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

Making reproducible research as natural as breathing

Peter CharltonPeter Charlton is a PhD student at King’s College London working as part of the Hospital of the Future (HotF) project. The overall aim of the HotF project is to provide early identification of hospital patients who are deteriorating. Peter’s work focuses on using wearable sensors to continuously assess patients’ health.

One of the key aims of the HotF project is to develop a technique to continuously monitor a patient’s “respiratory rate”: how often they breathe. Respiratory rate often changes early in the progression of a deterioration, giving advanced warning of a severe event such as a heart attack. However, it is currently measured by hand by counting the number of times a patient breathes in a set period of time. This approach is time-consuming, inaccurate, and only provides intermittent measurements. The alternative approach which I’m working on is to estimate respiratory rate from a small, unobtrusive, wearable sensor.

Wearable sensors are currently routinely used to monitor heart rate and blood oxygenation levels. It turns out that the signals which provide these measurements are subtly influenced by respiration, as demonstrated below. If these subtle changes can be extracted reliably, then we could monitor respiratory rate “for free”, without the need for any additional sensors. This may provide all-important information on changes in a patient’s health, allowing clinicians to identify deteriorating patients earlier.

PeterCharlton_heartratesignal

The heart rate is clearly visible in this signal since each spike corresponds to a heart beat. The spikes also vary in height with each of the four breaths. These subtle changes can be used to estimate respiratory rate.

So what’s all this got to do with reproducible research? Well, over the past few decades over 100 papers have been written describing methods for estimating respiratory rate electronically from signals that are already monitored by wearable sensors. If you read them (it takes a long time) then you find that hundreds of methods have been described. The key questions are: which method is the best, and is it good enough to use in clinical practice? Answering these questions can be a daunting task given how many different methods there are. Very few of the methods are publicly available, so to answer these questions you’d have to implement each of the methods yourself. Even once you have done this, you’d need to try them out on some data. Collecting this data is no easy task. Altogether, reproducing scientist’s previous work on this problem is quite difficult.

I’m hoping that this won’t be such a problem in the future. We have recently implemented many of the methods, collected a benchmark dataset on which to test the methods, and reported the results. All of this is publicly available. What’s more, you can download it all for free, from the methods, to the data, to the article describing the results. So in a few clicks you can catch up, reproduce our research, and start making progress yourself, even producing methods like this:

PeterCharlton_resp_video_gif_red

Well, nearly … I’ve written a tutorial on the methods, which is due to be published in a textbook soon. This work can be reproduced exactly. Since then we have extended the range of publicly available resources by adding more methods, and the new benchmark dataset. This most recent work can’t be reproduced exactly since we had to make a few changes before making it publicly available. I intend to make future work on this topic fully reproducible so that researchers can build on our work. Who knows, perhaps this will contribute towards earlier identification of deteriorating patients in the future.

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.

Steve_Keevil_IPEM
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.