Call for engagement - Institute of Physics and Engineering in Medicine

Transcription

P06 IMPACT OF TECHNOLOGY
An institutional experience of
new technology in radiotherapy
P07 DETECTOR DENSITY
Impacts on small-field
dosimetric measurements
P07 RANGE UNCERTAINTY
Proton range uncertainty in
patient stopping power ratios
SCOPE
INSTITUTE OF PHYSICS AND ENGINEERING IN MEDICINE | www.ipem.ac.uk | Volume 21 Issue 3 | SEPTEMBER 2012
A work of
fiction?
Alice through the
archive cupboard
Radiating
enthusiasm
IPEM at the 2012 Big
Bang Science Fair
Call for engagement
Science and Parliament
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PRESIDENT’S LETTER | SCOPE
A WIDER PERSPECTIVE
ecently, it was my
privilege to attend the
World Congress on
Medical Physics and
Biomedical Engineering
in Beijing, China, which
was held under the banner of
‘Promoting Health through
Technology’. Spread over 5 days and
with at least 17 parallel sessions, this
was clearly the challenge that came
through those elements that I was able
to experience directly!
This congress occurs every 3 years
and is held under the auspices of the
International Union of Physical and
Engineering Sciences in Medicine
(IUPESM). It brings together the
International Federation for Medical
and Biological Engineering (IFMBE)
and the International Organisation for
Medical Physics (IOMP), and these
societies were further supported by
the World Health Organization
(WHO) and the International Atomic
Energy Agency (IAEA) as global
organisations with specific objectives
in health.
The world congress can seem a
little remote from the issues in
healthcare science in the UK, or even
in Europe, especially as this was the
third time in 9 years that it has been
held in Asia. Although this perhaps
reflects the changes in the global
economic landscape, it soon became
clear to me that it is important not to
lose sight of the global health
challenges and the role that we could
and should fulfil both individually
and as IPEM.
R
INTERNATIONAL
RELATIONSHIPS
IFMBE is directly linked to the WHO
and the United Nations as a nongovernmental organisation
(NGO). It is a position to
which IOMP aspires and
hopes to achieve within
the next 3 years. This
relationship provides a
route to influence the delivery
of healthcare worldwide through
physics and engineering and is
already recognised in a programme
within the WHO which is seeking to
promote the development of
appropriate medical devices for
Peter Jarritt
President
▼ Being part of
the global
medical physics
community.
developing countries. This challenge
was powerfully delivered in a
plenary lecture given by Adriana
Velazquez Berumen who is coordinator of the Medical Devices Unit
at the WHO in Geneva. The
availability and access to appropriate
medical products and technologies is
one of the WHO strategic objectives
for its member states. It is not difficult
to understand such an objective in
relation to the developing world, yet
to me, the challenge was identical to
that facing the developed world. The
healthcare agenda in the UK is to
develop innovative, affordable and
appropriate healthcare technology to
address the health needs of the
population. The developing world
needs simple, low-powered, low-cost,
robust and accurate diagnostic tools
to solve their issues. Does this sound
familiar?
The congress had many themes,
some less familiar than others,
including education and training,
radiation safety, safety of medical
devices, developments in photon and
ion therapy and x-ray CT, biochipenabled translational medicine, signal
processing and bio-magnetism and
physiology modelling. It is good to
know that research and development
is alive and well.
IPEM INVOLVEMENT
IPEM will re-engage with
the worldwide
physics and
engineering
community
through the
International
Conference
on Medical
Physics to be
held in
Brighton,
1st–4th
September
2013. The
programme will
address the
international agenda as well
as showcase the latest scientific
research. Our response to and
involvement in these wider
agendas is important.
IPEM is formally linked as a
National Member Organisation to
the European Federation of
Medical Physics (EFOMP) and the
IOMP. IPEM is able to nominate
and support individuals who are
willing to stand as officers in these
organisations. Individuals do not
represent IPEM but stand to
develop and support the aims and
objectives of their respective
organisation. IPEM supports and
benefits from these activities
including the formal recognition
of the medical physicist as a
healthcare professional, the
specification of European
standards for the medical physics
expert, and the harmonisation and
recognition of training
programmes.
If you have a passion for
physics and engineering in
healthcare, I would encourage you
to consider if there is a role you
would be prepared to undertake to
support these wider agendas. This
might be through direct
involvement in programmes in
developing countries or through
an international organisation. The
websites of EFOMP
(www.efomp.org) and IOMP
(www.iomp.org) provide an
indication of their respective
activities. The IPEM VP
International, Dr Manivannan
([email protected]), can provide
further information and advice.
In conclusion we should not
lose sight of the immediate needs
of the profession in the UK and
the contribution it can and does
make to the delivery of healthcare.
I would refer you to the article
from Andrew Miller MP in this
edition of Scope. Parliament
represents the voice of the people
and we should equally heed his
encouragement to lobby and
inform our MPs, whether in
devolved governments or
Westminster, to ensure that our
contribution is recognised and
supported appropriately. This is a
role we can all undertake. If you
feel you would like support then I
would encourage you to talk to
Steve Keevil (President Elect) or
Carl Rowbottom (VP External).
SCOPE | SEPTEMBER 2012 | 03
SCOPE | CONTENTS
09
© r.nagy / Shutterstock
THIS ISSUE
COVER FEATURE
ENGAGEMENT CALL
The links between
science and
Parliament, and a
challenge for all
members
13
13
ALICE THROUGH THE ARCHIVE CUPBOARD
A short story about what medical physicists get up to in their spare time.
Can you find yourself?
17
RADIATING ENTHUSIASM: IPEM AT THE 2012 BIG BANG SCIENCE FAIR
How do you explain radioactivity to a 6-year-old? Celebrating science,
technology, engineering and maths with the next generation
18
THE LAUNCH OF IPEM OUTREACH STRATEGY
Helping members to communicate science and engineering to students to
encourage them to study the subjects further
TRAVEL AWARD
19
AAPM–IPEM MEDICAL PHYSICS TRAVEL GRANT REPORT
Jun Deng
MEETING REPORTS
17
23
26
30
BESPOKE SOFTWARE IN MEDICAL PHYSICS AND CLINICAL ENGINEERING
Andrew Robinson
2012 ESTRO 31/WORLD CONGRESS OF BRACHYTHERAPY
Ahamed Badusha Mohamed Yoosuf
REPORT ON NPL CLINICAL TEMPERATURE MEASUREMENT MEETING
Rosie Richards and Jason Britton
HISTORICAL FEATURE
46
A HISTORY OF MEDICAL PHYSICS
Francis Duck
26
REGULARS
03
05
06
33
35
40
36
04 | SEPTEMBER 2012 | SCOPE
PRESIDENT’S LETTER A wider perspective
EDITORIAL Farewell Marc
NEWS Recent discoveries in radiotherapy research
INTERNATIONAL NEWS International conferences in 2012 and 2013
MEMBERS’ NEWS Accolades for current and retiring members
BOOK REVIEWS Medical physics and popular science textbooks
COMMENT | SCOPE
Scope is the quarterly
magazine of the Institute
of Physics and Engineering
in Medicine
IPEM Fairmount House,
230 Tadcaster Road,
York, YO24 1ES
T 01904 610821
F 01904 612279
E [email protected]
W www.ipem.ac.uk
W www.scopeonline.co.uk
EDITOR-IN-CHIEF
Gemma Whitelaw
Radiotherapy Physics,
Basement, New KGV
Building,
St Bartholomew's Hospital,
West Smithfield,
London, EC1A 7BE
E [email protected]
ASSISTANT EDITOR
Usman I. Lula
Department of
Radiotherapy,
Poole Hospital,
Longfleet Road, Poole,
BH15 2JB
E [email protected]
MEETING REPORTS
EDITOR
Angela Cotton
Head of Non-Ionising
Radiation Support,
Medical Physics &
Bioengineering,
Southampton General
Hospital, Southampton,
SO16 3DR
E angela.cotton@suht.
swest.nhs.uk
NEWS EDITORS
Usman I. Lula
Department of
Radiotherapy, Poole
Hospital, Longfleet Road,
Poole, BH15 2JB
E [email protected]
and
Richard A. Amos
Department of Radiation
Physics, The University of
Texas M.D. Anderson
Cancer Center,
1840 Old Spanish
Trail,Houston,
Texas 77054, U.S.A.
T + 1 713 563 6894
F + 1 713 563 1521
E richamos@mdanderson.
org
BOOK REVIEW EDITOR
Usman I. Lula
Department of
Radiotherapy,
Poole Hospital,
Longfleet Road, Poole,
BH15 2JB
E [email protected]
MEMBERS’ NEWS EDITOR
Matt Gwilliam
Cancer Research UK
Clinical MR Research
Group, Institute of Cancer
Research and Royal
Marsden NHS Foundation
Trust, Sutton
SM2 5PT
E [email protected]
INTERNATIONAL EDITOR
(Developing countries)
Andrew Gammie
Clinical Engineer,
Bristol Urological Institute,
BS10 5NB
T +44(0)117 950 5050
extension 2448 or 5184
E [email protected]
(North America)
Richard A. Amos
Department of Radiation
Physics, The University of
Texas M.D. Anderson
Cancer Center, 1840 Old
Spanish Trail,Houston,
Texas 77054, U.S.A.
T + 1 713 563 6894
F + 1 713 563 1521
E richamos@mdanderson.
org
FAREWELL MARC
ONLINE EDITOR
Position vacant
Published on behalf of
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PRINTED BY
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Scope is published quarterly
by the Institute of Physics
and Engineering in Medicine
but the views expressed are
not necessarily the official
views of the Institute.
Authors instructions and
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found on the IPEM website.
Articles should be sent to
the appropriate member of
the editorial team. By
submitting to Scope, you
agree to transfer copyright
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We reserve the right to edit
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Copyright
Reproduction in whole or
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© IPEM 2012
ISSN 0964-9565
fter 5 years our Editor Marc
Miquel is stepping down. I
want to thank Marc for all his
hard work; he has achieved
many things whilst Editor,
including the launch of Scope
Online (www.scopeonline.co.
uk), several changes to the editorial board and
launching the Keith Boddy prize for best
educational article. It’ll be a tough act for me to
follow, a daunting but exciting challenge, and I
shall keenly miss the guidance and direction
Marc has given me whilst I was his deputy.
Thankfully his office is just across the road
from mine, so his unseen hand may be visible
until I find my feet.
This edition of Scope includes a fascinating
article kindly written for us by Andrew Miller
MP. Here he discusses the links between
science and politics and presents all IPEM
members with a challenge, which will
hopefully improve the profile of our field in
Parliament. Of course what goes for
Westminster MPs also applies to MSPs and
representatives in the other devolved
assemblies.
If you ever wondered what was lurking in
the back of your department’s archive
cupboard or what your colleagues do outside
the office, then look no further than Henry
Lawrence and Lynn Martinez’s article ‘Alice
through the archive cupboard’. Who would
have thought extreme ironing and free diving
were in our collective skill-set?
This issue also heralds other changes: Robert
Nielson, IPEM’s General Secretary, and Peter
Sharp OBE, the second President of IPEM, are
both retiring. I am sure they will both be
missed by all who have worked with them.
This issue also includes all the regulars such
as news from Richard and Usman, a very full
book review section and another absorbing
chapter in Francis Duck’s tales on the history
of medical physics. This one focuses on
statistical thinker and physician Jules Gavarret.
Scope is a magazine written by and for the
membership of IPEM. If you are a member
then it is your magazine! If you know
something that no-one else does or want to
share your point of view more widely amongst
your colleagues then this is the forum to join
in. So, please contact me if you wish to
contribute to or comment on our magazine.
A
Ryan D. Lewis
Department of Medical
Physics and Clinical
Engineering, Abertawe Bro
Morgannwg University,
NHS Trust, Singleton
Hospital, Swansea,
Wales, SA2 8QA
T +44(0)179 220 5666
extension 6438
E [email protected]
“
Please
contact me if
you wish to
contribute to or
comment on
our magazine
GEMMA WHITELAW
”
GEMMA WHITELAW EDITOR-IN-CHIEF
SCOPE | NEWS BY USMAN I. LULA AND RICHARD AMOS
IN BRIEF
HIFU REDUCES
SIDE EFFECTS
According to a study from
UCL UK, 42 patients
received focal HIFU
delivered to clinically
significant cancer lesions.
Twelve months after
treatment, urinary and
erectile function returned to
pre-treatment levels
(Lancet Oncol; doi:
10.1016/S14702045(12)70121-3). Early
evidence on cancer control
was also encouraging.
BRAIN MINI
MAGNETOMETER
In experiments performed at
the Physikalisch-Technische
Bundesanstalt in Germany,
the sensor was used for
magnetoencephalography
(MEG) to measure alpha
waves associated with a
subject opening and closing
their eyes, and signals
resulting from hand
stimulation (Biomed Opt;
doi: 10.1364/BOE.3.000981).
COILS MODULATE
ACTIVITY
Investigators from
Massachusetts have shown
that magnetic stimulation
can generate similar neural
activity to that elicited by the
electrical impulses used for
DBS. They demonstrated
that a magnetic coil could
elicit neuronal signals in
retinal cells when implanted
into the brain directly above
retinal tissue (Nat Commun;
doi: 10.1038/ncomms1914).
ENGINEERED
MICROVESSELS
Bioengineers at the
University of Washington,
Seattle, have developed a
means to grow small
human blood vessels,
creating a 3D test bed with
which to study vascular
phenomena such as
angiogenesis and
thrombosis. The engineered
vessels could transport
human blood smoothly, even
around corners.
Institutional experience of new
technologies in radiotherapy
TABLE 1
Category
Selections
Demographics
Date of event
Time of event (May 2007 onwards)
Number of treatment sessions for course
Treatment site
Treatment machine
Process step
of origination
Simulation
Treatment planning
Data entry/transfer
Treatment delivery
Event type
Simulation
Patient measurement
Simulation documentation
Treatment
planning
Incorrect manual application of transmission factor
Calculation error – inverse square
Calculation error – other parameters
MD prescription/planner prescription misinterpretation
Transcription error
Other planning error
Data entry
Incorrect manual entry of treatment parameters
Incorrect scheduling of treatment fields or treatment
sessions
Treatment
Incorrect/omitted block, bolus, compensator
Incorrect/omitted wedge
Incorrect/omitted static MLC shape
Incorrect/omitted dynamic MLC shape (IMRT)
Incorrect treatment record (charting)
Incorrect use of field parameters or R&V override
Incorrect treatment distance
Incorrect field position (other than distance)
2.5 mm
3%/3 mm
Event impact
Dosimetric magnitude per treatment session
Dosimetric magnitude over treatment course
Number of treatment sessions for which event occurred
Table 1: Patient event demographic and event type classification.
Thanks to Margie A. Hunt for supplying the image. Figure © Elsevier,
'The impact of new technologies on radiation oncology events and
trends in the past decade: an institutional experience’, Margie A. Hunt,
Gerri Pastrana, Howard I. Amols, Aileen Killen, Kaled Alektiar, Int J
Radiat Oncol 2012; article in press.
According to the Radiotherapy Risk
Profile report, published by the
World Health Organization, it is
estimated that treatments for
approximately 3,000 patients were
affected by radiotherapy errors
between 1976 and 2007. Analysis,
even of clinically insignificant
events, can uncover QA
deficiencies whilst also providing a
method to study the impact of
patient safety enhancements.
Some previous studies have
shown that new technologies such
as record-and-verify (R&V) systems
can both decrease certain event
types and increase the potential for
others, e.g. field parameter/R&V
override and charting events.
The purpose of this study, from
the Memorial Sloan-Kettering
Cancer Center in New York, was to
review the type and frequency of
patient events from external beam
radiotherapy over a 10-year period.
This was a period which
encompassed significant
technology change. The study would
allow the group to identify trends,
achievements and areas for
improvement.
Four radiation oncology process
steps were classified and further
sub-classified according to event
type (table 1): simulation, treatment
planning, data entry/transfer and
treatment delivery. Events were
segregated according to the most
frequently observed types.
There was generally a downward
trend over time in the event rate
mainly due to technological
changes, e.g. replacement of R&V
system and widespread
implementation of IMRT. A total of
284 events were recorded between
2001 and 2010. During this time,
approximately 30,600 new
treatment courses and 597,000
treatments were delivered, yielding
an event rate of 0.93 per cent per
course and 0.05 per cent per
treatment session. Frequency of
event types particularly in planning
and treatment delivery changed
significantly over the course of the
study. Treatments involving manual
intervention carried an event risk
four times greater than those
relying heavily on computer-aided
design and delivery.
Areas for improvement include
manual calculation and data entry,
late-day treatments and staff
overreliance on computer systems.
The changing roles of R&V systems
inherent in an electronic medical
record environment, the
introduction of even more complex
technology and the emergence of
hypofractionated treatment
paradigms may all lead to new types
of errors.
Further improvements in patient
safety are imperative, given the
severe consequences that can arise
from radiotherapy errors.
MORE INFORMATION
This work was recently published in Int
J Radiat Oncol 2012; article in press,
http://dx.doi.org/10.1016/j.ijrobp.
2012.01.042
NEWS BY USMAN I. LULA AND RICHARD AMOS | SCOPE
Detector density impacts
small-field dosimetry
A group of researchers at the
Clatterbridge Cancer Centre are
investigating how physical
characteristics of detectors
affect small-field dosimetric
measurements. The group
recently published their report
on the impact of density and
atomic composition on the
response of various detectors in
small fields.
Monte Carlo modelling was
used to examine variations of a
correction factor, Fdetector,
with field size. Fdetector is
defined as the ratio of dose to a
water voxel and dose to the
same voxel with the density of
the detector.
In total, three detector types
were studied: PTW diamond
detector (density 3.5 g/cm3);
PTW 31016 Pinpoint chamber
(0.0012 g/cm3) and Scanditronix
unshielded electron diode (2.3
g/cm3). Monte Carlo simulations
modelled a 15 MV beam incident
upon a water phantom with
source-to-surface distance
(SSD) of 100 cm. Detector voxels
were located at 5 cm depth with
volumes roughly equal to each
detector’s active volume.
The specific impact of
detector density on response
was isolated through two sets of
calculated values for Fdetector.
The group first calculated
Fdetector using the density and
mass radiological properties of
the modelled detectors, and
then repeated the calculations
using the densities of diamond,
silicon and air, but with mass
radiological properties fixed at
those of unit density.
Simulations using field sizes
ranging from 0.25 to 10 cm
showed that Fdetector varied
significantly as a function of field
size for all three detector types.
The high-density diamond and
silicon detectors over-read at
small field sizes, relative to
wide-field readings, whereas
the low-density air-filled
detector under-read at small
field sizes. Similar patterns
were observed for the densitymodified water voxels, although
values for Fdetector converged
to unity for large fields. This
behaviour suggests that the
variation of Fdetector at small
field sizes arises from
differences in detector density,
Fdetector as a function of field size.
rather than atomic composition.
The researchers then
studied integral doses of slit
fields using the silicon diode
and Pinpoint detectors. It was
observed that doses measured
along a profile varied far less
than central axis doses,
suggesting that, while doses at
the centres of individual small
fields would contain errors if left
uncorrected, integral doses
calculated for VMAT or IMRT
plans (which contain many
overlapping small fields) would
be approximately correct. This
implies that correcting
measured small-field dose
distributions simply by scaling
them using central axis
Fdetector values may lead to
erroneous estimates of the
integral doses delivered by
techniques using multiple small
fields. As such, the authors
describe the ideal small-field
dosimeter as having a small
active volume and water-like
density.
Work is ongoing to develop a
cavity theory that describes this
density dependence.
MORE INFORMATION
This story was first reported on Medical
Physics Web on 11th July:
http://medicalphysicsweb.org/cws/art
icle/research/50234
A closer look at proton range uncertainties
The major challenge for
accurate range calculations for
therapeutic proton beams is the
uncertainty in patient stopping
power ratios (SPRs). Margins
along the beam axis, both distal
and proximal to the clinical
target volume, are used during
the treatment planning stage to
account for this uncertainty and
ensure target coverage. A value
of 3.5 per cent has been
commonly used in the design of
these margins for many years,
but recently a group of
researchers at the University of
Texas MD Anderson Cancer
Center took a closer look at this
uncertainty.
Using a combination of
previously published data and
new, measured data, the
researchers assessed five
contributions to SPR
uncertainty in three
representative tissue types:
low-density lung, intermediatedensity soft tissue and highdensity bone. Four of the
contributing factors correspond
to steps in the stoichiometric
calibration method, the most
commonly used method for
deriving SPRs for different
tissue types. The fifth originates
from the dose calculation
algorithm used in a treatment
planning system. Stopping
power ratios vary with proton
energy and consequently vary
along the proton beam path,
whereas common algorithms
ignore this effect.
The researchers used the
uncertainties for each tissue
type to estimate the composite
range uncertainty for each
beam in the treatment plans of
15 patients who were
undergoing proton therapy for
lung, prostate and head and
neck cancers.
Uncertainty in individual
tissue types, expressed to one
standard deviation, ranged from
1.6 per cent for soft tissue to 5.0
per cent for lung. Expressed
using the 95th percentile,
beams used to treat lung
tumours exhibited the greatest
composite uncertainty of 3.4
per cent. Beams treating
prostate and head and neck
cancer both resulted in an
uncertainty of 3.0 per cent.
This study highlighted that
the currently used value of 3.5
per cent is appropriate as a
general recommendation to
account for SPR uncertainties,
and the group have no
immediate plans to change
their clinical practice.
MORE INFORMATION
This paper was published in Phys Med
Biol 2012; 57: 4095–115.
FEATURE | SCOPE
SCIENCE AND
PARLIAMENT:
A CALL FOR ENGAGEMENT
Andrew Miller MP discusses the links between
science and politics, outlining a challenge that
all members can be involved with in order to
benefit not only the profession but also
healthcare and the whole science community
especially acute in Parliament. MPs
are expected to take important
decisions not just about the science
budget but about the application of
science throughout the country we
seek to represent, dabbling in areas
ranging from education through to
why we should invest in CERN or
the next generation of astronomy.
You do not need to know much
about the political process to realise
that this presents a challenge;
politics is all about priorities. But as
only about 10 per cent of the House
of Commons (a figure that has
stayed relatively stable for some
time) have ever worked in an STEM
discipline, engaging with MPs is
essential.
At the end of the Ditchley Park
weekend we were each asked to sum
up in one sentence what we got out
of the event. In my case I learnt a
tremendous amount but it
convinced me more than ever of the
importance of continuing the
longstanding work I am involved in
within Parliament to help build a
bridge between science and politics.
SCIENCE IN PARLIAMENT
There are some stunningly good
arrangements in place, such as the
Royal Society’s pairing scheme,
which offers Fellows an opportunity
to pair with an MP or civil servant
▼
© r.nagy / Shutterstock
I
recently spent a weekend at
Ditchley Park in Oxfordshire,
a house that has not only been
graced with great names like
Winston Churchill among its
visitors, but has been the
home of high-level brain storming
sessions amongst experts on many
subjects over the last 60 years.
Initially Sir David Wills, who
conceived the idea and at that time
owned the house, saw it as a venue
for improving relations across the
Atlantic, especially between our
respective governments here and in
the US.
Today the transatlantic dimension
is just as strong but many other
nations participate in trying to find
solutions to problems that face us
all. That is why I leapt at the
opportunity when I was invited to
attend a seminar entitled ‘Putting
Science, Government, Business and
Innovation Together’. All of my
adult life I have been fascinated with
the challenge of how to use science
in a way that benefits people, and
also the vexed question of engaging
our society in the scientific
challenges of today and helping
people without a science
background to understand the
relevance of research that is
undertaken. Those challenges exist
throughout our society but are
SCOPE | FEATURE
WHAT ELSE IS NEEDED?
That all sounds like a long list but it
does not alter the fact that MPs are
under permanent pressure to be
doing other things and the degree of
engagement with science and science
policy is somewhat limited. So this is
where you come in!
IPEM members are working in a
discipline that every politician,
irrespective of their original training,
will see as relevant to the society
within which we live. Whilst the
scientists and technicians within the
Institute rarely get a mention in the
popular press compared with, say,
doctors and nurses, anyone who
has ever visited a hospital
either professionally or as a
patient will readily see the
importance of the
underlying science that
supports our health system.
So each and every one of you
are in a strong position to
help address the challenge I
have described. Whether you
ABOVE LEFT
Ditchley Park
in Oxfordshire.
▼
originated by the late Dr Eric
Wharton and continued by the
former MP for Bristol Dr Doug
Naysmith. The event is organised
and run by staff of the P&SC with a
tremendous amount of help from
learned societies and private
companies. This successfully brings
a great poster competition to the
House, gathering early career
researchers together from a number
of disciplines and most importantly
getting them engaged with MPs.
Both Houses have a Science and
Technology Select Committee
working on a range of topics. The
Commons Committee that I chair is
currently working on a number of
projects including, for example, a
report on medical implants. We are
supported by a team of extremely
well qualified science specialists and
clerks. (The name clerk in Parliament
applies to a highly qualified advisor
not simply a scribe.)
Parliament is also served by
brilliant librarians and the
Parliamentary Office of Science and
Technology (POST). The latter is
Parliament’s in-house source of
independent, balanced and
accessible analysis of public policy
issues related to science and
technology. The organisation has
some permanent staff as well as a
network of seconded extremely
bright young scientists.
▼
▼
and both spend time together in their
respective environments. My limited
knowledge of nanotechnology came
from such an experience. There are
also schemes like Newton’s Apple,
devised and run passionately by
Michael Elves, a man with a
distinguished industrial and
academic record who brings young
scientists into the House.
Similarly there are events like the
Parliamentary Links Day, now
organised by the Society of Biology
on behalf of the science and
engineering community, and
supported by the Institute of Physics,
the Royal Society, the Royal Society
of Edinburgh, the Royal Academy of
Engineering, the Biochemical Society,
the Society for Experimental Biology,
the Society for Applied Microbiology,
the British Pharmacological Society,
the Astronomical Society, the
Geological Society, the Council for
the Mathematical Sciences, the New
Engineering Foundation, the Royal
Society of Chemistry, the Campaign
for Science and Engineering and the
Parliamentary and Scientific
Committee. This year more than 120
people came to the House to focus on
a series of discussions around science
and sport; the subject was obviously
not chosen by accident!
The Speaker of the House of
Commons, Rt Hon John Bercow MP,
opened the meeting. He is quoted on
the Society of Biology’s website as
saying: ‘I know, from my unique
vantage point in the House, that
Members on all sides continue to
raise issues that have a scientific
aspect to them.
‘It is all the more important that
every Member of Parliament should
be able to benefit from non-partisan
assistance of the kind offered by
professional scientific bodies like the
Society of Biology, the Institute of
Physics, the Royal Society of
Chemistry and many others with
their proven commitment to public
interest.’
The first All Party Parliamentary
Group was the Parliamentary and
Scientific Committee (P&SC). All
Party Groups are made up of MPs
and peers working together across
parties on areas of common interest.
The P&SC engages regularly with the
science community and publishes its
quarterly magazine entitled Science
in Parliament.
One of the more recent
innovations is ‘SET for Britain’,
ABOVE RIGHT
Parliamentary
Links Day:
Julian Huppert
MP, Rt Hon John
Bercow MP,
Andrew Miller
MP and Dame
Nancy Rothwell.
work in a hospital or are involved in
designing or manufacturing tools for
the health service I simply invite you
to engage with your own local MP
and make sure that he or she
understands the importance of the
underlying science that supports the
great innovations that are going on in
healthcare on a daily basis. Don’t just
talk to MPs about healthcare but
about how modern science today
crosses disciplines. Without people
like Alan Turing would we have
mapped the genome so quickly? In
the great advances we have seen in
scanning and x-ray tools the
crossover between the needs of highend engineering companies working
in a whole range of industrial
disciplines and the application of the
technologies for the benefit of human
health are issues that each of you can
wax considerably more lyrically than
I, for example on how 3D printing is
going to have a significant role in
orthopaedics. But the key
message to get over is that
medicine does not exist in
isolation from the rest of the
science base and indeed
could not.
This is not just a challenge I
am laying down to IPEM
members. I think that it should be
© Ralph Loch 2010
FEATURE | SCOPE
the responsibility of every scientist to
engage with the political community
so that MPs get directly from the
people they are representing the
importance of work that has been
undertaken under their very noses in
their own constituencies. The more
we can make this happen the more
optimistic I would be that this
government and future governments
will take the science budget seriously.
The other end of the telescope is of
course what the Institute can do to
match the work that has been
undertaken by other learned societies
directly within Parliament.
Stephen Keevil and others are
frequently knocking on my door and
those of my colleagues to press the
case for the Institute. Many of the
larger or perhaps more well-off
societies have professionalised that
process; some hire in external
government affairs specialists, some
employ their own. Some societies
collaborate together and share the
costs of a person to front their
activities in Parliament. And there is
a high degree of co-operation
between various organisations, for
example the Links Day that I
mentioned earlier involves people
from earth sciences, biology, physics,
engineering and chemistry, etc.
“
They
have spinoff
benefits to
the whole
of the
health
machine
”
So my second challenge to the
Institute is to invite you to ask the
question: how do you get a better
voice in Parliament?
Both of the challenges I am setting
out for you are clearly not just good
for your own profession but they
have spin-off benefits to the whole of
the health machine, as well as much
more broadly across the science
community.
Finally, some of you will come
across difficult cases (I mean the MPs
not the patients) but each of you will
have anecdotes that will help get the
message across. For example, when I
was being treated by a consultant
who has now retired I went to one
appointment and found him in a
very excited mood.
He said, ‘Andrew, you’re
interested in technology; come and
have a look at my new system’.
Picture archiving had just been
switched on in his hospital and for
the first time he was able to send me
for an x-ray, having just read my
notes, and to have it in front of him
as I came up through the queue of
patients. He played with his
computer and showed me how he
could enlarge these shots of various
bits of me and alter the contrasts to
hone in in more detail. The net result
was a more satisfactory outcome
because he could better interpret the
data and equally importantly, as a
result of the fact that he no longer has
to re-read the patient’s file due to the
long gap between being sent off for
an x-ray and the information getting
back to him, he saw real productivity
improvements and was able, he
guessed, to see at least one more
patient in each clinic session. There
was a consultant who understood the
relevance of technology and here is a
patient who was grateful for its
application.
There are hundreds more such
anecdotes that are directly related to
health improvement in every single
constituency. MPs need to know
about them and the best people to
talk to MPs about technologies like
this are people like you. n
FURTHER READING
Science in Parliament
www.vmine.net/scienceinparliament
SET for Britain
www.setforbritain.org.uk
House of Commons Select
Committee of Science and Technology
www.parliament.uk/science
Parliamentary office of
Science and Technology (POST)
www.parliament.uk/post
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FEATURE | SCOPE
Alice through the
archive cupboard
Henry Lawrence (Ipswich Hospital) reveals what your colleagues really get up to in
their spare time! Illustrated by Lynn Martinez (Royal Free Hospital, London)
FIGURE 1.
Was that the
sound of music in
the distance?
charts stirred, and in one long, slow
movement avalanched over her.
She was completely covered, and
all went dark. Frantically she waved
her arms around, pushing papers
hither and thither. At last she saw
light, and looked up.
She turned around. There was no
sign of the cupboard! Or her office.
The whole medical physics
department of Lymeswold Hospital
had been transformed into a vast,
brooding forest.
She strained her ears. Was that
music in the distance? It sounded like
some sort of barn dance band,
banjos,42 mandolins,19,27 a flute,37
highland pipes,71 a ukulele72 and a
fiddle.2,58
‘Golly’, thought Alice, ‘that
sounds fun!’. I like to do a little
Appalachian clog dancing65 myself.
I’ll go and ask them where I am. As
she came to the brow of a hill she
looked down at a full-blown barn
dance27 in operation. Her experienced
ear told her straightaway… ‘That’s
North West Morris,6 I can’t dance
that! Maybe if they did some Welsh
folk dance7 I might stand a chance’.
No sooner did that thought cross
her mind when the band stopped,
and a woman in full seventeenthcentury costume brought her lute15
out from within the flowing folds of
her woven17 gown and the lilting
notes of Greensleeves filled the air,
joined by tenor and bass recorders.66
▼
B
▼
‘
other’, said Alice, ‘I’ll
never get this training
portfolio finished until
I can find that ion
recombination paper
by Havercroft’.1
She had looked everywhere,
Medline, Scopus, and worst of all she
remembered seeing a dog-eared copy
lying somewhere around the
department.
Her eyes drifted to the archive
cupboard. Nobody ever used it;
maybe once a year things no-one had
the courage to throw away got
dumped there. It was worth a try.
She opened the door. Slowly, then
with an unstoppable momentum,
generations of reports, graphs and
▼
And when the choirs5,11,16,20,23,33,64 joined
in, Alice was in seventh heaven. ‘But
she shouldn’t have been doing
Regency dance ‘,6 thought Alice.
‘That’s all wrong.’
‘What is this place?’, she
wondered. ‘And who are all these
people? Such a change from all those
boring people at work.’
The whirr of a Super-8 movie
camera brought her round.30 ‘It’s an
arty film’, the operator said, ‘and
we’re recording the soundtrack’. She
beckoned, and together they peeped
through a window.
Inside was a complete recording
studio,71 and a jazz band12 was hitting
a groove with a long solo. A bunch of
hangers-on sat behind the recording
desk. Some were doing crosswords,11
others origami,53 balloon modelling52
or playing board games;3 that solo
must have been going on a long time!
The film-maker panned her
camera round; a well honed
muscleman31 was bouncing up and
down on a trampoline.5 Some actors54
were practicing ice skating35 on the
pond, throwing Frisbees.55 A girl was
staring intently at a train set.19,35
‘Why is she playing with that?’,
asked Alice. ‘She’s secretly
committed to saving the
environment‘,10 replied the filmmaker. ‘She believes in “Small is
Beautiful”.’
“
‘Such
a change
from all
those
boring
people at
work’
”
There is something about the
smell of homemade bread.18,55 It was
wafting from behind the bushes.
Alice was there in a flash, in front of
a table laid out with cakes,
wonderfully decorated,41 showing the
sugar craft artist’s42 skills to
perfection. And in the middle, an
enormous jar of award-winning
marmalade!52
It was a market. Next to the cake
stall were all sorts of people selling
their wares. Someone was selling
felt,17 lovely crochet toys37 and leather
craft.42 A gallery stall was showing a
mixed exhibition of photographs,18,28
paintings40 and sketches.17 Another
was piled high with pottery39,42 that
FEATURE | SCOPE
FIGURE 2.
[ LEFT]
And there stood
the vicar,
vestments
blowing in the
wind.
▼
FIGURE 3.
[ RIGHT]
A sweating
woman was
balancing on her
head.
‘I want to play’, shouted Alice, but
ladies don’t play football. So
everyone played Korfball32 and
rounders8,13 instead.
Suddenly, some characters who
looked like they came out of a roleplaying game3 stood on the path in
full armour, but one of the horsemen
tucked his lance under his arm and
charged.45 The Aikido warriors16,43
drew their swords, but it was the
kung fu fighters2 who caused the role
players to retreat, and recommence
their Ars Magica game in the dark
recesses of the palace.
They came to a wide, slow flowing
river. Some kayaks and boats9,14,19
were heading upstream; they
▼
▼
would not have been out of place in
any Cornish seaside shop. And there
was even a detector calibration jig, all
built out of Lego.21
But best of all was the beaded
jewellery.2 ‘Who makes that?’, she
asked. ‘No-one knows’, replied the
cuckoo clockmaker.56 ‘But I hear she
is getting married on top of the
mountain.‘2 ‘Oh goody’, giggled
Alice. ‘I’d love to come.’
So off they went, some
hiking,19,47,61,66 some on mountain
bikes,28,51,62,69 some on horseback.45,68 A
sheep farmer seemed to be dancing
the Salsa.67 When they came to a
clearing some of the guys started
kicking a ball about.8,60,63
shouted and a sailing boat57 offered
to take them across. But just as she
stepped onboard, Alice slipped and
fell into the dark, murky water. A
scuba diver28 came straight to her
aid, but it was the bog snorkelling
champion34 who found her. Together
they brought her spluttering to the
surface.
‘Lucky I can do breath-hold free
diving‘,34 thought Alice as she broke
the surface.
On the other side of the river,
stretching high into the sky, stood
the mountains.
‘Good that I’ve done a bit of
climbing’, thought Alice. And so had
the others,2 and there were some
scoutmasters too,14,24,41 so everyone
was under safe leadership.24,40,59,70 The
paths looked like a maze,11 but
someone had a map; a secret map of
all the footpaths2 that had been
made clandestinely and handed
down through generations.
Thick clouds were forming on the
top of the mountain. ‘They’re not
clouds’, said Alice. She had done
research on extreme weather,49 and
knew it was a volcano. But the
sound of church bells2,11,29 spurred
them on, and the orchestra,2,22,26,36,37
played the wedding march as they
neared the top. She had never seen
so many church officials.2,22,26,36 But
which one was the vicar?
Almost on cue the church doors
opened to the insistent riff of
Hawkwind’s ‘Silver Machine’, the
band27,53 led by a large moustachioed
bass player.8 And there stood the
vicar, vestments blowing in the
wind, his Stratocaster pounding out
the chords.50
‘The groom should be along any
moment’, someone hoped. There he
is at the edge of the volcano crater.
‘It looks as if he’s ironing his
shirt‘,25 said Alice. ‘He must be very
proud of his appearance.’
‘It’s getting hot’, she thought as
she went up to a building next to the
church. ‘It’s like a sauna!’ Steam was
coming out, and she peeped inside.
A sweating woman was balancing
on her head.4,61 ‘Golly’, thought
Alice. ‘That’s the yoga Sirsha Asana
position.4 I could never master that.‘
‘Never mind’, said the inverted
practitioner. ‘You can always go
home and practice Thulaikatchi*
Asana.’
A buzz turned her attention
skywards. Were they model aircraft
close to,38,46 or real ones48,63 far away?
will grasp at a straw, and a trainee
clinical scientist will do the same to
a banner trailing from a model
aircraft when being chased down a
mountain by a stream of boiling
lava.
‘Lucky I learned how to climb
silks34,36 when I was at juggling27,52,72
school’, thought Alice, as she
performed her favourite double
hocks climb. It was when she was
safely near the top that she paused
and looked down at the writing on
the banner. It was Havercroft’s
paper on ion recombination, the
very one she had been looking for!
Engrossed by the elegance of
▼
▼
Some of the models were almost life
size,38 so it was hard to tell. But one
was trailing a long banner; the
writing too small to read.
Just then the volcano started
rumbling, and great plumes of
smoke billowed skywards. Panic set
in; everyone started running down
the mountain. Great folds of lava,
red hot, and sulphurous fumes
chasing them.
Alice could feel the lava lapping
at her feet, her lungs were bursting,
the smoke enveloping her. Just in
time, without a second to spare, the
plane with the banner swooped
down low on Alice. A drowning man
FIGURE 4.
‘Lucky I learned
how to climb silks
when I was at
juggling school.’
*‘Thulaikatchi’ is
Tamil for
‘television’.
Talekatchi Asana is
sitting in front of
the telly.
Havercroft’s analysis, she read on.
Soon she had quite forgotten her
plight, being towed behind a giant
model aircraft escaping from an
exploding volcano. And when she
had finished the conclusion she
looked up. Like a magic trick44 she
had recombined with reality! She
was back in her office at Lymeswold
Hospital, surrounded by a pile of
debris from the archive cupboard.
‘Golly, what an adventure!’,
thought Alice. ‘If I wrote it up, noone would believe me.2,27,47 I can’t
wait until I finish my portfolio and
meet up with some normal people
again.’ n
REFERENCES
1 Havercroft, Klevenhagen.
Phys Med Biol 1993; 38:
25–38.
2 Anon
3 Adrian Lonsdale
4 Agelos Saplaouros
5 Alexis Moore
6 Alison Scott
7 Andrew Tyler
8 Andy Beavis
9 Andy Buckle
10 Angela Cotton
11 Angela Newing
12 Arek Mazurek
13 Bruce Walmsley
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Caroline Rudland (May)
Carolyn Richardson
Catherine Eveleigh
Clare Hadley
Conor Heeney
David Carpenter
David Taylor
Ed Hockaday
Elizabeth Crawford
Eve Shin
Giles David Morrison
Graham Freestone
Heather Williams
Henry Lawrence
Ian Negus
29
30
31
32
33
34
35
36
37
38
39
40
41
42
Jack Aylward
Jacqueline Roberts
James Goracy
James Weston
Janet Droege (née
Havercroft)
Jason Cashmore
Joseph O'Brien
Karen Chalmers
Karen Fuller
Keith Mitchell
Lucy Winch
Lynn Martinez
Lynsey Hamlett
Maria Holstensson
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
Marina Romanchikova
Mark Powell
Mark Rawson
Mathew James
Matilda Nyekiova
Mike Avison
Neil S. Robinson
Paul Ganney
Peter Clinch
Peter Julyan
Philip Orr
Rachel Cooke
Robert Flintham
Robert Speller
Robin Laney
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
Rosalind Perrin
Rosemary Morton
Ryan Lewis
Samantha Eustace
Sarah Naylor
Sean Owen
Sharan Packer
Stephanie Wentworth
Stephen Mason
Steve Weston
Teresa Clark
Tom Jordan
Usman Lula
Wayne Gardner
Yatigammana Dylan
FEATURE | SCOPE
Radiating enthusiasm: IPEM at
the 2012 Big Bang Science Fair
Lisa Parker-Gomm (External Relations Manager, IPEM)
H
ow do you explain
radioactivity to a 6-yearold? This was just one of
the challenges IPEM’s
team of outreach
volunteers set
themselves at this year’s Big Bang Fair
– a national event for young people
which celebrates science, technology,
engineering and maths.
In March over 56,000 visitors
flocked to the NEC in Birmingham and
hundreds of them visited IPEM’s stand
where they had hands-on experience of
how physics is used in healthcare. Matt
Dunn, Head of Radiology Physics at
Nottingham University Hospitals NHS
Trust, led the IPEM team: ‘Our stand
seemed relatively low-budget – no
expensive plasma screens and suchlike.
But our real strength was in allowing
the visitors to get their hands on real
equipment that is actually used in
hospitals. Hundreds of people came to
our stand, and we were busy most of
the time’.
DISCOVERING RADIOACTIVITY
IPEM’s most attention-grabbing
offering was a simulated hospital
radioactivity incident. Every 30
minutes the alarms went off and it was
time to don the big yellow CBRN
protection suit, apron, gloves,
overshoes, hat and other pretend
‘protection’ gear and start searching for
radiation! No-one was in danger, of
course, but it gave visitors the
opportunity to scan unfortunate
victims with a Geiger counter to find
‘radiation’ (it was just alcohol vapour),
and also to discover how everyday
items such as bananas and potassium
salt (Lo-Salt) are radioactive too. As
well as being fun, the demonstrators
had the opportunity to explain the
many ways radiation is used in
medicine for the benefit of patients.
One parent asked a volunteer to
explain radioactivity to his 6-year-old
daughter. Amazingly, the child claimed
to know what atoms were, and they
were both happy with the impromptu,
if perhaps non-PC, explanation that
some atoms didn’t like the way they
looked, so they threw off bits of
themselves until they felt better!
Another activity on offer was using
an ultrasound scanner to identify
sweets and fruit concealed in miniphantoms. ‘The children enjoyed the
game, and on a few occasions we
scanned ourselves to show the very
enthusiastic ones our kidneys, hearts
and blood vessel in our wrists’,
commented Matt Dunn. This proved
to be a very engaging demonstration
when families would be guessing the
fruit together, and parents telling their
children about their experience with
ultrasound during pregnancy.
IPEM’s third offering was blood
pressure and pulse monitoring. ‘My
readings were sky high at the start
due to the stress of organising the
event!’, said Matt Dunn. ‘We were a
bit worried too in case some of the
visitors’ readings fell outside the
normal range, but fortunately that
didn’t happen.’ Children approached
the experience with anxiety, much
giggling and a spirit of competition to
see who had the best reading.
Volunteers agreed that although it
could be tiring to stand all day talking
to people, when they found someone
who was genuinely interested in what
they were saying it was a real joy. Matt
said: ‘Many of the kids were really
enthusiastic about science and it was
really good to see that. We weren’t
really trying to recruit them to be
medical physicists, but just trying to
inspire them to carry on their science
education so that hopefully in years to
come there will be a better supply of
scientists contributing to the UK
economy and society in general.’ Part
II trainee Kirsty Hodgson commented:
‘It was great to talk to so many
interesting people, not only the
children and teachers, but members of
the Science Council, the STEM
ambassador scheme and many others.
It will be a good experience to put into
my portfolio and it was nice to
promote physics in healthcare as
many people had not come across it
before.’
EngineeringUK in partnership with
the British Science Association, the
Institute of Physics, the Science
Council, the Royal Academy of
Engineering and Young Engineers, the
event is supported by the Department
for Business, Innovation and Skills as
well as numerous sponsors from
industry. IPEM has taken part in each
of the 4 years the event has been
staged. For more information see:
www.thebigbangfair.co.uk.
Next year’s national event will be
in London on 24th–26th March and
IPEM will once again be taking part. If
you’re passionate about your
profession and want to share this with
young people, why not give it a go?
IPEM has a range of pre-prepared
activities, supporting materials for
teachers, and will deal with all the
logistics – all we need is a little of
your time and enthusiasm. To find out
more, contact [email protected].
As Evelyn Shin, another volunteer
from Nottingham University
Hospitals, enthused: ‘If offered again,
I’d volunteer in a heartbeat. It was a
really great experience.’ n
▼ Scanning
victims to
detect
‘radiation’.
ACKNOWLEDGEMENTS
Thanks to the following for their contribution
to this report: Matthew Dunn, Head of
Radiology Physics, Nottingham University
Hospitals NHS Trust; Evelyn Shin, Nottingham
University Hospitals NHS Trust; Kirsty
Hodgson, University Hospitals Birmingham
NHS Foundation Trust; Eva McClean,
Development and Communications Manager,
IPEM, and to all the other volunteers who
helped on the stand or loaned equipment for
the demonstrations.
BENEFITS OF VOLUNTEERING
The Big Bang Fair is delivered by over
170 organisations from the public,
private and voluntary sectors. Led by
SCOPE | FEATURE
The launch of IPEM outreach
strategy to connect with students
T
he new IPEM outreach
strategy was recently
launched at the
communicating
science session at
MPEC 2012 in Oxford.
The outreach strategy aims to help
members communicate science and
engineering to students to encourage
them to study these subjects further.
It is vital that students understand
the excitement and importance of
science, technology and engineering
in medicine. The NHS alone is by far
the largest employer of scientists in
the UK yet students are often
unaware of the career opportunities
in healthcare science and
engineering. The types of events that
members currently support is wideranging. Examples include:
▼
Matthew Dunn (Nottingham University Hospitals NHS Trust)
Working with
school children to
stimulate their
interest can be
hugely rewarding.
n school careers fairs,
n classroom experiments and
demonstrations,
n hospital open days,
n departmental visits or tours,
n teacher-focussed events.
IPEM and the membership have
supported 35 such events throughout
2011 and 2012.
Every event has a different
audience so it is important that the
right type of activity is matched to
the event in order to maximise
impact. The purpose is to encourage
the study of general science GCSE
and A-level subjects and to introduce
the concept of scientists and
engineers working in medicine.
Students are generally surprised to
learn that physics and engineering
degrees can lead to jobs in the
medical industry and healthcare.
IPEM’S OUTREACH ACTIVITIES
IPEM’s outreach activities have
traditionally been delivered and
supported by individual members on
a local level, often in their own time.
As a result efforts were often
duplicated and experiences not
shared. The impact was sometimes
limited as the activities were not
always targeted at the appropriate
“
The
types of
events that
members
currently
support is
wideranging
”
group and were costly in terms of
time to develop and administer. In
the last few years more office support
has been requested by members and
the resulting increase in outreach
activities requires a more strategic
approach to IPEM’s outreach efforts.
IPEM Council has allocated funding
to deliver this strategy over 2 years.
IPEM will also continue to directly
support a limited number of events
such as the national Big Bang Fair
(www.thebigbangfair.co.uk, see
page 17).
The vast majority of outreach
activity is best delivered by volunteer
IPEM members; however, the effort
involved in delivering outreach
activities can be substantially
reduced by having a range of ‘readymade’ activities and resources which
can be downloaded from the website
or sent out to members from the
office. When developed these
materials will allow members to
concentrate on the delivery of
outreach.
IPEM members at all stages of
their careers are encouraged to
support the initiative and get
involved in outreach activities from
talking to students to developing
activities or experiments. Although
working with school children may
initially be daunting, most members
find the experience hugely rewarding
and also a great way of improving
communication skills. n
GET INVOLVED
To find out more or volunteer please
contact the outreach team:
[email protected]
TRAVEL AWARD | SCOPE
2011 AAPM–IPEM MEDICAL PHYSICS
TRAVEL GRANT REPORT
JUN DENG Yale New Haven Hospital, New Haven, CT, USA
I
n April 2012 I visited the UK
after receiving an
AAPM–IPEM Medical
Physics Travel Grant. Here I
outline my experiences at
each of the centres that I went
to and the people that I met.
16TH APRIL: CASTLE
HILL HOSPITAL
After a long train ride from London to
Hull, I finally arrived at the Castle
Hill Hospital where Dr Andy Beavis,
Head of the Radiation Physics
Department, was the host for my first
stop during this trip to the UK. My
visit started with a tour of the
department led by Dr Beavis. The
whole oncology centre is very new
with eco- and patient-friendly designs
everywhere, which to me makes it
seem rather more like a hotel than a
cancer centre for radiotherapy. Then I
gave a lecture talking about the
kVCBCT imaging doses and the
associated cancer risks, after which
we had a round-table meeting for
physics staff so that everyone could
get involved in a more interactive
discussion. The primary concerns
were about the imaging doses and
why CT manufacturers did a better
job than the linac manufacturers for
CBCT in terms of imaging dose
reduction, protocol optimisation and
patient safety. I also learnt that a
virtual CT reconstructor has been
developed by this group so that
virtual CT scans can be simulated to
study the correlation between the
imaging doses and the image quality
without actually performing a scan
on a patient. I was very interested in
this project and indicated that our
group was developing a similar tool
dedicated to CBCT virtual simulation
and reconstruction. Finally, I was
lucky enough to experience a state-ofthe-art technology named VERT
developed and co-founded by Dr
Beavis. VERT (virtual environment
for radiotherapy and training) is a
linac simulator set in a 3D virtual
environment, which can help users
train with full access to the linac
functionality without interfering with
the clinical workflow. We actually
took a picture as shown in figure 1
with VERT displayed in the
background.
17TH APRIL: CLATTERBRIDGE
CENTRE FOR ONCOLOGY
The following day I visited the
Clatterbridge Centre for Oncology
where Dr Alan Nahum was my
host. We actually started our
conversion with our fond memories
of the past. I was fascinated by all
sorts of legendary stories told by
Alan about our common friends.
Alan’s postdoc Dr Julien Uzan gave
me a brief introduction to their latest
research tool called Biosuite, aiming
to facilitate biologically based
treatment planning and
optimisation. The software analysed
the DVH data exported from
conventional treatment planning
systems and computed TCP and
NTCP based on published Marsden
and LKB models. In addition, the
software was able to optimise the
plan with a fixed NTCP value, the
so-called isotoxic planning scheme,
and generate a series of plans with
different TCP values corresponding
to different fractionations. Later on,
I gave a lecture on kVCBCT and was
engaged in a very interactive
discussion with dozens of physicists
and research staff. I enjoyed some
tough questions raised by Alan and
Dr Geoff Lawrence. Finally, I was
kindly given a tour of the only
proton radiotherapy facility in the
UK, Douglas Cyclotron (figure 2), by
Dr Andrzej Kacperek. It produced a
single energy of 62 MeV proton
beams dedicated to radiotherapy of
eye tumours due to its limited
treatment depth in tissue of 3 cm.
The highly acclaimed
professionalism and rigorous efforts
to quality control the clinical
practices at every step made it a
highly successful facility, which
treated one-third of eye patients in
the UK and dozens of patients
across the world. It was a busy day
for me. In fact, I was so involved
with the intensive discussions that I
forgot my room number when I got
back to my hotel. Luckily I did not
forget which hotel I was staying in!
▼
▼
FIGURE 1.
Dr Andy Beavis
and Jun at
Castle Hill
Hospital.
SCOPE | TRAVEL AWARD
▼
▼
FIGURE 2.
Dr Andrzej
Kacperek, Dr
Alan Nahum and
Jun at
Clatterbridge
Centre for
Oncology.
▼
FIGURE 3.
Dr Jonathan
Sykes, Dr Vivian
Consgrove and
Jun at St James's
Institute for
Oncology.
▼
FIGURE 4.
Jun, Dr Jim
Warrington, Dr
Margaret
Bidmead, Dr
Ellen Donovan
and Dr Phil Evans
at Royal Marsden
Hospital.
▼
FIGURE 5.
Dr Elizabeth
Macaulay and
Jun at Churchill
Hospital.
18TH APRIL: ST JAMES’S
INSTITUTE FOR ONCOLOGY
My third visit took place at St James’s
Institute for Oncology in Leeds where
Dr Vivian Consgrove, Head of
Radiotherapy Physics, was my host
(figure 3). The centre has ten Elekta
linacs for clinical treatments and two
for research. With about 6,500 patients
treated annually, it is quite a challenge
to manage the whole clinical workflow
seamlessly without errors. I noticed
three major factors contributing to their
high efficiency: (1) a well thought-out
design of the clinic such that patients
received professional care from a
dedicated group of clinicians while
maintaining a high degree of privacy;
(2) a clear structure of management and
easy-to-follow guidelines and policies,
and (3) all the photon beams are
matched throughout the department.
Later on, I gave a lecture on imaging
doses from kVCBCT and their
associated cancer risks. Although my
study indicated large imaging doses
from CBCT procedures, I emphasised
more than once that people should not
be scared by the potential cancer risks
associated with the medical imaging
procedures as long as those procedures
are administrated in a prudent way and
are clinically justified. The risk of not
having those procedures done would
be much greater for most of the cancer
patients. Dr Jonathan Sykes, one of the
physicists doing research work on IGRT
and kVCBCT, exchanged his ideas with
me on how to correlate CBCT with CT
as planning CT has always been
considered as reference to the CBCT
images in determining the shifts. I
pointed out that another possible
approach would be to use online CBCT
image datasets as the reference instead
of planning CT as long as the
Hounsfield number in CBCT images is
accurately determined.
19TH APRIL: ROYAL
MARSDEN HOSPITAL
I visited Royal Marsden Hospital
(RMH) in Sutton the next day. My host
was Dr Phil Evans, Head of the
Radiation Physics Department, who
gave me a detailed introduction to the
organisation of RMH (figure 4). He
showed me a copy of the RMH’s 2010
annual report and discussed some of
the fascinating projects that were
conducted during 2010. I delivered my
oral presentation to a large audience
including the staff members from the
Chelsea site. My lecture generated quite
a few questions regarding the CBCT
TRAVEL AWARD | SCOPE
applications in the clinic. I also
emphasised in my talk that prudent
medical imaging procedures always
outweighed the potential cancer risks,
because missing the tumour target
would lead to greater cancer risks in
the future if necessary medical imaging
procedures were not performed. Later
on I had the opportunity to have a oneon-one discussion with some of the
research fellows, postdocs and PhD
students at RMH. The topics were very
interesting and significant, covering
imaging dose, toxicity and margin
reduction correlations in breast cancer
radiotherapy with CBCT, patient
fatigue study in IMRT treatments of
head and neck cancer, a CT x-ray
energy spectrum simulator, breast
tissue segmentation for better and
more accurate contouring and dose
painting, dynamic leaf tracking for
Elekta MLC, as well as a new CMOS
technology developed to replace
current EPID for better and quicker
responses to high-dose radiation. I had
a pleasant and in-depth discussion
with each one of them and caught a
glimpse of what was going on in each
project. In fact, it was an unforgettable
experience for me as I was exposed to
so many different projects within such
a short period of time.
20TH APRIL: CHURCHILL
HOSPITAL
My last stop was the Churchill
Hospital in Oxford, a beautiful college
town and host to the University of
Oxford. Dr Elizabeth Macaulay, Head
of Radiation Physics, was my host in
this visit and gave me a quick tour of
the facility (figure 5). My talk on
kVCBCT was well received and
generated a lot of discussions on
CBCT applications and imaging
doses. Three research scientists from
diagnostic imaging remained after my
talk and we had further discussions
on the status and future directions of
CBCT as compared to the CT
technology. I acknowledged that our
current CBCT technology was still not
mature yet, and more research work
would be needed from both academia
and industry to further improve it to
be more efficient and safer for the
patients. As our colleagues in CT are
“
I had a
pleasant
and indepth
discussion
with each
one of
them
”
doing everything they can to optimise
the scan protocol and reduce the dose
to patients, we should also be engaged
in efforts to optimise our clinical
routines so that low-dose CBCT can be
administered to patients in an optimal
and individual way.
This concluded my 10-day visit to
five great institutions in the UK.
During this trip, I not only met many
wonderful colleagues in the UK and
learnt a lot about their research
projects and clinical practices, but also
shared my experiences with them on
some mutually interesting topics,
which was indeed an invaluable
experience to me and my future career
development. I would like to take this
opportunity to express my sincere
gratitude to Drs Andy Beavis, Alan
Nahum, Vivian Consgrove, Phil Evans
and Elizabeth Macaulay for their
valuable time and genuine hospitality.
Finally, I’d like to thank both AAPM
and IPEM for this wonderful travel
grant that allowed me to visit the UK
and exchange ideas and share my
research work with my fellow
physicists in the UK.
Austrian
Austrian Medical Center Upgrades
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Physicians at SALK and Paracelsus
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n versity have been
impressed with the rapid beamshaping capabilities of their new
Agility™* 160-leaf MLC, treating 33
patients on their Agility-equipped
Elekta Synergy® treatment system
on its first day of clinical use, May
14. Now entering its third month,
clinicians use the system to treat 60
patients per day.
An MLC, a device made up of
numerous, individual tungsten
“leaves,,” is used to shape radiation
therapy beams, which are delivered
from diff
ffeerent angles around the
patient. Using 160 high-resolution
leaves, Agility precisely sculpts
delivered radiation to the distinctive
contours of the tumor, while reducing
exposure of healthy normal tissues.
Beam-shaping speed is provided by
the MLC’s ultra-fast leaf movements
– twice as fast as other MLCs
commonly used in the industry –
enabling physicians to fu
urther exploit
the most advanced cancer therapies
such as stereotactic radiosurgery
(SRS), stereotactic radiation therapy
(SRT
T) and Volumetric Modulated Arc
Therapy (VMA
AT).
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Further, with a new lower radiation
transmission design, research has
shown Agility can significantly
reduce the patient’s non-therapeutic
radiation exposure as compared to
other conventional MLC’s.1
Experience the Elekta
lekta Differ
Difference
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Based on their experience, clinicians
at the Salzburg center report that the
Agility MLC’s new design provides
them not only with additional speed,
but also more precise dose sculpting
capabilities and remarkably lower
non-therapeutic radiation dose
delivered to the patient.
“Looking closely at several cancer
cases, we’ve calculated a measurable
improvement in dose shaping
precision with Agility’’s highresolution, five millimeter leaves,,”
says
y Felix Sedlmayer, M.D., Profeessor
and Chairman, Department of
Radiotherapy and Radio-Oncology,
SALK and Paracelsus Medical
University. “This greater precision
improves our ability to focus radiation
to the tumor, while strictly limiting
exposure to surrounding critical
structures..”
“We were astonished at the amount
of healthy tissue dose reduction we
could achieve,” he adds. “This capacity
theoretically enables us to improve
outcomes and reduce the potential for
complications.”
Harnessing Agility’’s unique ability
to deliver high-resolution beamshaping over a large 40cm x 40cm
field, the medical center has used this
new technology to treat virtually all
indications, including stereotactic
(SBRT/S
T/
T RT
T) cases and other advanced
IMR
RT therapies.
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While the clinical performance of
Agility is now foremost in the minds
of the Salzburg physicians and
physicists, the speed of the Agility
upgrade also made an impression.
“Our main interest was in limiting
downtime, since we are operating
only three linacs and could hardly
compensate for one linac being
down for a long period of time,” says
Peter Kopp, Ph.D., Deputy Head of
Medical Physics. “Two weeks seemed
extremely ambitious to accomplish a
complete swap out of the MLC heads
and to perform the measurements.
But we all worked together – the
Elekta personnel, our local service
engineer, Georg Schröcker, in
addition to the medical center physics
staff and IT engineers – to make it
a success..”
Agility is offered in new systems or
as an upgrade to existing treatment
systems. For more information, visit
www.elekta.com/agility
www
.elekta.com/agility
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4513 371 1012 08:12
MEETING REPORTS | SCOPE
BESPOKE SOFTWARE IN MEDICAL PHYSICS
AND CLINICAL ENGINEERING CONFERENCE
ANDREW ROBINSON The Harley Street Clinic, London
UCLH INSTITUTE FOR CHILD HEALTH 28th May 2012
IT WAS A WONDERFULLY SUNNY DAY IN MAY
when nearly 90 delegates descended on London for this
conference organised by IPEM’s Informatics and
Computing Special Interest Group (ICSIG). The Special
Interest Group was keen to highlight the key work that
is performed by medical physicists and clinical
engineers in designing, developing and maintaining
bespoke software that is used in their departments.
Presentations on a variety of applications across all
medical physics and clinical engineering specialities
were delivered, as well as a large collection of scientific
posters that delegates could peruse at their leisure
during the breaks.
PRESENTATIONS
▼
David Willis (Norfolk and Norwich University
Hospital, Norwich) opened the conference with an
informative presentation entitled ‘Bespoke software:
concept to clinical’, where he went through his
experience of software development from a
commercial, research and clinical perspective (figure 1).
His presentation summed up the role of the bespoke
software/in-house developer well. He also hit the nail
on the head with the often found problem in
departments that rely on one or two people to make
bespoke software: ‘Couldn’t <insert your name> write
us a program to do that?’, a statement that may
resonate with some readers! It was also interesting to
hear about some of the radiotherapy-related software
that he has developed, including software to perform
transit EPID dosimetry, an area where there are few
commercial alternatives.
A highly enjoyable talk was given by the
conference’s invited speaker Ian Wells (University of
Surrey, Guildford). In his talk ‘In-house software
development: a retrospective view’, he gave an
overview of how computing had changed during his
career, as well as highlighting the importance of
ensuring that software meets appropriate standards
from both a patient safety and professional point of
view. He had four questions for in-house software
developers to take away with them: is your software
durable? Are your systems safe? Is your methodology
appropriate? Are your qualifications suitable, and does
▼
FIGURE 1.
A slide from
David Willis’ talk.
SCOPE | MEETING REPORTS
▼
▼
FIGURE 2.
A slide from Ian
Well’s talks.
▼
FIGURE 3.
Overview slide for
Ed McDonagh and
Laurence King’s
presentation.
diffusion techniques in MRI will be of vast importance
soon as neurosurgeons heavily rely on the information
yielded by this type of scan.
At lunchtime delegates took the opportunity to look
at the large collection of posters that were on show, as
well as speak with the authors about the work on
display. One author even bought an interactive
demonstration to accompany their poster on
applications of MatSOAP (Rasam Teymouri). The
poster session was a good opportunity to network,
and also for delegates to discuss ideas with each other
about implementing different software solutions back
in their respective hospitals.
DISCUSSION
At the end of the meeting there was time for a
discussion about various topics that had come up in
the day. One area that was highlighted was the need to
have an appropriate amount of computing covered in
the new Modernising Scientific Careers curriculum for
medical physics and clinical engineers. Another was
the desire for more of a ‘community’ for professionals
working in medical physics and clinical engineering,
where computing advice could be sought and
resources shared. All in all the conference seemed to be
well received, with the potential for similar meetings
in the future a distinct possibility given the interest
shown in this meeting (figure 4). n
▼
this really matter? Professor Wells also talked about the
use of software as a medical device and the importance
of knowing what any software that you develop will be
used for once you have released it, citing an example
where he was asked to be an expert witness in a
criminal trial following the analysis of data using
software that he had developed (figure 2).
By far the most animated presentation of the day
was by Ed McDonagh and Laurence King (Royal
Marsden Hospital, London), whose presentation
dazzled the audience with their work on automating
dose audits in diagnostic radiology through a variety
of techniques, including optical character recognition
software (figure 3). As dose audits can be particularly
time consuming and span multiple equipment
manufacturers, their work to automate this process
across multiple manufacturers has a significant impact
on reducing their workload, and is something that
other centres may wish to look into.
There were a couple of talks from scientists Marc
White (National Hospital for Neurology and
Neurosurgery, London) and Peter Wright (University
Hospital of North Staffordshire, Stoke on Trent) about
applications of bespoke software in MRI. One thing
that I learned was how vast the DICOM standard
actually is, and that it even has a ‘tag’ for how many
legs a patient has. An interesting point that was
discussed during the MRI talks was that QA of
FIGURE 4.
Delegates
enjoying a coffee
break.
IPEM TRAVEL BURSARY: 2012 ESTRO 31/
WORLD CONGRESS OF BRACHYTHERAPY
AHAMED BADUSHA MOHAMED YOOSUF Northern Ireland Cancer Centre, Belfast
BARCELONA 9th–13th May 2012
THE EUROPEAN SOCIETY OF RADIOTHERAPY AND
Oncology (ESTRO) is an interdisciplinary society with
an aim to advance all aspects of radiation oncology.
Events are organised to facilitate the meeting of
professionals to share their ideas and work. This year
ESTRO 31 and the World Congress of Brachytherapy
(WCB) were organised as a joint conference. Being an
Indian medical physicist working in the UK, there is so
much that I wanted to learn and experience for myself
about radiotherapy practice in Europe. As a recipient of
an IPEM bursary award, I had the opportunity to attend
the ESTRO 31/WCB conference from 9th–13th May
2012, held in the International Convention Centre in
Barcelona. The city offers a feast of sculptures, paintings,
mosaics, impressive architecture and fashion. Especially
remarkable is the work of architect Antoni Gaudí
(figures 1 and 2), which can be seen throughout the city.
GLOBAL CONFERENCE
This year’s conference was a huge success with almost
4,000 delegates from 50 different countries in
attendance. Eighty exhibitors in the 10,000 m² exhibition
area provided the opportunity to discover the latest
products and services within radiation oncology. There
were 300 invited speakers, 188 oral presentations, 241
oral posters and 662 e-posters. At any one time there
were eight parallel streams spread across different
auditoriums of the International Convention Centre
(figure 3), allowing delegates the ability to attend
relevant sessions throughout the conference.
I predominantly attended World Congress of
Brachytherapy sessions. This is a 4-yearly conference
and is attended by physicians, physicists, biologists,
technicians and company reps from all over the world
with a keen interest in brachytherapy. This is the fifth
edition of this joint meeting and the programme took
place over 4 days, including a pre-meeting course
covering many aspects of brachytherapy.
The scientific programme was organised by Groupe
Européen de Curiethérapie and The European Society for
Therapeutic Radiology and Oncology (GEC-ESTRO), in
co-operation with the American Brachytherapy Society
(ABS), Asociacion Latino-americana de Terapia Radiante
Oncologica (ALATRO), Indian Brachytherapy Society
(IBS) and Australian Brachytherapy Group (ABG). My
goal on attending this conference was to expand my
current knowledge of brachytherapy physics and gather
useful information which could be adopted in our
centre’s practice to improve our service.
The first day of WCB (9th May) started with a premeeting workshop on ‘Recent advances in
brachytherapy physics’ that brought together eminent
speakers from a variety of backgrounds, both medical
and scientific, from Europe and the USA. The workshop
demonstrated the most recent advances in high dose
rate (HDR) and low dose rate (LDR) brachytherapy.
Topics included source calibration, quality assurance,
3D conformal imaging, advanced treatment planning
using model-based algorithms, in vivo dosimetry,
uncertainties in brachytherapy and professional society
recommendations.
The use of model-based algorithms in brachytherapy
treatment planning was reported by Luc Beaulieu
(Laval University Cancer Research Centre, Québec,
Canada) and a review of current developments in
planning systems was discussed. In current practice, all
dose calculations in brachytherapy treatment planning
are based on AAPM Task Group (TG) Report 43 which
utilises a factor-based algorithm. In a recent study
published by Mark Rivard et al. (United States), the
limitations of TG 43 were described and it was found
that in lower photon energies, as used in brachytherapy,
the absorbed dose in water to tissue differs due to
higher photoelectric effect cross-sections of tissue
compared to water. Similarly, the mass attenuation
coefficient of tissues differs at low photon energies.
Dose calculation algorithms are being developed based
on Monte Carlo methods, collapsed cone and solving
the linear Boltzmann transport equation. Also reported
was the recommendation that routine in vivo dosimetry
should be introduced in brachytherapy procedures, as at
present these are performed without any record and
verify systems.
INTRODUCTORY SESSIONS
The official opening ceremony took place at 6pm in the
main auditorium with a special lecture by the keynote
speaker Manel Esteller (IDIBELL – Bellvitge Biomedical
Research Institute, Barcelona, Spain), about medical
applications of epigenetics, a study of heritable changes
in gene expression caused by mechanisms other than
changes in the underlying DNA sequence, in health and
disease. After the lecture we were entertained by the
innovative music show of Pagagnini (figure 4), who
brought to life some of the most treasured musical
pieces in the key of comedy. The day was rounded off
by a special opening reception in the exhibition area
where the technical exhibition was formally opened.
With such a massive exhibition and hundreds of
scientific posters, the conference had an extremely
vivacious atmosphere.
Thursday began with the symposium on ‘Modern
brachytherapy: role of new image modalities’ with six
presentations discussing the latest imaging innovations,
from orthogonal radiograph to functional imaging, and
their impact in brachytherapy. Although every
presentation was informative, the topic I found most
appealing was the role of ultrasound in modern
brachytherapy. In brachytherapy, ultrasound has a role
in prostate, gynaecological and interstitial applications.
▼
▼
FIGURE 1
[TOP LEFT]
Casa Batlló,
Barcelona.
▼
FIGURE 2
[TOP RIGHT]
La Sagrada
Familia,
Barcelona.
▼
FIGURE 3
Barcelona’s
International
Convention
Centre (CCIB).
▼
▼
FIGURE 4.
Pagagnini music
show.
▼
FIGURE 5.
[LEFT]
Discussion in the
poster area
during a coffee
break.
▼
FIGURE 6.
[RIGHT]
Poster
presentation.
Developments in ultrasound were fundamental to the
rise in activity in prostate brachytherapy in recent years
based on the transrectal ultrasound-guided transperineal
implant technique.
Ultrasound techniques have matured with further
scientific developments and are integrated with modern
dosimetry algorithms; image fusion techniques enable
ultrasound to be combined with computed tomography
(CT) and magnetic resonance imaging (MRI) in prostate
brachytherapy which can result in accurate real-time
imaging and may translate into better patient dosimetry.
The use of ultrasound images in gynaecological
brachytherapy was presented by Sylvia Van Dyk (Peter
MacCallum Cancer Centre, East Melbourne, Victoria,
Australia). With the advent of high-quality threedimensional imaging, ultrasound can provide an
excellent representation of the cervix and uterus
enabling the definition of clinical target volume (CTV) as
per the GEC-ESTRO requirements. It was demonstrated
that the size and shape of the cervix measured in
ultrasound and MRI images correlate well. For those
centres with limited or no MRI facility, ultrasound
provides a more readily available tool to define CTV for
conformal planning.
POSTER PRESENTATION
Throughout the duration of conference, the poster area
and manufacturer’s stalls kept us occupied during coffee
breaks (figure 5).
I felt honoured that my abstract was accepted for
poster presentation and to be displayed amongst the sea
of posters (figure 6). On Thursday evening there was a
poster reception at 6.30pm so I tethered myself to my
poster during this time. The poster is entitled ‘Sector
analysis of I-125 prostate implants provides an effective
method comparing pre- and post-implant dosimetry’. In
this study, a sector analysis treatment planning tool was
used as a scientific method of examining the distribution
of dose within 12 separate sub-volumes or ‘sectors’ of
the prostate and compared pre- and post-implant
dosimetry.
The next two days also consisted of an intense
programme of educational courses, lunchtime
symposiums, debates and scientific sessions. The
conference covered many areas of ‘state-of-the-art’
brachytherapy and was very informative. The meeting
was an exceptional educational opportunity and a great
forum for discussion. I gained an essential insight into
the current status and future development of
brachytherapy physics and found this ESTRO 31/WCB a
valuable experience.
I am grateful to IPEM for giving me the chance to
attend this very useful conference. I would also like to
thank colleagues in Radiotherapy Physics, Northern
Ireland Cancer Centre, for their support and
encouragement, especially Geraldine Workman and Dr
Darren M. Mitchell who supported me in the research
work reported in the poster presentation. n
REPORT ON NPL CLINICAL TEMPERATURE
MEASUREMENT MEETING
ROSIE RICHARDS North London Consortium
JASON BRITTON Leeds Teaching Hospitals NHS Trust
NATIONAL PHYSICAL LABORATORY 30th January 2012
THE NATIONAL PHYSICS LABORATORY (NPL), AT
their premises in Teddington, hosted a one-day
scientific meeting on clinical temperature measurement
with some excellent speakers and interesting
discussions on the research and development
presented. The meeting was jointly organised by the
National Physical Laboratory and the IPEM
Physiological Measurement Special Interest Group.
The morning keynote speaker was Helen McEvoy
(NPL, Teddington), who talked about clinical
thermometry using tympanic thermometers. Helen has
been investigating different approaches to the training
of clinical staff in the appropriate use of the devices,
such that the uncertainty associated with the technique
may be reduced. She covered the factors to consider
when measuring temperature and the risks to consider
when using such a device. The risks include: (1)
misdiagnosis due to an inaccurate reading which could
be due to poor calibration, handling or storage, or (2)
injury due to the probe being pushed too far into the
ear or cross-contamination. A focussed 1-hour training
programme has now been developed working with
Oxford Radcliffe Hospitals NHS Trust which can now
be purchased and is delivered by NPL.
TIME FOR A CHANGE
The second speaker was Martha Sund-Levander
(Hoegland Hospital, Eksjo, Sweden), whose
presentation entitled ‘Time for a change when
assessing and evaluating body temperature in clinical
practice’ looked at the variability of clinical
temperature measurement and the factors that may
affect the readings in different healthcare settings. She
discussed a literature review carried out by her and
colleagues reviewing the variability of temperature
measurements made at different body sites and how
this could impact on the clinical management of
patients. Her work also looked at the effects of ageing
on normal body temperature ranges. It has been
identified that elderly patients with dementia may be
at risk of hypothermia as slightly lower than normal
temperature readings in this patient cohort may not be
seen as clinically significant. The discussions following
prompted Francis Ring (University of Glamorgan,
Pontypridd) to comment that paracetamol (which
Martha had discussed in relation to its effect on
temperature) was not an anti-inflammatory drug,
having only analgesic effects, and was not now
routinely used in clinical practice.
Following this, the programme moved onto an
interesting presentation by Sheera Sutherland
(Churchill Hospital, Oxford) who has researched the
potential of monitoring the core temperature of
patients (with established renal failure) during
haemodialysis with a thermal imaging camera and
establishing if this can have a positive impact on their
overall clinical management. The research
investigated the affects of lowering the dialysate
temperature to less than 37°C (which is traditionally
used in haemodialysis treatments). There is some
evidence that this may be actively warming the
patient with a statistically significant difference in preand post-dialysis temperatures shown at a level of p =
0.001. However, it has been found that some patients
do not tolerate cooler dialysate. Thermal imaging was
also used to investigate the possibility that changes in
measured core body temperature could be correlated
with a ‘crash’ or hypovolemic event that commonly
occurs. Kevin Howell (Royal Free Hospital, London)
commented that hypovolemia may be the main issue
to consider.
DENTAL THERMOGRAPHIC IMAGING
The next speaker, Paula Lancaster (Leeds Dental
Institute), showed her work on vital dental
thermographic imaging. The aim of the work was to
investigate the temperature of the tooth in the hope of
using this as an objective method to measure the
vitality of the tooth.
Currently sensitivity tests are performed to
subjectively assess the neural supply to the tooth but
this does not tell the dentist anything about the blood
supply. Alternatively an x-ray may be taken of the
patient’s mouth; however, this carries concerns of the
use of ionising radiation (albeit in very low doses). A
dental x-ray will only provide anatomical rather than
physiological information. The researchers tested the
theory that the central core of the tooth is warmer
than the rest of the crown by using a skeletal model.
They found that a thermal gradient could be detected,
when the tooth is subjected to external cooling. This
may be promising for using a similar model in vivo
once ethical approval is obtained. Paula suggested
that possible applications of thermography may
include:
n assessment of vitality of the tooth in people with
toothache and the provision of information on
which to base treatment decisions,
n assessment of the extent of trauma to the teeth,
n assessment of the development of the root in tooth
transplant (this is currently done using
radiographs).
Any methods developed need to be simple and
need to give consistent results. The discussions that
followed this talk brought up issues such as how to
find the emissivity of enamel. Since the tests are
looking for relative differences in temperature, it was
suggested that this may not be too important.
The day’s presentations then moved on to research
into thermal symmetry on the upper and lower
extremities on normal healthy volunteers carried out at
Glamorgan University by Ricardo Vardasca
(University of Minho, Braga, Portugal). For this work
high-resolution thermal imaging cameras were used to
capture a large number of images of the upper and
lower extremities. Unlike previous work in the area,
the images were captured in a controlled environment
and the analysis was not based on single points. The
images were then collated and standardised using
geometric models. The models were used to scale the
images to the same shape and size for each subject. The
final outcome showed a small difference of 0.5°C ±
0.3°C between left and right regions. A difference of
0.1°C was also found between ventral and dorsal
regions. Francis Ring commented after the presentation
that there is a measurement uncertainty associated
with the cameras which must be accounted for when
reviewing the results. It was also unclear how the
results could be used in the management of patients
and where this may be used in the care pathway.
The next speaker, Ismael Fernandez Cuevas
(Universidad Politecnica de Madrid), presented results
of a pilot study looking at the effects of the circadian
cycle on skin surface temperature. The measurements
were conducted in a controlled thermal environment
and were taken periodically over a 13-hour day with
the subject standing in the same position. Although
there was no obvious pattern resulting from the
measurements at different times, the temperature
fluctuations were fairly constant for all areas of the
body that were analysed. After correcting the
temperature using the calibration area, the data
showed similarities with existing results in this field
by Professor Ring et al. Since observations showed that
when the body was expecting food intake the
temperature increased, a member of the audience
suggested that the glucose level could be monitored if
the experiment was repeated. Discussion also took
place about the ‘constant core-variable shell’ theory
that is often applied to thermal regulation of the
human body.
THYROID-ASSOCIATED EYE DISEASE
John Allen (Freeman Hospital, Newcastle upon Tyne)
was the next speaker, presenting work on ‘Detecting
inflammatory disease in patients with active (Graves)
thyroid eye disease’. The treatment regimen used for
thyroid-associated orbitopathy depends on the
outcomes of subjective clinical assessment. John’s pilot
investigation was aiming to develop a working
protocol for thermal imaging of the eye and use it to
explore a range of characteristics in patients with this
pathology. Complications involved blinking, sweating
and tearing which may be asymmetric. Before the
The Handhound voice-operated
‘hands-free’ hand monitor
Designed for use in radioisotope handling
situations where hands could be contaminated.
t
t Entirely voice operated.
t
t Sensitive scintillation counter for gamma emitters.
t
t Fixed or dynamic alar
alarm
m thresholds.
t Automatic record keeping against user
t
names, to aid with HSE compliance.
t Automatic background updates.
t
t Stainless steel housing for ease of
t
cleaning and decontamination.
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Tel : 01273 4 9 7 6 0 0
ISO STANDARDS
The second keynote speaker of the day was Francis
Ring, whose presentation was entitled ‘ISO standards
for fever screening and their implications’. This
presentation raised questions about the feasibility of
fever screening on a large scale.
The reason for continued investigations into fever
screening is that there is always a risk of a new
influenza virus emerging and spreading. This would
cause disruption to society and fatalities, especially in
vulnerable groups such as the elderly and children.
Francis described the various stages of an influenza
pandemic before moving on to speak about fever
screening requirements. Finally, he presented some
results of the research investigating the mean inner
canthus temperature in febrile and afebrile children
presenting at an A&E department in Warsaw. It was
unclear from the presentation as to why the research
could not have been undertaken in the UK and if all the
possible variables had been sufficiently well controlled
or properly investigated.
The penultimate speaker, Kevin Howell, reviewed
his work on the use of a low-cost (£2,500), low thermal
and spatial resolution (160 × 120 pixels) thermal imager
in the clinical assessment of patients with Raynaud’s
phenomenon. The aim of the work was to determine
whether the low-cost portable thermal camera would
give comparable results to a more expensive device
(£10,000–£11,000) with higher resolution and better
thermal resolution which has been used to assess this
cohort of patients at the Royal Free Hospital. Despite
small differences in the measured finger temperatures,
the results demonstrated that the cheaper thermal
imager can be used in assessing patients with
Raynaud’s phenomenon and when compared to the
more expensive device clinically it would have no
impact on clinical management. It was therefore
concluded that low spatial resolution is not a limitation
for Raynaud’s phenomenon work (see figure 1).
THERMAL IMAGING APPLICATIONS IN
CRYOTHERAPY
The final speaker of the day, Armand Cholewka
(University of Silesia, Katowice, Poland), presented on
thermal imaging applications in whole-body
cryotherapy. This was an interesting application of
thermography using the cold environment to constrict
surface vessels and detect and treat deeper areas of
inflammation. A typical cryosauna has a temperature of
−120°C and the patient is required to spend 2–3
minutes at a time in it. The aims of Armand’s work
were to evaluate the effects of cryotherapy and to
determine the skin response due to the low
temperature used in whole-body cryotherapy. After the
patients had been in the chamber thermal images were
captured of different skin segments. These showed a
mean whole-body decrease in temperature of 5.8°C
with a maximum of 8.7°C. After use patients reported a
significant recovery after one to ten cryogenic sessions.
There was also a slight improvement in the fitness of
the patients. In conclusion, Armand claimed that there
was increased diagnostic value of thermal imaging
after body cooling and that thermal imaging can be
helpful in the monitoring of therapeutic effects of
whole-body cryotherapy. However, very little evidence
was presented to support this view and it was unclear
from the presentation how thermal imaging
contributed to patient care or overall management, and
where this would be used in the care and diagnostic
pathway.
It was clear from the presentations that outside the
use of thermal imaging for patients with Raynaud’s
phenomenon a lot of possible clinical uses are in the
very early stages of development and have not really
become established in mainstream clinical practice.
SUMMARY
The meeting was attended by about 25 delegates and
will hopefully become a regular event in the NPL
calendar since it proved to be a great success. n
MORE INFORMATION
All of the slides and talks can be accessed via YouTube at:
http://www.youtube.com/playlist?list=PL08A8E92B0363DA68&fe
ature=plcp
▼
▼
images were obtained the environment was cooled to
allow inflammatory areas (deeper vessels) to become
dominant. The initial results were quite encouraging
and the thermal imaging results demonstrated elevated
temperature in the eyes in patients where the disease
was active compared to inactive. John presented some
statistical analysis to show that a probability graph or
contour plot may be the way forward to classify these
patients in the future. However, this was only based on
a cohort of 15 patients and therefore its statistical
validity is equivocal.
FIGURE 1
Images from the
more expensive
thermal imaging
camera (left)
when compared
to the less
expensive device
(right). As can be
seen, very little
clinical
difference can be
observed.
INTERNATIONAL NEWS | SCOPE
MEETINGS 2012/2013
This is a non-exhaustive list of meetings of interest. For IPEM workshops and meetings and a full list of meetings, please check the IPEM website:
http://www.ipem.ac.uk/Conferencesandevents
EUROPEAN MEETINGS
Meeting
Venue and dates
More information
Dublin, Ireland
5th–8th September
http://www.wmicmeeting.org/
6th European Conference on Medical
Physics
Sibiu, Romania
6th–9th September
http://www.ecmp2012.ro/
IPEM Medical Physics and Engineering
Conference
Oxford, UK
10th–12th September
http://www.ipem.ac.uk/Conferencesandevents/
mpec/Pages/default.aspx
Mathematics of Medical Devices and
Surgical Procedures
London, UK
http://www.ima.org.uk/conferences/conferences_cal
endar/maths_of_medical_devices_&_surgical_proce
dures.cfm
7th IET International Conference on
Appropriate Healthcare Technologies for
Developing Countries (AHT2012 )
London, UK
http://www.theiet.org/aht2012
Annual Meeting of the German Society of
Medical Physics (DGMP)
Jena, Germany
http://www.conventus.de/dgmp2012/
International Conference on Medical Image
Computing and Computer Assisted
Intervention
Nice, France
1st–5th October
http://medical.rob.uni-luebeck.de/miccai2012rt/
3rd Newport 1-Day Update Course on
Phototherapy Dosimetry
Newport, Wales, UK
2nd October
International Cancer Imaging Society 12th
Annual Teaching Course
Oxford, UK
4th–6th October
http://www.bini.rtu.lv/isbemp
International Symposium on Biomedical
Engineering and Medical Physics
Riga, Latvia
10th–12th October
http://www.bsbpe.org
European Medical Physics and Engineering
Conference (EMPEC 2012)
Sofia, Bulgaria
18th–20th October
Contact ESMRMB Society
MR Safety Training Course
Vienna, Austria
18th–20th October
4th International Symposium on
Radionuclide Targeted Radiotherapy and
Dosimetry (ISTARD)
Milan, Italy
27th–31st October
12th IEEE International Conference on
BioInformatics and BioEngineering
(BIBE 2012)
Larnaca, Cyprus
11th–13th November
http://bibe2012.cs.ucy.ac.cy/
2012 International Conference on
NeuroRehabilitation
Toledo, Spain
http://www.icnr2012.org
IAEA International Conference on Radiation
Protection in Medicine – Setting the Scene
for the Next Decade
Bonn, Germany
3rd–7th December
http://www-pub.iaea.org/
mtcd/meetings/Meetings2012.asp
38th World Hospital Congress – Future
Healthcare
Oslo, Norway
18th–20th June 2013
http://www.oslo2013.no
▼
World Molecular Imaging Congress
SCOPE | INTERNATIONAL NEWS
MEETINGS 2012/2013
NORTH AMERICAN MEETINGS
Meeting
Venue and dates
More information
Applied Health Physics (5-week course) Oak
Ridge Associated Universities Hands-on
Training in the Radiological Sciences
Oak Ridge, TN
10th September–12th October
http://www.orau.org/environmental-assessmentshealth-physics/capabilities/health-physicstraining/course-descriptions-and-schedules.aspx
Computed Tomography Hands-on Workshop
for Physicists
Houston, TX
http://www.mdanderson.org/education-andresearch/departments-programs-andlabs/departments-and-divisions/imagingphysics/education/index.html
Principles and Practices of Radiation Safety:
Occupational and Environmental Radiation
Protection
Boston, MA
23rd–27th September
https://ecpe.sph.harvard.edu/programs.cfm?CSID=
OERP0913&pg=cluster&CLID=1
ASTRO Annual Meeting
Boston, MA
28th–31st October
https://www.astro.org/Meetings-and-Events/2012Annual-Meeting/Index.aspx
IEEE Nuclear Science Symposium, Medical
Imaging Conference and Workshop on
Room-temperature Semiconductor X-ray
and Gamma-ray Detectors
Anaheim, CA
29th October–3rd November
http://www.nss-mic.org/2012/NSSMain.asp
Respiratory Motion Management for
Radiation Therapy
St Louis, MO
http://radonc.wustl.edu/pdf/MMRTCourse.pdf
Radiological Society of North America
(RSNA) Annual Meeting 2012
Chicago, IL
http://www.rsna.org/Annual_Meeting.aspx
Practical Aspects of Stereotactic Body
Radiation Therapy (SBRT)
Stanford, CA
30th November–1st December
HPS Mid-year Topical Meeting on Medical
Health Physics and Accelerator Dosimetry
Scottsdale, AZ
27th–30th January 2013
http://hps.org/meetings/meeting33.html
7th International Conference on Ethical
Issues in Biomedical Engineering
New York, NY
20th–21st April 2013
http://www.downstate.edu/orthopaedics/
bioethicsconf2013/
Thai International Workshop on New
Technologies in Radiotherapy
Bangkok, Thailand
22nd–25th August
http://www.cccthai.org/en_/
12th International Conference on Radiation
Shielding (ICRS-12) and 17th Topical Meeting
of the Radiation Protection and Shielding
Division of the American Nuclear Society
Nara, Japan
2nd–7th September
http://www.icrs12.org/
IC3DDose: 7th International Conference on
3D Radiation Dosimetry (formerly known as
DOSGEL)
Sydney, Australia
4th–8th November
http://www.ic3ddose.org
Engineering & Physical Sciences in Medicine
Conference (EPSM2012)
Gold Coast, Queensland, Australia
2nd–6th December
http://www.epsmconference.org/
IEEE-EMBS – International Conference on
Biomedical Engineering and Sciences
(IECBES 2012)
Langkawi, Malaysia
17th–19th December
http://iecbes2012.myembs.org/
17th International Conference on the Use of
Computers in Radiation Therapy (ICCR)
Melbourne, Australia
6th–9th May 2013
http://www.iccr2013.org
Email: [email protected]
REST OF THE WORLD MEETINGS
MEMBERS’ NEWS | SCOPE
Röntgen Prize of the British Journal of Radiology
of Radiology. Founded in 1924, in
memory of Professor W.C.
Röntgen, this prize is awarded
annually to a member, or a team
of workers including a member,
whose contribution to the British
Journal of Radiology has
been of special merit.
The subject of the
contribution must be
related to radiotherapy,
radiobiology or physics.
The BIR stated in
their citation that:
‘Throughout his NHS career Dr
Mountford served the British
Institute of Radiology with
distinction. In 1994 he joined the
Editorial Board of
the British
Journal of
Radiology
and later
became
Deputy
Editor for physics and
technology. He additionally
made scientific contributions to
the BJR in numerous articles
published between 1976 and
2009 and, for 6 years, was a
member of the BIR Radiation
Protection Committee.
The BIR recognises with
gratitude Peter Mountford's long
and distinguished association
with its activities and is
delighted to award him the 2010
Röntgen Prize.’
I think that our whole
readership would wish to join
me in congratulating Peter on
his achievement.
▼
One of our own, Peter Mountford,
was recently awarded the
prestigious Röntgen Prize of the
British Journal of Radiology.
Peter was formerly Director of
Medical Physics and Clinical
Technology, University
Hospital of North
Staffordshire, Stoke-onTrent, and also a Reader in
the School of Postgraduate
Medicine of Keele
University.
At a reception
held at UKRC in
Manchester on
Monday 25th
June 2012,
Peter was
awarded the
2010 Röntgen
Prize of the
British Journal
Peter Mountford (right) and
Dr Stephen Davies, the President
of the British Institute of
Radiology. Thank you to the BIR
for providing the image.
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SCOPE | MEMBERS’ NEWS
Robert Neilson
Peter Sharp acknowledges the exceptional hard work of IPEM’s retiring General Secretary
ne can argue as to
who is the more
important person in
the Institute, the
President or the
General Secretary. A President
is rather like a pigeon, he (or
she) flies in, makes a mess and
then flies off again after 2 years.
The General Secretary has the
brush and pan and is
responsible for cleaning up
afterwards.
O
MAJOR ACHIEVEMENTS
As one of the first pigeons that
Robert had to clean up after, I
have no doubts about the
importance of the role of the
General Secretary. Of course he
is now well supported by an
administrative team in
Fairmount House, but he
carries the ultimate
responsibility. I asked Robert
what his greatest challenge had
been and certainly well up the
top ten list was the introduction
of the new computer system.
Those of you who are keen
subscribers to Private Eye will
frequently read about the
disasters that befall many
government departments when
they try to introduce new
computer systems and IPEM,
while not (yet) featuring in that
august organ, was not immune
from that. I have often said that a
new President has two options;
either introduce a new computer
system for the office or
undertake a reorganisation of
how IPEM works. Either way
he/she will have an excuse for
putting off any difficult decisions
until after their term of office. But
Robert is the man with the brush
and pan.
“
The General
Secretary has the
brush and pan and
is responsible for
cleaning up
”
Like many leading lights in
IPEM Robert has Scottish roots.
Being a keen amateur
genealogist Robert has traced
one part of his family back to St
Ninians, near Stirling. However,
in the middle of the nineteenth
century they moved down to
Yorkshire, first to the York area
and then, his sub-branch, to
Knottingley, where Robert
himself was born. Robert is now
a fully fledged Yorkshireman,
having lived in the county all
his life. Not only does he
love its moors and
dales but as a
committed Christian
Robert has many
connections through
his work with the
Congregational
Church in Pontefract.
Those of us who
have had the privilege of working
with Robert over the years
appreciate his openness, honesty
and full commitment to the aims
of the Institute. When I suggested
to Robert that perhaps not being
a scientist would have been a
disadvantage in his early days, he
pointed out that he had always
been keen on science and it was
only a quirk of the educational
system that meant he had ended
up on the arts side. Also, in his
previous jobs in the power
industry, he had worked with
scientists and engineers and
needed a strong technical
background to carry out audits
and manage the functions for
which he was responsible at a
power station and in the fuel
supply chain.
That devotion to the
profession showed itself again
when I asked Robert of what
achievement he was most proud.
He said that it was the work he
did with the Science Council, on
behalf of the Institute. During
that time the Chartered Scientist
designation was developed and
he played an important role on
the Registration Authority, acting
as its chair during the crucial
formative period when CSci
standards were set and initial
licences were awarded. In the
last year he has been involved in
introducing the RSci and
RSciTech qualification for
science technologists at different
career stages, with IPEM being
one of the first organisations to
be able to award the new
designations. There is something
in the genes of medical physicists
that makes them cynical about
the value of qualifications but, in
a competitive world, marks of
professional standing are
increasingly important and
Robert must be congratulated on
his work.
So how has the role of the
General Secretary developed over
the time Robert has been in
office? He reminded me of a
question that I had asked him at
his interview, ‘Do you feel that
this job is really a full-time one?’
His answer had been that no, it
wasn’t, at least not as we had
described it in the job
specification, but it should be full
time as there was much more
that needed to be done and he
promptly listed all the extra
tasks. Despite that he was
appointed.
CHALLENGES FACED
The main change has been the
move from the post being
primarily administrative to one of
being the Chief Executive, the
person who makes a significant
contribution to the strategic
vision of the Institute. Now that
the Institute has a well-organised
office to take on the many tasks
that an organisation of our size
needs doing, the role has been
much more hands-off with
Robert increasingly being asked
to represent the Institute on
external bodies, such as the
Science Council. I know that
during my time as President I
found it very helpful to have
Robert sitting next to me at
committee meetings to provide
wise advice and remind me when
I was straying from the party line.
Of course in the past few years
the landscape in which the
Institute operates has changed
significantly. The Institute is faced
with an administration in
Westminster which does not
always appreciate the value of
professional societies and seems
to prefer to take on much of their
roles themselves. Robert’s view
of the challenges facing his
successor is that they need to
create an organisation that gives
RETIREMENT
‘
Eight IPEM Presidents and the President-Elect had lunch with Robert Neilson in York to mark his retirement as General Secretary.
Back row (left to right): Peter Sharp OBE (1997–99); Steve Smye (2001–03); Peter Wells CBE (1995–97); Peter Jackson (2005–07); Keith Ison
(2007–09); Peter Williams (2003–05). Front row: Chris Gibson (2009–11); Peter Jarritt (2011–13); Robert Neilson (General Secretary,
1996–2012); Steve Keevil (President-Elect, 2011–13). Rod Smallwood (1999–2001) was unable to attend at the last minute.
a strong professional
leadership. The old model of the
majority of work being carried
out by volunteers is now not so
appropriate with everyone
under much more scrutiny as to
how they use their time. More
reliance will need to be on paid
staff with appropriate
professional backgrounds. He
also has a typically trenchant
view on who is the audience of
IPEM. Of course the NHS is a
major customer (I can hear
Robert mutter four devolved
NHS organisations) but we need
to service a far broader
congregation; academia, biology
and related industries, perhaps
even agriculture.
Robert has served the
Institute well for the past 16
years and even in his final
months his enthusiasm for the
work of the Institute is strong.
We will miss his wise guidance,
his hard work and his strategic
vision. We will also miss his
many anecdotes from his
previous jobs! We wish him a
long and productive retirement
which he says he will spend
bringing to fruition five books
and finally tracing his Scottish
ancestry beyond a blank period
in records, which he believes
was caused by a ‘disruption’ in
the established, Scottish
Presbyterian Church in St
Ninians. He is amused, as a
member of a church that had its
origins in similar principled
dissent from the 1662 Act of
Uniformity in England, that his
Scottish ancestors may
themselves have been involved
in the Scottish version of dissent
in the 1700s.
SCOPE | MEMBERS’ NEWS
Professor Peter Sharp OBE, FRSE, FIPEM, CSci, FInstP
Robert Neilson pays tribute to the incredible work achieved in a long career
rofessor Peter
Sharp retired from
his twin
appointments as
Professor of
Medical Physics at the
University of Aberdeen and
Clinical Director of Medical
Physics for NHS Grampian at
the end of August 2012. He is
one of a decreasing number of
people with truly dual
appointments, whose salary is
paid by both the university and
the hospital. He observes that
this means both employers
expect him to do a full-time job
for them! He actually has found
the arrangement very useful, as
working with medical staff in
his NHS role has given him
opportunities for spotting
research projects that he could
carry out in his university role.
P
EARLY CAREER
Born in Lincolnshire, and after
a grammar school education in
Spalding, Peter read Physics at
Durham University and was
awarded the degree of BSc
(Hons) in 1968. During his final
year he applied to Aberdeen for
a place on the MSc in Medical
Physics course developed by
John Mallard OBE, who was the
first Professor of Medical
Physics at Aberdeen, and whom
Peter would later succeed as
the second Professor. Peter
decided his interests really
were in going on to do a PhD,
and gave this as the reason for
withdrawing his application.
John Mallard countered by
offering Peter a place as a PhD
student to undertake research
into the quality of nuclear
medicine images, and the rest,
as they say, is history.
When Peter had completed
his PhD, he obtained a
permanent appointment and
stayed for the whole of his
working life, eventually
succeeding John Mallard as
Professor of Medical Physics
when he retired.
When asked why he had spent
his entire career in Aberdeen, he
said simply that there was a lot of
interesting scientific work going
on there and he wanted to be part
of it. In the early 1970s two SPECT
“
This means
both employers
expect him to do a
full-time job for
them!
”
scanners were built, the first in
the UK and predating the x-ray CT
scanner. Later, a gamma camera
was mounted on the stand from
an old cobalt machine to produce
an early SPECT camera. In the
early 1980s Aberdeen developed
the first clinical whole-body MR
imager and established a PET
centre in Aberdeen, the first in the
UK apart from the MRC PET
Centre at Hammersmith
Hospital. This involved
dismantling a cyclotron that had
been used in a radiotherapy
project in Edinburgh, shipping it
up to Aberdeen (courtesy of the
Army) and then reassembling it.
The Aberdeen PET centre also
used a second-hand PET scanner
that had previously been at the
Hammersmith PET centre.
Initially there was nowhere to put
the equipment, so money had to
be raised to buy an old farm
building which was then
converted into a PET centre with a
radiochemistry facility. Peter
remembers it as fun to see so
much being achieved on a
shoestring budget, although it
didn’t seem like it at the time.
PROFESSIONAL WORK
Peter has spent most of his
career working in nuclear
medicine, but when he succeeded
John Mallard as Chair and as
Head of Department in 1992, he
relinquished his role as Head of
Nuclear Medicine, whilst
retaining a professional interest
in the area. His continuing
interest resulted in him
persuading the hospital to pay for
a new building for the PET centre
to bring it on to the hospital site,
raising money for a new cyclotron
and radiochemistry facility and
purchasing a new PET imager. A
few years later the Scottish
Government wanted to know if
PET was likely to be of value in the
management of cancer, and
Peter was asked to chair an
advisory group to formulate
advice. A model was constructed
showing how PET would be used
in the clinical setting, and
populated with measures of the
sensitivity and specificity of PET
for various cancers, to work out
the likely costs of a PET service
and then demonstrate that it
would be cost effective. The
Scottish Government was
persuaded that they should invest
in PET scanners, which by this
time were PET/CT scanners, and
equip the four cancer centres in
Scotland. Peter was awarded the
Norman Veal Medal of the British
Nuclear Medicine Society in 1999
in recognition of his contribution
to nuclear medicine.
Away from nuclear medicine,
Peter’s research interests had
developed into the science
underpinning ophthalmology.
There was a strong research
group at Aberdeen University
interested in the biology of
diabetic eye disease, which is the
most common cause of blindness
in the working age population.
This group approached Peter’s
physics team to see if they could
develop a scanning laser
ophthalmoscope. This was a
device that scanned a laser beam
over the retina of the eye and built
up a picture from the reflected
light. The team went further and
built a machine that used three
lasers at different wavelengths, to
give a full colour, rather than
monochromatic, image. It also
went on to modify the scanner so
that it would image individual
blood cells as they flowed
through the retinal vasculature in
rats and genetically modified
mice. This allowed measurement
of their speed and number of
cells, thus providing tools to
investigate vascular diseases
where it was believed that the
blood cells would stick to the
walls of the vessels.
Peter’s team was then
approached by a group of
ophthalmologists who were
running a diabetic retinal
screening service in Scotland.
Every person in Scotland with
diabetes has annual images of
their eyes taken to look for early
signs of eye disease. They were
training retinal screeners to
examine the tens of thousands of
images and clearly it was
extremely time consuming,
expensive and not very reliable.
The physics team’s task was to
develop software that would
analyse the retinal images for the
pathology that was indicative of
early eye disease. If none was
found then the person would
simply be told to return the next
year for another picture. If there
were some abnormal features
then the images would be passed
on to a human screener for
further analysis. The required
software was developed and
trialled with thousands of
patients. The trials showed that it
was reliable, and cheaper than
‘
employing human screeners for
basic screening. A licence on
the software was taken up by a
company and the system is now
in routine use in the Scottish
Screening Service.
HONOURS RECEIVED
Research supporting
ophthalmology continues.
Another clinical trial
concerning automating
macular oedema detection has
just been completed; another
project is looking at whether
diabetic eye disease is a
predictor of cardiovascular
disease, and another is looking
at the information that can be
derived from serial retinal
photographs.
In 2000 Peter’s department
was awarded the Queen's
Anniversary Prize for Higher
and Further Education in
recognition of its ‘pre-eminence
in medical imaging technology
for over 30 years’. As Peter had
been there for the entire 30
years (and now 12 years more),
this was not only a recognition
of the work that the department
had been doing, it also reflected
his contribution to it.
But Peter’s work and
achievements must also be set
in the context of his wider
professional contribution in
Scotland, in the UK and, more
recently, in Europe.
Even as a PhD student,
Peter’s research involved
contact with the NHS
department in Aberdeen and
John Mallard quickly persuaded
him to join HPA/IPSM,
predecessor organisations of
IPEM. He recalled that an early
involvement in professional
body ‘corridors of power’ was
when he attended a meeting of
the IPSM Professional
Committee at the Institute of
Physics’ former offices in
Belgrave Square, where the
HPA/IPSM office was then hosted.
Keith Boddy, who was to attend
the meeting, was delayed
because he had been asked to
meet with IOP officers, to be given
the news that HPA /IPSM were
being asked to find alternative
office accommodation. It was
decided to move to York, where
IPEM (as it now is) now occupies
its third office premises.
Peter was the second IPEM
President (1997–99), having
previously served as the first
IPEM Vice President (1995–97)
and the last Honorary Secretary
of IPSM (1992–95), prior to which
he was IPSM’s Assistant
Honorary Secretary (1990–92).
His reward for such dedicated
service, post Presidency, was to
be nominated by IPEM to be Chair
of the Association of Clinical
Scientists, to chair RPA 2000
(which certificates Radiation
Protection Advisers on behalf of
the Health and Safety Executive),
to chair IPEM’s Professional
Conduct Committee, to represent
IPEM on the Executive of the
IOP–IPEM Medical Physics
Group, to be Company Secretary
of Radiation and Oncology
Congresses, to represent IPEM
on the Scottish Forum for
Healthcare Science (which he
also chaired), to be Honorary
Treasurer of the (UK) Federation
for Healthcare Science, to be
Honorary Treasurer of the
European Federation of
Organisations for Physics in
Medicine (EFOMP) and to be a
member of the Science Council’s
Registration Authority. Peter was
elected as a Fellow of the
Royal Society of Edinburgh
(FRSE) and has served on
its Council and its
Fellowship Appointments
Committee.
OTHER INTERESTS
As retirement (from employment,
at least!) has drawn closer, Peter
has managed to hand over most
of his roles that had not already
come to the end of a defined term
of office. He remains a member of
the Science Council’s
Registration Authority and in
January 2011 stood down after 5
years as Honorary Treasurer to
become Vice President of EFOMP,
in the knowledge that he would
succeed to the Presidency of
EFOMP from January 2012 for a
term of 3 years.
He confesses that he has ‘lived
to work rather than worked to
live’, but does find time for some
interests that are not workrelated. He chairs the
Administration Board for the
Diocese of Brechin in the Scottish
Episcopal Church. Several years
ago he was appointed as an
Honorary Sherriff, which in the
Scottish legal system is the
equivalent of a judge. However,
while he has the power to give
custodial sentences, he is not
allowed to preside at trials by jury.
Peter enjoys classical
music,
especially
opera,
and
believes
that the
Kindle is
one of the
most
useful
devices to
have been
developed
RETIREMENT
in the past 10 years. So, although
it looks as if reading is on his
retirement agenda, erecting more
bookshelves is not!
Over a long and successful
career, Peter’s contribution to
medical physics has been
incalculable, even for a physicist
or mathematician, and IPEM and
the profession in general in the
UK will be the poorer to lose his
active presence. His outstanding
contribution has, however,
recently been recognised by the
award to him of an OBE in the
Queen’s Birthday Honours List,
for services to healthcare
science. However, with his
retirement from employment, the
UK’s loss is Europe’s gain, for a
few more years at least, as he
brings his accumulated wisdom
to bear on medical physics
matters European. Peter has also
agreed to be the President of
ICMP 2013 (the International
Congress of Medical Physics), to
be hosted by IPEM in Brighton in
September 2013, and which will
incorporate, with IOMP’s 50th
anniversary congress, IPEM’s
annual Medical Physics and
Engineering Conference
(MPEC) and EFOMP’s
biennial European
Medical Physics
Congress (EMPC).
So, as Peter retires
from his career in
medical physics in
Aberdeen, for IPEM it
will not be a complete
‘goodbye’, but ‘au revoir’,
and we wish him well in
his far-from-inactive
retirement.
SCOPE | BOOK REVIEWS
elcome to another
issue of Scope
‘Book Reviews’!
This time around
we have had the
highest number of
reviews submitted
by our team of Ubidesk book reviewers. A
special thanks to our reviewers who have,
for the first time this year, supplied more
than the target number of book reviews!
Textbook reviews cover both the medical
physics and popular science genres. A list
of the reviewed titles with reviewers can be
found below in table 1.
As with each Scope issue, there are a
number of new medical physics textbooks
in the ‘Just Published’ section. You will
find some interesting reports listed in the
‘New Reports’ section, such as ‘Health
Effects from Radiofrequency
Electromagnetic Fields’. I have included a
reference to a relatively recent report
published by the Department of Health in
2011, ‘Radiotherapy Dataset Annual
Report’, for completeness. You may also
want to have a look at the ‘Safer
Radiotherapy’ newsletter of the HPA, the
last of which was published in 2011 (issue
6). Reader(s) who are interested in
reviewing listed/unlisted books please do
get in touch with me so I can arrange to
send you the required material directly
from the publisher. Note that some of the
new reports are freely available to
download from the respective websites.
A warm welcome to another book
reviewer – Ms Rebecca Quest, Principal
Clinical Scientist specialising in MRI and
working at the Imperial College Healthcare
NHS Trust in London. Dr Mark McJury,
Consultant Clinical Scientist, rejoined us
after moving hospitals – he now works at
the Beatson Cancer Centre as the Head of
Research and Development in
Radiotherapy Physics.
We do require more book reviewers to
allow us to consistently hit our 2012 target
W
of eight book reviews per quarter, so please
drop me an email if you are interested in
becoming a reviewer. The reviewing
process is relatively relaxed, and there are
no tight deadlines. If you are new to
reviewing, then there is a process
document on finding your way around
Ubidesk as well as a guidance document
on reviewing textbooks.
Usman I. Lula, Clinical Scientist, Radiotherapy
Physics, Poole Hospital NHS Trust
[email protected]
Cardiac Fibrillation–
Defibrillation
This is an impressive book offering a review
of current biomedical concepts in atrial and
ventricular fibrillation – initiation,
maintenance, pharmacological therapies and
engineering solutions for treatment are all
given their due. Chapters cover fibrillation
mechanisms, including the multiple ectopic
foci, re-entry and rotor theories of
fibrillation, as well as general concepts of
defibrillation (minimum defibrillatory mass,
pharmacological and electrical defibrillation,
monophasic and biphasic DC shocks, etc.).
The design and generic build of external
defibrillators is discussed, as are algorithms
that adjust delivered energy based on
measures of transthoracic impedance.
Implantable cardiac defibrillators (ICD) are
passed over in brief, mainly in reference to
software methods to discriminate ventricular
tachycardia/fibrillation from normal or
benign cardiac rhythms. From a personal
perspective, this section was fascinating
given the clinical issues that can arise which
necessitate device reprogramming to
prevent inappropriate discharge. The real
focus in this section though is on the
application of such software to automated
external defibrillators, which I suppose
makes the book useful to any reader who
regularly frequents large public spaces.
Approaches to fibrillation detection are
discussed in escalating order of complexity,
from probability density functions and
threshold crossing intervals through to
time-frequency Fourier techniques and
phase space analysis.
The biggest selling point of the book is,
to my mind, the balance between the clinical
and engineering content. As a clinician, I
found the electrophysiology sections to be
the most useful, but there is plenty of
material to keep the engineer happy. There
were sections that were harder going for me
– I confess that the section on theoretical
models went over my head (non-linear
microscopic models of cardiac dynamics), as
did the chapter on electrodes and pastes –
but this is only really a reflection of the
multidisciplinary appeal of the book.
Although now more than 16 months old
(more considering the standard delay
between submission and publication), this is
a very readable account of current
understanding based on a broad analysis of
the field. I read the book from cover to cover
over three Winchester–London train rides,
which should give some idea of its length
and easy accessibility. Like many textbooks
purporting to cover the current state-of-theart, there is the significant danger of being
out of date almost upon publication.
Indeed, it is likely that those most interested
in this field will refrain from an outright
purchase in favour of one or more journal
subscriptions. This would be a shame as the
majority of the material discusses
established concepts. I give this book a
TABLE 1
Book title
Reviewer
Cardiac Fibrillation–Defibrillation
James Stirrup
The Emperor of All Maladies
Jennifer Lowe
Physics of Societal Issues
Malcolm Sperrin
The Fundamentals of Imaging
Lisa Davenport
The Essential Physics of Medical Imaging
Elizabeth Berry
Susceptibility Weighted Imaging in MRI
Glyn Coutts
Biohybrid Systems
Julie Wooldridge
Quantitative MRI in Cancer
John McLean
Proton Therapy Physics
Angela Newing
USMAN I. LULA | SCOPE
Dr James Stirrup is a Clinical Research
Fellow at the Cardiac Imaging National Heart
and Lung Institute, Imperial College, London.
He is also a Cardiology Specialist Registrar at
the Wessex Deanery, UK
CARDIAC FIBRILLATION–DEFIBRILLATION:
CLINICAL AND ENGINEERING ASPECTS –
SERIES ON BIOENGINEERING AND BIOMEDICAL
ENGINEERING
Author: Max E. Valentinuzzi
Publisher: World Scientific
Volume: 6
ISBN: 978-9814293631
Pages: 304
developed by pulling together different
strands from different researchers,
hospitals and countries across the world.
The ‘chapters’ are introduced with a wide
variety of quotations – historical, literary,
and from contemporary media, activists,
researchers and cancer patients which gave
added interest and context to the material.
The book is predominantly plain text
but in the middle section there are eight
pages of black-and-white photos, cartoons
and drawings offering, in my opinion, a
limited and random selection of pictures of
varying significance to cancer treatment. I
did feel somewhat disappointed when the
book abruptly ended a significant distance
from the back cover. However, for the
reader who wants to delve deeper, the 70
or so pages of notes, references and
bibliography at the end of the book will be
invaluable. A comprehensive index is also
included to facilitate returning to passages
of interest.
“
The Emperor of All
Maladies
I loved this book which was a slight relief
as it would have been interesting to write a
review in opposition to the many people
who decided that this book was worthy of
a Pulitzer Prize (General Nonfiction, 2011),
the Guardian First Book Award 2011 and
shortlisted for both the Duff Cooper Prize
2011 and the Wellcome Trust Book Prize.
The author, Siddhartha Mukherjee, is a
well-published cancer physician and
researcher who lives in New York. He
started researching the history of cancer
when he began his advanced training in
medical oncology in Boston, which after
about 7 years resulted in this book. The text
follows a roughly chronological path
through the history of cancer from its first
description around 2500 BC in Egypt, to
recent discoveries in the understanding of
the activation or inactivation of genes or
pathways that result in cancer. The
‘biography’ is also interspersed with the
very human stories of a few of Mukherjee’s
own patients and the successes and failures
of their cancer treatments.
The book is very well written, and in
spite of being packed with lots of
interesting facts and historical references, I
found it to be a gripping read. I
particularly liked how each theme was
The text follows a
roughly chronological path
through the history of
cancer from its first
description around 2500
BC in Egypt
”
I doubt that I will directly make use of
any knowledge gained from this book in
my future radiotherapy work, but I feel
that I am more informed about the field in
general and will have a better appreciation
of how far medicine has come (and still has
to go) in the treatment of cancer.
Specifically I found it very interesting to
see how clinical trials and randomisation
developed and learning of some of the
naming conventions for cancer drugs.
I highly recommend this book to anyone
with an interest in medical history and/or
who is working in, or close to, the field of
oncology. I found it to be highly
informative, a real page-turner and a
welcome Christmas present. As the
paperback edition is currently available on
Amazon.co.uk for a bargain price of £6.79,
I think it would be rude not to.
Mrs Jennifer Lowe is a Clinical Scientist
(Radiotherapy) currently on a career break,
Falls Church, VA, USA
THE EMPEROR OF ALL MALADIES:
A BIOGRAPHY OF CANCER
Author: Siddhartha Mukherjee
Publisher: HarperCollins
ISBN-13: 978-1439107959 (US)
Format: Hardback
Pages: 592
Physics of Societal
Issues
This title is not necessarily one that jumps
off the shelf at you as a prime text for
medical physics applications, but I would
strongly urge you to at least have a browse
through it. One implication from the title is
that the content is accessible to a lay public;
however, I would suggest that the content
does require a good deal of advanced
scientific competence. The reviewed edition
was published in 2007 and although only 5
years old the implications of the Fukushima
nuclear disaster clearly play no part in the
scientific analysis. That being said, it is an
easy extrapolation of the book’s analysis to
those events in Japan. This book looks to
provide a well considered scientific
approach to many of the influences on
everyday life and there is considerable
cross-over with our profession.
The book is broadly divided into:
national security, environment and energy,
but these broad categories do not fully
convey their content. For instance, Chapter 7
discusses nuclear pollution, albeit not from a
medical standpoint; nevertheless, the
analysis is applicable for those of us who
have a professional interest in radiation
protection. Similarly, Chapter 9 discusses
electromagnetic fields and epidemiology
which continue to be very much in the
news. Other chapters such as Chapter 16 on
energy economics are reasonably considered
to be peripheral to our profession,
nonetheless the analytical approach and
important subject matters are of general
interest. In addition, there are useful
appendices and reference/bibliography lists
at the end of each chapter which, whilst
limited, certainly do provide routes for more
insight into some of the complex social
arguments discussed within the text.
As might be expected, the text is
American and allowances need to be made
for the units and also some of the content
which is American-centric, but that aside,
the text is very readable. One useful aspect
of each chapter is the inclusion of ‘problems’
and I have used many of these to discuss
aspects of general physics with my trainees
▼
confident recommendation to biomedical
engineers, and for that matter, anyone for
whom cardiac electrophysiology forms a
significant part of their working life.
▼
and to encourage a breadth of awareness of
physics in addition to the specialist
applications more familiar to us.
To my knowledge there are very few
other books either of this type or with the
same general usefulness, although the
Internet does give access to some of the
material albeit in a less consolidated form.
Unfortunately, many of the diagrams and
images could be clearer but that is more of a
convenience than a limiting factor. I would
highly recommend this text, probably as an
inclusion to a departmental library rather
than to an individual but I can see it being
well used.
Professor Malcolm Sperrin is the Director of
Medical Physics and Clinical Engineering at the
Royal Berkshire Hospital NHS Trust, Reading, UK
PHYSICS OF SOCIETAL ISSUES: CALCULATIONS
ON NATIONAL SECURITY, ENVIRONMENT, AND
ENERGY
Author: David Hafemeister
Publisher: Springer
ISBN: 978-0-387-95560-5
Pages: 488
The Fundamentals of
Imaging
I was a bit worried that this book was going
to be massive and maybe a bit dull. It
encompasses, as the title suggests, almost
all imaging techniques, which is quite a big
subject (especially everything the author
considers to be imaging – more on that
later) and potentially a hard slog for
someone who doesn’t read physics books
for fun (I’d just like to point that out now).
However, not only is it compact, but it is
also very easy to read and I even found it
quite endearing in parts.
The author sets the scene by explaining
why sight is by far the best human sense
before telling us about the human visual
system and the evolution of all different
eyes (I now know all about flatworm and
nautilus eyes if you have any questions).
Then we embark on the proper physics
sections. There is the obligatory bit on
medical imaging but that is only a tiny bit
of a book that covers waves and image
formation, microscopes, photography, film,
television, infrared imaging, radar, imaging
the universe, imaging with sound and
imaging atoms and particles. As I
mentioned at the beginning, there are a few
bits I wasn’t sure about as to their imaging
credentials, but they were some of my
favourite bits: classical map making, trig
points and aerial archaeology. Not that the
book isn’t up to date – 3D television and
imaging the Eyjafjallajökull ash cloud are in
here too.
The author’s writing style is friendly and
charming, and the book includes lots of
historical bits. The physics throughout are
explained simply with equations where
need be and plenty of pictures and
diagrams.
I would not recommend this book if you
are looking specifically for an introduction
to medical imaging as the section is really
brief. Likewise, I found the seismic imaging
section a bit short. On the other hand, the
universe sections seemed to take up quite a
lot of the book, but I have to confess
skipping those, having managed to avoid
anything space-related in my life to date.
However, the book is clearly intended as a
basic introduction to everything and for
that it serves its purpose really well.
As for the target audience, well, the
introduction states that it should be
accessible to those with an interest in
science and who have studied it at school –
I can only agree with that. It’s good for
explaining all those things you (or at least I)
never thought about before such as how an
intruder alarm works.
“
The book is clearly
intended as a basic
introduction to everything
and for that it serves its
purpose really well
”
In conclusion, I think that any physics
book that mentions beluga whales and
Bradford Media Museum can only be a
good thing. And did you know that in 1880
they could detect the heat radiated by a cow
at a distance of 400 m?
Mrs Lisa Davenport is a Clinical Scientist in
Radiation Protection at the Radiation Physics
Department, Bradford Teaching Hospitals NHS
Foundation Trust, Bradford, UK
THE FUNDAMENTALS OF IMAGING – FROM
PARTICLES TO GALAXIES
Author: Michael M. Woolfson
Publisher: Imperial College Press
ISBN: 9781848166851
Format: Paperback
Pages: 360
Price: £32.00
The Essential Physics
of Medical Imaging
This is the third edition of a well-respected
text on the physics of medical imaging. It
covers all the expected imaging modalities
together with radiation biology and
radiation protection. Although the earlier
editions were intended for radiologists-intraining, the comprehensive coverage made
the book a popular graduate-level text for
medical physicists too. In this third edition,
the physicist readership has been recognised
with the inclusion of an appendix on Fourier
transforms and increased mathematical
rigour throughout.
The content of the book has been
thoroughly overhauled. In line with the
spread of digital technologies, the section on
informatics has been moved into the basic
concepts section and has been expanded
upon. There have been corresponding
reductions in the material on analogue
techniques. Modalities that have entered
clinical use since the last edition, such as
digital breast tomosynthesis and dual
modality imaging systems, have now been
included.
The book is surprisingly colourful inside,
not only giving it a contemporary feel, but
also helping to communicate information.
There are coloured text headings, tables,
photographs and figures. Many of the
figures have been redrawn for this edition,
and with colour they get their messages
across very well indeed. Figures and
photographs have been brought up to date,
showing the thoroughness of the revisions.
For example, a photo of a film badge
belonging to one of the authors now shows a
badge dated 2011; the badge in the second
edition was dated 2000.
Another innovation is the inclusion of
access to online content. You scratch a sticker
inside the book to reveal a code, visit the
publisher’s website and use the code to
register. Once registered, you can access
online content – this comprises the entire
content of the book, displayed in your
browser using Adobe Flash Player
technology format. The content is searchable
and, for a book of this length, this provides a
welcome alternative to using the index.
Dr Elizabeth Berry of Elizabeth Berry Ltd in
Leeds, UK
THE ESSENTIAL PHYSICS OF MEDICAL IMAGING,
3RD EDITION – INTERNATIONAL EDITION
Authors: Jerrold T. Bushberg, J. Anthony Seibert,
Edwin M. Leidholdt Jr and John M. Boone
Publisher: Lippincott Williams & Wilkins
ISBN: 9781451118100
Format: Hardback
Pages: 1,048
Susceptibility
Weighted Imaging in
MRI
‘Susceptibility weighted imaging (SWI)
consists of using both magnitude and phase
images from a high-resolution threedimensional fully velocity compensated
gradient echo sequence.’ The reader will
encounter this sentence or similar many
times in this text, followed by a brief
description of the use of phase masks and
minimum intensity projections (mIP).
However, this is merely a symptom of the
ambition of this volume in which 66
contributors seek to cover every aspect of
fully exploiting the phase information
content in the acquired MR signal in a
manner that is accessible to an audience of
radiologists, physicists, cardiologists,
oncologists, biochemists and students.
The first eight (arguably nine) chapters
(of Part I: ‘Basic Concepts’) serve as an
introduction to the technique, ranging from
what many will find familiar such as signal
formation in gradient echo imaging through
to advanced but necessary concepts – for
instance, high-pass filtering and the
influence of voxel aspect ratio – to the more
daunting, such as the formation of phase
images from multiple receiver coils. This
then leads into the application of these
concepts to MR venography, with the by
now familiar high-resolution, high-contrast
images, and brain imaging.
Part II covers current clinical applications
and may well be the starting point for those
just beginning to use this technique.
Included are vascular applications along
with imaging cerebral microbleeds and
haemorrhage, imaging of brain tumours,
exploiting iron content in
neurodegenerative disease and imaging of
breast calcification. The book includes
reprints of three seminal papers published
in 1997, 2004 and 2006, but it is a mark of
how much this technique is in its infancy in
that much of the work presented here is
based on relatively small studies from
single research centres.
The final chapter in Part II introduces
SWI at ultrahigh field strengths (7T or even
9.4T) with a balanced summary of both the
opportunities and challenges. The last and
largest section, Part III, is headed
‘Advanced Concepts’ and ranges across
applications which may well bear fruit for
SWI, such as quantification of iron content,
the effects of contrast agents, quantification
of oxygen saturation and the interplay with
the BOLD effect, as well as advanced
acquisition methods. Also discussed in
these chapters is susceptibility mapping
which effectively inverts the problem in
order to produce maps of the susceptibility
sources that are producing the measured
phase patterns, with the aim of producing
quantitative information about, say, the iron
or calcium content of tissues.
There is inevitably some variation in
style across the many contributors but for a
work of this size and scope the errors of
grammar, presentation and suchlike are
relatively few. Throughout, the text is
supported well by the images, including
colour images where needed.
It will be of interest in a few years’ time
to see how much progress has been made in
fully exploiting susceptibility differences as
a basis for (quantitative) MR imaging. For
now this volume will be a useful reference
for any MRI department.
Dr Glyn Coutts is a Clinical Scientist at the
Christie Medical Physics and Engineering, The
Christie NHS Foundation Trust, Manchester
Department, UK
SUSCEPTIBILITY WEIGHTED IMAGING IN MRI
Editors: E. Mark Haacke and Jürgen R.
Reichenbach
Publisher: Wiley-Blackwell
ISBN: 978-0-470-04343-1
Format: Hardback
Pages: 776
Biohybrid Systems
This text offers a detailed overview of recent
advances in biohybrid systems interfacing
nerves, muscles and machines. It contains
numerous mathematical models of
neurophysiology, ranging from models of the
cell biology such as membrane equivalent
circuits to the mathematical descriptions of
neural spike trains. The text also considers
the hardware required to interface with a
neuron, in particular the dynamic clamp
which is used to influence membrane
potentials and the latest nanotransducers,
being developed using carbon nanotubes.
This book is primarily aimed at researchers
in the field with recommendations on the
best software for implementing a dynamic
clamp and suppliers of real-time control
boards for neuronal models.
Each chapter commences with a short
introduction, placing the subject matter into
context with the other chapters. Each also
closes with a conclusion which generally
does a good job of summing up the salient
points of the text, particularly useful for the
first-time reader. Much of the modelling
assumes a high level of background
knowledge in mathematics, electronics and
neuroscience. This should probably not be
considered an introductory text; however,
even the casual reader will come away with
an enhanced understanding of the field.
The chapters are well written and despite
being a multi-authored work there is little
repetition and appropriate links to other
sections are provided. There are a good
number of illustrations, most of which are
▼
Books in this subject area can become
somewhat unbalanced in their later
editions, with rather short chapters on
modalities such as ultrasound and MRI
dominated by the ionising radiation
content. Whilst this is true to a degree here,
the balance in this book is good.
Furthermore, in spite of the range of topics
and multiple authors, the style is clear and
consistent throughout the book. This is very
much a reference text, and does not include
questions or exercises to help radiologists
with their exam preparation. One concern
about using this book outside the US is the
lack of information on European and more
specifically UK legislation and regulation
concerning ionising radiation.
The book is comprehensive,
authoritative, well illustrated and bang up
to date. It makes a suitable masters level
textbook, and is an ideal reference text for
the training or practicing medical physicist.
It provides good value for money, and
owners of the second edition will not regret
buying a replacement.
▼
very useful, in particular in Chapter 6 with
its scanning electron micrographs of
microelectrode arrays and Chapter 7 with
numerous Simulink diagrams providing
excellent support to an introduction of
biohybrid systems analysis.
“
The medical physicist
will find little description
of the practical
applications of this
technology until the last
three chapters
”
Aside from a very interesting short
section in the first chapter on an actuated
articulated false-foot orthosis (designed to
aid crutch-free walking for injured combat
troops), the medical physicist will find
little description of the practical
applications of this technology until the
last three chapters. This makes some of the
intervening chapters rather ‘dry’ and it’s a
shame that more short examples of the
applications weren’t included. The last
part of the book is dedicated to a few
examples of medical applications,
including neuromorphic hardware for
audition and vision, neurocardiology and
sensing of insulin demand. This is where
the readers’ hard work in the earlier
chapters will pay off! Chapter 9,
‘Neuromorphic Hardware for Control’, is
particularly interesting, demonstrating a
biohybrid system to restore lost locomotor
control and a silicon retina in which spatial
and temporal filtering are computed at
pixel level allowing low-power real-time
control of a system.
As a research text, this book will find
little immediate application in the majority
of clinical engineering departments. Many
of the systems demonstrated will be
confined to studies in research laboratories
for some time to come. However, for
anyone intrigued by the latest
neuroprostheses showcased in the news or
nature, this publication offers a fascinating
insight into the field.
Ms Julie Wooldridge is a Trainee Clinical
Scientist in Electrodiagnostics and Clinical
Engineering at the University Hospitals of
Leicester NHS Trust, UK
BIOHYBRID SYSTEMS: NERVES, INTERFACES
AND MACHINES
Editor: Ranu Jung
Publisher: Wiley-VCH
ISBN: 9783527409495
Format: Hardback
Pages: 224
Quantitative MRI in
Cancer
I was keen to review this book as I have an
interest in QMRI methods. Probably the
most comprehensive book to date on this
topic is the QMRI in the brain book by Paul
Tofts. However, it has been several years
since it was published and I was interested
to see how others presented these themes.
The unique selling point of this new book
is its focus on the application of QMRI
methods in the treatment of cancer. This
book provides a focussed, disease-led
approach to presenting QMRI methods. This
reflects the target audience, who in this case
is likely to be researchers and clinicians with
an interest in the application of novel
imaging methods to cancer.
A further feature of this textbook is that it
does not focus solely on the brain by
covering QMRI techniques applied to a
range of other areas of the body such as the
breast and prostate.
The book itself is structured into five
sections, namely: ‘The Physical Basis of
MRI’; ‘Characterising Tissue Properties with
Endogenous Contrast Mechanisms’;
‘Characterising Tissue Properties with
Exogenous Contrast Mechanisms’, and
ending with ‘Image Processing in Cancer
and Emerging Trends’.
The introductory chapters on the biology
and imaging of cancer set the scene for the
rest of the book. The chapters on the physics
of MRI and in particular the chapter on
hardware and data acquisition are some of
the best I’ve seen where the text is well
supported by clear figures and equations.
Beyond the introductory chapters of the
book the QMRI methods begin to be
introduced. Many of the chapters follow the
structure of having both quantitative and
then qualitative descriptions. This makes the
book accessible to readers who may just
want an overview of the topic as well as
providing more detailed quantitative and
mathematical descriptions for those who
may wish to try and implement or develop
the methods for themselves.
The structure and choice of sections of the
book are sensible and there is an entire
section (five chapters) devoted to image
processing methods in cancer. This reflects
the importance of modern image processing
methods in facilitating quantitative
methods. The individual chapters contain
the essential descriptions and underlying
mathematics for each of the topics.
Throughout this book each chapter is well
referenced and importantly the authors
direct the reader to associated software tools
that have been used to perform image
processing tasks.
The final section of the book introduces
emerging trends of QMRI in cancer. These
are the use of MRI in radiation therapy;
molecular and cellular imaging and the use
of hyperpolarised MR in cancer. These topics
are exciting and it is right that they have
been included in a text such as this to enable
the reader to get the best perspective on the
current status of active research in this
particular field.
Overall, this is an excellent book for
anyone interested in the application of
QMRI methods ‘to cancer’. This textbook
would also be useful for anyone interested
in QMRI methods, irrespective of their
disease of interest.
Dr John McLean is a Clinical Scientist in
Neuroradiology at the Institute of Neurological
Sciences, Glasgow, Scotland, UK
QUANTITATIVE MRI IN CANCER
Editors: T. Yankeelov, D. Pickens and R. Price
Publisher: CRC Press (Taylor & Francis)
ISBN: 9781439820575
Format: Hardback
Pages: 338
Proton Therapy
Physics
Did you know that the possibility of using
protons in radiotherapy was first postulated
as long ago as 1946 by R. R.Wilson at
Harvard University? He suggested that the
finite range and Bragg peak of proton beams
could be used to treat deep targets in the
body with minimal damage to normal
tissue. The idea was taken up a few years
later by Tobias and his colleagues at
Berkeley Laboratories in California and the
first small group of patients was treated
there in 1954.
This was a revelation to me and, I
imagine, to most readers of Scope today. In
the UK at Clatterbridge, protons have been
used to treat ocular tumours, with good
results, since 1989. Worldwide, many
different sites have been treated since the
1970s, with Russia and Japan leading in
contention with the United States. There
has been an exponential rise in interest
over the last 30 years as demonstrated by
the rise in papers in peer-reviewed
journals. From one or two in 1980, there
were almost 150 in 2010. You will find all
this in Chapter 1 of this amazing book.
There are 22 contributors, mostly
American physicists, but with input from
Germany, Switzerland, NPL (UK) and the
Netherlands. The editor, who provides
several chapters himself, is of German
origin but has been the Director of Physics
Research in Boston, Massachusetts, for
some years.
The basic physics is thoroughly
explored in the 60 pages of Chapter 2.
Cyclotrons, synchrotrons and accelerator
technologies are dealt with in Chapter 3,
followed by several chapters on clinical
uses, dosimetry and treatment planning.
There is comprehensive coverage of all
aspects of proton radiotherapy here, set out
in a concise manner for readers who have a
good knowledge of physics to start with.
“
Did you know that the
possibility of using protons
in radiotherapy was first
postulated as long ago as
1946?
”
I think that this book will be an
indispensable aid for physicists beginning
to work in the area of proton therapy and I
have no hesitation in recommending it.
The future of radiotherapy depends
upon precise beam shaping and being able
to use the distal fall off in dose due to finite
beam range.
Professor Angela Newing is a Retired
Director of Medical Physics for
Gloucestershire, UK
PROTON THERAPY PHYSICS (SERIES IN
MEDICAL PHYSICS AND BIOMEDICAL
ENGINEERING)
Editor: Harald Paganetti
Publisher: CRC Press (Taylor & Francis)
ISBN: 9781439836446
Format: Hardback
Pages: 704
Just Published!
technology that provides clinicians with
real-time biochemical data.
Electrical Safety Handbook by John Cadick,
Mary Capelli-Schellpfeffer, Al Winfield and
Dennis K. Neitzel (McGraw-Hill) is an
essential, fully updated on-the-job safety
resource covering every major electrical
standard. It is written by experts in
electrical construction safety and medicine
as a practical guide for electrical workers
and others exposed to electrical hazards.
External Beam Radiotherapy, 2nd Edition
by Peter Hoskins (Oxford University Press)
provides practical guidance of the use of
external beam therapy. It takes the reader
through the basic principles covering
indication, treatment and then developing
this by individual sites.
Biomedical Signals and Sensors I by
Eugenijus Kaniusas (Springer) focuses on the
interface between physiologic mechanisms
and diagnostic human engineering. This is
the first part of a two-volume set and this
volume describes the basic cellular level up
to their advanced mutual co-ordination
level during sleep.
Walter & Miller’s Textbook of
Radiotherapy by Paul Symonds, Charles
Deehan, Catherine Meredith and John Mills
(Elsevier Health Sciences) covers underlying
principles of physics and offers a systematic
review of tumour sites, concentrating on the
role of radiotherapy in the treatment of
malignant disease and setting its use in
context with chemotherapy and surgery.
Technologies of Medical Sciences by
Renato Jorge, Joao Tavares, Marcos Barbosa and
Alan Slade (Springer) explores some of the
latest innovations being employed in
medicine. It covers areas such as
computation modelling and simulation,
image processing and analysis, medical
imaging, human motion and posture, tissue
engineering, design and development of
medical devices and mechanic biology.
How to Land a Top-paying Medical
Physics Professors Job by Randy Spencer
(Emereo Ltd) is a complete guide to
opportunities, resumés, cover letters,
interviews, salaries and promotions.
Towards Practical Brain–Computer
Interfaces by Brendan Allison, Stephen
Dunne, Robert Leeb, Jose Millan and Anton
Nijholt (Springer) features contributions by
many of the top brain–computer interface
researchers and developers. This book
reviews the latest progress in the
components of BCIs with a discussion that
includes a range of practical issues in an
emerging BCI-enabled community.
Point-of-Care Diagnostics on a Chip by
David Issadore and Robert Westervelt
(Springer) reviews the latest biochip
technology, examining progress in moving
medical tests out of the laboratory and into
the home, with automated and inexpensive
New Reports
n Functionality and Operation of
Fluoroscopic Automatic Brightness
Control/Automatic Dose Rate Control
Logic in Modern Cardiovascular and
Interventional Angiography Systems: A
Report of Task Group 125, Imaging
Physics Committee. Medical Physics 2012;
Volume 39, No. 5.
n Dose Calculations for Photon-emitting
Brachytherapy Sources with Average
Energy Higher than 50 keV: Report of the
AAPM and ESTRO. Medical Physics 2012;
Volume 39, No. 5.
n Avoidance of Unnecessary Dose to
Patient while Transitioning from
Analogue to Digital Radiology. Medical
Physics 2012; IAEA TECDOC 1667.
n Guidance on the Import and Export of
Radioactive Sources. IAEA; 2012.
n Communications with the Public in a
Nuclear or Radiological Emergency,
Emergency Preparedness and Response,
EPR-Public Communications. IAEA; 2012.
n Risk of Solid Cancers following Radiation
Exposure: Estimates for the UK
Population, RCE 19. HPA; 2012.
n Health Effects from Radiofrequency
Electromagnetic Fields, RCE 20. HPA;
2012.
n Doses to Patients from Radiographic and
Fluoroscopic X-ray Imaging Procedures
in the UK – 2010 Review, HPA-CRCE-034.
HPA; 2012.
n The Measurement of X-Ray Beam Size
from Dental Panoramic Radiography
Equipment, HPA-CRCE-032. HPA; 2012.
n Radiotherapy Dataset Annual Report
2009/2010. Department of Health,
Gateway Reference 16350; 2011.
n Safety Is No Accident – A Framework for
Quality Radiation Oncology and Care.
ASTRO Blue Book; 2012.
A HISTORY OF MEDICAL PHYSICS
THE STORY OF JULES GAVARRET (1809–1890)
FRANCIS DUCK returns to Paris for the seventh part of his history series
▼
J
ules Gavarret
(1809–1890) was
Professor of Medical
Physics in the Faculty of
Medicine in Paris for 33
years. By the time of his
death he had earned an enviable
national and international
reputation, and many tributes were
paid for his contributions to physics,1
to medicine2 and to education.3 He
was then largely forgotten. Recently,
his name has reappeared in the
histories of medicine and science.4,5
This is his story.
FIGURE 1.
Jules Gavarret
(1809–1890) (BIU
Santé, Paris).
Louis-Dominique-Jules Gavarret
(figure 1) was the second son of a
provincial doctor. He was born on
28th January 1809, in the small town
of Astaffort in southern France. His
intelligence and ability was
recognised early and, on leaving his
local town college in Agen, he
gained a place at the prestigious
École polytechnique in Paris, a
gateway to high office in the
professions, education and
government. Here he met some of
the greatest men in French science
including Siméon Poisson
(1781–1840) and Claude-Louis
Navier (1785–1836). He initially
turned away from the family’s
profession, medicine. For a young
man who would be later described
by a friend as a pense-libre, a
freethinker,3 his first career choice
was surprising: he joined the army.
But his own character and army
discipline were incompatible, and
after 2 years at the artillery officers’
training school at Metz, he had a
row and resigned. Some of his
military colleagues never forgave
this insult.
HISTORICAL FEATURE | SCOPE
THE CONCOURS FOR THE
CHAIR OF MEDICAL PHYSICS
Back in Paris in early 1833, now 24years-old and with a strong interest in
mathematics and physics, but also the
need to gain a professional
qualification, Gavarret turned to
medicine. He spent the next 10 years
in the Faculty of Medicine, at first in
medical training, and subsequently in
physiological research.
It is usually possible to see early
evidence in publications of a creative
talent that will later flower into a full
scientific career. Not so with
Gavarret. His first publication, in
1840, was a full-length monograph on
medical statistics.4,6 At that time, the
term statistics meant, for the medical
profession, simply the careful
gathering and tabulation of
comparative data.
Our present understanding of
probabilities, correlations and
associations was entirely absent, and
Gavarret’s book was the first time
that such analysis had been applied
to medical data. Built around
Poisson’s methods of statistical
analysis, Gavarret used many
examples to demonstrate the
importance of using large numbers of
observations, of ascertaining limits of
error from laws of probability, and
the erroneous nature of results drawn
without such analysis. It is perhaps
unsurprising that this seminal work,
by a then unknown author, failed to
make the impact it deserved. Medical
reputations were potentially
threatened, being often based on
particular treatment regimes. It
would not be until the twentieth
century that such statistical methods
started to make any inroads into
medical thinking.
Gavarret then engaged in an
intensive and highly productive 4year period of original physiological
research, under the renowned
physiologist Gabriel Andral
(1797–1876). He published work on
haematological pathology,7
emphysema and cardiopulmonary
disease (his MD thesis), analysis of
exhaled CO2 (figure 2) and body
temperature during intermittent
fever. His emerging talent started to
be appreciated outside France. The
Lancet gave his work positive
reviews, the studies on
haematological pathology were
published in America,7 and his book
on medical statistics was translated
into German.
The chair of medical physics in the
Faculty of Medicine in Paris fell
vacant on 20th July 1843, when Pierre
Pelletan resigned. Pelletan had
become heavily involved in business
and industrial enterprises and had
overstretched himself financially.
Pressed by creditors, he resigned
from his post and left France.8
The method by which senior
academic posts were filled in France
at this time was known as the
concours (contest), a gruelling process
of competitive interviews and
examinations. The 1843 concours for
the chair of medical physics consisted
of four examinations, one written,
two oral and a practical, and the
defence of a thesis. The candidates
appeared before a formidable
academic panel consisting of nine
professors from the Faculty of
Medicine and four from the Faculty
of Science. The panel was chaired by
Claude Pouillet (1790–1868), a
physicist whose name appears
repeatedly in the story of medical
physics.8,9
The field was very strong. Of the
six candidates, three had taken part
in the previous concours, 13 years
earlier.8 Jacques-Henri Maissiat
(1805–1878) had been Pelletan’s
assistant (agrégé) and had been giving
the medical physics course since
1839. The prize was highly attractive.
The post was tenured. The salary was
6,000 francs, about 10 times the
average wage of a working man at
that time, and well towards the upper
end of government-supported
salaries. Furthermore, there was no
comparable post elsewhere at this
time: in the other two full medical
schools in France, at Montpellier and
Strasbourg, the teaching of medical
physics was still combined with that
of hygiene.
The written examination was
about the human voice. For the first
oral examination the candidates were
each given their own topic, with 24
hours’ notice to prepare a lecture. The
six topics were: atmospheric
humidity and its physiological
effects; electrical phenomena in fish
(Gavarret’s subject); sight; animal
heat; capillarity and endosmosis, and
radiant heat. There were only three
topics for the second oral, which the
candidates had to prepare with only
3 hours’ notice: the microscope in
medical science; physiology of gas
“
Gavarret’s
book was
the first
time that
such
analysis
had been
applied to
medical
data
”
and liquid pressure, and atmospheric
electricity. The 25-minute physics
practical examination followed: the
explanation and use of Rumford’s
calorimeter and Cagniard de Latour’s
siren (figure 3). Finally, Gavarret
defended his thesis on the laws of
dynamic electricity.
A report in the press (the concours
was public) said that all candidates
performed to a very high standard.
Gavarret himself was deemed to have
the best mind. The votes of the panel
were equally divided between
Gavarret and Maissiat, six each,
leaving Pouillet to make the casting
vote. Maissiat represented the safe
option, known by the medical faculty,
and capable of competent delivery of
the first-year physics lectures to a high
standard. Gavarret had presented as
an outstanding and clear-minded
intellect, with a high-quality, though
brief, track record in research, but
with no teaching experience.
But Pouillet knew that he was
living in a time of extraordinary
change, both in physics and in
medicine, and this was a critical
appointment if Paris had any chance
of maintaining its international
position as a centre of medical
excellence. He chose Jules Gavarret.
The endorsement of his appointment
was announced as a ministerial order
on 16th January 1844.
GAVARRET AS A TEACHER
The record of Gavarret’s life for the
next 10 years is muted. He settled
himself into his new role, his ideas on
how to apply physics to medicine
undergoing a slow gestation. He
engaged quickly with the life of the
faculty, and in the year of his
appointment as professor he also
became assessor to the Dean. But
those who might have expected
further research output were
disappointed, and no new textbook on
medical physics appeared to replace
Pelletan’s Physique general et médicale.
His defence might have been that, in
common with all academics, the
combination of lecture preparation,
examinations, tutorials and
administration left no time for
anything else; and furthermore,
medical training at that time required
no laboratory experience, so he had no
space for experimental work. Perhaps
Pouillet’s confidence had been
misplaced, and he had selected
another time-serving middle-rate
academic.
▼
GAVARRET’S CAREER IN
MEDICINE
SCOPE | HISTORICAL FEATURE
▼
HISTORICAL FEATURE | SCOPE
FIGURE 6.
[BOTTOM LEFT]
Voice analysis
using the dancing
flame.12
physiology, pathology and anatomy.
Such was the interest in these lectures
that typically more than half his
audience consisted of qualified
doctors, anxious to update themselves
on the possible impact on their
medical practice of new developments
in physics.
In 1869, he published a book
derived from this course, Phénomènes
physique de la vie. Once more we see
him applying modern physics
concepts to medical problems,
allowing him to peer into the future
whilst remaining cautious about
inappropriate extrapolation from
present knowledge. In the
introduction he applauds the value of
physical measurement, using the
example of Marey’s multichannel
measurements on intra-cardiac
pressure: he was Marey’s examiner for
his thesis in 1859.
Étienne-Jules Marey (1830–1904)
later became famous for his use of
photographic methods for analysis of
animal locomotion. He even included
the comment that, since the brain is
doing work during thinking,
comparing, wanting and so on, its
energy use may be sufficient cause
and not just a necessary condition for
all mental activity, and by implication
subject to the same energy
considerations as any other organ. In
this he draws on the new concepts in
physics that clearly excited him most,
the reciprocity of forces and the
conservation of energy. Using the
terminology of the time, he says that
travaille is as universal as mass, and
that its conservation is as
fundamentally true in living as in
inorganic materials. It is here, he says,
that physiological phenomena, heat,
bio-electricity, muscular power and
nutrition, will find their true
explanation. In comparison with his
British contemporaries, he felt no need
to mention any apparent conflict with
religious thought, although he had to
fight against a residual belief in a vital
life force, still maintained by the
dominant French physiologist Claude
Bernard (1813–1878).
It was left to his younger colleagues
Desplats and Gariel to write the next
full medical physics text13 in 1870, to
which Gavarret added an
introduction.
POLITICS
Jules Gavarret lived through a highly
turbulent time in French history. He
was just 4 years old when Napoleon
▼
Gavarret was always concerned to
avoid a too narrow interpretation of
the physics syllabus for first-year
medical students. He knew that there
was insufficient time during his three
physics lectures per week to do justice
to the broader applications of physics
to medicine. In response to this
conflict, around 1866 he started to
offer an advanced course called
Biological Physics, where he assumed
his audience had some knowledge not
only of physics, but also of
FIGURE 5.
[BOTTOM RIGHT]
Electrical
telegraph
transmitter c.
1850.11
▼
BIOLOGICAL PHYSICS
FIGURE 4.
[MIDDLE LEFT]
Intra-muscular
temperature
using
thermocouples by
A.-C. Becquerel
(1788–1878):
1835.10
▼
Gavarret’s next books, on optics and
acoustics, endorsed his reputation as
an outstanding educational
communicator. They also serve to
emphasise his understanding of his
unique role – to understand
contemporary developments in
physics in depth, and to interpret
them for his colleagues in medicine.
Much had already been written on the
optics of the eye, and he saw it as
unnecessary to go over this well-tilled
soil. So, instead, he wrote an
interpretation of Gauss’s 1840
Dioptrishe Untersuchungen. In his book,
entitled Images par reflexion et par
refraction (1866), he gave a clear
exposition of Gauss’s paraxial
approximation for focal systems,
giving a tool using principal and
nodal points that could be easily
applied in physiological optics. The
preface of the 1891 translated Russian
edition of Gavarret’s book emphasises
its considerable value in the teaching
of optics.
In his last book12 he reviewed the
mechanisms of speech and hearing,
drawing on the work of Helmholtz
and Fourier, including several
appendices of a more mathematical
nature. The text itself draws strongly
on experimental physics, including
many examples of physical
measurements applied to
physiological acoustics (figure 6).
FIGURE 3.
[TOP RIGHT]
Cagniard de
Latour’s siren.
▼
Gavarret planned to write a book
about animal electricity. He said so in
the introduction to his next book, on
animal heat.10 This book was a
thorough review of a topic for which
considerable advances in measurement
techniques (figure 4) and
understanding had recently occurred.
This was to be the first in his Medical
Physics series, in which he intended to
review carefully each aspect of physics
in its relationship to medicine. (In fact,
none of his later books bore this series
title.) Animal electricity would have
been Volume 2 in this series. But
controversy still surrounded this
subject: Du Bois Reymond’s visit to
Paris in 1850 did little to clear the air.9
So, instead, Gavarret’s next book was a
thorough review on the current state of
electricity as a whole, publishing his
Traité d’Électricitié in two volumes in
1858 and 1859. However, he omitted
biomedical electricity, which he says
needed to mature further before a
proper review could be written. This
book established his reputation as an
academic author who could explain
difficult concepts in easily-understood
prose, without compromising scientific
accuracy. The book was also soon
published in German.
He was immediately invited to
serve as a member of a commission of
the Ministry of Finance to give advice
on the electric telegraph. This was at
the start of the nineteenth-century
communications revolution, both in
extent and speed, with an impact
comparable with that which arose from
the introduction of the World Wide
Web. Up to 1844, when the first electric
telegraph line was installed from Paris
to Tours, there were only five
LIGHT AND SOUND
FIGURE 2.
[TOP LEFT]
Gavarret’s
apparatus for the
measurement of
expired CO2.10
▼
HEAT AND ELECTRICITY
semaphore lines in France, and a
message took 20 minutes to reach
Toulon. Within 7 years, London and
Paris were in instantaneous
communication by a telegraph cable
under the English Channel, and by
1860 there were 22,000 km of lines
criss-crossing the whole of France. In
1861 Gavarret published a detailed
book on the telegraph (figure 5).11 This
book was again followed by a German
translation.
▼
But Gavarret had not ceased
thinking. In 1849 we see the next
example in which he demonstrated
that he was following developments at
the interface between physics and
medicine, in this case electricity.
Conventional wisdom in France still
broadly held to Volta’s electrochemical
model to explain all galvanic sources,
rejecting Galvani’s view of animal
electricity as an innate property of
living tissues. Gavarret published a
careful review based on the best
evidence he could find, concluding
that much criticism of Galvani had
been inappropriate, and that there was
much new evidence to suggest that
electric phenomena were inherent to
all living matter.
SCOPE | HISTORICAL FEATURE
▼
lost the battle of Waterloo. During his
formative teenage years, the country
was under the strict right-wing
regime of Charles X. The year after
his arrival as a student in Paris, he
watched the violent riots that
deposed Charles and established the
July Monarchy of Louis Phillipe.
Gavarret lived through the 1848
revolution and the coup d’état of 1852,
which created the second Empire
under Napoleon III. He survived the
siege of Paris, the subsequent
commune, and observed its bloody
suppression and the formation of the
Republic. At each swing of the
political pendulum, academic
positions, being public appointments,
were potentially under threat.
Pouillet, for example, lost his
professorship at the Conservatoire des
arts et métiers in 1852 when he refused
to swear allegiance to the Emperor.
Gavarret’s name is nowhere linked to
political activity and he was able to
gain the approval of each new
administration.
Decorated with the Legion
d’honneur in 1847, towards the end of
the July Monarchy, he was made an
Officer of this order in 1862 during
the second Empire, and finally raised
to Commander in 1882 by the
Republic. Liberal by inclination, the
only reference linking his name to a
political event occurred at the start of
the 1867 academic year. Some
students, objecting nominally to
changes in the opening ceremony,
started singing the Marseillaise as he
entered the lecture hall. The row
continued and, after an hour,
Gavarret reportedly looked at his
watch and left. It seems that this
demonstration was directed towards
the establishment rather than
against him.
GAVARRET’S LATER LIFE
During his early life Gavarret
remained single. Eventually, on 14th
September 1860, he married Eudoxie
Binesse de Saint-Victor, a lady in her
late 30s from an aristocratic family.
They set up home in rue de Grenelle on
the Left Bank, and became part of
Parisian society. Affable and replete
with anecdotes, told with manners of
speech from his southern childhood,
Gavarret presided over many
Saturday night soirees with ‘the ladies
of medical assistants who were
seeking professorships’.5
In 1873 he was appointed to review
the preparatory medical schools, with
a view to recommending those
appropriate for upgrading, and 6
years later became the inspectorgeneral for higher medical education.
He continued writing, contributing
articles on popular science to the
Moniteur universel and compiling all
17 physics definitions in the
Dictionnaire encyclopédique des sciences
médicales. Still active in his 70s, he
became President of the Academy of
Medicine in 1882, and presided over
the revision of the French
pharmacopoeia in 1884. He retired in
1885 and was subsequently awarded
an honorary professorship. He was
replaced by Charles-Marie Gariel
(1841–1924).1,13 His death came on 30th
August 1890, whilst on holiday with a
friend, and only 5 months after that of
his wife.
“
His
high
academic
status
ensured a
legacy for
medical
physics
”
GAVARRET’S CONTRIBUTION
TO MEDICAL PHYSICS
The nineteenth century saw
extraordinary advances in science,
technology and medicine. By his
appointment as the only full professor
of medical physics in France at that
time, Gavarret was placed in a unique
position to develop and clarify this
new discipline. It is difficult to fault
him. He gained considerable respect
from his medical colleagues as an
outstanding communicator and for
his ability to explain difficult concepts
of physics without compromising
scientific integrity. He understood
that a medical physicist must
constantly keep abreast of
developments in physics and
mathematics, which for him included
Poisson’s statistics, the optics of
Gauss, and insights into acoustics and
energy conservation from Helmholtz,
and be prepared to understand these
in depth in order to apply them and
explain them to his medical
colleagues. His high academic status
ensured a legacy for medical physics
both in his own highly-respected
department and elsewhere in
France.14,15,16 Within a decade of his
death, the discovery of x-rays and
radioactivity permanently cemented
the relationship between medicine
and physics in a way that would
probably not have surprised him.
ABOUT THE AUTHOR
Francis Duck is Honorary Consultant
Medical Physicist in the Department of
Medical Physics and Bioengineering at
the Royal United Hospital Bath NHS
Trust and visiting professor at the
University of Bath.
Email: [email protected]
REFERENCES
1 Gariel C-M. Médecine. In École polytechnique. Livre du
centenaire 1794–1894, 1897; Vol. 3: 394–408.
2 Corlieu A. Centenaire de la Faculté de médecine de Paris
(1794–1894). Ch IV: Chaire de Physique. 1896.
8 www.scopeonline.co.uk/pages/articles/history/history.shtml
9 Duck F. A history of medical physics – Adolf Fick and
physiological physics. Scope June 2012: 50–54.
10 Gavarret J. Physique Médicale – de la Chaleur Produite par
les Êtres Vivants. Paris, 1855.
3 Laborde M. Le professeur Gavarret. Bull Soc
d’Anthropologie de Paris, 4th ser, 1890; 1: 645–51.
11 Gavarret J. Télégraphie Électrique. Paris, 1861.
4 Huth E. Jules Gavarret’s Principes Généraux de Statistique
Médicale. J R Soc Med 2008; 101: 205–12.
12 Gavarret J. Acoustique Biologique – Phénomènes
Physiques de la Phonation et de l’Audition. Paris, 1877.
5 Beyneix A. Le professeur Jules Gavarret (1809–1890) et
l’application des méthodes mathématiques et physiques à
la médecine. Bull Acad Natle Med 2001; 185: 1327–35.
13 Desplats V, Gariel C-M. Nouveaux Éléments de Physique
Médicale. Paris, 1870.
6 Gavarret J. Principes généraux de statistique médicale.
Paris, 1840.
7 Andral G. An Essay on the Blood in Disease. Translated by
Meigs & Stillé. Philadelphia, 1844.
14 Gréhant N. Manuel de Physique Médicale. Paris, 1869.
15 Wundt W, Monoyer F. Traité Élémentaire de Physique
Médicale. Paris, 1871.
16 Lefèvre J. Manuel de Physique Médicale. Paris, 1889.
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Knowing what
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Call for engagement - Institute of Physics and Engineering in Medicine

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