Interview with PhD student Radiographer Eli Eikefjord, 10.04.2013
Eli was born in Florø and studied at Bergen University College (HiB). She took her Bachelor in
Radiography in 1998, and has been working as Radiographer in Bergen since 2001. Eli finished her
Master in 2005 and started her PhD study in 2012.
Currently, Eli is involved in a research project at Dept. of Radiology: A MedViz platform for MRIbased assessment of kidney function (MedViz project #6). The Phd is primarily financed by Helse-Vest
with the working title “Towards clinical application of MR Renography; Optimization of technical
performance and evaluation of clinical feasibility”. Eli Eikefjord is supervised by Professor Jarle
Rørvik, Dr. Erling Andersen and Professor Arvid Lundervold, and she is part of a wider research group,
managed by professor Rørvik and including Antonella Zanna Munthe-Kaas, Erlend Hodneland, Frank
Zøllner, Arvid Lundervold, Erling Andersen and Erik Hanson.
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What are the primary objectives of your PhD work?
In this project we aim at establishing a high-quality dynamic contrast enhanced (DCE) MR-acquisition
technique giving a precise kinetic modeling for the estimation of the clinical relevant measures of
kidney function. A number of challenges must be solved to achieve this. My aims in this respect are
to address the acquisition design, evaluation of image quality and the assessment of renal functional
parameters and finally the feasibility of the technique for clinical practice.
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What kind of challenges do you meet in your research?
Well, I feel that I work in the forefront of a research area where no other radiographers have been
actively involved before. Another challenge is the methodical framework, where we partly have to
develop our own methods and we also relay on new methods developed by the mathematicians in
the research group. It is a challenge to work multidisciplinary, like we do in the present project, and
also to understand “the language” used in the different disciplines, but it is also very valuable to
learn how other researchers think and to implement their knowledge into my field. Radiography as a
research field is presently limited. I am currently the only radiographer in Helse Bergen who works at
PhD-level, but I get very good support from my colleagues, especially from radiographer Jan Anker
Monssen. I wish to see more radiographers in our research network, which is a triangle network
between physicians, natural scientists and radiographers. It is thus nice to see that the University of
Bergen and Bergen University College educates several new Master students in radiography to
ensure future potential recruitment into research.
Moreover, MR as modality is quite complex when it comes to the choice of sequence parameters and
its impact on image quality. A dynamic examination like MR renography requires effective
compromises between e.g. tissue coverage, spatial-temporal resolution, signal to noise ratio and
contrast-to-noise ratio. Also variation in image quality between subjects represents a challenge. In
some studies we therefore investigate reproducibility on the same patient. To make mathematical
models on physiological processes under the present technical conditions can thus be quite
challenging.
A specific challenge addressed by the research group is that the kidneys are in constant movement
during breathing and is also partly rotating. We have to compromise between fast acquisition with
impaired quality of the signals versus slow acquisition and simultaneously not being able to track the
perfusion and filtration adequately. This trade-off work with modified methods is in progress.
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How many patients do you need to get statistically significant results?
We build our results on n = 10 – 20 per subtask (4 subtasks in total), which is a minimum to fulfill the
statistical needs, but repeated measures on the same patient ensures the data quality. Additionally,
we also compare the data with a so-called “gold” standard, and several healthy volunteers take part
in the study to improve the data quality. Moreover, we apply strict exclusion criteria for the
volunteers because as many as 10-15% of the normal population has Chronic Kidney Disease (CKD).
MR might become an early indicator for this type of disease.
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What is unique about your study compared to other patient studies?
The present study pays strong attention to the choice of acquisition sequences and the quality of the
images. We apply the so-called KWIC sequence which, to our knowledge, never has been applied
before on glomerular filtration rate (GFR) - measurements. The present mathematical models have
neither been applied by others.
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What kind of scanning methods do you apply?
We apply dynamic contrast-enhanced MRI (DCE-MRI) which is based on visualization of the passage
of gadolinium contrast agent through the kidney and subsequent analysis of the contrast
concentration in renal tissue. MR enables calculation of single-kidney glomerular filtration rate.
Other non-enhanced methods will be compared such as diffusion weighted imaging (DWI). It is also
important to minimize the risk-effects of the contrast agent gadolinium per se, especially for patients
with severe renal dysfunction, who are outside our target group.
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Have you achieved any results so far, to be included in your PhD dissertation?
Data collection from part 1 is finished and the analyses are ongoing. We have already published one
paper from this project: "Segmentation-driven image registration- Application to 4D DCE-MRI
recordings of the moving kidneys" (2013) by Erlend Hodneland, Erik A.Hanson, Arvid Lundervold, Jan
Modersitzki og Antonella Munthe-Kaas. The methods for analysis should therefore be in place now.
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What are your further plans for 2013?
I was lucky to receive a travel grant of 50 KNOK from MedIM Research School. This made it possible
for me to visit Medical Physicist, Assoc. Prof. Magnus Båth at Sahlgrenska UH in Gothenbourg to
learn more about the method Visual grading characteristics (VGC) to improve my skills in
interpretation of clinical image quality from MR data, developed there. We have thus extended our
network.
I also recently visited the ISMRM conference in USA and I presented a poster at the Nordic Congress
in Radiology in Bergen in late May. I am also planning to visit other cooperative partners in Germany
and UK to learn more about acquisition and methods.
More specifically related to finalizing my PhD, I will carry out subtask 1 and start the activities under
subtask 2 this year. Subtask 3 including patients will start in 2014.
I would also like to add a final comment that the PhD conference organized by MedIm and all the
other activities organized by MedViz is highly appreciated and very important for the success of
cross-disciplinary and translational projects. Our present project is a good example of convergence
between different disciplines.