Investigator demographic data to include:
Principal Investigator:
Professor Savvas Andronikou is a pediatric radiologist and the lead investigator for
the proposed study, based at the Bristol Royal Hospital for Children and the CRIC
Bristol (an MRI research site of the University of Bristol) in the United Kingdom.
He is an experienced pediatric radiologist supported by 3 other experienced pediatric
radiologists, a team of pediatric Emergency medicine physicians and pediatric
pulmonologists working at the Children’s Hospital.
Contact details for Prof. Andronikou:
Personal Address:
Apartment 160
The Crescent
Hannover Quay
Harbourside
BS1 5 JQ
E-mail: docsav@mweb.co.za
Tel: +44 747 0043985
Co-Investigators:
Dr. Jade Thai – Centre Manager CRICBristol and Senior Researcher at the University of Bristol
Dr. David Grier - Clinical lead pediatric radiologist Bristol Royal Hospital for Children
Dr. Stephanie Mackenzie - Pediatric radiologist Bristol Royal Hospital for Children
Dr. Isidora Holjar- Erlic - Pediatric radiologist Bristol Royal Hospital for Children
Professor John Henderson – Pediatric Pulmonologist Bristol Royal Hospital for
Children and University of Bristol
Dr. Mark Lyttle – Paediatric Emergency Medicine Consultant and Senior Research
Fellow, Bristol Royal Hospital for Children
Summary of proposed research plan:
Title:
Feasibility and diagnostic capability of ‘FAST’ MRI for diagnosing pneumonia and its
complications in children
Abstract:
Purpose:
To determine feasibility and acceptability of ‘FAST’ protocol non-anaesthetized
MRI scans of the lung in children with suspected pneumonia and to evaluate quality
of successful scans. To interpret MRI scans for a diagnosis of pneumonia, detecting
associations and features pointing to a causative organism and the detection of
complications.
Methods:
A prospective feasibility study is proposed for imaging children with suspected
pneumonia using ‘FAST’ limited sequence MRI of the lung parenchyma.
Children (<13 years) will be enrolled when referred for chest X-ray for suspected
pneumonia. Participants’ names will be obtained from the PACS during the reporting of
radiographs based on clinical requests. Consecutive patients will be selected until 100
have been recruited. Patients in ICU and those too ill to be moved to MRI will be
excluded. Recruitment will reflect community-acquired pneumonia in ambulant
patients. MRI will be performed only after patients are stabilized clinically and consent
is obtained. Two MRI centers with 3 Tesla Siemens Magnetom Skyra units will
perform sub-ten-minute protocols using axial DWI B500 (post-processed as coronal
inverted images) and coronal STIR sequences without sedation / anaesthesia.
Images will be reviewed by 3 pediatric radiologists blinded to the clinical and
radiographic findings, and each other. A majority consensus of presence, location,
extent and signal of air-space disease; lymphadenopathy; effusion and other
abnormalities will be recorded. Blinded chest radiograph review will be performed at a
separate sitting. The consensus recordings for the two modalities will be compared to
each other. Feasibility of ‘FAST’ MRI for pneumonia will be reported as the number of
completed scans, which will be graded for quality.
Resources and Environment:
Research sites:
a) Bristol Royal Hospital for Children is the regional centre for specialist in-patient
paediatrics in the South West of England (UK). It serves a population of
approximately 6 million. There are 180 beds and the hospital hosts paediatric
oncology, surgery, nephrourology, cardiac services, bone marrow transplantation,
medicine & endocrinology, intensive care, neurosciences, burns, plastics, spinal
surgery and major trauma services on site.
The radiology department is currently staffed by 4 pediatric radiologists who are coresearchers in this study: Prof Savvas Andronikou [P.I.], Dr. David Grier, Dr. Stephanie
Mackenzie, Dr. Isidora Holjar- Erlic. All radiologists are qualified for over 6 years and there
is a combined experience in pediatric imaging of 70 years.
There are trained MRI radiographers / technologists including a specialised pediatric MRI
technologist who is the chief technologist at the Children’s hospital.
The children’s hospital has capacity for additional MRI scans during unbooked periods and
after hours (17h00 – 20h00 daily) as well as weekends.
The Children’s Emergency Department represented by Dr. Mark Lyttle is the main
provider of secondary care for the children of Bristol, and a tertiary Emergency
Department for Bristol and the South West region. It has a well-established research
program with a clinical research nurse team capable of recruiting participants at the
time of presentation to the CED.
b) Clinical Research & Imaging Centre (CRICBristol) is a joint venture between University of
Bristol (UoB) and University Hospital Bristol NHS Foundation Trust (UHBristol). It is a
dedicated research centre located within UHBristol’s St Michaels Maternity Hospital. The
centre was designed and equipped to run clinical research across the life span from neonates
to aged populations. The centre is managed by Dr. Jade Thai, who is the centre manager &
Senior Research Fellow for UoB. Dr Thai has technical MRI expertise and extensive
experience of clinical applications of advanced MR imaging in paediatric populations. The
centre hosts over 59 MRI research projects ranging from fetal/neonate to old age and dementia.
The centre core staff includes a lead Research Radiographer and MR physicists. The Centre’s
facilities also include a 4-room clinical investigation suite and a 2-bedroom sleep laboratory. It
has the support of the UHBristol resuscitation team and the MR suite is equipped with full MR
compatible physiological monitoring and pipeline medical gases.
Bristol Children’s Hospital and CRIC Bristol have identical 3T Siemens MR scanners
and it is proposed to use both for the purposes of the study.
·Major Equipment:
MRI scanners:
Both sites offer state of the art high field strength 3 Tesla Siemens Magnetom Skyra
MRI scanners, which have a large bore and short length especially designed to increase
comfort and compliance for non-sedated children. CRICBristol MRI scanner is 64Channel transmit and receive system with Multi-channel coils for fast parallel imaging
and increased signal to noise. MR sequences with respiratory and cardiac gating to
improve image quality and artifact reduction. The MRI suite is also equipped with
audio visual patient entertainment system .
MR Images obtained for this study will be uploaded to and stored on the UHBristol
PACS (Insignia).
There are seven viewing monitors / reporting stations available within the children’s
hospital for image review.
Both areas have teams, which are experienced in performing imaging on children.
Additional Information:
The MRI scanner in the Children’s Hospital is located adjacent to the theatre
complex, which offers additional clinical support in case of emergency. In addition
the hospital has a response unit for emergencies, which can be contacted
telephonically.
The CRICBristol is supported for emergencies by the resuscitation team of the St
Michaels hospital in which it is situated.
Award Payment Information:
Research and Innovation
University Hospitals Bristol NHS Foundation Trust
Education & Research Centre Level 3
Upper Maudlin Street
Bristol BS2 8AE
Tel:
0117 342 0233
Fax:
0117 342 0239
Grant Administrator Information:
Research and Innovation
University Hospitals Bristol NHS Foundation Trust
Education & Research Centre Level 3
Upper Maudlin Street
Bristol BS2 8AE
Tel:
0117 342 0233
Fax:
0117 342 0239
Co-Investigators:
Dr. Jade Thai – Centre Manager CRICBristol and Senior Research Fellow and Centre Manager
at the University of Bristol
Dr. David Grier MB ChB, MRCP(UK), FRCR- Clinical lead pediatric radiologist Bristol Royal
Hospital for Children
Dr. Stephanie Mackenzie MB ChB, DMRD, FRCR- Pediatric radiologist Bristol Royal
Hospital for Children
Dr. Isidora Holjar- Erlic MD - Pediatric radiologist Bristol Royal Hospital for Children
Professor John Henderson – Pediatric Pulmonologist Bristol Royal Hospital for
Children and University of Bristol
Dr. Mark Lyttle – Paediatric Emergency Medicine Consultant and Senior Research
Fellow, Bristol Royal Hospital for Children