1UCL MEDICAL PHYSICS AND BIOMEDICAL ENGINEERING

Medical Physics and Biomedical Engineering Annual Newsletter 2016TRANSFORMING TECHNOLOGY INTO HEALTHCARE

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CONTACTS Department of Medical Physics and Biomedical Engineering,University College London, Gower Street, London WC1E 6BT

Web: www.ucl.ac.uk/medphysTel: 020 7679 0200Email: medphys.newsletter@ucl.ac.uk Twitter: @UCLMedphys

Welcome

WELCOME TO THE 2016 EDITION OF THE ANNUAL NEWSLETTER OF THE UCL DEPARTMENT OF MEDICAL PHYSICS AND BIOMEDICAL ENGINEERING.

Once again our newsletter features some of the new and exciting research activity in the department and includes miscellaneous news items which we hope will be of particular interest to former students and staff.

Research topics include advances in radiotherapy for prostate cancer, image-guided neurosurgical treatment of epilepsy, MRI susceptibility mapping for assessment of cancers, and functional electrical stimulation as an aid for patients with spinal cord injury. We also present new research on the modelling and measurement of high-intensity ultrasound fields, the study of the biomineralization of tissues, new methods of monitoring nasal blockage, and exploring security applications of X-ray phase contrast imaging.

We are also delighted to include reports from undergraduate students who visit to the Royal National Orthopaedic Hospital, and from research students who took part in a two-week course involving shadowing doctors at the Royal Free Hospital and National Hospital for Neurology and Neurosurgery. We also hear from some former students who generously contributed to our 2016 medical physics careers event.

Finally, we include an article on the importance of inspiring more children, and particularly girls, towards science and engineering, and another on the history of the Joel Chair of Physics Applied to Medicine.

We hope you enjoy our newsletter. If you have any questions or comments, we would be delighted to hear from you, via medphys.newsletter@ucl.ac.uk.

Jeremy C. Hebden | Head of Department

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Departmental news

CENTRE FOR NEUROIMAGING TECHNIQUES EARLY CAREER INVESTIGATOR Dr Jorge Cardoso was winner of the 2015 Early Career Investigator in Neuroimaging Techniques Award, which is awarded annually by the UCL Centre for Neuroimaging Techniques. His work is based mostly on the concept of information propagation, with an emphasis on the Geodesic Information Flow. Image, on right, presents the thickness of the cortical GM as a colour code, with thinner parts parts of the cortex in purple and thicker in green.

UCL TEACHING AND LEARNING CONFERENCE We were very proud to see the department’s strong showing at the UCL’s 2016 Teaching and Learning conference. There were 10 presentations from members of the department covering diverse topics such as tutoring, peer assessment, distance learning, developing practical sessions with student support and 3D printing. We were pleased to see the excellent teaching delivered in the department be recognised by UCL. The highlight was undoubtedly the keynote speech given by Stecia Fletcher, one of our undergraduates who has worked with us on two teaching internships.

OBITUARY In September 2015 we were shocked and saddened by the sudden death of Jenny Nery, an extraordinarily enthusiastic and hard working member of our administrative team. Jenny joined our department in March 2011 as a Research Administrator, where she played a very significant role in establishing one of the highest annual research incomes per academic of any department at UCL. Jenny was promoted in January 2014 to the role of Project Manager of the department’s Translational Imaging Group and also managed a £10M Wellcome Trust – EPSRC funded project “Guided Instrumentation for Fetal Therapy and Surgery”. As well as being a highly skilful and effective administrator, Jenny had abundant energy and remarkable proactivity. She loved being busy, and was totally committed to UCL and her colleagues. Jenny made immense contributions to the success and sustained growth of the department, and her lively presence is sadly missed by us all.

PROVOST’S TEACHING AWARD Dr Jamie Harle, Director of our MSc programme, was awarded the Provost’s Teaching Award under the “Leadership and Impact” category.

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Departmental news

NEW APPOINTMENTS

Andre Altmann – MRC Medical Bioinformatics Research Fellow Frederik Barkhof – Professor Christos Bergeles – LecturerSergio Bertazzo – LecturerRob Cooper – EPSRC Healthcare Engineering FellowJan Deprest – ProfessorMarco Endrizzi – Royal Academy of Engineering Research Fellow Alexandra Ferrell – Finance ManagerJulian Henty – Teaching FellowAnna Nikopoulou – Teaching and Learning AssistantSeb Ourselin – Director of the UCL Institute of Healthcare Engineering Neha Shah – Staffing OfficerJames Vallerine – Senior Teaching and Learning AdministratorWeng Wong – Business Development Manager

STAFF LEAVING

Vikki Crowe – Moved to the Royal College of Obstetricians and Gynaecologists Jo Pearson – Jo left the department in June 2015 to take up a position with the UCL Department of Computer Science Marta Polancec – Left CMIC/TIG

PROMOTIONS

Adrien Desjardins – Senior LecturerLaura Panagiotaki – Senior Research AssociateMaria Zuluaga Valencia – Senior Research AssociateMaria del Pilar Garcia Souto – Senior Teaching FellowRebecca Yerworth – Senior Teaching Fellow

NATIONAL WOMEN IN ENGINEERING DAY 2015

Professor Clare Elwell spoke at the National Women in Engineering Day 2015, an event packed with inspiring talks, interactive sessions as well as speed-networking sessions with the aim of encouraging and motivating girls and young women to become future engineers.

INAUGURAL LECTURES 16th July 2015 – Professor Ivan Rosenberg gave his Inaugural Lecture titled “RadioAstronomy to RadioTherapy: Chasing high energy particles”. 18th December 2015 – Professor Heather Payne gave her Inaugural Lecture titled “RADARS of the lost particle”.

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Research highlights

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Modelling and measurement of high-intensity ultrasound fields

AUTHORS: BRADLEY TREEBY, ELLY MARTIN AND LOUIS ROBERTSON

Ultrasound is very widely used for medical imaging, and is now increasingly used for the treatment of cancer and other diseases. By focusing very intense ultrasound waves into a small region, tumours are destroyed by rapid heating while surrounding healthy tissue is left unharmed. Currently, focused ultrasound treatments are monitored by real-time imaging rather than planned rigorously in advance, like radiotherapy. Sometimes the treatment fails because the ultrasound beam is distorted by different tissues in the body on its path to the tumour. This means heating may happen in the wrong place, or not at all. This could be avoided by using carefully validated mathematical models to predict the path of the ultrasound in the body.

One of the primary research areas of the UCL Biomedical Ultrasound Group is the development of model-based treatment planning tools for therapeutic uses of ultrasound. This includes a wide variety of activities, including developing new mathematical models that describe how ultrasound waves propagate through the body, developing new numerical methods to solve these equations to minimise the computing resources needed, developing open-source and regulatory compliant software for use by researchers and clinicians, and performing validation measurements under a wide range of conditions.

One area of particular interest is for ultrasound therapies in the brain. The main difficulty in performing these treatments is the presence of the skull, which has very different acoustic properties to the soft tissue and brain. This means the ultrasound waves are distorted as they travel through the skull, which in turn destroys the sharp focus. We have been developing new models that can accurately predict and correct for this distortion based on an anatomical image of the patient. An example is shown on the opposite page (lower image), which illustrates the acoustic pressure inside the skull with and without correction for distortion. The models account for all the wave phenomena that occur inside the skull, including absorption, scattering, and the generation of shear waves.

Another focus of the group is experimental validation to ensure that model predictions are quantitatively accurate.

This is a critical step towards clinical translation of the treatment planning tools. However, this kind of experiment is challenging because as the ultrasound is intended to destroy tissue, it will often destroy measurement equipment as well. We have been working with the Photoacoustic Imaging Group, led by Professor Paul Beard, to develop and apply new measurement techniques that can rapidly map intense ultrasound fields. An example of a model validation experiment for transcranial therapy is shown on the opposite page (top image).

The modelling tools developed by the group are periodically released as part of an open-source toolbox called k-Wave. This toolbox is widely used in both academia and industry, and now has more than 5000 registered users from more than 60 countries. As one example, researchers at the Harvard Medical School are using k-Wave to predict non-thermal ablation in the brain using ultrasound. This research was recently featured on the front cover of the journal Medical Physics.

What is high-intensity focused ultrasound? High-intensity focused ultrasound (HIFU) works by sending a tightly focused beam of ultrasound into the body. At the focus, the ultrasound energy is sufficient to heat the tissue and cause cell death in a very localised region, while the surrounding tissue is not harmed. This is akin to focusing sunlight through a magnifying glass, where only in the focus is the energy high enough to singe an object. HIFU therapies are currently performed under image guidance with real time monitoring to assess which regions of tissue have been destroyed. Almost 90,000 people have now been treated worldwide at a growing number of treatment sites, and research into new treatment applications is increasing. At present, HIFU is most widely used to treat prostate cancer, uterine fibroids, liver cancer, and to relieve pain caused by bone metastases, with fewer side effects than radiotherapy or invasive surgical treatments.

HIFU

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Image, above: Photograph of an experiment used to validate numerical simulations through skull bone. A single element transducer is shown on the left, a 3D printed skull segment in the centre, and a needle hydrophone (used to measure the pressure field) on the right.

Image, below: Predicted pressure field inside the skull from a hemispherical ultrasound array. Without correction for the skull, the ultrasound waves are significantly distorted (left). Using a numerical model, this distortion can be predicted and a correction applied which restores the tight focus required for therapy (right).

Transducer array

Skull

No correction Model-based correction

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The iCycle – cycling for walking after spinal cord injury

AUTHOR: LYNSEY DUFFELL

An injury to the spinal cord causes an interruption or, in some cases, a complete block of the normal messages that pass between the brain and parts of the body. As a result, people living with spinal cord injury (SCI) have limited or no ability to feel or move their affected limbs: SCI is a life-altering condition with currently no known cure. Over the past few decades, our understanding of the central nervous system has improved greatly, and we have seen that it remains plastic, to some extent, even into adulthood. So we now believe there to be a possibility that, by tapping into this neuroplasticity with the right intervention, we may be able to help people with SCI to recover at least some of their lost sensation or mobility. The difficulty is finding the right intervention.

Functional Electrical Stimulation (FES) (see opposite page), has been used since the 1980’s to assist in generating functional movements for people with SCI. While FES training demonstrates clear benefits to health, evidence to show that it can cause neuroplasticity is rather limited. Famously, Christopher Reeve (‘Superman’) did regain some sensation and movement of his limbs after several months of FES (see opposite page) – some evidence of neuroplasticity. Based on this and other case studies, we are now exploring the possibility that FES should be combined with voluntary drive (“concentration”) and appropriate feedback of successful movements, in order to bring about neuroplasticity.

The iCycle was the brain child of Prof Nick Donaldson, head of the Implanted Devices Group (IDG) in Medical Physics and Biomedical Engineering, and Prof Jane Burridge (University of Southampton). It is based on FES cycling, but additionally encourages voluntary drive by providing real-time virtual reality feedback to the participant. Usually, when training with FES, it is almost impossible to differentiate movements that are due to the FES, and those that are due to voluntary intent. The iCycle solves this problem by only providing FES on alternate revolutions, which allows us to separately measure the forces generated by the cyclist’s intent to cycle (voluntary drive) from those generated by the FES. Movements due to voluntary drive only are fed back to the virtual reality software, to provide motivating feedback to the cyclist.

The iCycle has been developed over the past 5 years, partly in student projects, and we now have a clinical trial running at the Royal National Orthopaedic Hospital (RNOH) in Stanmore. Six people with incomplete SCI and their physiotherapists initially trialled version 1 of the bike, with support from the engineering team, and provided feedback. Based on this, the bike was modified to produce version 2, and a small training study was initiated. So far, three people have completed a 4-week training programme using the iCycle, and we are continuing to recruit people to take part. To understand whether neuroplasticity has taken place, we are assessing each participant’s level of sensory and motor impairment, and their ability to carry out functional tasks such as walking before and after the training. In addition, we are using a technique called Transcranial Magnetic Stimulation (TMS), which allows us to assess the integrity of the neural pathways between the brain and the muscles before and after training. So far, the results look promising.

The cyclists report enjoying their training, and that the virtual reality provides an element of competition to their sessions which substantially impacts their voluntary drive. They have also anecdotally reported small changes in their abilities to carry out day-to-day functional tasks during and after the training programme; these small changes can have a huge impact on their quality of life. Our long-term target is for neuroplasticity after iCycle training to result in improvements in walking but, to achieve this, more work is required: now we have a recovery tool to begin to explore the neuroscience of recovery after SCI, we can use this knowledge to optimise the engineering and to achieve even greater results.

Two computer generated images, top, opposite page: Virtual reality feedback provided by the Tacx software, based on the voluntary drive of the cyclist. The cyclist is able to race against his or her own previous performance or against other cyclists previous performances.

Lower image, opposite page: A cyclist carrying out a training session on the iCycle (Version 2) with FES. Virtual reality feedback is being provided on a large screen in front of the cyclist.

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What is Functional Electrical Stimulation?

Functional Electrical Stimulation (FES) is a technique that uses electrical currents to activate specific paralysed or impaired muscles in a pre-determined pattern to achieve a desired motion. FES has been used for standing, walking, cycling, rowing and, in the upper limbs, reaching and grasping. Typically it is used in patients that have experienced neurological damage after a stroke or spinal cord injury to allow them to carry out functional tasks that they may otherwise be unable to achieve.

Five years after his injury, Christopher Reeve discovered that he could move his left index finger. Later, Dr McDonald asks him to try to move another digit in that hand. “I decided that my thumb might be the most likely candidate so I focused all my attention on it, trying to make the connection that I had established with my index finger. After a few moments of concentration I silently ordered my thumb to move. It did. First there was a flicker, and then with repetition the movement became increasingly obvious.”

Nothing is impossible, Christopher Reeve, Century Books, London, 2002, page 120.

FES

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“Why measure a blocked nose?”

AUTHORS: TERENCE LEUNG, CHIA-HUNG LI AND PETER ANDREWS

Nasal blockage is a common condition which could indicate a range of pathologies from the common cold, nasal valve collapse to malignancy. In this interdisciplinary project, clinicians and engineers, including senior managers at Integrated Technologies Ltd (ITL) have teamed up to develop a new clinical device to monitor nasal blockage. To understand the requirements of such a device from the clinical community, a survey has been carried out and some interesting results have emerged.

The growing importance of evidence based medicine has led to the increasing need to use objective methods to assess nasal blockage. Currently, there are a number of well-established objective methods at the disposal of rhinologists. For example, the peak nasal inspiratory flowmeter can measure the airflow rate during maximum nasal inhalation, while the rhinomanometer can calculate the nasal airflow resistance based on the measurement of nasal airflow and nasopharyngeal pressure.

To gain an insight into the experiences of rhinologists in using these objective methods, we carried out a clinical survey at the 15th British Academic Conference on Otolaryngology held between 8th and 10th July 2015 in Liverpool. A six page questionnaire entitled “Survey of Current Practice in the Assessment of Nasal Patency” was designed to gather data on types of objective methods used, and how they were used to (i) diagnose nasal obstruction, (ii) screen patients for corrective surgery, (iii) evaluate surgical results, and (iv) educate patients.

A total of 78 attendees of the conference participated in the survey, including 40 consultants, 24 trainee clinicians and other healthcare professionals. One interesting finding from this survey was that although these objective methods could provide quantifiable measurements for nasal blockage, most clinicians did not routinely use these methods, largely because these devices were not even available to them. Instead, they relied on clinical history and physical examination to inform clinical judgement. They also cited accuracy and ease of operation as amongst the most important characteristics for an objective method; and that better correlation with subjective measures reported by the patients, and the ability to assess both nostrils separately but also simultaneously, would most improve upon the existing methods.

The results from the survey have provided a set of guiding principles for us to develop a new nasal blockage monitoring device which would meet the real needs of clinicians and patients. The details of the survey have been submitted to a rhinology journal. We have recently started a clinical study (adopted by The NIHR Clinical Research Network Portfolio) to test a prototype device in the Royal National Throat, Nose and Ear Hospital. This project is supported by the EPSRC and ITL through a CASE PhD studentship.

Image, above: Peak nasal inspiratory flowmeter as demonstrated by Lawrence Nip, an iBSc student (2014-15), who worked with the team in his 3rd year project.

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Medical Imaging miniMD

AUTHORS: LU AN, ANN ZAMIR, EMMA BIONDETTI AND ELIZA ORASANU

In June 2015 four PhD students from the department took part in the Medical Imaging miniMD, a two week course in collaboration with UCL School of Life and Medical Sciences, which aims to give non-clinical scientists an insight into translational research and clinical medicine through shadowing doctors at the Royal Free Hospital and National Hospital for Neurology and Neurosurgery (NHNN).

At the NHNN we were able to observe multi-disciplinary team meetings (MDTs) led by radiologists who shared their expertise in the interpretation of patient images with the clinicians responsible for the patients’ care. We saw many different imaging modalities and techniques used for a range of diseases and medical disciplines including neurology, neurovascular conditions and dementia. This gave a comprehensive overview of the status quo in routine medical imaging and insight into how our own research may fit into this landscape.

Though individual patients were discussed for up to ten minutes in MDTs, the majority of images do not require MDT discussion and are reported on by radiologists, who summarise their interpretation of the image for other clinicians to read. This brought into light the time frame available for radiologists to analyse images and was in stark contrast to the time that we, as student researchers, might dedicate to analysing a single image.

Sitting in on a Multiple Sclerosis Clinic brought us closer to the patient experience and enabled us to appreciate how images we had seen discussed, play a role in patients with lifelong conditions as a tool not just to diagnose, but to monitor progression and response to treatment.

At the Royal Free Hospital a visit to vascular studies allowed us to observe ultrasound in action, which was appreciably different from the diagnostic images we had observed at the NHNN in that images are viewed and analysed in real-time in the presence of the patient.

We also had the opportunity to be present in the procedure room during interventional radiology procedures which not only highlighted a number of open research problems (such as the need for minimization of the dose to both the patient and medical staff during procedures such as angioplasty), but also allowed us to appreciate a more complete patient pathway.

Lu An, whose research looks at quantitative photoacoustic imaging, said that “One of the best things was that we could follow the procedures from diagnoses of the patients to recovery”.

Overall, the miniMD was a fantastic experience which gave a comprehensive overview of patient pathways and the everyday use of medical images in the clinical setting which we can take back to our research. Emma Biondetti, whose PhD looks at optimising the MRI technique Susceptibility Mapping to image brain Arteriovenous Malformations said of our experience: “I strongly valued the opportunity of getting in touch with clinicians and patients, and I would recommend a similar experience to anyone developing their research in medical imaging.”

Image, below: Preparing for the operating theatre.

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X-RAY PHASE

Improving baggage scanning for explosives detection via X-ray phase contrast imaging

AUTHORS: ALBERTO ASTOLFO ON BEHALF OF THE X-RAY PHASE CONTRAST IMAGING GROUP

X-ray phase contrast imaging (XPCI) is an innovative technique that exploits the phase information carried by X-rays. Compared to conventional radiology, which relies only on X-ray attenuation, XPCI has the potential to enhance the contrast of details that would be otherwise invisible. In addition to attenuation contrast, XPCI techniques provide high sensitivity to the object borders, thanks to the refraction taking place at interfaces, and its microstructure (dark-field contrast). The applications of these new capabilities are potentially endless, however there are a few technical limitations that so far prevented the translation of XPCI into the market. First, a limited field of view (FOV), up to now typically of a few square centimetres; second, the difficulties related to the fabrication of the required optical elements, and third the high stability requirements.

In this challenging context, the UCL XPCI group is making significant progress towards solving all these issues. The technique developed by the group, called Edge Illumination (EI), has significant advantages over alternative approaches because it uses simpler optical elements, which translates into easier fabrication, less stringent stability requirements, and larger FOV.

In collaboration with Nikon Metrology (Tring, Hertfordshire), the group is building a large FOV demonstrator which combines all the advantages of EI and applies them to the field of explosive detection. This project is funded under the Innovative Research Call in Explosives and Weapons Detection 2013 initiative. This is a Cross-Government programme sponsored by a number of Departments and Agencies under the UK Government’s CONTEST strategy in partnership with the US Department of Homeland Security, Science and Technology Directorate.

X-ray baggage scanners, which we usually see at airports, exploit the capability of X-rays to ‘see through’ our bags. The operator can recognize objects through their shape, and obtain some clue on their compositions through their X-ray attenuation properties, typically by using multiple X-ray energies. For thin material, new techniques that further improve the current capability are beneficial. Another potentially challenging situation is that some prohibited items can have similar

attenuation properties as other non-threat materials which results in false alarms. In both these cases, EI could be a game changer. Refraction and dark-field signals from low absorbing details can be detected at high energy even behind highly absorbing objects. Moreover, the dark-field signal can provide a characteristic fingerprint for plastic explosives. Since these new channels of information are provided together with the conventional attenuation contrast, EI has significant potential to further improve the sensitivity and specificity of X-ray baggage scanners.

The first stand-alone demonstrator system has been already assembled at the Nikon Metrology laboratories. It provides the largest FOV ever realised in an XPCI system (up to 50 cm in the scanning direction). The system is currently under commissioning, after which a series of representative threat situations will be tested. Once built, the scanner will be used for proof-of-concept testing in other areas (e.g. low-dose XPCI mammography), paving the way for further developments of the technique in medical applications and beyond.

What is X-ray Phase Contrast?

X-ray Phase Contrast is an innovative X-ray imaging technique which goes beyond the X-ray attenuation used in conventional radiology. It is sensitive to small changes in X-ray phase, which are effectively variations in X-ray speed inside the imaged object. Phase contrast is almost invariably much stronger than attenuation contrast. It provides excellent detail detectability in situations where attenuation is not sufficient, for example on low absorbing materials or very thin features. Phase contrast does not require X-rays to stop in matter to create contrast, hence in principle it does not require dose deposition, which suggests it as the right tool for in-vivo medical imaging.

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Image, above: The cabinet containing the system. Images, below: White board marker scanned at the system which provide three images: attenuation, refraction and dark-field.

Image, above: The setup with (from top to bottom): the pre-sample mask, the sample translator, the detector mask and the detector.

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Joel Chair of Physics Applied to Medicine

AUTHOR: ROBERT SPELLER

The story goes back to 1745 when the Middlesex Infirmary was established in two houses in Windmill Street close to Tottenham Court Road. In 1792, Mr S Whitbread, the then current surgeon at the Middlesex Infirmary, decided to provide the first cancer wards for the reception of sufferers of the disease, where, in the founder’s happy phrase, they could remain until “relieved by art or released by death”. Approximately forty years later, six members of the medical staff of the Middlesex Hospital petitioned the Board of the Hospital to start a Medical school and in 1835 the first medical students were admitted. Appointments were made in surgery, medicine, midwifery, anatomy & physiology, therapeutics, chemistry, forensic medicine and botany.

In the years 1895 and 1896 two discoveries took place that had a major impact on medicine and the world at large. These were the discoveries of X-rays and of radioactivity respectively. These discoveries were quickly picked up by the medical community including those clinicians working at the Middlesex Hospital. In fact the first X-ray source was purchased by the hospital secretary in March 1896 (reputedly costing £12) and hence the ‘Electrical Department’ was established. The use of ionising radiation, particularly radioactive isotopes, for treatment of disease rapidly expanded and by 1913 a large stock of radium had been acquired. At a hospital board meeting the application and security of the radium stock was discussed and it was decided to create an appointment to the hospital of a physicist to look after the radium. This is believed to be the first UK hospital physicist and it was Sydney Russ who held this appointment.

Apart from the developments in the Middlesex Hospital and in science in the latter half of the 19th century there were other developments taking place around the world. One of these rapidly evolving industries was to make a major impact on the Middlesex Hospital and its research into cancer. In 1850 and 1851 two brothers were born in the East End of London. These two boys, Henry and Barney Barnato were born into a family that was working hard but with little prospect of improving its position in society. With this in mind the boys decided to try their fortunes in the rapidly expanding diamond fields of South Africa. Hence at the age of 21 they moved to South Africa and became diamond traders. Initially they would purchase small

low value diamonds and sell them at a profit. Any money they made was used to purchase claims on discontinued workings. These were workings that had been abandoned after the ‘easy’ diamonds had been found. However, Harry and Barney thought they could still hold large deposits if only the harder rocks that caused them to be abandoned could be mined. This they did and made a fortune. During this period they brought over from London three of their uncles (Solly, Jack and Wolf Joel) to help with expanding their diamond mining company and just 17 years after Harry and Barney had arrived in South Africa, in 1888, they sold out to DeBeers for £5.3M! They continued to develop a gold mining business in South Africa but they made frequent visits back to England. All five of these family members led ‘interesting’ lives. Barney committed suicide in 1897 by jumping over the side of a ship. Solly, who was with him on the trip, was initially accused of murder but was eventually cleared. Jack, whilst in South Africa, was arrested for illegal dealings in diamonds, jumped bail and came back to England where he, and brother Solly became race horse owners. They won the Irish National, the Grand National and other races many times. Wolf successfully raced Bentley motor cars and was one of the ‘Bentley Boys’ but was eventually shot on his return to South Africa in 1898.

His death was not without incident. Some months before his death he was in London and he organised a dinner at the Savoy Hotel for thirteen of his friends. On the day of the dinner one could not attend and so only 13 people sat down for dinner. The staff at the Savoy said this was unlucky but Solly took no notice. At the end of the dinner, he rose to leave and one of the guests told him he should stay because the first to leave would die early. Solly laughed this off, left the Savoy and the following day returned to South Africa. He was shot three days later. The Savoy Hotel now has a tradition that if 13 sit down for dinner, Kasper, a model cat, is brought in to join them to make up the number to 14!

Henry died in 1908 in London and left an estate worth in excess of £5M. In 1910 the trustees of the estate left £250,000 to the Middlesex Hospital and Medical School and with this money the Barnato-Joel Cancer research facilities were expanded with new laboratories. In 1920 part of the Barnato-Joel bequest was used to endow the Joel Chair in Physics Applied to Medicine. This was the first chair in Physics Applied to Medicine in the world and Sydney Russ was appointed to this newly established position in the Middlesex Hospital Medical School. Since then the appointees have been Eric Roberts, James Tait FRS, John Clifton, Roger Ordidge and the current holder is Robert Speller.

To celebrate the chair, a new lecture series, The Joel Lectures, was started in June 2012. The first Joel Lecture was delivered by Professor Steve Webb. This is an annual event.

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Image, above: Professor Robert Speller presents the 2012 Annual Joel Lecture with a presentation titled ‘Can nuclear particle therapy fill a gap?’

JOEL LECTURE

What is the Annual Joel Lecture?

The Joel Professor of Physics Applied to Medicine was the first chair of its kind worldwide. Prof. Sidney Russ was the first holder at UCL in the 1920s. The current chair, Prof. Robert Speller, now hosts an annual event in London to celebrate the role of medical physics in promoting global advances in healthcare. Each year, a distinguished member of the Medical Physics community is asked to review developments in their specialism to a layman audience.

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MRI Susceptibility Mapping in cancer research

AUTHOR: ANITA KARSA

Susceptibility Mapping (SM) is a technique that uses Magnetic Resonance Imaging (MRI) to produce a map of the magnetic susceptibility in the brain or body. An MRI scan outputs two independent images containing complementary information: a magnitude image which is usually used in clinical applications, originating from a combination of proton density and tissue relaxation times, and a phase image which is usually discarded. The phase image obtained from a gradient echo MRI scan is proportional to the local magnetic field variations induced by the heterogeneous spatial distribution of susceptibility. This means that a map of the tissue magnetic susceptibility can be calculated from the MRI phase image.

I am part of the MRI group, led by Dr Karin Shmueli, where we are developing and optimising SM techniques for a range of clinical applications. My project focuses on head and neck squamous cell carcinoma (HNSCC), one of the most common cancers worldwide. Many of these tumours are hypoxic, meaning that they have low oxygenation levels. Hypoxic sites respond poorly to radiation therapy as the lack of oxygen induces radiation resistance. Therefore, measuring the oxygenation level in tumours is clinically important in predicting tumour responses to treatment. However, there is currently no non-invasive way in standard clinical practice to identify hypoxic tumours. SM is a promising candidate for measuring tissue oxygenation as a high deoxyhemoglobin concentration in tumour vasculature could indicate hypoxia, and deoxyhemoglobin is paramagnetic. Therefore, we expect to detect an increased susceptibility in hypoxic tumours.

One of the aims of my PhD is to produce clinically applicable susceptibility maps of the head and neck. SM in this region is particularly challenging due to motion artefacts around the mandible, and large unwanted magnetic field variations induced by tissue/air interfaces (around the nasal sinuses and oral cavity) which superimpose onto the interesting smaller field variations from the internal tissue structures. My aim is to apply several existing SM techniques as well as developing some of my own in order to overcome these problems. I have also performed extensive simulations to estimate the optimal resolution and field-of-view of the MRI acquisition necessary for accurate susceptibility maps.

Many different constituents, from calcium and iron to deoxyhaemoglobin and beyond, can change the susceptibility of tissue so susceptibility mapping has the potential to reveal a wide variety of pathologies or tissue changes. Please do contact us at k.shmueli@ucl.ac.uk if you think tissue magnetic susceptibility mapping might be useful in your research.

What is magnetic susceptibility?

Magnetic susceptibility is an intrinsic property of a material which relates the applied magnetic field to the resulting, induced magnetic field within the object. It determines whether the material is magnetised in alignment with or opposite to the applied field as well as the extent of the magnetisation. In Magnetic Resonance Imaging (MRI), heterogeneous susceptibility (e.g. tissue/air interfaces) is often detrimental to image quality as the resulting field variations cause geometric distortion or signal loss in the tissue. However, the inherent tissue magnetic susceptibility distribution can also be recovered from the images by a technique called Magnetic Susceptibility Mapping making it possible to identify diamagnetic (negative susceptibility) or paramagnetic (positive susceptibility) structures such as calcifications or iron deposits respectively.

MAGNETICSUSCEPTIBILTY

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Image, above: MRI Susceptibility Mapping of the head and neck. Magnitude and phase images acquired in a healthy volunteer as well as the corresponding susceptibility map. The vein indicated by the orange arrows barely appears in the magnitude image, but becomes visible in the susceptibility map with high contrast.

Magnitude image Phase Image Susceptibility Map

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Seeding STEM at the roots

AUTHOR: JOANNA BRUNKER

As a female physicist, statistics appear to suggest that the prospects for academic progression are not in my favour. Although the current proportion of females on undergraduate programmes in the UCL Department of Medical Physics and Biomedical Engineering is 51% (impressive since the degree programmes require A level physics, and only about 20% of A level physics students are female) this proportion drops steadily up the academic ladder from first degree to a fully-fledged academic member of staff. Sadly only one in six permanent academics in the department are female (although the total number has doubled in the past 18 months). Similar trends are replicated in science and engineering departments across the UK and beyond.

There are various reasons for the observed trend. One of these is the fact that the numbers and proportions of female undergraduate students have increased over the last decade (as shown in Figure 1), and it will take some years for this increase to filter through the pipeline.

There are collective attempts to address the gender imbalance through schemes such as those conducted under the Athena SWAN Charter, which was established in 2005 to “encourage and recognise commitment to advancing the careers of women in science, technology, engineering, maths and medicine (STEM) employment in higher education and research.” Our department was awarded a Bronze Athena SWAN award in 2012.

Figure, above: The dramatic increase in numbers and proportions of female undergraduate students in the UCL Department of Medical Physics and Biomedical Engineering over nine academic years.

A more effective approach towards addressing the male-female scientist imbalance may be to make a concerted effort to target the problem at a younger age. There is evidence that girls and boys demonstrate equivalent ability and enthusiasm for STEM subjects during early childhood, but many of the girls drop out as they progress to higher school years. Various new initiatives, such as STEMgrowth and the National STEM Clubs Programme, aim to encourage children into science; if hooked at an early age, they will be less likely to succumb to external pressures causing them to drop out later on.

We as qualified researchers at a prestigious institution have a responsibility to channel our efforts in a way that will benefit the future generations. In particular, we should target schools and parents who do not have knowledge, funds and resources to provide children with sufficient stimulus in STEM (and other) subjects. By encouraging natural childhood inquisition, we may be able to access a vast untapped resource of scientific brilliance in boys and girls alike. Regardless of where my career path takes me, I hope I can continue to help fight the battle that will prevent us losing the next Einstein – or Einstein-ess.

Where can I find information about STEM?

There are several organisations designed to inspire children from an early age to pursue subjects in Science, Technology, Engineering and Mathematics (STEM). These include: STEM growth (www.stemgrowth.co.uk) National STEM Clubs Programme (www.stemclubs.net) The Brilliant Club (www.thebrilliantclub.org) For more information, and resources: Departmental website: www.ucl.ac.uk/medphys/ dept/schools UCL Outreach: www.ucl.ac.uk/prospective-students/widening-participation Institute of Physics and Engineering in Medicine: www.ipem.ac.uk/CareersTraining/ OutreachSupport.aspx STEMnet ambassadors scheme: www.stemnet.org.uk STEM Directories: www.stemdirectories.org.uk http://stem-works.com/ www.stem.org.uk/resources

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Clinical engineering visit to Royal National Orthopaedic Hospital

AUTHORS: NISHAT AHMED AND BINDIA VENUGOPAL

On Wednesday the 11th of November, we visited the Royal National Orthopaedic Hospital in Stanmore. After missing trains due to tube closures and our taxi rides arriving a half hour late, we finally managed to reach the hospital in time to attend the Multi-Disciplinary Team meeting.

We found the meeting very interesting, watching the consultant surgeons and nurses discuss real case studies of patients. They collaborated well to work out the best way to rehabilitate patients, whether this was through further surgery or simply giving them advice and support.

Later on we headed to the operation theatres. Adhering to hospital dress code we put on our scrubs, hair nets and masks beforehand. Since we were only allowed three students at a time in the theatres, we split into groups and then went off to watch various operations taking place. The first surgery we watched involved attaching a metal plate to a fractured tibia bone to aid its healing process. It was fascinating watching the surgeon screw the bone together and then brace the join with a metal plate. The screws held the fracture under compression, this meant it was forced to combine together rather than slide apart, and the metal plate stopped it from twisting.

The second surgery we went to was an extremely rare case where the surgeons ended up dislocating the hip bone in order to remove a benign tumour from inside the bone. They sawed the hip bone in half as bone-to-bone healing worked best compared to tendon-to-bone healing. The challenge was in trying to avoid damaging the femoral head to get to the tumour.

After this we had a tea break and then made our way to our next surgery. This was a spinal surgery where the patient had a twisted spine due to being paralysed for 10 years. They operated with a diathermy machine which uses electricity to cut through the skin and muscles as this reduces blood loss. Although we only saw the surgery for 10 minutes we learnt how vital it was to keep the fluids in the patient regulated. This job was monitored by the anaesthetist, who informed us about the patient and the precautions which needed to be taken. Two neurophysiologists were monitoring electrical activity in the spinal cord to ensure that it wasn’t damaged by the surgery.

After watching all the surgeries, we went to have lunch which was provided by the lovely team at Stanmore. In the afternoon we got a tour around the BME department at the hospital and learnt about all the weird and wonderful things they collect and experiments they run. In fact, we found out that they have over 6000 failed hip replacements from 25 different countries in their labs to study and analyse. They conduct experiments to research why implant failure happens in some patients the way it does, especially those with metal on metal implants. They use tools for metrology which accurately measure the exact size of the ball and socket implants.This information is then used to work out the amount of corrosion that happened in the body when the implants were inserted.

Overall, we had an amazing and truly valuable experience. The entire team were extremely friendly and helpful. We loved that we could ask questions and interact with the staff so well. It was remarkable to see the transition from a real-life patient problem to actually seeing the solution executed in the surgeries. It was also encouraging to see how the hospital carries out their own research which can then be implemented to the surgery procedures in only a few years’ time.

On behalf of our whole BME department, we thank you for this experience Professor Hart and RNOH!

Image, below: Ready for the visit.

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Developing Image-guided Neurosurgery for Epilepsy

AUTHOR: KATIE KONYN

A project developing image-guided neurosurgical treatment of epilepsy has received fresh funding from the Wellcome Trust Health Innovation Challenge Fund. The Epilepsy Navigator (EpiNavTM) is an interactive neuronavigation system being developed between researchers from the Translational Imaging Group, the Department of Clinical and Experimental Epilepsy (Institute of Neurology) and the National Hospital for Neurology and Neurosurgery, to assist in planning and guiding surgical interventions for individuals with epilepsy.

The programme was launched in 2012 with a Health Innovation Challenge Award (funded by Wellcome Trust and the Department of Health) and continues over the next 4 years with a grant from the Health Innovation Challenge Fund (funded by Wellcome Trust) awarded to Professor John Duncan, Professor Sebastien Ourselin and colleagues.

One-third of individuals with focal epilepsy continue to have seizures despite optimal medical management. These patients are potentially curable with surgery if the brain region responsible for seizure generation can be identified and resected. This needs to

be balanced by the risk of causing new deficits, such as paralysis or impaired speech. Improved diagnostic methods and surgical precision will improve the benefit/risk ratio of epilepsy surgery, and will increase treatment availability.

Stereo-electroencephalography is used to record epileptic activity through intracerebral depth electrodes to identify the region of the brain responsible for seizure generation. Precise planning of electrode placements is essential. The clinical team must achieve effective coverage of brain areas implicated in the causation of the epilepsy, eloquent areas subserving functions such as speech and motor control, and ensure safe electrode trajectories that will not cause a haemorrhage from damaging arteries or veins in the brain. Commonly 10-16 electrodes will be placed into the brain which requires highly skilled neurosurgery to do so accurately. Epileptic seizures are then recorded over several days. Having determined the part of the brain giving rise to the epileptic seizures, surgical resection is then planned, to give the best possible chance of a cure, and with minimum risk of causing a new deficit.

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The EpiNavTM platform combines information from an array of imaging technologies including MRI (for brain structure, blood vessels, white matter tracts), fMRI (for speech and motor function) and PET to provide an integrated 3D image of multiple brain structures and functions in order to assist in accurate surgical planning and electrode placement. The EpiNavTM software is custom-designed for multimodality image integration, advanced 3D visualisation and epilepsy surgery planning, and runs on the NifTK platform14, a translational imaging platform that combines NiftyReg, NiftySeg and NiftyView. The emphasis is on ease of use in a clinical scenario, allowing real time use of software by clinicians, and rapid incorporation into the clinical pipeline.

The goal of the new grant is to establish a single software platform to manage the entire clinical work flow for epilepsy surgery. Toward this end new software is currently being developed to provide analysis of EEG signals obtained from Stereo-EEG electrodes and plan curative brain resections. In parallel, the use of robotic guidance, which would be controlled by the output of EpiNavTM, will increase the accuracy and speed of electrode placement. To date, EpiNavTM has enabled neurosurgeons to plan the best operative approach for inserting electrodes and surgical resections. Clinical trials are currently taking place at the National Hospital for Neurology and Neurosurgery and the software is being deployed to beta testing sites throughout the EU. All development is undertaken in collaboration with Medtronic to ensure compatibility with the Medtronic StealthStation in the operating theatre, and to facilitate subsequent global dissemination.

At present, half of patients considered for epilepsy surgery do not proceed as the risk/benefit ratio is not favourable. By combining the research strengths from both departments it is hoped the number of patients suitable for curative treatment can be significantly increased. It is also anticipated that the new technology will be applied to other areas of neurosurgery, such as tumour biopsies or removals, and delivery of focal treatments anywhere in the brain.

Image, above: Screenshot of the EpiNavTM software showing the planned trajectories (coloured lines) and the implanted bolts with inserted electrodes.

Image, page left: Screenshot of the EpiNavTM software showing planning aids combined with variety of imaging modalities.

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Selected grants 2015–16Sponsor Project Title Total award Investigator

The Academy of Medical Science

3D In-Focus Endoscopic Imaging With Light-Field Cameras: Optomechatronics and Algorithms at University College London

99,876.00 Dr Christos Bergeles

EPSRCFellowship Wearable Neuroimaging Technologies for the Neonatal Intensive Care Unit

990,376.00 Dr Robert Cooper

EC Horizon 2020MOPHIMPOC – Optical Ultrasound Imaging for Real-Time Guidance of Intracardiac Procedure

97,255.60 Dr Adrien Desjardins

EPSRCAll-Optical Pulse-Echo Ultrasound Imaging for Real-Time Guidance of Minimally Invasive Procedures

1,087,556.00 Dr Adrien Desjardins

EPSRCDevelopment and Clinical Translation of Scalable HPC Ultrasound Models

352,912.93 Dr Bradley Treeby

Fight For Sight Single-Shot Digital 3D Ophthalmoscopy with Micro-Lens Arrays 20,000.00 Dr Christos Bergeles

Royal SocietyHigh-Performance Image Registration Algorithms for Prostate Cancer Intervention

11,442.00 Dr Dean Barratt

Cancer Research UK

A Computer-Assisted 3D Navigation System for Endoscopic-Ultrasound-Guided Diagnosis and Minimally-Invasive Treatment of Pancreatic Lesions

369,851.83 Dr Dean Barratt

STFCXnext: Next Generation X-Ray Digital Imaging Modules for Healthcare: High Resolution and Sensitivity Detection of Dynamic Scenes

130,979.55 Prof Gary Royle

Wellcome Trust Fellowship: Early Bedside Biomarkers of Cognitive Function Following Neonatal Brain Injury

1,198,478.00 Dr Ilias Tachtsidis

Royal Academy of Engineering

Fellowship: Laboratory-Based X-Ray Dark Field Microscopy and Microtomography

511,516.00 Dr Marco Endrizzi

Royal SocietyMedical Imaging Technologies For Cancer Screening and Early Diagnosis In China

13,000.00 Dr Mingxing Hu

Toshiba Research Europe Ltd

Studentship: The Lifetime of Implanted Electronic Nerve Interfaces

98,218.60 Prof Nick Donaldson

Royal Society Fellowship: Next Generation, Quantitative, Pre-Clinical Imaging 492,414.35 Dr Peter Munro

Nokia R & D UK Ltd

Studentship: an Investigation into the Viability of Graphene Based X-Ray Detectors for Clinical and Medical Practices

26,890.00 Prof Robert Speller

EC Horizon 2020Fellowship: Imaging Ultra-Small Angle X-Ray Scattering with Edge-Illumination: Exploiting Sub-Pixel Information in Medical Diagnostics, Materials Science and Security Screening

128,418.36 Prof Sandro Olivo

NIHR/UCLH Biomedical Research Centre

Strategic Imaging Initiative Project 112,817.00 Prof Sebastien Ourselin

NIHR/UCLH Biomedical Research Centre

Studentship: BRC PhD Scholarships Support – Centre For Doctoral Training In Medical Imaging

191,176.00 Prof Sebastien Ourselin

EPSRC EPSRC UK Image-Guided Therapies Network+ 639,288.00 Prof Sebastien Ourselin

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PhD award successes

James Avery (28/06/2015) Improving electrical impedance tomography of brain function with a novel servo-controlled electrode helmet

Mark Borg (28/10/2015) The use of a figure-of-merit (FOM) for optimization in digital mammography: an exploratory study in Malta

Isabel Christie (28/05/2015) Investigating the mechanisms underlying BOLD fMRI signals using optogenetics, viral vector gene transfer and two photon microscopy

Matthias Ehrhardt (28/07/2015) Joint reconstruction for multi-modality imaging with common structure

Yusuf Helo (28/09/2015) Cerenkov emission in radiotherapy

Albert Hoang Duc (28/08/2015) Atlas-based methods in radiotherapy treatment of head and neck cancer

Da Ma (28/02/2016) Automated morphometry for mouse brain MRI through structural parcellation and thickness estimation

Thomas Millard (28/08/2015) Microbubbles as a quantitative contrast agent for X-ray phase contrast imaging

James O’Callaghan (28/12/2015) Development of magnetic resonance imaging techniques for mouse models of Alzheimer’s Disease

Ruth Oliver (28/12/2015) Improved quantification of arterial spin labelling images using partial volume correction techniques

Niral Patel (28/07/2015)Development of radiotracers for neuroimaging

Rajiv Ramasawmy (28/08/2015) Measurements of Pre-Clinical Liver Perfusion Using Arterial Spin Labelling MRI

Matthew Rowe (28/07/2015) New tractography methods based on parametric models of white matter fibre dispersion

Mihaela Soric (28/02/2016) Investigation of the interaction between superabsorbent polymers and fluids for hygiene applications

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Careers Event

AUTHOR: GLAFKOS HAVARIYOUN

In February 2016, the department held a Careers Event for its undergraduate and MSc students, which featured a series of short presentations about careers in the NHS, industry, and academic research, as well as advice about preparing for employment. We were particularly pleased to hear from some of our former students, who spoke about their careers and why and how they began working in their chosen areas. Four of these former students tell us a little about their careers here.

Glafkos Havariyoun BSc Physics with Medical Physics UCL, 2013

I am currently on the Scientist Training Programme (STP) at King’s College Hospital, training to become an Imaging Clinical Scientist. I am involved with all issues regarding imaging with ionising radiation, such as quality assurance, optimisation, safety, research, etc. I am particularly interested in hybrid imaging such as PET/CT and SPECT/CT.

Paul Doolan MSc Radiation Physics UCL, 2011 PhD Medical Physics UCL, 2014

I am a Radiotherapy Physicist at University College London Hospital, with the primary responsibility of optimising the radiation treatment dose for cancer patients. This involves regular quality assurance of the systems, the design of cancer treatment plans, and the introduction of new techniques.

Imogen House BSc Physics with Medical Physics UCL, 2012

I am Assistant Global Media Manager at Unilever. I work with brands like Hellmann’s and Flora, advising them on the best media channels to reach their consumers. The job involves liaising with our strategy, planning and creative agencies and being an expert on the latest trends in technology and social media. I love thinking about how to sell a product to a customer. You have to know the facts of your story and the interests of your audience, along with the limitations of the media channel. Studying Physics with Medical Physics gave me a great analytical grounding and trained me to approach problems effectively. However, I still wince when I see an unlabelled graph in a report, and I hope one day to convince my colleagues that the abbreviation for million is M not mn. This is a small price to pay for a great company culture, good progression prospects and lots of transferrable skills. Previously I worked as Marketing Assistant for Hallmarq Veterinary Imaging, advising horse and pet owners and vets on the benefits of MRI.

Ben Price BSc Physics with Medical Physics UCL, 2006 PhD Medical Physics UCL, 2010

I am a project manager and applied physicist at X-Tek, a subsidiary of Nikon Metrology. I am heavily involved in the development of novel X-ray sources and micro CT systems as well as the management of EU funded research projects. I joined X-Tek in 2011 having obtained a BSc, and then a PhD, in medical physics at UCL.

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Prizes

The Annual Student Prize Award Ceremony (clockwise from top left): Patrycja Dzialeck: Excellent use of the Instron machineOscar Bennett: Joseph Rotblat Prize for best performance by an MSc studentEdward James: John Clifton Prize for best performance by a non-final-year undergraduateFabio Vittoria: Medical Physics & Biomedical Engineering PhD PrizeSimrun Virdee: Sidney Russ Prize for best performance by a final-year undergraduateOskar Blaszczyk: IPEM Prize for best MSc project (not pictured)

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Research Image Gallery

Images: Density-dependent colour scanning electron micrographs of heart tissue displaying calcification in the form of spherical particles. Above: The micrograph was coloured in post-processing by combining two images acquired using secondary electron detectors and one backscattering detector. The orange/pink colours correspond to the calcification formed by calcium phosphate, while structures that appear in blue and green are less dense and correspond to the extracellular matrix.Right: This micrograph was coloured by combining images acquired using a single secondary electron detector and a backscattering detector. Features in blue correspond to the calcification formed by calcium phosphate, while structures in red correspond to the extracellular matrix. The original image was mirrored for artistic purposes. Image credit: Dr Sergio Bertazzo.

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CONTACTS Department of Medical Physics and Biomedical Engineering University College London Gower Street London WC1E 6BT

Web: www.ucl.ac.uk/medphysTel: 020 7679 0200Email: medphys.newsletter@ucl.ac.uk Twitter: @UCLMedphys

Cover Image: Density-dependent colour scanning electron micrograph (DDC-SEM) combined with false colour applied to the calcified particle (in orange) on an aortic valve surface (in green). Micrograph was coloured in post-processing by combining an image acquired using secondary electron (in lens) detectors and another using backscattering detectors. Image credit: Dr Sergio Bertazzo.