Health Service Focus

Developing excellence in clinical lung imaging

A new technology for clinical lung imaging could help Sheffield become a national centre of excellence in the imaging field. NHE’s David Stevenson went to meet Jim Wild, Professor of Magnetic Resonance Physics and NIHR Research Professor in Pulmonary Imaging.

A £7.5m grant has been awarded to the University of Sheffield to expand its development of world-leading clinical lung imaging technology.

For the last 15 years, experts at Sheffield have been developing a state-of-the-art methodology for clinical lung imaging with hyperpolarised gases and proton MRI, which provides detailed images of patients’ lungs without relying on X-ray radiation.

Using the innovative technique, developed by the Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS) project, the team has been able to create highly detailed, functional images of lungs affected by conditions such as smoking, cystic fibrosis, emphysema, pulmonary hypertension and asthma.

The technique of hyperpolarised gas MRI involves a person inhaling small amounts of noble gases (Helium-3 and Xenon-129), which are then imaged inside an MRI scanner. The gases are hyperpolarised using high-power lasers by a process called optical pumping.

The group has also developed specialised gas laser polarisers and custom MRI scanner hardware. These provide high-resolution images not currently available using conventional methods.

Jim Wild, Professor of Magnetic Resonance Physics and NIHR Research Professor in Pulmonary Imaging, who has led the project, told NHE: “The Medical Research Council (MRC) has recognised that we are good at what we’re doing and has invested £7.5m in us to expand our facilities.

“That funding will allow us to do two things. First, to scale-up the facilities here for imaging the lungs with inhaled hyperpolarised gases – Helium-3 and Xenon-129. And, secondly, to build hardware that we can lend to other centres to get them up-to-speed to do similar things that we can do here already.”

The MRC added that the expansion of the gas polarisation facilities enabled by its grant will have many benefits for both Sheffield and collaborating centres, by creating a “national hyperpolarised gas imaging facility for collaborating institutions that don’t have access to this technology”.

NHE interviewed Professor Wild at the university’s Academic Unit of Radiology in the Royal Hallamshire Hospital. He stated that in parallel to the funding, the unit has just been granted a licence for routine clinical referral. “Up until now our work has all been under research but the MHRA has just granted us a special manufacturing licence,” he said.

In recent years, the experts have been working with clinicians inside and outside Sheffield who have referred patients to the city for lung scans.

“We are currently scanning patients from Leicester, Manchester, Dublin, Rotterdam and Cardiff, so for certain scans – where the technology is not accessible locally – we’ve been operating this type of model,” he said.

“This method is a big step away from X-ray, as we can image the lungs. In asthma, for instance, it has helped us look at how things change in the lungs before and after the patient has had their medication.”

Technical barriers

Prof Wild said the team have been working on the engineering and physics of how to image the hyperpolarised gases in the lung. “Now we’re clinically evaluating them as part of this project,” he added.

Technical barriers, such as ease of polarisation of the gases used and the additional hardware required for the MRI scanners, still need to be overcome before this technology can become a more routinely used clinical method.

NHE was told that the continuing methodological research into MRI scanner hardware and image acquisition will ensure the UK leads the world in this important area of diagnostic pulmonary medicine.

Work to automate and streamline the scanner technology is underway. “The major technical hurdle is making it more transferrable to a district general hospital somewhere else. That is part of our challenge as engineers: making it more accessible.”

The university has been working with the ‘big three’ MRI vendors – Philips, GE and Siemens – to develop something that interfaces with those systems.

“Clearly there should be commercial opportunities off the back of this and that is what we’re looking to explore. Some of our technology is patent-pending, but most of it is know-how rather than protected IP,” said Prof Wild.

Asked how long it will take to overcome the technical barriers, he said: “I would like to think that by 2017-18 we’ll have got a network of sites beyond Sheffield working with this methodology.”

After that comes conversations with NICE and discussions about the guidelines, he said. “We can say, ‘here’s an imaging modality that’s proven in a variety of areas, here are the indications of where it is useful and this is how it fits in with the NHS pathway for diagnostic imaging’.”

Prof Wild also hopes the work will help Sheffield become the first national centre of excellence and referral for pulmonary imaging.

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