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The capacity for cognitive function may be missed by clinical examination in severely disabled survivors of acquired brain injuries, resulting in individuals being mislabelled as being in the vegetative state (VS). Work from David Menon and John Pickard has shown that functional brain imaging provides a more consistent and less observer-dependent means of detecting and quantifying such cognitive capacity. As a result of this work, the use of functional imaging has been integrated into clinical protocols as the basis for: identifying patients with such covert cognition; prognosticating on outcome; defining a rational framework for patient selection in clinical trials; and exploring the use of brain-machine interfaces to improve communication with such patients.
New methods to study the biophysical action of the human digestive system were developed in Nottingham using high speed magnetic resonance imaging (MRI) and have been used by: (i) the food and drug industry (Unilever, Proctor & Gamble, Mitsubishi Chemicals, Reckitt Benckiser, Glaxo and McNeil Pharmaceuticals) to develop new products; (ii) Plant Bioscience Limited (PBL) to develop an artificial Dynamic Gut Model (DGM) which is now being applied commercially to characterise drug and food ingestion; (iii) the BBC and other media agencies in programmes related to the promotion of better understanding of nutrition in an effort to combat obesity.
The FLAIR (Fluid Attenuated Inversion Recovery) MRI sequence developed at Imperial College has transformed the sensitivity of clinical neuroimaging for white matter brain lesions. FLAIR has had significant commercial impact with incorporation as a standard imaging sequence offered by all manufacturers on their MRI scanners. The inclusion of FLAIR in routine diagnostic MRI protocols in radiology centres worldwide provides evidence of the continued extensive reach of impact for better healthcare outcomes through improved diagnosis and management. The use of FLAIR has led to more powerful Phase II trial designs for development of medicine for stroke, neuroinflammatory disorders, epilepsy and neuro-oncology based on imaging outcomes.
Work led by researchers at UCL has had a national and international impact on the way that patients with symptoms suggestive of colorectal cancer are investigated. Specifically, investigation of the role of CT colonography (a relatively novel and non-invasive method of investigating the large bowel using an X-ray scanner) has led to this examination replacing the standard alternative of barium enema in the UK National Bowel Cancer Screening Programme and for symptomatic patients in the NHS. The research has also led to easing of pressure on over-subscribed endoscopy services in the NHS because patients can be safely diverted towards CT colonography as an alternative.
We have developed a new technique of performing cardiac catheterisation in children and adults with congenital heart disease. This has led to the commercialisation of hybrid MRI and X-ray cardiac catheterisation laboratories, a new scientific technique for studying cardiac physiology and pathology and most importantly is being routinely used in clinical practice as it dramatically reduces X-ray radiation exposure (by a factor of 8) and improves the accuracy of physiological measurements leading to better clinical decision making and impact.
Nottingham researchers constructed the world's first 3T MRI scanner, thus demonstrating the viability and benefits of high-field MRI. This provided a stimulus for magnet and MRI system manufacturers to develop 3T scanners, which have now become established as the standard platform for high-end clinical MRI studies. We estimate that since 2008: 2500 3T scanners have been installed, representing a global investment of $5 billion;and 30-40 million patient examinations have been performed with 3T MRI scanners. Technical advances which underpinned the Nottingham 3T scanner also impacted on the development of functional MRI, thus opening up a new field of medical research and clinical application. In a subsequent phase of research, the Nottingham group developed ultra-high (7T) magnetic MRI in partnership with PhiIips; forty 7T MRI scanners (current unit cost >$10M) have now been installed across the world.
Imaging speed is of critical importance in most Magnetic Resonance (MR) imaging applications. King's College London (KCL) researchers have developed spatiotemporal undersamplings, or "k-t" methods, for three-dimensional (3D) imaging and corresponding image reconstruction methods that have increased the speed of imaging significantly, so that particular scans are now 5-7 fold faster. This has directly impacted the experience of the patient whose overall examination time has been reduced from more than 1 hour to less than 30 minutes depending on the application. The technology has been patented and has been implemented by Philips Healthcare, one of the three major manufacturers of MR equipment. A clinical solution platform for 3D MR cardiac perfusion and quantitative flow imaging, based on the technology developed at KCL, has also been launched by the Swiss company, GyroTools LLC.
Theoretical and computational methods for optimising the design of gradient and shim coils with arbitrary shapes and topologies were developed in collaboration with Magnex Scientific as part of a CASE award (2004-07). The resulting software was licenced to Agilent (who now own Magnex Scientific), for whom it has opened up new market opportunities in the supply of novel magnetic resonance imaging systems, leading to £3.4M sales since 2009. The software has also been used by Paramed Medical Systems to improve their `open' magnetic resonance imaging systems, which are optimised for orthopaedic imaging, allow vertical subject posture, and facilitate image-guided treatment, as well as offering a better patient experience. Our work has thus resulted in impact in the economy and healthcare.
Research to address the detection of weak structured signals from within highly variable cluttered imagery, originally for vehicle tracking, is being used to identify textural variations in organ tissue. The technology has been spun out into a company, TexRAD Ltd, using the methodology as a means of detecting tissue abnormalities, typically cancer, assessing response to treatment, and predicting patients' chances of survival. The detection process is being assessed through clinical research use in the UK, Europe and the USA. Regulatory approval for mainstream clinical use is being prepared.
University of Bristol researchers at the Bristol Heart Institute (BHI) have pioneered the development and clinical take-up of the novel technique of off-pump coronary artery bypass (OPCAB) surgery. Over ten clinical trials and several large cohort analyses have assessed the impact of this technique on elective and high-risk patients. The results have shown that it is as safe as the conventional coronary artery bypass grafting (CABG) technique that uses a cardiopulmonary bypass pump and cardioplegic arrest. Most importantly, however, OPCAB significantly reduces the risk of post-operative complications, and reduces morbidity and mortality. It also uses less hospital resources, reducing time in intensive care and length of hospital stay. In 2011 (the last year for which data are available), 20% of CABG operations in the UK were carried out with the OPCAB technique and it has had significant take-up overseas (for example, 18% of CABG operations in the US and 21% in the EU in 2010). NICE has recommended the safety and efficacy of OPCAB surgery.