption on to acoustic waves it avoids the penetration depth/spatial resolution limitations of purely optical imaging techniques such as light microscopy or diffuse optical tomography that arise from the strong optical scattering of tissue. At the same time it retains the high molecular based contrast and spectral specificity of optical methods enabling visualisation of anatomical features indistinguishable with other imaging modalities such as ultrasound. The technique is particularly well suited to visualising blood vessels on account of the strong optical absorption of haemoglobin. Exploiting this capability for studying the abnormal blood vessel networks associated with tumours with a view to improving the diagnosis and treatment of cancer has been an important focus of our work. As part of this effort we have pioneered a completely new type of photoacoustic imaging instrument based upon on a highly sensitive optical ultrasound detector. We have now developed a high resolution photoacoustic scanner based on this UCL Medical Physics and Bioengineering | Newsletter 2013 principle which can provide exquisite 3D images of tissue structures as illustrated in the figures here. The success of this approach is a consequence of the combination of the very high sensitivity of the detector and the use of novel image reconstruction algorithms based on time-reversal principles that compensate for the resolution degrading effects of tissue acoustic attenuation. In collaboration with colleagues at the UCL Cancer Institute (Barbara Pedley and Martin Pule) and the Centre for Advanced Biomedical Imaging (Mark Lythgoe) we have used this system to explore the potential of photoacoustic imaging as a preclinical imaging tool. An important example of this work is a study in which we imaged the growth of the vasculature of a whole subcutaneous tumour and its subsequent destruction by a cancer drug that works by selectively inhibiting blood flow in tumour vessels – something that has not previously been possible using any imaging modality. As well as demonstrating the potential of the technology as a research tool for evaluating new cancer therapies, these studies illustrate its broader potential application in biomedicine. For example, it could be used clinically for the diagnosis and treatment monitoring of skin cancers, cardiovascular disease and inflammatory skin conditions. Indeed, following the recent award of an EPSRC/Cancer Research UK grant to set up a Cancer Imaging Centre with King’s College London, we plan to construct a dedicated clinical scanner and undertake human studies to explore the use of photoacoustic imaging for the assessment of head and neck cancers. development of the technology marches forward in the quest to develop more sensitive detectors, more accurate and faster image reconstruction methods and find ways of extracting physiological and molecular information from photoacoustic images. A particularly promising new avenue is the development of miniature endoscopic probes that can be inserted into the body to provide images of the interior of hollow organs such as the colon for cancer detection or coronary arteries for the assessment of cardiovascular disease. This area offers the prospect of opening up an entirely new branch of medical imaging with many new applications in interventional oncology, cardiology and surgery. Image, page left: In vivo 3D photoacoustic image of tumour vasculature in a mouse model of colorectal cancer Image, above: Photoacoustic images of a colorectal tumour showing its progression over a 5 day period With the underlying feasibility of the technology now demonstrated, the future prospects for photoacoustic imaging are exciting. After several years of intensive effort devoted to refining the instrumentation and image reconstruction methods, the translation to practical application in medicine and biology is underway. At the same time the 7 Measuring respiration with an accelerometer: an undergraduate project Author: Jonathan Mayhew Currently in my fourth year of Medical School, I chose to study Medical Physics and Bioengineering for my intercalated BSc; not many medical students have an appreciation of physics, so it is often overlooked as a choice. Luckily I was contacted by Dr Gibson after my project finished with details of a potential vacation bursary from EPSRC through the Engineering Faculty. I was keen to pursue the technology further, and the grant was available to repurpose the prototype device for use in the detection of breathing. Simply put, there is a lack of cheap, comfortable, and non-invasive automated respiration rate monitors in routine clinical practice, so the idea was to detect breathing from the physical displacement of the chest wall using the accelerometer. It was very easy to jump back into the research, and all the skills I had learnt throughout the year meant I could get straight back into complex LabVIEW programs without a problem. Although concerned about timing and workload, I was able to balance these effectively, and even managed to fit in a part-time job working at the London 2012 Olympic Games in the Athletes’ Village. I chose it mainly for the problem-solving nature of the material, and also because medicine is increasingly dependent on technology in terms of imaging, radiotherapy, as well as interventional radiology. I genuinely enjoyed my time in the department, as the courses were very well structured, and the methods of teaching were diverse: I even achieved YouTube fame with a video I made about EEG for Dr Adrien Desjardins’ Biophysics course. My project with Dr Adam Gibson and Dr Nick Everdell concerned motion detection and analysis during seizures. I was drawn to the project initially because it sounded novel. The first phase involved building a simple accelerometer and then writing LabVIEW programs to extract and process data from the device, and the second phase involved actually collecting data from a range of everyday arm and hand motions to test the ability of the system to discriminate them. My project involved a lot of LabVIEW programming, which had a steep learning curve, as I had no programming experience. However I found that as the project went on I became much more proficient using it. It was also a lot of fun to have a tangible, physical side to the project: being able to design and build a prototype device involved learning many new skills, and having something to physically test ensured that I didn’t lose sight of the goal. 8 Now I’m in my first year of clinical training, and I’m glad I chose to do my BSc in Medical Physics; not least because of the skills I’ve learned, but also because of the head-start it gives in terms of understanding medical technology. Knowledge of artefacts and the limitations of imaging devices can save embarrassing conversations with colleagues and certainly help prevent medical errors. UCL Medical Physics and Bioengineering | Newsletter 2013 Proton induced X-ray emissions for range verification in proton therapy Authors: Vanessa La Rosa, Adam Gibson, Gary Royle Approximately 1200 cases of eye cancer are diagnosed each year worldwide. The tumours occur more often in the back of the eye and is called “uveal melanoma”. Proton radiotherapy is ideal for treating eye cancers since it can be tuned so that it deposits radiation dose in the tumour region whilst minimising dose to critical healthy tissue such as the optic nerve. radiation-related side effects are the most important variables to keep into account. Gold was chosen for our preliminary experiments due to its well-known properties of compatibility with the human tissues. However more encouraging results were obtained with metals with a lower atomic number, which will be used for the future development of this application. The success rate of proton radiotherapy for eye cancer is about 95%. However, a significant number of patients may lose vision. This occurs when the optic nerve, which may be sited directly behind the tumour, is damaged by the treatment. Current treatments include an uncertainty of about 2 mm on distance travelled by the protons in tissue (the “range”). Rather than trying to minimise the effect of this uncertainty, we aim to develop a method for verifying the range during treatment. The method we have been investigating exploits the proton induced x-ray emissions (PIXE) from a metal marker which is implanted near to the optic nerve prior to the treatment. The number of characteristic x-rays depends on the energy and the number of the protons interacting with the marker. Therefore they can be used to determine the range in tissue and the dose delivered to the optic nerve. If x-ray emissions are observed, this tells us that we may be irradiating the optic nerve, so we can turn the beam off and restart the treatment with a reduced proton range. In this case the optic nerve would be spared from unwanted proton dose. Image, above: Vanessa La Rosa carrying out experimental work on the beamline at CATANA We used a compact x-ray detector to perform preliminary measurements at the Clatterbridge Cancer Centre proton therapy facility (UK) and at the CATANA proton beam line (Italy). Computer simulations were also carried out in order to plan the experimental set up, design the shielding for the detector, optimise the signal-to-noise ratio and predict the possible outcome. The choice of the most suitable metal is a key point of this research study, as it will define the accuracy with which the proton range can be estimated. Getting a good signal even when at low proton energies (i.e. small range errors) is critical for this application to be clinically useful. On the other hand, biocompatibility of the chosen metal and possible 9 UCLH Radiotherapy Physics Authors: Reshma Patel and Georgina Bagge Radiotherapy is the treatment of cancer with ionising radiation. Human tissue cells are damaged by ionisation of their DNA bonds, leading to the death of the cell when it tries to replicate. The success of radiotherapy in controlling cancerous growth without excessive damage to healthy tissues depends both on biological factors (differential cell resistance and repair) and on confining the high radiation dose to the tumour volume while minimising the dose to surrounding tissues and organs (Therapeutic Ratio). The role of medical physicists is to explore and develop techniques and modalities to improve the therapeutic ratio, thus improving the outcome of cancer treatment. The Department of Radiotherapy Physics at UCLH, based in 250 Euston Road (1st Floor, East), is part of the multi-disciplinary team in the cancer services directorate which also includes the radiotherapy, haematology and chemotherapy departments. The Radiotherapy Physics Department, which comprises of fifteen physicists, three planning radiographers and four radiotherapy engineers, provides scientific and technical support to the Radiotherapy Department. This includes dosimetry (treatment planning), quality assurance, and engineering services (sometimes in conjunction with manufacturers) needed to maintain the Radiotherapy Department’s treatment and imaging systems in good and safe working order. The Radiotherapy Physics Department provides support for brachytherapy planning using 2D and CT data for gynaecological malignancies, high dose rate prostate brachytherapy, bronchial and oesophageal brachytherapy and a variety of head and neck and sarcomas. We also administer Iodine-131 for thyroid cancer and are responsible for the monitoring and discharge of all patients undergoing molecular therapy. The department strives to be at the cutting edge of technology to deliver high precision, highly conformal radiotherapy treatments for cancer patients. We were among the first institutions in the UK to introduce both intensity X-ray Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) techniques, in conjunction with improved accuracy in delineation and localisation of tumours by registering MRI, PET/CT and now PET/MR with planning scans. We were the first in the UK to treat patients with the 10 latest “TrueBeam” accelerator, with innovative FFF beams of high intensity, superior mechanical accuracy for Stereotactic Radiotherapy and integrated On-Board Volumetric Imaging. We are involved in many research collaborations with the UCL Department of Medical Physics and Bioengineering. We are studying patterns of tumour and organ motion during treatment with a view to develop models that can predict these changes. We are developing methods of following the changes in patient shape and internal density and of calculating in real time the effect of these changes on the dose distribution. We are engaged in improving the accuracy and registration of dose delivery to the required volumes, taking into account the movements we measure. The ultimate aim is Adaptive Radiotherapy (ART), that is, to modify the treatment parameters to continually adapt to the biological changes in the patient, thus improving the therapeutic ratio by delivering the full dose to the tumour while sparing healthy tissues. Another new exciting approach to improve the therapeutic ratio is to use a different radiation modality known as Proton Radiotherapy. These beams of charged particles have markedly different dose deposition properties than X-rays and offer significant advantages in sparing healthy tissues, while fully irradiating tumours even in difficult anatomical locations. This treatment modality, currently available in only about 30 centres worldwide, is especially indicated for children and young adults, as it promises to markedly reduce side effects of treatment over their long life expectancy. UCL Medical Physics and Bioengineering | Newsletter 2013 UCLH, together with Christie Hospital in Manchester, has been designated and funded by the Department of Health to provide a National Proton Radiotherapy service. Much physics research, development and training will be needed to make a success of this promising initiative. UCLH Radiotherapy Physics and UCL Department of Medical Physics and Bioengineering are already collaborating on several projects that should come to fruition before the start of patient treatments, expected in 2017. These projects range from comparative studies of treatment planning systems for proton beams, to development of proton radiography, to exploration of in-vivo dosimetry based on detection of secondary particles produced by proton interactions in the body and to the extension of ART techniques to proton radiotherapy. Image, page left: This figure illustrates the path of the treatment beam around the patient. The patient is immobilised with a thermoplastic mask while the treatment is delivered Image, top: A comparison of two treatment options for this patient’s disease. The image on the right demonstrates a plan with discrete beam angles while the left shows a dynamic treatment distribution Image, bottom right: A dose distribution for a rapid arc plan showing the highly conformal high dose region in red over the tumour 11 UCL Medical Physics and Bioengineering | Newsletter 2013 Optical neuroimaging of cognitive function in African infants Authors: Maria Papadametriou and Clare Elwell using a multichannel NIRS system designed and built by Dr. Nick Everdell. The primary aim of the current study was to field test this system and prepare the ground for a full-scale longitudinal study of cognitive development in Gambian infants. In February 2013 Prof Clare Elwell (Near Infrared Spectroscopy group) and her team (Dr Maria Papademetriou, UCL and Dr Sarah Lloyd-Fox, Birkbeck University of London) went on a journey to the rural Gambia to use a novel neuroimage technique to investigate the effects of undernutrition on brain development in African infants. This innovative project idea was awarded a Grand Challenges Exploration Phase 1 grant from the Bill and Melinda Gates Foundation in collaboration with the MRC International Nutrition Group from the London School of Hygiene and Tropical Medicine. Poor nutrition is the primary health problem plaguing developing countries and dietary insufficiency in the first 1000 days of life can contribute to poor cognitive development. If the specific impact of nutritional deficiencies can be measured in the brain then it is possible that this information can be used to inform and target a programme of nutritional intervention in the developing world. Existing neuroimaging technologies (e.g. MRI and EEG) fall short of applicability in resource-poor settings or provide only limited spatial localisation. Near infrared spectroscopy (NIRS) is a compact, non-invasive, easy-to-use and inexpensive technique for measuring the changes in brain blood flow associated with localised brain function. The NIRS group in collaboration with Babylab at Birkbeck, have already performed a range of cognitive development studies on infants in the UK 12 The studies took place in the MRC field station in the village of Keneba, in a remote, rural area of Gambia. Transporting the purpose build NIRS system across continents and through a bumpy, unmade road was a challenge but the kit survived the journey well. Field workers recruited infants for the study by visiting the locals in their compounds and gaining consent from both parents. The mothers and infants were then collected the next day early in the morning by a Landrover and transported to the field station. During the study the infants were sitting on their mother’s lap facing a screen where the auditory and visual stimuli were displayed sequentially. The visual stimuli included human action (Gambian actors performing hand and eye movements) and non-human motion (still pictures of cars and helicopters). Similarly, the auditory stimuli included human sounds (coughing, crying, laughing and yawning) and environmental sounds (water running, and toys such as rattles). After two weeks of field testing, data from a total of 42 Gambian infants, 4-8 months old, had been acquired. Initial analysis revealed that the Gambian infants showed a preferential response to the human (rather than non-human) visual and auditory stimuli with activation clearly seen in the temporal cortex. These observations are in agreement with the studies in the UK infants. NIRS has proved a feasible neuroimaging technology for this resource poor setting and may well be a useful tool in assessing nutritional-specific interventions. Plans are now in place to return to the Gambia and collect more data to characterise longitudinal brain development in a large cohort of infants and children. Image, top left: A Gambian infant sitting on his mother’s lap waiting for the study to begin. The infant is wearing the custom made headgear accommodating the NIRS sources and detectors. and he is facing towards the screen showing the stimuli 13 Edge illumination X-Ray phase contrast imaging: Nanoradian sensitivity at synchrotrons and translation to conventional sources Authors: Charlotte Hagen and Paul Diemoz 14 UCL Medical Physics and Bioengineering | Newsletter 2013 Conventional x-ray techniques rely on the variations of absorption within the imaged object in order to derive contrast. Consequently, weakly absorbing details are often invisible in x-ray images, and features with similar absorption properties (like soft biological tissues) can be hard to distinguish. X-ray phase-contrast imaging (XPCi), instead, exploits a different physical effect. Besides being absorbed, x-rays also experience a slight deviation from their original path when travelling through an object. The deviation angle is proportional to the object thickness and to the gradient of its refractive index. Since this can be up to a thousand times larger than the absorption coefficient, a much improved detail visibility can be achieved by exploiting this effect. Several XPCi techniques have been developed. However, due to the need for a highly coherent beam, their use is still, with only few exceptions, restricted to synchrotron facilities. A novel approach to XPCi, the so-called edge illumination (EI) technique, has been under continuous development by our group at UCL over recent years. The basic idea is to use a narrow x-ray beam and to align it with the edge of a line of detector pixels. When an object is introduced, the narrow beam gets refracted either into or out of the detector pixels, causing an increase or a decrease in the detected intensity. By scanning the object through the narrow beam, an image is created, which shows bright and dark fringes at the edges of all details inside the imaged object. This edge enhancement effect strongly increases the visibility of weakly absorbing features. Object scanning can be avoided by multiplexing the EI principle over the entire field of view with the use of appropriate masks (“coded aperture” implementation of the EI method). The EI XPCi technique was demonstrated to be insensitive to beam polychromaticity and to work efficiently even with source sizes up to 100 µm: it is thus fully compatible with the use of conventional x-ray tubes and detectors, a very important aspect as far as the translatability of XPCi into widespread (e.g. clinical) applications is concerned. The EI setup is also scalable and relatively insensitive to mechanical and thermal instabilities. Two scanner prototypes have been built and are currently in operation in the Radiation Physics laboratories at UCL. They have already been used for the investigation of several low absorbing samples (for which conventional x-ray methods would provide little or no contrast), in different fields including medicine, biology, materials science, cultural heritage, homeland security, etc. Examples of applications are the detection of tumours in breast tissue, the imaging of murine cartilage samples, the analysis of cracks and defects in composite materials. An example of an EI XPCi image taken with a conventional setup can be seen opposite. Recently, we also showed that, when used with highly spatially coherent beams like those available at synchrotron radiation facilities, the EI method can provide unprecedented angular sensitivity. As an example, plastic filaments were imaged at a very high X-ray energy (85 keV), where the absorption signal is negligible. Not only are the filaments visible in the image (see fig. above), but refraction angles of the order of a few nanoradians can be resolved, which is at least one order of magnitude better than values published for other XPCi techniques (P.C. Diemoz et al, recently accepted for publication in Physical Review Letters). This result means that, besides being perfectly compatible with conventional sources, if used at synchrotron facilities EI allows imaging samples with a greatly increased sensitivity compared to existing techniques. It is expected that this unprecedented sensitivity will enable new, previously inaccessible applications in many scientific areas of investigation. Image, page left: Image of an onion flower taken with the scanner prototype in the Radiation Physics laboratories at UCL Image, top: Extracted refraction angle images and profile plot for three wire samples 15 Biomedical Ultrasound: Imaging, Guidance and Therapy Author: BEN COX Ultrasound imaging is perhaps best known due to its use for foetal scanning during pregnancy, but ultrasound – both as a diagnostic as well as a therapeutic tool – is already used in a much wider range of applications in medicine, ranging from eye surgery to cancer therapy. Furthermore, in recent years there has been widespread recognition that non‐invasive and minimally‐invasive surgery allows faster patient recovery, and are therefore good both for patients’ health as well as hospital budgets and waiting times. In this context, biomedical ultrasound will have an increasingly crucial role, both as a low cost and real-time imaging modality (for guidance as well as diagnosis) and more recently as a non‐invasive therapeutic (surgical) technique. The Biomedical Ultrasound Group (www.ucl.ac.uk/medphys/ research/ultrasound) recently formed to provide a focus for research involving ultrasonics and acoustics within the Department of Medical Physics & Bioengineering. The aim of the group is to undertake research that will extend what is possible with ultrasound in medicine and the biomedical sciences. Current projects range from the design of new optical hydrophones technologies (an area pioneered by Prof. Paul Beard), through the development of novel modelling and software tools, to clinical applications. For example, one project, led by Dr. Dean Barratt and shown in the image below, involves the development of enabling software-based technologies - in particular image registration algorithms - that allow data from diagnostic or surgical planning images (typically MRI or CT) which are available before a procedure, to be aligned with ultrasound images that can be obtained during the procedure to aid surgical navigation. 16 Much of the research at UCL in this field has focussed on developing methods that employ three-dimensional (3D) ultrasound imaging as a tool for surgical guidance. Applications include neurosurgery for brain tumours, hip replacement surgery, and more recently, minimally-invasive procedures for the diagnosis and treatment of prostate and liver cancer, including high-intensity focused ultrasound therapy. Several aspects of, and applications related to, high-intensity focused ultrasound therapy (HIFU) are being actively researched both within the UK and internationally. One application of HIFU is to use intense bursts of tightly focussed ultrasound to heat tissue to necrosis. By guiding the ultrasound focus appropriately, it can be used to ablate diseased tissue. It is therefore a non-invasive way of treating conditions, such as tumours in the brain or other organs, which would otherwise require risky and time consuming surgery. Being able to predict accurately where the sound will go and what it is going to do when transmitted into the body is clearly important when planning HIFU surgery, especially close to critical structures such as nerves or blood vessels. The development of large scale tissue-realistic acoustic models that can accurately predict the acoustic field, and so help with treatment planning and dosimetry, has been one outcome of the numerical modelling work of Drs Bradley Treeby and Ben Cox (www.k-wave.org), illustrated in the image on page 17. Image, below: a) A 3D MRI-derived model of the prostate registered to transrectal ultrasound images. b) A slice view of the original MR image with the tumour and prostate boundaries indicated. c) The corresponding ultrasound slice view. The arrows indicate the locations of small cysts, which indicate a good alignment following image registration UCL Medical Physics and Bioengineering | Newsletter 2013 Image, above: A 2D slice through a 3D simulation of high-intensity focused ultrasound (HIFU) treatment of the kidney. The acoustic properties of the tissue are estimated from X-ray CT images of the patient. The acoustic (ultrasonic) waves are modelled using k-Wave (www.k-wave.org), a toolbox designed for tissue-realistic simulations of the propagation of ultrasound waves for biomedical applications. The toolbox was written and developed in the Medical Physics and Bioengineering Department at UCL and at the Australian National University in Canberra 17 UCL Medical Physics and Bioengineering | Newsletter 2013 Getting the message out: The Continence Product Advisor website Authors: Margaret Macaulay, Sabrina Falloon, Mihaela Soric, Tal Hart and Alan Cottenden Millions of people worldwide suffer from incontinence, the involuntary leakage of urine or faeces, relying on containment products to manage their symptoms and enable them to have a full and active life. There are many products available; the most commonly used are absorbent pads but male and female devices, catheters and accessories, and toileting aids are also widely used. However, people find talking about their incontinence difficult and are often unaware of the wide range of products available to them and how to select and use them effectively. The Continence & Skin Technology Group has developed an international programme of work over the last 30 years based on the need to understand and address the most important issues for incontinent people, caregivers and manufacturers of products. Specifically this has focused on: • Development and refinement of products which are effective at containing leakage and are acceptable to product users, using multiple approaches including mathematical modelling, laboratory experimentation and clinical (user) testing. • Ensuring that all parties with an interest in continence product technology have access to the best evidence-based information, to enable appropriate product selection and maximum effectiveness. Until now, research evidence underpinning the selection and use of continence products has been confined to book form. Every four years all evidence relating to continence products is reviewed and updated in ‘Incontinence’ (eds: Abrams, Cardozo, Wein and Khoury). Over the last 18 months, CSTG staff, together with a sister group from the University of Southampton and the IT department of the International Continence Society, have developed a new website based on the information in Chapter 20 ‘Management using continence products’. The Continence Product Advisor website (http://www.continenceproductadvisor.org/, to be launched in summer 2013) is an international site providing generic, impartial, non-commercial and evidence-based information for product users, their caregivers and others who need to know about incontinence products. Visitors to the site are guided to relevant information either based on their symptoms, physical characteristics, lifestyle and preferences or directly to specific products. The website does not provide information specific to national health care systems or particular brands. Visitors are guided to their own national organisations for local help. It is anticipated that this fledgling site may in the future be translated into other languages in order to reach a greater number of people. Early feedback from product users and health care professionals has been very positive. There are some who are unlikely to have access to such information: people living in nursing homes are a group for whom incontinence is a particular problem. They are usually elderly and frail, and around 70% experience urinary incontinence requiring the use of absorbent pads (pads); leakage is often ‘heavy ‘requiring the use of large pads or diapers. Some incontinent people are unaware that they have passed urine and therefore may sit in a wet pad for several hours before the pad is replaced. It is therefore important to develop pads which are kind to the skin and highly absorbent, and to develop methods to alert patients and their carers to the presence of urine in pads. Our current research covers each of these aspects individually, with PhD projects on: • frictional interaction between the skin and top sheet of the pad (made from a nonwoven fabric), leading to their eventual improvement and the reduction in skin damage • the value of superabsorbent polymers in pads, correlating properties such as swelling kinetics, porosity and permeability with absorption performance, and • the design and placement of sensors in diapers to maximize their accuracy, according to the posture of the patient, where the urine lands in the diaper, etc. It is hoped that this research will one day lead to products that are better at meeting the needs of people such as those seeking help from the Continence Product Advisor website. 18 Graduate success! We were delighted that our two most recent PhD graduates have both gone on to work in medical technology related fields; Dr. David Cottenden to Medical Devices group, The Technology Partnership Ltd, near Cambridge, and Dr. Raquel Santamarta to Kimberley Clark in Spain. Image, above: Enhanced optical micrograph of a nonwoven fabric used next to the skin in incontinence pads. The constituent polypropylene fibres are 15µm in diameter Conferences The Continence and Skin Technology Group helps to organise two biennial conferences which aim to provide a ‘state of the art’ update for people interested in continence technology, and to bring together people from different disciplines to find innovative solutions to the difficulties of effectively managing incontinence and dealing with associated difficulties. The first is ‘Innovating for Continence: The Engineering Challenge IV’ – the most recent of these was held in Chicago in April 2013; they are run jointly with the Simon Foundation for Continence (US). All members of the CSTG presented their work. The second is ‘Incontinence: The Engineering Challenge IX’, which will take place at the Institute of Mechanical Engineering (London) in November 2013. 19 Mapping tissue magnetic susceptibility with Magnetic Resonance Imaging (MRI) Author: Karin Shmueli What is tissue magnetic susceptibility and why is it useful? Magnetic susceptibility is the physical property of a tissue that determines how easily and strongly it can be magnetised by the very high magnetic field found inside an MRI scanner and the direction of this magnetisation relative to the applied field. Through most of MRI’s roughly 30-year history, susceptibility has usually been associated with the word “artifacts” because the difference in the susceptibility of tissue relative to air and bone (e.g. around the air-filled sinuses in the head) leads to image artifacts such as geometric distortion and signal drop-out. My research focuses on turning to our advantage susceptibilityrelated effects that used to be thought of as a nuisance, to provide an exciting new source of tissue contrast in MRI. Tissue regions with different magnetic susceptibilities change the magnetic field around them. Using MRI, we can measure these local magnetic fields using a sequence of radio-frequency and magnetic field gradient pulses known as a gradient-echo sequence. The local magnetic field is directly proportional to the phase of the complex MRI signal we detect. However, conventional MRI only uses the magnitude of the signal to form images and the valuable phase information is often discarded. Now we are looking closely at these phase images as they are complementary to the standard magnitude images and also have a higher contrast-to-noise ratio, resulting in dramatic improvements in visualisation of human and animal brain anatomy, particularly at high magnetic field strengths. Unfortunately, phase images do have some drawbacks: their contrast varies depending on the orientation of the tissues relative to the direction of the scanner’s main magnetic field and is also non-local, spreading out around any areas of different magnetic susceptibility. To overcome these problems, I have developed techniques to calculate maps of the underlying susceptibility from MRI phase images. These tissue magnetic susceptibility maps overcome the orientation-dependent and non-local contrast found in phase images and more closely represent tissue composition. This is illustrated by the iron-rich deep-bran structures that stand out brightly in the susceptibility maps in the figure but are not visible in the magnitude image. 20 Susceptibility mapping is a rapidly growing research area and new methods for calculating susceptibility maps from phase images are constantly emerging. So what are the applications of this exciting new technique? Susceptibility maps are uniquely sensitive to changes in both the tissue iron content as well as the amount of myelin (the fatty sheath encasing nerve fibres). This means they are very well suited to investigating a variety of neurological diseases associated with accumulation of iron (including Parkinson’s and Alzheimer’s diseases) and loss of myelin (such as Multiple Sclerosis) in different brain regions. I have shown that susceptibility mapping can be used to improve the localisation of target structures for neurosurgical techniques such as deep-brain stimulation. As well as revealing brain structure, susceptibility mapping has just started to be used to investigate brain function in functional MRI (fMRI) studies. These were performed at the high magnetic field strength of 7 Tesla and offer the advantage of detecting dynamic changes in blood-oxygenation that accompany brain activity much more directly than in conventional magnitude-based fMRI. Adam Tyson, an MSci student in my group, has just finished a project testing the feasibility of functional susceptibility mapping at the clinical MRI field strength of 3 Tesla. Moving beyond the brain, my PhD student, Eoin Finnerty, is working to translate susceptibility mapping techniques into the body to reveal the health of other vital organs. He will work to overcome the challenges of acquiring useful phase images in the presence of respiratory motion and large magnetic field non-uniformities found in the body. Magnetic susceptibility is an intrinsic tissue property, so susceptibility maps are easier to interpret than phase images, and have the potential to reveal fine-scale pathology, leading to earlier diagnosis and providing useful clinical biomarkers. UCL Medical Physics and Bioengineering | Newsletter 2013 Image, below: MRI Susceptibility Mapping Reveals Iron-Rich Deep-Brain Structures. Iron-rich deep-brain structures that do not appear in the standard magnitude MR image are clearly visible in the phase image. In the phase image the contrast around the red nuclei (upper arrow) and substantia nigra (lower arrow) varies with direction and spreads outside these structures whereas the locally increased susceptibility inside these structures is clearly visible in the susceptibility map (arrows). These images of a healthy human volunteer were acquired on one of UCL’s 3 Tesla Siemens MRI systems using standard gradient-echo MRI 21 Selected grants 2012–13 22 Sponsor Project Title Total award Investigator European Commission National Physics Laboratory Multi-scale modelling of ultrasound heating effects in bone €140,803 Dr. Bradley Treeby EPSRC Optimising Magnetic Susceptibility Mapping to Enhance MRI of Microbubbles £124,354 Dr. Karin Shmueli EPSRC Medical Imaging Markers of Cancer Initiation £1,016,717 Prof. David Hawkes European Research Council F/SHIP: MOPHIM: Molecular photoacoustic imaging during ultrasound-guided interventions € 1,499,331 Dr. Adrien Desjardins EPSRC Multimodal neuroimaging: novel engineering solutions for clinical applications and assistive technologies £1,233,939 Prof. Clare Elwell EPSRC Wafer Bonder £242,473 Prof. Nick Donaldson EPSRC Exploiting the unique quantitative capabilities offered by simultaneous PET/MRI £614,839 Prof. Seb Ourselin EPSRC Dynamic High Resolution Photoacoustic Tomography system £499,965 Dr. Ben Cox European Research Council FP7: FAMOS: Functional anatomical molecular optical screening € 692,796 Prof. Paul Beard MRC Early thrombolytic intervention in acute stroke by imaging with Electrical Impedance tomography £992,367 Prof. David Holder The Wellcome Trust / Department of Health Smart Laparoscopic Liver Resection: Integrated Image Guidance and Tissue Discrimination £1,069,149 Prof. David Hawkes The Inspire Foundation Development and testing of an ergometer for an experiment in functional recovery £14,095 Prof. Nick Donaldson EPSRC Fast optical tomography for imaging seizure activity in newborn infants £1,077,710 Prof. Jem Hebden The Wellcome Trust / Department of Health Novel Multimodality Imaging Techniques for Neurosurgical Planning and Stereotactic Navigation in Epilepsy Surgery £455,294 Prof. Seb Ourselin The Wellcome Trust / Department of Health SmartTarget: Image-guided Diagnosis and Treatment of Localised Prostate Cancer £757,038 Dr. Dean Barratt NIHR Ketamine augmentation of electroconvulsive therapy to improve outcomes in depression £49,073 Prof. Clare Elwell The Royal Society High-Speed Near-infrared spectroscopy with Hadamard Matrix Encoding £74,595 Dr. Adrien Desjardins Action Medical Research Improved detection of seizure activity in the neonatal and infant brain. £131,150 Prof. Jem Hebden EPSRC Computational Models of neurodegenerative disease progression models £287,819 Prof. Seb Ourselin EPSRC Development and Application of Fibre-Laser Based Excitation Sources for Biomedical Photoacoustic Imaging £391,810 Prof. Paul Beard NIKON X-Ray Phase Contrast Imaging £48,563 Prof. Robert Speller / Dr. Alessandro Olivo MRC EPICure@19- the extremely preterm young adult £191,214 Prof. Seb Ourselin Bill and Melinda Gates Foundation Novel Biomarkers of Nutrition Related Cognitive Development $100,000 Prof. Clare Elwell EPSRC Optical and Acoustic Imaging for Interventional Device Guidance £125,000 Dr. Adrien Desjardins UCL Medical Physics and Bioengineering | Newsletter 2013 PhD award successes Baptiste Allain (28/01/2012) Re-localisation of microscopic lesions in their macroscopic context for surgical instrument guidance. Aaron Oliver-Taylor (28/01/2013) Parallel transmission methods for arterial spin labelling magnetic resonance imaging. Elke Brauer-Krisch (28/06/2012) Experimental dosimetry for Microbeam Radiation Therapy. Kate Ricketts (28/03/2012) Nanoparticles for tumour diagnostics. Adrienne Campbell-Washburn (28/12/2012) Development of MRI methods forexperimental disease models. Raquel Santamarta Vilela (28/01/2012) Development of a washable, nonwoven-based absorbent product from incontinent women. Kylie De Jager (28/12/2012) Knee extension with less hip flexion: biomechanical and evoked EMG analysis during selective surface stimulation of the quadriceps. Magdalena Szafraniec (28/02/2013) Coded Aperture Phase Contrast Tomosynthesis. Juan Fritschy (28/04/2012) Automatic detection of EEG patterns using machine learning techniques. Sangeeta Kumari Maini (28/09/2012) Development of a Breast Tissue Diffraction Analysis System using Energy Dispersive X-ray Diffraction. Manuel Machado Cardoso (28/11/2012) Automated Morphometric Characterization of the Cerebral Cortex for the Developing and Ageing Brain. Thomy Mertzanidou (28/09/2012) Automatic correspondence between 2D and 3D images of the breast. Marc Modat (28/02/2012) Efficient dense non-rigid registration using the free-form deformation framework. 23 UCL Medical Physics and Bioengineering | Newsletter 2013 Prizes AwardS SET for Britain We held our annual student award ceremony on 28 November 2012. Prof John Clifton, our Head of Department from 1962–1992, was again willing to present the undergraduate prize named in his honour. We were also delighted when Prof Clifton later informed us that he wished to permanently endow the prize via a very generous gift. Many congratulations to Joanna Brunker who also received the gold medal at the highly prestigious “SET for Britain” competition, held at the House of Commons on 18 March 2013. The event provides an opportunity for Britain’s most promising scientists and engineers to present their work to MPs. Joanna received the award for her research involving the development of photoacoustic imaging (see page 6) which has the potential to improve our understanding and treatment of tumours. This year we introduced a new award for the PhD student who, in the opinion of our panel of judges, submitted the best paper to a scientific journal during the preceding twelve months. The winner of our inaugural PhD student prize was Joanna Brunker, for her paper: Joanna Brunker and Paul Beard, “Pulsed photoacoustic Doppler flowmetry using time-domain cross-correlation: accuracy, resolution and scalability,” J. Acoust. Soc. Am. 132, 1780-1791 (2012). Suffrage Science The work of Professor Clare Elwell was recognised at the Medical Research Council’s 2013 Suffrage Science Event, which annually honours 12 leading female scientists in the fields of engineering and the physical sciences, as applied to medicine. WINNERS Focus on the Positive Marta Caballero – John Clifton Prize for most outstanding performance by a non-final-year undergraduate. Mathew Elameer – Sidney Russ Prize for the most outstanding performance by a final-year undergraduate. Edwina Peck – Joseph Rotblat Prize for the most outstanding performance by an MSc student. Richard Pearse – IPEM Prize for the best MSc project. Joanna Brunker – PhD Student Prize for the most outstanding publication. We have had two winners of UCL’s Focus on the Positive event, run by the UCL Public Engagement Unit. UCL researchers pitch an idea to an audience of 120 people, who then vote to decide which idea they want to support. Gibril Kallon (a third year undergraduate) proposed a project to develop a simple system using ultraviolet light to detect carcinogenic toxins in crops for use by in farming communities in Sierra Leone. Kate Ricketts (a post-doctoral researcher) won funding for a network for UK radiotherapy professionals to support and train colleagues in Ghana and elsewhere in Western Africa. Athena SWAN Bronze Award The department has recently been awarded an Athena SWAN Bronze Award in recognition of our on-going commitment to promoting good practice in the recruitment and retention of female staff and students at all levels. 24 Gallery A selection of images taken in the department. Copyright © Matt Clayton/ UCL Communications 2013. Newsletter design and photography (inside front cover and page 1) Copyright © UCL Creative Media Services 2013. ConTACTS Department of Medical Physics & Bioengineering University College London Gower Street London WC1E 6BT Web: www.ucl.ac.uk/medphys Tel: 020 7679 0200 Email: medphys.newsletter@ucl.ac.uk Twitter: @UCLMedphys