Imaging has become a crucial part of the biomedical sciences, not only for diagnosis within clinical medicine and the delivery and objective monitoring of subsequent therapy, but also for providing unique insights into causation of disease, pathophysiology and the translation of novel treatments from the laboratory into patients. There are excellent imaging facilities including Computed Tomography (CT), Magnetic Resonance (MR), ultrasound, Nuclear Medicine (NM), Positron Emission Tomography (PET) and radiochemistry. An experienced, innovative and expanding group of imaging scientists provide support for clinical researchers and their patients. There are fruitful collaboration with departments in other Schools especially Physical Sciences and Technology, and groups further afield. Future plans include creating a School of Imaging Science to train the next generation of imaging scientists.
State-of-the-art equipment is used both for clinical work, including critically ill patients, and research. Amongst many facilities the Wolfson Brain Imaging Centre is of particular note. Small animal imaging is being developed to support phenotyping and molecular imaging studies for metabolic, endocrine, neuroscience and cardiovascular medical research. Imaging goals in cancer research include evaluation and design of novel tumour therapies, including immunotherapy and anti-vascular and gene therapies. Such research will also increase understanding of the biology of cancer and the determination of tumour-associated MR parameters for diagnosis, prognosis and monitoring of therapy. Current work includes the use of hyerpolarised gases and paramagnetic particles for imaging cell death and measuring pH.
Cambridge imagers have extensively exploited methods for the detection, diagnosis and monitoring of human disease in novel ways, many of which have translated into clinical practice. For example, pioneering studies using CT for diagnosing and characterising abdominal conditions have removed the need for 'diagnostic' laparotomy. Multiple studies on the accuracy and efficacy of MR examinations of the knee have contributed to the redundancy of surgical diagnostic knee arthroscopy. Numerous non-invasive image-guided biopsy strategies have been developed which have replaced formal open surgical diagnostic biopsy for many diseases - most recently using ultrasound guidance for core biopsies of head and neck tumours and lymph nodes. The replacement of therapeutic surgery has been achieved in several conditions through development of novel image guided techniques that allow drainage of acute abdominal and pelvic abscesses and collections in almost any location.
We have also performed numerous efficacy studies evaluating the benefit of widely employed diagnostic MR examinations and their impact on clinical diagnostic confidence, management and patient outcomes. These have proven the effectiveness of MRI in the triage of patients with diverse but common clinical problems such as intracranial/spinal symptoms, knee/shoulder/wrist disorders and sensorineural deafness. Such work has been critical in the development of nationally established 'Guidelines for Imaging' and 'Health Technology Assessments', helping NHS decisions about additional MR purchasing. Our cumulative applied clinical research work has had considerable beneficial impact on routine NHS clinical practice and the delivery of patient care.
At a more fundamental level several imaging groups in Cambridge are developing novel imaging technologies for future clinical application. These include the development of real-time interactive MR based fluoroscopy, high resolution carotid artery wall and plaque imaging and a novel PET/MR system. Novel 3D ultrasound imaging technology is currently being developed to eventually support real time 3D ultrasound monitoring of percutaneous interventions and elastographic measurements of tissue stiffness. Terahertz imaging applications and network grid computing for image processing and transfer are also being developed.
Current imaging research activity includes several ongoing pilot studies that may eventually contribute to improved patient care. We are evaluating newer functional methods such as MR perfusion for assessing early solid tumour response to therapy (e.g. cervix tumour response to radiotherapy with biopsy validation). These are based on the pioneering CT perfusion techniques originally developed in Cambridge in the early 90s. MR based direct arthrography that avoids the need for X-ray fluoroscopy is undergoing evaluation and MR venography is being investigated in the characterisation of benign intracranial hypertension. A range of quantitative techniques for measuring body and hepatic fat distribution are also being evaluated along with spectroscopic (1H and 31P) techniques for diffuse liver disease. Studies to assess carotid artery plaque macrophage response using iron agents are aimed at identifying surrogate markers of "vulnerable" plaque that might be used for patient treatment selection. Diffusion Tensor Imaging with MR is being evaluated to delineate important nerve tracts in relation to brain tumours and has the potential to both improve outcomes from tumour resection and radiotherapy, thereby predicting likely impairments following surgery.