Early Diagnosis - Virtual event blog

James Ingham, University of Liverpool, Nov 2020

It was a pleasure to attend the STFC cancer diagnosis network event, which turned out to be a fantastic melting pot of both research and commercial groups from a variety of backgrounds and interests, including the day to day medical diagnostics/treatments and also new and emerging technological fields. Coming from a physics (instrumentation) background I see events such as this as a crucial opportunity to bring the people from the front lines of treating patients and people developing the emerging technologies together. At Sciascan we are developing a probe for the rapid detection of cancer, we do this by implementing a variety of technological and machine learning advancements. Events such as this are critical for us to engage with the medical community to ensure the probe is designed in a robust and easily accessible package which meet the needs of the medics.

The event kicked off with a great set of talks from medical experts in a range of settings, from the GP surgery to the operating theatre. As each talk had a slightly different perspective on the current ‘needs’ for cancer diagnostics it meant each talk took a different approach and would likely appeal to a wide range of technologies which was brilliant. The talks were followed by a panel section allowing for great interaction and a review of the current funding landscape by both STFC and CRUK.

After a small break we entered into the breakout portion of the event where we were divided into groups of five or so with a range of expertise and tasked to give input on relevant questions form the previous panel section. We then reviewed the questions/answers among all the attendees where we could share our insights. I found this to be a very interesting and informative part of the event.

The event was then finished with a section where the attending commercial groups were placed into individual breakout rooms and a ‘speed dating’ style format was used where interested researchers/medical professionals could pick and choose which groups they wanted to talk to further. I personally found this section to be a great experience as the people who had an overlapping area of interest were able to have an informal back and forth chat.

Overall, the event was a great example of bringing people together from different backgrounds to share ideas and bring a range of insights to the common goal of cancer diagnosis.

Blog 5 - Bringing the voices of patients and clinicians into research - Sept 2020, Tracy O'Regan

Written by Caroline Wood

“It doesn’t matter how amazing a new technology is, if it can’t work within, improve, or develop the healthcare system then it will never be used.” Dr Tracy O’Regan is making sure that the voices of patients and clinicians are heard within the STFC Cancer Diagnosis Network (CDN).

The ultimate aim for all cancer research is to improve patient outcomes. But new diagnosis methods and therapies will only be beneficial if they can be used by front-line staff within existing or emerging clinical settings and pathways. To achieve this, Dr Tracy O’Regan, an officer for The Society and College of Radiographers (SCoR), wants to encourage greater engagement between STFC CDN and clinicians and patients. “This isn’t about stifling innovation or quashing new ideas” she says. “The purpose is to make sure that new technologies really do address the needs within the healthcare system.”

Having worked as a diagnostic radiographer in a variety of clinical settings – from outpatient care to A&E - Tracy appreciates first-hand how much care pathways can vary from one sector to another. Adding to this complexity, an increasing number of the patients within our ageing societies have multiple diseases or long-term conditions. Yet there can be huge differences between the various departments required to fully address the needs of local populations, from the format of appointments to technological gulfs. “Radiographers, for instance, have always been fully embedded in technology, whereas other departments still use hand written notes” Tracy says. She argues that this complexity within clinical care needs to be appreciated when new treatments and diagnostic tools are developed, with innovators working with clinicians from the planning phase and not just at the point of implementation. “What is really needed is a demand-signalling approach where researchers work closely with clinicians, patients and carers, to understand the issues and bottlenecks in current and evolving practice so that they can purposefully address these” she says.

Recent years have also seen the voice of the patient brought to the centre of healthcare. “Health systems used to have a very patriarchal approach, where the doctor knew best and the patient’s role was to simply follow their advice. But now we recognise that patients are experts by experience, which has led to the concept of ‘person-centred’ care” Tracy says. Increasingly, new technologies are being developed using a co-creation approach, where innovators work with patients throughout the process to deliver solutions that both achieve health benefits and are well tolerated. For example, the Patient Advisory Group for SCoR provides input on a range of the society’s activities, including their publications, consultation responses and research agenda.

Whilst she hopes that similar groups could help STFC CDN access patient and carer perspectives, she recognises that relying on volunteers has its limitations: “These groups can have a certain bias because it tends to be a particular type of person that will step forward, for instance in response to a poster in a waiting room inviting them to take part. Certain demographic groups, or patients who have experienced difficult treatments, may be more hesitant to engage in this way.” Nevertheless, it is still crucial to capture as many viewpoints as possible, as Tracy explains: “It is important to recognise that you cannot simply group people together: different cancers and treatments have very distinct effects and even patients with the same type of cancer will have different experiences depending on their individual values, overall health and preferences.” Fortunately, with a little creativity, there are many ways in which healthcare professionals, academics and researchers can work with patients and the public in partnership. “The best approach is to reach people where they feel comfortable in engaging, whether this is through community groups, working men’s clubs, faith groups or online support groups” Tracy says.

Understanding the views of patients and clinicians will become even more important as the health service responds to the colossal challenges facing it, from widespread obesity to an impending dementia epidemic. The COVID-19 pandemic has highlighted the pressures already apparent within the NHS and the demand for technologies that can increase capacity and speed up processes – particularly for medical imaging and radiotherapy. “During the acute phase of the pandemic, many NHS and private provider diagnostic radiographers were redeployed, for example to focus on chest imaging for suspected COVID-19 patients” Tracy says. Consequently, screening services for cancers, imaging for long-term conditions such as arthritis and osteoporosis, or acute services, for example, musculoskeletal trauma, virtually came to a standstill. Even as these services slowly reopen, their capacity has been drastically reduced due to more stringent requirements for social distancing, cleaning and disinfection. “We are going to see a massive backlog as a result of the lockdown and there is a real worry that cancer diagnoses will be missed or people will be presenting at a later stage of disease than usual.” Ultimately, it highlights the need for technologies to increase capacity and innovations to enable new ways of working. Tracy cites the example of ‘drive through’ imaging, where patients wait in their cars until summoned by a text message to the room where the scan will be taken, meaning that services are not restricted by the finite capacity of traditional waiting rooms.

“It’s more important than ever for research, development and innovation to be in partnership alongside healthcare staff and service users, with the intention of improving the diagnosis, treatment, quality and experiences of services for people” Tracy concludes.

Tracy O'Regan, SCoR Professional Officer
SCoR World Radiography Day poster, 2020
The Society of Radiographers,

Blog 4 From particle physics to PET scans: making cancer diagnosis cheaper, faster and safer - August 2020, Joshua Porter

Written by Caroline Wood

“What excites me most about this work is the possibility of making it cheaper and easier to detect cancer and save lives – that is a big motivator for me” Josh Porter

A project supported by STFC CDN is applying a new particle physics technique towards making PET scanners cheaper, safer and more accurate for cancer diagnosis.

Accurate diagnosis is perhaps the most critical point of a cancer patient’s treatment journey. But it can also be a bottleneck within healthcare systems: the machines are expensive, the procedures can be lengthy and there are often risks associated with exposure to high-power radiation. A new technology supported by the STFC Cancer Diagnosis Network (STFC CDN) could help overcome these challenges – inspired by one of the world’s most ambitious particle physics experiments.

Positron emission tomography (PET) scanning is a standard procedure for locating tumours and diagnosing cancer. Patients are injected with a mildly radioactive substance which becomes concentrated in cancerous cells. The emitted radiation is detected by an external sensor, which converts the signals into the scan image. The problem, as particle physicist Josh Porter (University of Sussex) explains, is that the detectors are made of ‘absurdly expensive’ crystals, which contribute significantly to the multimillion-pound price tag of a PET scanner. “It’s difficult to replace this material because you must find something that can as accurately pinpoint where the radiation is coming from, and at what energy, in order to picture the tumour” he says. As it happens, developing a new way to accurately measure radiation was a challenge Josh was already wrestling with before he became involved with STFC CDN, although originally for a very different purpose.

“My work with the STFC CDN came about through a particle physics project to develop a new technology for neutrino detection, specifically for the Deep Underground Neutrino Experiment (DUNE)” says Josh. DUNE is an international collaboration studying neutrinos, which are little-understood subatomic particles that could hold the answer to some of the most fundamental questions in the universe, including why the universe is made of matter rather than antimatter. Neutrinos only feebly interact with matter and can travel galactic distances without interference. Consequently, enormous and exquisitely sensitive detectors are required to see them. “Many neutrino detectors use a transparent liquid that acts as a ‘scintillator’” Josh explains. “If a neutrino hits this, a flash of light is emitted and this is detected by sensors around the edge. By measuring the pattern and amount of energy in the flash of light, we can learn something about what type of particle caused the radiation. This is challenging because light is very fast! It is like trying to figure out how far away lightning is by counting how long it takes to hear the thunder.” Last summer, as part of a project between his Masters and PhD courses, Josh developed simulations for an alternative approach called ‘LiquidO’. In this method, the liquid scintillator is infused with paraffin wax, to give a cloudy, opaque substance. This confines the emitted light to a much smaller area than a clear liquid would, allowing the radiation produced to be reconstructed much more precisely.

During his project, Josh attended a conference and it was over the evening meal discussions that he was first introduced to the idea of the LiquidO approach in PET scanners. “If we can replace the crystals in the scanners, this could reduce the price of the machine significantly” he says. “It is also highly likely that it would achieve much better sensitivity and thus more informative scan images.” A scoping grant from STFC CDN allowed Josh to dedicate time to modifying simulations for use in a PET scanner. This included identifying candidate materials that would be dense enough to stop the radiation more quickly. “It’s very important that the radiation emitted from the patient is stopped by the detector and deposits all of its energy there” he explains. “If the radiation scatters, it loses energy and can appear as though it is originating from somewhere else, meaning that any tumours won’t be precisely located.” The results of this work helped obtain follow-on funding from the STFC to develop the technology alongside his PhD studies. “The next stage will be to optimise the algorithms that generate the image from the timing information of the emitted radiation” he says. “We then hope to simulate a patient inside a PET scanner to model what the clinician would see from the scan image.”

It’s clear that STFC CDN has shaped Josh’s career ambitions by opening up an opportunity he hadn’t previously known existed. “I am committed to following this idea through to it being applied on patients” he says. “Ultimately, this could result in cheaper PET scanners so that more hospitals can purchase them and more tests can be carried out. We also expect that our method will be more efficient, so that the patient won’t need to be injected with as much radiation. This could allow a more relaxed approach towards prescribing PET scans in children, since the risk from radiation exposure would be lower.”

“I love physics but also the idea of being able to help people directly. Being part of STFC CDN has given me the opportunity to combine these two passions” he concludes.

Joshua Porter, August 2020
As a caption: Positron annihilation in a simulated version of the new PET scanner technology. Two gamma particles emitted back-to-back hit create balls of light in opposite points of the detector, Joshua Porter, August 2020

Blog 3 Istituto Nazionale di Fisica Nucleare, Umbria, Italy - Feb 2020, Alice Porter

My research focuses on the development of 3D diamond detectors for particle tracking and dosimetry. These are detectors with graphite column electrodes inscribed within a diamond as opposed to the conventional metal plates either side of the sensitive volume. In February 2020, I went on academic exchange to INFN Perugia, with the aim of performing the initial tests of a new 3D diamond prototype. The prototype has surface graphitisation to replace the metal layer that is conventionally fabricated on the top surface of a diamond sensor, to make electrical connection to the readout electronics. This layer changes the behaviour of the electric field and impacts the appropriate applied voltage to operate the detector efficiently. The detector was designed with the focus of radiation dosimetry in the clinical setting. Therefore, a low operation voltage and minimised metallic components in the interest of patient safety albeit high enough for precise dose measurements.

During the placement, I conducted characterisation tests using a lab-based x-ray tube. These tests were to understand the detector response at different voltages to varying beam currents (a proxy for dose rate) before exposing it to clinical dose ranges. At the end of the placement, the group and I visited Careggi University Hospital in Florence. We then could test the detector’s response to clinical dose rates provided by the treatment LINAC. The fast response of 3D diamond detectors allows the possibility to resolve individual LINAC pulses at low pulse frequencies, which is of high interest to the field. Using the detector, we can characterise the LINAC pulses with high temporal and energy resolution. We mounted the detector on top of a moveable robotic stage to take measurements of the LINAC’s beam profile. This is done by taking repeated measurements of the beam but taking a small step in one direction between each exposure. These measurements can help us to understand the spatial resolution of the detector, which is important for measuring the absorbed dose during treatment. Upon finishing the placement, I have a large dataset to analyse and quantify the sensor behaviour.

It was a fantastic opportunity to be focused on practical laboratory testing environment and gain direct experience with experts of using diamond detectors for medicine. I really enjoyed my first time performing beam tests in a real hospital treatment room. Working on a cutting-edge device and showing promising results in real time is exciting, and I am full of motivation to conduct a thorough analysis. Amongst enjoying the Italian food (Perugia is famous for its chocolates) and vistas, it was incredibly valuable to discuss the results and experimental approach and technical problem solving with my colleagues in Perugia. I look forward to the continued collaboration with INFN Perugia during and beyond the data analysis and to discovering full the impact of the findings, hopefully in my first publication as corresponding author!

The detector prototype being aligned with the LINAC laser beam at Careggi University Hospital. Alice Porter, Feb 2020
The Fontana Maggiore in the centre of the Historic Centre of Perugia. Alice Porter, Feb 2020

Blog 2 Challenge Workshop 1: Precision and Quantitative Imaging - 20th Jan 2020, Hannah Brown

My PhD research will contribute towards the development of a CZT detector system for application in Low Dose Molecular Breast Imaging. Therefore, the workshop was a great opportunity to attend talks exploring different Precise and Quantitative Imaging techniques currently being developed for cancer diagnosis. From PET to nanophotonics, the diverse expertise and approaches to diagnosis allowed for a range of interesting perspectives and ideas to be shared.

Facilitated breakout sessions were organised as to group participants according to research interests. These networking groups were incredibly beneficial as they encouraged open discussions surrounding shared interests and challenges. On a broader scale, the knowledge exchange between experts from different working sectors is crucial to answer questions such as ‘what do hospitals need?’ and ‘what can Physicists provide?’

On the whole, the workshop was a great opportunity to get a feel for the ongoing research into cancer diagnosis, in particular for me the different approaches to imaging mammographically dense breasts. The network is a great opportunity to share ideas, offer fresh perspectives and build a community with a common aim of working together to continue to improve means of cancer diagnosis.

Blog contributer - Hannah Brown, PhD student. Feb 2020

Prof Nigel Allinson talking about 'Proton CT in Proton Beam Therapy: Getting New Technology into the Clinic' at the Leicester event. January 2020
Facilitated breakout sessions at the Workshop Challenge, Leicester. January 2020

Blog 1 Launch Event in Liverpool - 9th September 2019, Sarah Bugby

The STFC Cancer Diagnosis Network+ was officially launched on 9th September 2019. More than 90 delegates attended the launch event at the University of Liverpool with attendees from universities, STFC facilities, industry, and healthcare.

The day kicked off with an introduction to the network from Dr Laura Harkness Brennan (University of Liverpool), including the training and funding opportunities available.

We then heard overview talks on each of the network’s key challenge themes. Multimodal Techniques were introduced by Prof Paul Marsden (Kings College London and Guy’s and St Thomas’) who discussed the breadth of imaging technologies currently in use for cancer diagnosis. Dr Ramona Woitek (University of Cambridge) discussed Precision and Quantitative Imaging, and introduced the audience to the varied field of radiomics. Prof Nandita de Souza (Institute of Cancer Research and Royal Marsden Hospital) drilled in to one of the key challenges of Early Diagnosis – we don’t know what it is that we’re not looking at – and provided an overview of the clinical need and challenges. The final challenge theme – Data Science applied to Imaging – was introduced by Dr Mathieu Hatt (French National Institute of Health and Medical Research) who covered the vast potential (and potential pitfalls) of applying machine learning techniques to clinical images.

After lunch, focus shifted to the STFC capabilities which could be applied to these challenge themes, with Dr Andrew Boston (University of Liverpool) providing a broad overview of all aspects of the STFC’s remit. This was followed by case studies showing how STFC research has been applied to medicine, ranging from Dr Martyn Winn’s (STFC Scientific Computing) work on analysing genomic data to the application of quantum entanglement to PET imaging by Prof Daniel Watts (University of York). The series of talks were rounded out by Dr Marlies Goorden (Delft University of Technology) who discussed how technology can be progressed from a lab to the clinic.

The event ended with refreshments and a chance for networking between attendees. Overall, the launch event was a great success and the Cancer Diagnosis Network+ is starting out with more than 50 members, and will only grow from here. After this broad introductory event, future events will be targeted to individual challenge themes, so keep an eye out for events in your area.

Blog contributer - Dr Sarah Bugby, Oct 2019

Members of the STFC CDN+ leadership team at the Launch Event, Liverpool. Sept 2019
Prof Paul Marsden from King’s College London talking about how multimodal techniques are used in cancer diagnosis at the Launch Event, Liverpool. Sept 2019