New technology to improve 20 week ultrasound scan

Dr David Lloyd is a Clinical Research Fellow at King’s College London and has recently joined a multi-disciplinary team all working together on an exciting new project called iFIND.


The last two months have been some of the most interesting and exciting in my career, leaving my clinical post as a doctor in paediatric cardiology to start a PhD and join an exciting and ambitious project called iFIND, based at King’s and funded by the Wellcome Trust and the Engineering and Physical Sciences Research Council. The aim of the project is to produce a fully automated system to replace the 20-week ultrasound scans that are currently routine for all pregnant women in the UK. These scans are performed by experienced, highly trained sonographers, but unfortunately detecting every problem is just not possible – in fact only around half of all congenital abnormalities are picked up in this way.

3D ultrasound
3D ultrasound

So the project is a revolutionary one that could make a huge difference – but then, when you really start to think about it, replacing humans in this process is a pretty daunting task. Can we really make machines that are so dexterous and sensitive that they can perform ultrasound scans on pregnant mothers? What do humans really “see” when we are looking at ultrasound images anyway? Our brains are incredibly adept at recognising and interpreting visual patterns, in ways we don’t yet fully understand – can we really teach a computer to see in the same way as a person? Can we then teach them to recognise what is normal and not normal? Unsurprisingly, the team at iFIND think the answer to all those questions is – or will be – a resounding yes, but there’s still a huge amount of hard work to do to make it all a reality.

And the truth is that there’s very little you’d put beyond the reach of the iFIND team. My last three years working as a doctor looking after children in hospital with congenital heart disease has been a world of non-stop pagers, busy hospital wards and outpatient clinics, so the first few weeks here were a bit of a culture-shock; a whirlwind not just of new faces, but also of new ideas and new technologies. Whether I’m watching over the shoulder of my colleague Alberto wearing his 3D glasses and firing up his new holographic display, or staring blankly at Josh bamboozling me with a discourse on proton spins and the complex physics of MRI, or seeing James and the robotics team demonstrating the motion and pressure sensors that collect the data that will eventually inform the robotic arms that will perform the ultrasound scans. It’s continually inspiring to be working amongst such a motivated, passionate and intelligent group of people.

MRI scan of a fetus
MRI scan of a fetus

Personally, my particular clinical interest is in one of the fastest growing fields within cardiology – fetal cardiology, so the project suits me well. But what difference does it actually make, picking up a heart, limb, lung or brain abnormality in a baby that is not yet born? Actually, this can be extremely beneficial —it gives us the opportunity to spend time with parents and explain exactly what the diagnosis means for their baby; it means we can plan ahead and put everything in place to keep them healthy once they are born; and ultimately it means we can give them the support they need to grow and develop as early as possible. In rare circumstances we can even perform keyhole-type interventional procedures on the fetus if needed.

So my new role has been challenging, eye opening, and ultimately inspiring. Being part of such diverse and dynamic team working on such an important project is a real privilege; not just that sense that we are all working together towards a common goal, but also watching the new technologies that are being created along the way, bringing real benefits to real patients. And perhaps that’s the most inspiring thing of all – seeing the faces on prospective parents as they watch images of their unborn baby for the first time, so generously giving their time to help us make a difference for the families of the future.

This work was supported by the Wellcome Trust and EPSRC, Innovative Engineering for Health Award [102431].

The author acknowledges financial support from the Department of Health via the National Institute for Health Research comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust.


The role of the Institute of Physics and Engineering in Medicine

In this post, Steve Keevil, President of IPEM and Professor of Medical Physics at King’s College London, outlines IPEM’s remit and his role within it. He also highlights how they are engaged in outreach programmes.

Me, as President of IPEM (centre) with the presidents of the International Organisation for Medical Physics and the European Federation of Organisations for Medical Physics

In the summer of 1943, with the world still tearing itself apart and the NHS five years away, a group of hospital physicists met in London and established the Hospital Physicists’ Association (HPA), the world’s first professional organisation for medical physics. Over the years, through a series of changes and mergers, the HPA gave birth to the Institute of Physics and Engineering in Medicine (IPEM), now the professional body for medical physics and clinical engineering in the UK. In 2013, almost 70 years to the day after the formation of the HPA, I became President of IPEM.

So what does IPEM actually do, and what is my role in it? IPEM is a membership organisation, providing a professional ‘home’ for around 4000 people ranging from those with a general interest in the subject who may join as Affiliates to the most senior and experienced practitioners who are Fellows of the Institute. Our members are mainly based in the NHS, with increasing numbers in universities and in industry. A key part of my role is to engage with this disparate membership and make sure their views are represented in all that we do. But IPEM is established as a charity, and exists primarily for the public benefit. As Chair of the Board of Trustees, it is my job to make sure that this is at the forefront in all of IPEM’s activities, and ultimately to hold our CEO and National Office to account for the proper running of the charity.

As the professional body for our sector of the NHS healthcare science workforce, IPEM is heavily involved with NHS and government bodies. As President I sit on any number of committees, and as I write this I am on my way to a meeting with other professional leaders to discuss joint approaches to issues that cut across the whole of healthcare science. We have a leading role in the planning and delivery of training at all levels, and are currently developing standards for the accreditation of medical physics and engineering services in the NHS and beyond.

Delivery of professional development opportunities is another key part of IPEM’s mission. We organise around 20 one-day conferences on a range of topics throughout the year, as well as the annual Medical Physics and Engineering Conference and other events in partnership with allied bodies. All of these events are delivered by volunteer members, supported by the Conference Department within IPEM’s National Office.

IPEM tries to influence national policy by responding to government consultations, through membership of organisations such as the Parliamentary and Scientific Committee (members of the Division who have attended ‘SET for Britain’ at the House of Commons in recent years may have seen me there), and through links with other groups such as the Campaign for Science and Engineering and Sense About Science. A lot of this work is done in partnership with others, for example through the national Clinical Imaging Board, which I currently chair, which brings IPEM together with the radiologist and radiographer professional bodies.

We have a very active outreach programme, with over 50 events a year and central resources available to members who want to promote medical physics and engineering in schools and elsewhere. Recently, IPEM sponsored the Medical Physics Zone of ‘I’m a Scientist, Get Me Out of Here’, won by trainee medical physicist and King’s College London MSc student Glafkos Havariyoun.

On the wider stage, IPEM represents the UK medical physics and engineering community at international level. Next month I will be off to Toronto for the World Congress on Medical Physics and Biomedical Engineering, where a series of meeting will set the direction of our international organisations for the next three years (and King’s colleague Slavik Tabakov will become President of the International Organisation for Medical Physics).

A key objective for me has been to increase academic engagement with IPEM in the light of the rapid development of academic biomedical engineering (in which King’s is playing a major part). Students can now join for free, and postdocs and established academics are eligible for Membership or Fellowship. Chartered Engineer (CEng) and Chartered Scientist (CSci) status are also available to those who qualify. New groups have been established within IPEM to lead on development of our academic programme, and a future within IPEM for the annual Bioengineering Conference and associated activities of the Bioengineering Society is under discusSteve_Keevil_IPEM_KHPsion.

Looking at a photograph of the HPA annual dinner in 1949, it is remarkable how many people around the table had links to what is now King’s Health Partners. King’s and its partners have always been and remain a major focus for leadership in our profession, and I am proud to be a part of that tradition.


Raising my head above the (lab) parapet

Last week was British Science Week and the Division took part in an exhibition in the corridors of St Thomas’ Hospital to highlight the research that we do here. Claire Thornton, Lecturer in KCL Perinatal Brain Injury Group talks about her experience.

Science Week stickers

One of the great things about being a cell biologist is that no two days are the same. At a fundamental level, there are new discoveries to be made and problems to be solved; nothing ever beats that rare moment when you know your experiment has worked unequivocally, your cells actually behaved in the way you predicted and your hypothesis really is true! As you climb the science career ladder further, the lab work becomes balanced by writing papers and grants, giving talks, teaching and supervision, all of which bring more variety (not to mention their own peculiar challenges). But one thing I rarely get a chance to do is present what we do directly to the public. I was able to change that last week, by taking part in a British Science Week exhibition at St Thomas’ Hospital. The exhibition was also a chance for healthcare scientists to showcase their various and diverse fields so we would be in good company.

The research in my lab aims to discover the molecular mechanisms behind brain injury in preterm and term babies. Currently there are no treatments available for preterm brain injury and only one, therapeutic hypothermia, for term brain injury. We believe that understanding these disease mechanisms will enable us to identify targets for which new therapies can be designed. This is obviously a very emotive area so it was with a little trepidation that we planned our exhibition.

Ana getting ready for pipetting

We set up a variety of microscopes to show people the differences in post-mortem brain tissue from babies with no brain injury compared with babies who experienced term brain injury. We also brought with us a fluorescence microscope to look inside live neurons at structures such as nuclei and mitochondria, and the changes that occur in them when a cell death mechanism is triggered. Finally, as we work with such small volumes, we challenged our visitors to have a go at using our pipettes to measure out anything from 1ml down to 1μl (a millionth of a litre)!

Veena explaining what visitors are seeing through the microscope

What a positive experience! Ana, Veena, Ginger and I had lots of interest in our work and some very searching questions about our research. Initially I was concerned that visitors might be put off by the idea of talking about injured babies, but it was exactly the opposite. We seemed to be explaining and answering questions solidly for 4 hours! The overriding opinion we heard was that it was a pity these exhibitions didn’t happen more often, and that there should be some kind of schools roadshow. The adults were as enthusiastic as the children and were very good at getting stuck in! Of the children and young adults I talked to, the majority were considering a career in science, engineering or medicine, and were very keen to interact with all of the exhibits, both on our stand and the others. There were teams from Medical Physics, Cardiovascular and Biomedical Resources showing everything from cardiac ultrasound and 3D printed hearts to wireless robots directed by arm movements and making strawberry DNA.

Me pointing out the coloured neurons

For me, not only was it a reminder about why we do this work, it was also a chance to reconnect with my fundamental awe at the elegance of brain cells and their interconnections.  How these complex cells sense their environment and communicate with each other and how trauma alters their behaviour and triggers their death is something I am happy to work on for a very long time.


My trip to Parliament

Communicating your research to various audiences is a key skill for PhD students and early career researchers. One audience that biomedical engineering PhD student Simone Rivolo wanted to work with was policy makers and taking part in the SET for Britain competition was one way of doing this. Simone was shortlisted from hundreds of applicants to appear in Parliament and this is his take on the experience.

“Dear Simone, you have been selected to present your research at the Houses of Parliament.” Wow..Me? At Parliament? Seriously?

Let’s start from the beginning. How often do you read about how important it is to promote your research? How crucial it is to engage as many people as possible? I am up for it! Following advice from Alice, our Comms Manager, I submitted an application for the competition SET for Britain, which gives early-career scientists the opportunity to present their research to Members of both Houses of Parliament at Westminster, and I have been selected ! Let’s go to Parliament !

First step: buy a suit, shirt and tie, since the average PhD student looks are not much appreciated within Parliament. Done!
Second step: prepare a poster to present your research to MPs. Therefore, make it attractive but most importantly keep it simple. That’s hard, really hard. After a few sessions where my supervisor and I try to explain what we do in our scientific (dry, technical, probably boring) way, and Alice stares at us thinking “what didn’t you understand about keep it simple?”, the poster is ready.

Simone presenting his poster
Me presenting my poster

Here I am, on 9th March 2015 entering Parliament for the first time (and probably the last). It is huge, so many things going on, so many people running around. I slowly find my way to the conference room, hang my poster and nervously wait for the event to start. Will the MPs be interested? What will they ask? Will they find what I do cool?

The first MP walks towards me, looks at the poster and says, “it looks really nice, is it innovative?”. I didn’t expect this question. I smile and guide him through my poster convincing him about the originality of my work. After breaking the ice, everything flows naturally and a lot of MPs are interested in my work. Most of them have a relative or friend who had coronary heart disease (roughly my research topic) and would like to know what I am doing, how we can defeat it, where the research is leading us. That’s so nice, everyone is looking at you like you are The Expert, The Scientist! This doesn’t happen much during my PhD.

The 2 hours of the event quickly finish and I have a little time to enjoy the buffet, with all sorts of food and drinks (not bad being an MP).

It was an amazing experience. It teaches you a lot about how to communicate your research, how to engage people, how to keep their attention. It is so different from a conference. Everyone is relaxed, interested and positive. Nobody tries to put you down.

I strongly recommend everyone to submit next year and enjoy a trip to Parliament!


Uncovering the mechanisms of high blood pressure


Researchers at King’s College London have found a new procedure to diagnose high blood pressure, as recently reported in the journal Hypertension. These findings could help reduce NHS spending on drugs as well as reducing the number of GP visits. The NHS currently spends over £8bn per year on drugs, and a large portion of this is blood pressure lowering drugs.

Cardiovascular disease is the number one cause of death globally: more people die annually from problems with their heart and blood vessels than from any other single cause. Most of these people suffer from high blood pressure, or hypertension. Around 30% of people in England have hypertension but many don’t know it. If left untreated, high blood pressure increases your risk of a heart attack or stroke. The main way of knowing there is a problem is to have your blood pressure measured.

The traditional understanding of hypertension is that is it caused by hyper-constricted muscles surrounding arteries increasing the resistance to flow, pushing blood pressure up. Many hypertension drugs target these muscles, relaxing them to decrease resistance and therefore blood pressure. The most common way to diagnose hypertension is using a cuff on your arm. However this is not completely reliable due to errors from devices we used to measure blood pressure, as well as hypertension masked as normal blood pressure variation. For example if you have cup of coffee or run up some stairs your blood pressure will rise temporarily but will return to your normal resting pressure.

More recently, the contribution from the stiffness of the artery wall has been shown that it perhaps more important impact upon blood pressure.  Pulse wave velocity (PWV) is the measure of the speed at which a pulse travels down the arteries every time the heart beats, and indicates stiffness. There are draw backs with PWV measurement too.  It too varies with varying blood pressure, meaning that this practice hasn’t been picked up by clinicians.

They set out to change the way aortic stiffness is measured such that there is no confounding effects of blood pressure.  While using a pressure sensor on the fingertip and one in a mouthpiece, they measured the PWV variations every heartbeat while subjects perform breathing manoeuvres. From this, they were able to obtain to characterise an individual’s arterial stiffness over a wide range of pressures upon the aorta wall.  Thus they were able to obtain a more complete assessment of the health of the arteries, and discern an individual with truly stiff arteries from a healthy individual, regardless of blood pressure confounding the measurement.

Professor Phil Chowienczyk, Professor of Cardiovascular Clinical Pharmacology who is leading on this study said “We know that there is room for improvement in the diagnosis and treatment of hypertension and this needs to start with a better understanding of what causes high blood pressure, and how to distinguish individuals at risk from those who are not.”

There has been continuing debate to whether the apparent increased stiffness in patients with hypertension is due to increased blood pressure stretching the aorta, making it appear stiff; or whether there has actually been a structural change.

These findings show that they can obtain an individual specific measure of arterial stiffness, and therefore cardiovascular risk. They also showed that arterial stiffening is a result of a structural change of the aorta wall, rather than just higher pressure making the aorta appear stiffer.

Dr Nicholas Gaddum, Clinical Research Fellow in the Division of Imaging Science & Biomedical Engineering at King’s College London added “We need to know if any drugs are truly assisting those who have stiffer aortas, and if not use a measure such as that used in our study to develop effective treatment.”

This research has the potential to reduce the burden on national health costs, improve the early detection of arterial disease in patients, and allow us to assess and develop drugs which focus on aortic stiffness.

Preliminary research was funded by the MRC. The EPSRC are funding the development of this work into a more comprehensive analysis of cardiovascular disease whereby patients can have a personalised assessment of what is causing their high blood pressure.