Taking part in a research study: a different perspective

Jenny Cook
Dr Jenny Cook

Dr Jenny Cook is a Research Associate at King’s College London studying the impact of engaging publics with health research.

I am a researcher in Public Engagement for King’ College London and the National Institute for Health Research Biomedical Research Centre, part of my job role is to promote taking part in clinical research to the general population.

So last month I decided to practice what I preach and took part in a research study at the Division of Imaging Sciences and Biomedical Imaging based over at St Thomas Hospital. The study is called the iFind project which stands for intelligent Fetal Imaging and Diagnosis.

The study, funded jointly by the Wellcome Trust and EPSRC aims to improve the accuracy of routine 18-20 week screening in pregnancy, by bringing together advanced ultrasound and magnetic resonance imaging (MRI) techniques, robotics and computer aided diagnostics.

So when I realised I was eligible to take part, for a couple of extra hospital visits, I thought it would be for a good cause!

I had worked previously with the iFind team to engage different audiences with the project as educational and interactive sessions using a pregnant tummy mannequin and the ultrasound machines for the King’s Health Partners Summer School and International Clinical Trials day.

I emailed them for more details and was put in touch with a very friendly Research Midwife who sent me over a patient information pack and some available dates.

I arrived at the Clinical Research Facility on a grey drizzly morning and was met by Josie, a friendly researcher who ran through some final consent and information forms with me. She reassured me about the practical details of the study, like who would be present and how long each part would last.

I went into the Ultrasound room and was met by three people; a research sonographer, one fetal cardiac clinician researcher and another working on the imaging robotics part of the project.

They talked me through the images they were collecting and explained what they meant and why they were important to the study. They also showed me how they can create the 3D images using the new software and at the end printed me out five pictures for me to take home.

Since taking part in iFind, I was also contacted to take part in another study, this time using Magnetic Resonance Imaging (MRI) to look at fetal brain development in the Developing Human Connectome Project. The aim of this study is to map the baby’s brain development before and after birth to understand better how the brain grows and how problems may arise.

This involved coming into St Thomas’s post-natal scanning department and spending about 60 minutes inside a big MRI machine. I have to admit, it was quite noisy and cramped in there, but the imaging team were fantastic and reassuring. I had music in my headphones, plenty of pillows and came out a couple of times for a quick break. After the scan, Laura from the team went through my images with me and showed me a video of my baby moving in my stomach and the different parts of her brain. They also sent me links to the images, so I can keep them.

babyjenny
A saggital view of Jenny’s baby’s brain

The results of these images and scans in the future will contribute to a database of images that will help research. By understanding the potential benefits of using imaging and detecting more problems before birth, they hope to provide better information to parents and their doctors, and allow babies to get access to the treatments they need as soon as possible after they are born.


If you are interested in participating in the iFind project or any other fetal studies please contact: gst-tr.fetalbookings@nhs.net.
For further information on the iFIND study please contact: iFIND@gstt.nhs.uk

Moving scenes

Dr David Lloyd is a Clinical Research Fellow at King’s College London and working as part of the iFIND project. The overall aim of the intelligent Fetal Imaging and Diagnosis project is to combine innovative technologies into a clinical ultrasound system that will lead to a radical change in the way fetal screening is performed.

David
David

One of the most important goals of the iFIND project is to build an “atlas” of the fetus: a comprehensive map of fetal anatomy at around 20 weeks gestation (when routine antenatal scans are performed). This means getting the best quality images that we can, from as many women as we can – but as I’m learning, taking pictures of a 20 week fetus while they’re still in the womb really isn’t that easy.

For one thing, they’re very (very) small. The fetal heart, for example, with all of its tiny chambers and valves, is only about 15mm long: less than the size of penny. Ultrasound technology – used in all routine antenatal scans in the UK – is actually fairly good at visualising these tiny structures. It uses very high frequency sound waves which are reflected back (“echo”) from the structures inside the body to produce an image. In fetal ultrasound, the images produced can be excellent; but unfortunately that’s not true for every patient. Ultrasound has to be able to “see” through the body to the parts of the baby we want to image, and that isn’t always easy. It will depend on the age of the baby, how they are lying in the womb, the size of the mother, and many other factors.

MRI, which uses a strong magnetic field and radio waves to produce images, isn’t so limited. It can see the structures inside the body regardless of whether there’s bone, muscle or fat in the way; and in some cases it can give us even more detailed images than ultrasound. Importantly, it is also one of the few imaging techniques that is safe to use in pregnancy. The problem? MRI isn’t great with small, moving targets – like we see in the fetus.

So that’s why we ask our iFIND volunteers to have both an ultrasound and an MRI scan. By combining the strengths of these two technologies, we hope to get the best of both worlds to produce the most accurate fetal atlas we can.

blue_fetuses
Of course though, even that isn’t quite so simple. Fetal movements – like twisting, rolling, stretching and kicking – are a particularly tricky problem, even when we use both technologies together .

Watch this MRI clip from one of our volunteers. Unfortunately there’s not much you can do when your patient decides to start breakdancing half way through a scan! At least, you’d think there wasn’t… but amazingly even that may not be an insurmountable problem. In the last few months I’ve been involved with some of the work of Bernhard Kainz and his colleagues, who have devised clever algorithms to automatically correct for small fetal movements during MRI and produce usable images.

These techniques show a huge amount of potential, and are an example of how the iFIND project is helping to generate exciting new technologies on its way to the ultimate goal: to improve the way we see developing babies in the womb.

Read previous posts about the iFIND project written by David Lloyd.