March 2012 - Institute of Physics and Engineering in Medicine

P06 3D ACOUSTIC FIELD 

Model to measure ultrasound 

scatter by the human ribs 

P07 ACCEPTANCE CRITERIA 

An analytical approach for 

quality assurance of IMRT 

P08 LONG-TERM EFFECTS 

Susceptibility-weighted 

imaging post radiotherapy 

SCOPE 

INSTITUTE OF PHYSICS AND ENGINEERING IN MEDICINE | www.ipem.ac.uk | Volume 21 Issue 1 | MARCH 2012 

Novel surgical 

implant design 

Method to optimise 

bone locking implants 

Engineering 

World Health 

Meeting reports about 

the company’s work 

History in London 

Nineteenth-century medical physics

DOSIMETRY 

SOLUTIONS

PRESIDENT’S LETTER | SCOPE 

A REFORM AGENDA 

As members of IPEM, 

we are committed to 

promoting the 

application of physics 

and engineering to 

medicine and biology. 

There is no doubt the NHS reforms 

will impact us with the 

implementation of its aims and 

objectives bringing challenges and 

opportunities. The recent Department 

of Health report ‘Innovation, health 

and wealth: accelerating adoption and 

diffusion in the NHS’ has identified 

the importance of adoption and 

spread of our novel and innovative 

ideas into clinical practice. The 

medical physics and clinical 

engineering workforce are in a key 

position to develop this key strategy. 

This is vital to the NHS reform agenda 

and indeed to supporting a recovery 

from the current economic malaise. 

The aims of IPEM remain clearly 

relevant and appropriate. However, 

we must ensure that our structures 

and activities are relevant to the 

challenge set before us whether we 

work in the NHS, academia or the 

industrial sector. 

The membership of IPEM will 

become more diverse in its 

background and qualifications. 

Further change will be evident as the 

NHS reform agenda integrates service 

providers from the private and third 

sectors. As a counter balance, the 

Engineering and Science Councils 

provide common platforms with 

which to recognise the achievements 

and professional standing of its 

registrants. IPEM is committed to 

supporting these registers on behalf of 

its members and accrediting 

programmes that support these 

awards. 

The Engineering Council is the UK 

regulatory body for the engineering 

profession. It holds the national 

registers of Engineering Technicians 

(EngTech), Information and 

Communications Technology 

Technicians (ICTTech), Incorporated 

Engineers (IEng) and Chartered 

Engineers (CEng). It sets and 

maintains the internationally 

recognised standards of professional 

competence and ethics that govern the 

award and retention of these titles. 

Peter Jarritt 

President 

▼ Integrating 

with others will 

provide more 

opportunities. 

This ensures that employers, 

government and wider society – both 

in the UK and overseas – can have 

confidence in the knowledge, 

experience and commitment of 

registrants. 

IPEM is already licensed by the 

Engineering Council to accredit 

academic programmes to meet the 

requirements for both Chartered and 

Incorporated Engineer registration and 

to assess applications for admission to 

the CEng, IEng and EngTech registers. 

The Science Council licenses 

professional bodies including IPEM to 

award the Chartered Scientist (CSi) 

designation on its behalf to their own 

individual members. IPEM has 

awarded CSci since 2004 and 

revalidated registrants’ competence 

through CPD. The Science Council is 

committed to raising the professional 

standing of all those working to 

advance science and its applications, 

and ensuring opportunities for further 

training and professional development 

at every level. It recently announced 

the development of new professional 

registers for scientists and science 

technicians at similar levels to the 

Engineering Council’s IEng and 

EngTech. There is increasing demand 

for science skills in associate 

professional and technical roles. The 

new registers will provide professional 

recognition for some of the science 

workforce for the first time. 

IPEM is one of seven professional 

bodies awarded licences to pilot the 

Registered Science Technologist 

(RSciTech) and Registered Scientist 

(RSci) registers. 

This is a significant opportunity 

for IPEM and is a welcome addition 

to the development of professional 

qualifications to support training and 

recognise knowledge and skills at 

these professional levels. These new 

registers complement Chartered 

Scientist status and enable us to 

recognise our members at all 

professional levels. 

IPEM’s proposals to pilot RSci and 

RSciTech have been well received and 

began with special (grandparenting) 

application arrangements from 

January 2012. After 2012 the Science 

Council intends to open the registers 

to other member bodies. Alongside 

these changes in science and 

engineering IPEM must consider its 

membership structures. A proposal, 

currently under development, will 

recommend merging the MIPEM and 

IIPEM membership categories into a 

new MIPEM category. The Overseas 

Affiliate category will be renamed 

and a new, lower-cost Affiliate 

category introduced for those 

interested in associating with the 

aims and objectives of the Institute, 

but who are not directly employed in 

relevant science and engineering 

organisations. The membership will 

be balloted on the proposal in 2012. 

This is an important change and 

seeks to recognise the diversity of 

skills and expertise within the 

membership and the contribution 

that each makes to fulfill its aims and 

objectives. It will provide multiple 

routes of entry to membership of 

IPEM encompassing the range of 

backgrounds and qualifications 

available in the workplace. More 

importantly it will allow us to move 

away from structures that have 

become inflexible and outdated, and 

facilitate flexible and 

distributed networks of 

practice. 

The combination of the 

introduction of 

universally recognised 

professional registers 

along with a revised 

membership structure will 

form one of the key 

building blocks that will 

enable us to better fulfil 

our aims and objectives. 

SCOPE | MARCH 2012 | 03

SCOPE | CONTENTS 

THIS ISSUE 

50 

COVER FEATURE 

HISTORY IN LONDON 

The history series 

continues with changes 

that took place in 

science in nineteenthcentury 

London 

Cover image © Getty Images 

09 IMPLANT DESIGN 

A novel method to investigate peri-implant bone distribution, to optimise 

the design of locking implants 

08 

09 

19 

MEETING REPORTS 

12 ENGINEERING WORLD HEALTH’S WORK IN DEVELOPING WORLD HOSPITALS 

Emmanuel Akinluyi 

16 CAREER PROMOTIONS FOR TECHNOLOGISTS/RADIOGRAPHERS 

Kim Howe 

16 APEN AND ATEN AT THE EUROPEAN MEDICAL PHYSICS CONFERENCE 2011 

Sarah Higgins, Ruth Ruddlesden, Richard Axell and Nathan Rivers 

19 EUROPEAN MEDICAL PHYSICS AND CLINICAL ENGINEERING CONFERENCE 

Paul T. Lee 

22 24TH EUROPEAN CONFERENCE ON BIOMATERIALS, 2011 

Raechelle D’Sa 

24 APPROPRIATE HEALTHCARE TECHNOLOGIES FOR DEVELOPING COUNTRIES 

Emmanuel Akinluyi 

26 SPECIFYING, EVALUATING AND SELECTING MEDICAL EQUIPMENT 

John Amoore 

30 24TH ANNUAL CONGRESS OF THE EANM 

Kimberley Saint 

32 ELECTRONS: DOSIMETRY, PLANNING AND TREATMENT 

James Williams and Susan Buckley 

34 EUROPEAN SCHOOL OF MEDICAL PHYSICS – 14TH SESSION 

Leila Nichol 

36 WEST MIDLANDS REGIONAL SCIENTIFIC MEETING 

Mark Baker, David Lines, Sarah Higgins, Zoe Adey, Jim Philips, Rebecca Cain 

38 IPEM MR-SIG/BC-ISMRM JOINT SESSION 

Mike Hutton 

40 ADVANCED CLINICAL MR IN ONCOLOGY 

Sarah Bacon and Daniel Wilson 

REGULARS 

03 PRESIDENT’S LETTER A reform agenda 

05 EDITORIAL Changes ahead 

06 NEWS Stories making headlines around the world 

43 INTERNATIONAL NEWS International meetings for 2012 

44 MEMBERS’ NEWS New members 2011 

46 BOOK REVIEWS Six reviewed books in this issue 

32 

04 | MARCH 2012 | 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 

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W www.ipem.ac.uk 

W www.scopeonline.co.uk 

EDITOR-IN-CHIEF 

Marc E. Miquel 

Clinical Physics, 

4th Floor Dominion House, 

St Bartholomew’s Hospital, 

London EC1A 7BE 

T +44 (0)203 4655 785 

F +44 (0)207 377 7100 

E m.e.miquel@qmul.ac.uk 

ASSISTANT EDITOR 

Gemma Whitelaw 

Radiotherapy Physics, 

Basement, New KGV 

Building, St Bartholomew's 

Hospital, West Smithfield, 

London, EC1A 7BE 

E gemma.whitelaw@barts 

andthelondon.nhs.uk 

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 usman.lula@poole.nhs.uk 

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 usman.lula@poole.nhs.uk 

ENGINEERING & 

ACADEMIC EDITOR 

Dr Constantinos Zervides 

Radiation Inspection and 

Control Service, 

Department of Labour 

Inspection, Ministry of 

Labour and Social 

Insurance, 12 Apelli street, 

1493 Nicosia, Cyprus 

E czervides@dli.mlsi.gov.cy 

T 00357 22405695 

F 00357 22663788 

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 mattgwills@gmail.com 

INTERNATIONAL EDITOR 

(Developing countries) 

Andrew Gammie 

Clinical Engineer, 

Bristol Urological Institute, 

BS10 5NB 

T +44(0)117 950 5050 

extension 2448 or 5184 

E agammie@iee.org 


(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 


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 ryan.lewis@swanseatr.wales.nhs.uk 

ONLINE EDITOR 

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Scope is published quarterly 

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but the views expressed are 

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© IPEM 2012 

ISSN 0964-9565 

“ 

Every difficulty 

is an opportunity 

and we have been 

extensively 

discussing the 

future of Scope 

” 

FCHANGES AHEAD 

MARC E. MIQUEL EDITOR-IN-CHIEF 

COMMENT | SCOPE 

irst issue of the year and we 

have a shower of meeting 

reports, with articles reaching 

double figures. This is the ideal 

opportunity to underline the 

stellar job Angela Cotton is 

doing as Meeting Reports Editor, 

without her it would be a lot harder to put an 

issue together. 

Meetings have always been central to Scope 

but with only four issues per year and 

obvious delays in writing and publishing, 

reports can sometimes look out-of-date. This 

was one of the motivations behind the 

creation of Scope Online. Unfortunately, with 

the online editor recently resigning – thanks 

again Damian for all your hard work – we are 

once again suffering some delays. Every 

difficulty is an opportunity and we have been 

extensively discussing the future of Scope and 

its better integration with the new shiny IPEM 

website. 2012 should see some changes, not 

least my long overdue retirement, but 

hopefully with the format of the magazine, so 

watch this space. 

With such a multitude of reports, we only 

had a very limited space for other articles. 

Constantinos, our Engineering Editor, 

provided us with a feature from Switzerland. 

In this article Damiona Schiuma and his 

colleagues report on the design optimisation 

of surgical implants. 

Obviously, Richard and Usman are 

reporting on recent news and Usman also 

collated a selection of book reviews. 

Once more, we are closing this issue with 

the popular Francis Duck’s history of medical 

physics series. Part 5 focuses on London in the 

nineteenth century. It is not often I have the 

opportunity to meet Scope contributors and 

discuss their articles face to 

face. It was therefore a real 

pleasure to have lunch 

with Francis when he 

came to visit the St 

Bartholomew’s archives 

last November. 

Please, keep 

sending your 

contributions 

and I hope 

you will enjoy 

this issue. 


SCOPE | NEWS BY USMAN I. LULA AND RICHARD AMOS 

Modelling a 3D acoustic field: scatter 

by human ribs during ultrasound 

Non-invasive, high-intensity focussed 

ultrasound (HIFU) offers considerable 

advantages over techniques such as 

chemotherapy and surgical resection, 

in terms of its reduced harmful side 

effects. One challenge is the need to 

transmit sufficient energy through 

the rib cage to induce tissue necrosis 

at the required location whilst 

minimising the formation of side 

lobes (e.g. liver, kidney and pancreatic 

cancers). Ribs both absorb and 

reflect ultrasound strongly, which 

means a common unwanted side 

effect of HIFU in regions located 

behind the rib cage is the overheating 

of bone and surrounding tissue 

leading to skin burns. Successful 

treatment in this clinical situation 

therefore requires a thorough 

understanding of the way in which the 

ultrasonic pressure field from a HIFU 

array is scattered by the ribs. 

A study addressed this issue by 

developing a type of boundary 

element approach to focus the 

acoustic field of a 256-element 

random phased HIFU array 3 cm 

deep beyond human ribs at particular 

locations requiring intercostal and 

transcostal treatment. The boundary 

element routines were supplied by 

PACSYS Ltd (PAFEC VibroAcoustics 

software). 

The 1 MHz acoustic pressure field 

produced by the HIFU array in the 

absence of scatterers was modelled 

as a superposition of plane circular 

piston sources. Simulations were 

carried out on a 3D mesh of quadratic 

pressure patches generated using CT 

scan anatomical data for adult ribs. 

The methodology was validated on 

rigid spherical and cylindrical 

scatterers using an assumed 

homogenous medium. Acoustic field 

calculations were also carried out for 

idealised ribs, consisting of arrays of 

strip-like scatterers, demonstrating 

the effect of splitting at the focus 

(figures 1 and 2). Figure 3 shows the 

corresponding acoustic pressure 

distribution on the surface of the ribs 

showing maximum pressures just 

over 1.8 MPa. 

This implementation had the 

advantage of fully accounting for 

scattering and diffraction effects 

involved in complex 3D structures 

under continuous wave excitation. 

The model is also a useful tool for 

assessing the efficacy of a given 

multi-element transducer design in 

the presence of arbitrary scatterers 

such as the ribs and enables a better 

understanding of their influence on 

the nature of the focus. 

This work was part of a wider 

project whose goal is the design of a 

prototype HIFU system for treating 

upper abdominal tumours and to 

develop treatment planning 

software. This will feature a multielement 

transducer with electronic 

steering capabilities together with a 

system for the monitoring of 

treatment and acoustic cavitation. 

The technique presented in this 

work will form an integral part of the 

treatment planning software. 

FIGURE 1 [TOP]. 

Total acoustic pressure field of 1 

MHz random-phased HIFU array 

for transcostal treatment 

location approximately 3 cm deep 

into the rib cage behind rib 10 on 

the right side. Rib contours are 

shown in black. 

▼ 

FIGURE 2 [MIDDLE]. 

Scattered acoustic pressure field 

of 1 MHz random-phased HIFU 

array for transcostal treatment 

location approximately 3 cm deep 

into the rib cage behind rib 10 on 

the right side. Rib contours are 

shown in black. 

▼ 

FIGURE 3 [BOTTOM]. 

Total acoustic pressure on 

surface of ribs 9-12 on the right 

side resulting from field of 1 MHz 

random-phased HIFU array for 

transcostal treatment location 

approximately 3 cm deep into rib 

cage behind rib 10 on the right 

side. Source-velocity distribution 

obtained using phase conjugation 

based on a point source 

calculation. 

▼ 

MORE INFORMATION 

This work was published in Phys Med 

Biol 2011; 56(17): 5553: 

http://dx.doi.org/10.1088/0031- 

9155/56/17/007 


NEWS BY USMAN I. LULA AND RICHARD AMOS | SCOPE 

IMRT quality assurance: an analytical 

approach to acceptance criteria 

TABLE 1 

Size of error 

MLC offset 

Detectability γ citerion 

required 

Pre-treatment phantom-based 

QA measurements for individual 

IMRT patients are a common 

practice. The gamma (γ) criterion 

is used during the evaluation of 

these measurements. 

Acceptance criteria have 

generally been based on what is 

achievable or on purely 

dosimetric criteria. Research 

groups in the USA have recently 

demonstrated that verification of 

single planar fields may hide 

dosimetric inaccuracies in a 

NTCP 

increase (%) 

(Nahum parameters) 

combined 3D dose distribution 

which can be in anatomical 

regions of interest. 

The study aimed to ‘relate 

measurement acceptance 

criteria to the predicted clinical 

impact in terms of tumour 

control probability (TCP) and 

normal tissue complication 

probability (NTCP)’. 

Measurement of the sensitivity to 

and clinical impact of three 

machine pathologies were 

considered (each representing 

TCP reduction (%) 

0.5 mm 2 % / 2 mm 0.2 0 0 

1 mm 2 % / 2 mm 0.4 0.1 0.1 

1.5 mm 2 % / 2 mm 0.6 0.3 0.3 

2 mm 3 % / 2 mm 0.8 0.6 0.5 

2.5 mm 4 % / 2 mm or 2 % / 3 mm 0.95 0.9 0.8 

Gravity effect amplitude 

0.5 mm 2 % / 2 mm 0.3 0 0 

1 mm 2 % / 2 mm 0.6 0.1 0.1 

1.5 mm 2 % / 3 mm 0.8 0.5 0.2 

2 mm 3 % / 2 mm or 2 % / 4 mm 1.15 0.5 0.4 

2.5 mm 3 % / 3 mm 1.45 0.7 0.5 

Dose error 

–4% 5 % / 2 mm or 4 % / 4 mm –1.8 5.8 4.0 

–3% 4 % / 2 mm or 3 % / 3 mm –1.3 4.5 3.1 

–2% 3 % / 2 mm or 2 % / 3 mm –0.9 2.9 2.1 

–1% 2 % / 2 mm –0.4 1.4 1.1 

+1%* 2 % / 2 mm 0.4 –1.3 –0.9 

+2%* 3 % / 2 mm or 2 % / 3 mm 0.8 –2.5 –1.8 

+3%* 4 % / 2 mm or 3 % / 3 mm 1.2 –3.7 –2.6 

+4%* 5 % / 2 mm or 4 % / 4 mm 1.5 –4.8 –3.3 

(RT01 parameters) 

*Note that for an increase in dose the TCP is actually increased with a corresponding increase in NTCP 

Table 1: Detectability and impact of artificial errors. Shown also is a TCP comparison between Nahum and 

RT01 datasets used as input parameters for the Marsden model. Table kindly supplied by Antony Carver, 

Physics Department, Clatterbridge Centre for Oncology, Bebington, Merseyside CH64 1SS. Table © 

Elsevier, ‘An analytical approach to acceptance criteria for quality assurance of intensity modulated 

radiotherapy’, Antony Carver, Martyn Gilmore, Stephen Riley, Julien Uzan and Philip Mayles, Radiother 

Oncol 2011; 100(3): 453–5. 

the ‘modified’ plan with MLC 

adjustments made to plan DICOM 

files prior recalculation): 

1. dose delivery error: by 

changing the total planned 

monitor units (MUs) by ±4 per 

cent; 

2. offset MLC leaves: introducing 

MLC positional errors of up to 2.5 

mm; 

3. gravity-induced MLC leaf sag: 

by applying a sinusoidal 

transform to leaves of a 

maximum amplitude of 2.5 mm. 

The Eclipse treatment 

planning system (TPS) was used 

to calculate the doses using the 

analytic anisotropic algorithm 

(AAA). The TPS was also used to 

compare the dose volume 

histogram (DVH) between the 

various plans which were then 

analysed using the in-house 

BIOSUITE software (for TCP / 

NTCP). TCP values were 

calculated using the Marsden 

model, based on the clinical target 

volume (CTV); NTCP values were 

calculated using the Lyman- 

Kutcher-Burman (LKB) model. 

Treatment fields were 

delivered with a Varian RapidArc 

enabled linac and the dose 

distribution measurements 

acquired using the Delta 4 

phantom, corrected for output 

variation. Delta 4 software was 

used to determine the ‘γ-index’ 

values for each plan with a γ-index 

criterion ranging from 2 per cent 

and 2 mm to 7 per cent and 4 mm. 

In all tests, a failure was defined 

as

SCOPE | NEWS BY USMAN I. LULA AND RICHARD AMOS 

IN BRIEF 

PHOTOACOUSTIC 

TOMOGRAPHY 

Researchers in St Louis 

have used photoacoustic 

tomography to image the 

accumulation of gold 

nanogages in the lymph 

nodes of rats. It is thought 

that this technique could 

be used to obtain a better 

understanding of transport 

kinetics in the lymphatic 

system, thus enabling new 

tools to be designed for 

cancer therapy. 

INTEGRATED 

PET/MR SYSTEM 

Investigators have 

determined that negligible 

mutual influences exist 

between the two 

subsystems of the recently 

released Siemens 

Biograph mMR whole-body 

PET/MR scanner, 

concluding that the 

integrated architecture 

shows no significant 

impact on either the PET 

or MR performance. 

CONFIGURABLE 

PET DETECTION 

A group at Gachon 

University of Medicine and 

Science in Korea has 

designed a PET system 

that is able to adapt its 

detector diameter 

according to the size of the 

subject being imaged. 

MICROBUBBLES 

IN STROKE RISK 

Based on recent findings 

that microbubbles are 

retained within 

atherosclerotic plaques, 

researchers are developing 

a means of diagnosing an 

increased risk of stroke by 

administering ultrasound 

contrast microbubbles to 

subjects. If an 

atherosclerotic plaque is 

present, late-phase 

contrast-enhanced 

ultrasound is used to 

detect the signal produced 

by bubbles retained within 

the plaque. 

Susceptibility-weighted imaging 

reveals post-radiotherapy effects 

Susceptibility-weighted imaging 

(SWI), a form of MRI, has been 

shown to reveal long-term 

radiation-induced damage to 

normal-appearing brain tissue in 

glioma patients. 

Investigators at the University 

of California, San Francisco 

(UCSF), retrospectively studied 25 

patients who had received 

radiotherapy and/or 

chemotherapy to treat glioma. 

Using multiple 7-Tesla SWI brain 

scans, they were able to detect 

the incidence and anatomical 

location of sub-millimetre 

microbleeds, for up to 20 years 

post treatment. Microbleeds are 

considered to be manifestations 

of intermediate and long-term 

adverse effects of radiation 

therapy in normal brain 

parenchyma. 

Whilst radiation therapy is an 

effective treatment for brain 

cancer patients, it has been 

implicated in damage to cerebral 

microvasculature and the 

resulting haemorrhage and 

associated deterioration of 

neurologic function. However, 

little is known of the effects of 

radiation and the mechanisms of 

disease progression. The group at 

UCSF aimed to assess the 

potential of 7T SWI to elucidate a 

better understanding of the 

treatment effects. 

SWI is a post-processing 

technique exploiting 

inhomogeneities in magnetic 

susceptibility that arise as a result 

of iron-containing compounds 

entering extra-cellular space 

during microbleeds. The 

inhomogeneities distort the local 

magnetic field, resulting in 

dephasing at the sites of the 

microbleeds, consequently 

appearing as well delineated, lowintensity 

lesions in the phase 

image. The phase image is filtered 

and scaled before being 

multiplied into the accompanying 

magnitude image, producing a 

combination phase-magnitude 

SWI image in which the contrast 

of the microbleed, relative to the 

surrounding brain tissue, is 

enhanced. 

The imaged microbleeds were 

identified, counted and 

categorised according to their 

location relative to the original 

treatment site. Of the six patients 

who did not receive radiotherapy, 

none of them exhibited 

microbleeds. Of the 19 patients 

who did receive radiotherapy, an 

overall increase in microbleeds 

with increasing time following 

treatment was observed, starting 

at 2 years. The proportion of 

microbleeds found outside the 

high-dose treatment volume also 

increased with time posttreatment, 

in some cases 

extending into the contralateral 

hemisphere. Data was available 

for three patients to allow fusion of 

the dose distribution with the SWI 

scans, revealing a correlation 

between incidences of 

microbleeds and areas of the 

brain that received higher doses 

during the treatment. 

Work continues to answer 

questions of whether some areas 

of the brain are more susceptible 

to microbleeds than others and 

how their presence affects 

cognitive function. 

MORE INFORMATION 

This story was first reported on Medical 

Physics Web on 13th December: 

http://medicalphysicsweb.org/cws/art 

icle/research/48095 


IMPLANT DESIGN 

NOVEL METHOD TO OPTIMISE SURGICAL IMPLANTS 

Damiano Schiuma, Stefano Brianza and Andrea Tami (AO Research Institute, Davos 

Platz, Switzerland) have a method of improving the design of surgical implants 

Recent studies report 

insufficient, immediate 

post-operative stability 

of surgical implants. 

The use of locking 

screw technology – 

based on threaded screw heads 

locked in threaded plate holes – has 

shown to be beneficial for the 

treatment of osteoporotic fractures. 1,2 

However, the implant design seems 

to be not yet optimised for the 

characteristics of osteopenic and 

osteoporotic bones. 3 Design 

optimisation could further improve 

Investigating 

peri-implant 

bone quality 

distribution for 

the design of 

locking implants. 

▼ 

the fixation success rate, for example 

by aiming locking screws at regions 

with proven better bone quality. 

Several in vitro investigations have 

verified a direct relationship between 

mechanical behaviour and bone 

properties for different anatomical 

regions. 4,5 Currently, surgical implants 

are manufactured taking into account 

bone shape, fracture type and 

macroscopic information about bone 

distribution. 6,7 The influence of local 

bone properties on implant stability 

has been addressed, 8 but more 

detailed information is lacking about 

anatomy-specific, peri-implant bone 

properties. This supports the need for 

a tool to quantify bone quality and 

strength at the exact location, where 

the anchoring elements (i.e. locking 

screws) will be inserted. 

We developed a method 9 to 

improve the design of locking 

implants aimed for epiphyseal 

regions by finding the optimal paths 

for the locking screws, based on local 

bone mineral density (BMD) 

distribution and bone microarchitecture 

(BMA). The BMD related 

parameters include volumetric bone 

▼ 


SCOPE | FEATURE 

▼ 

FIGURE 1. 

Description of the 

method. 

▼ 

FIGURE 2. 

Reference points 

for the PHILOS 

plate and the nonfixated 

humerus. 

▼ 

mineral density, bone tissue mineral 

density and bone volume fraction, 

while BMA is defined by trabecular 

thickness, trabecular number, 

trabecular separation, degree of 

anisotropy and structural model 

index. This method assesses the BMD 

and BMA in the cancellous bone 

regions where the anchoring elements 

of an implant (in our study, the 

locking screws) are to be placed, 

before the actual fixation is carried 

out. By identifying the directions in 

bone where the best purchase can be 

achieved, the implant design can be 

optimised. The method is applicable 

to any locking implant, and we have 

tested its feasibility on a locking 

proximal humeral plate available on 

the market. 

METHOD 

The method consists of four steps: 

(1) temporary, partial fixation of the 

plate to the humeral shaft using 

locking screws (outside the region of 

interest) in order to define a reference 

system, (2) implant removal and 

high-resolution peripheral 

quantitative computed tomography 

(HR-pQCT) of the bone, (3) 

determination of BMD and BMA 

along the implant-anchoring locations 

(within the region of interest) and (4) 

evaluation of alternative, optimised 

directions for implant-anchoring 

locations (figure 1). 

FIGURE 3. 

Implant 

optimisation 

procedure by 

assessing the 

local bone 

properties along 

alternative paths 

for each screw. 

▼ 

Reference system definition 

We defined two co-ordinate systems, 

one for the plate and one for the 

specimen. Two sets of three unaligned 

reference points on the corresponding 

3D reconstruction were retrieved 

(figure 2). For the plate, the first 

reference point (A) was the most 

distal locking hole, the second 

reference point (B) was the second 

most distal locking hole and the third 

reference (C) point was the tip of the 

locking screw in the second most 

distal hole. For the bone, the first 

reference point (A) was the most 

distal hole on its medial side, the 

second reference point (B) was the 

second most distal hole on its lateral 

side and the third reference point (C) 

was this same hole on its medial side. 

Virtual screw position and 

evaluation of peri-screw bone 

quality 

The co-ordinates of the proximal 

screws were collected from the 

absolute co-ordinate system of the 


FEATURE | SCOPE 

plate 3D model. Given the position 

and direction of the screws in the 

plate 3D model, a transformation 

matrix was defined to determine the 

virtual position and direction for each 

proximal screw in the 3D model of 

the humerus. 

The intact humeral head was 

aligned to each calculated virtual 

screw direction, allowing the volume 

of interest (VOI) around each screw 

to be defined. Bone parameters were 

assessed in a cylindrical VOI (25 mm 

in length, 6 mm in diameter). 

Optimisation procedure 

We investigated all the bone quality 

parameters (BMD and BMA) along 

four alternative directions. The head 

of the screw was always kept at the 

same location while the tip was 

displaced either anteriorly (Ant), 

posteriorly (Pos), proximally (Pro) or 

distally (Dis) (figure 3). For each 

proximal PHILOS plate screw, the 

best direction was calculated. 

Peri-screw bone distribution 

The method was used to assess 

differences in peri-screw bone 

distribution for a population of 19 

humeri. 10 BMD was determined in the 

exact locations where the six 

proximal screws would have been 

positioned after completing the 

instrumentation. Univariate analysis 

of variance weighted for age was 

used to compare the different 

positions with respect to BMD. 

RESULTS 

The method described here was able 

to find the position and direction the 

real screws would occupy in the 

humeral head. The optimisation 

carried out on the cadaveric 

specimen showed the possibility of 

finding combinations of new screw 

directions characterised by better 

bone properties compared to those of 

the actual directions. We chose the 

best screw directions based on the 

apparent density and bone volume 

fraction, as they are the most 

representative indicators of bone 

strength 11,12 and the most variable 

parameters for the alternative paths. 

The effect of the method’s accuracy 

was found to be negligible when 

compared to the variability of the 

parameters obtained from the 

optimisation procedure. 

Significant differences in BMD 

were found between screw positions. 

In particular, the posteromedial part 

of the humerus was found to have a 

significantly higher bone quality. 

These results prove that different 

screw configurations could have an 

effect on bone strain distribution and 

magnitude during loading. 

SUMMARY 

We developed a novel method to 

investigate peri-implant bone quality 

distribution. The method can be used 

to optimise the design of locking 

implants. It defines the optimal, 

mechanically most valid paths for the 

anchoring elements based on local 

bone properties. The novel design 

must still take into consideration the 

surgical approach and the anatomical 

structures (e.g. soft tissue dissection, 

blood vessels and nerves). 

The strengths of the method are: 

(1) the resolution of the performed 

scans which allows the analysis of 

bone quality parameters; (2) the 

complete lack of metal artifacts, and 

(3) the possibility of accurately 

investigating local bone properties 

while taking into consideration the 

implant geometry and fixation 

technique. The goal is to design 

implants that better fit and take 

advantage of local bone 

characteristics in osteopaenic and 

osteoporotic patients. 

There are also some limitations to 

the method. It is based on the 

assumption that surgeons will 

position the same implant in different 

patients similarly, using a standard 

surgical access. The method also 

assumes that better mechanical 

properties of the bone-implant 

construct are achieved by aiming the 

implant-anchoring parts at bone 

regions with proven higher BMD and 

better BMA. 

Different screw configurations 

were found to have an effect on bone 

strain distribution and magnitude 

during loading, but additional 

mechanical testing on paired 

cadaveric bones and in vivo clinical 

trials are mandatory to show that 

implants optimised using this method 

offer better mechanical performance 

in fracture fixation. 

In conclusion, this study has 

shown that screw paths encountering 

better purchase can be identified. The 

resulting optimised implant can 

potentially better distribute the stress 

on cancellous regions, and thus help 

surgical intervention in reaching 

better clinical outcomes with less 

post-operative complications. n 

REFERENCES 

1 Südkamp N et al. Open reduction and internal 

fixation of proximal humeral fractures with use 

of the locking proximal humerus plate. Results 

of a prospective, multicenter, observational 

study. J Bone Joint Surg Am 2009; 91: 

1320–28. 

2 Sanders BS, Bullington AB, McGillivary GR, 

Hutton WC. Biomechanical evaluation of 

locked plating in proximal humeral fractures. J 

Shoulder Elbow Surg 2007; 16: 229–34. 

3 Tingart MJ, Lehtinen J, Zurakowski D, Warner 

JJ, Apreleva M. Proximal humeral fractures: 

regional differences in bone mineral density of 

the humeral head affect the fixation strength 

of cancellous screws. J Shoulder Elbow Surg 

2006; 15: 620–24. 

4 Hernandez CJ, Keaveny TM. A biomechanical 

perspective on bone quality. Bone 2006; 39: 

1173–81. 

5 Hernandez CJ. How can bone turnover modify 

bone strength independent of bone mass 

Bone 2008; 42: 1014–20. 

6 Kozic N et al. Optimisation of orthopaedic 

implant design using statistical shape space 

analysis based on level sets. Med Image Anal 

2010; 14: 265–75. 

7 Nobari S, Katoozian HR, Zomorodimoghadam 

S. Three-dimensional design optimisation of 

patient-specific femoral plates as a means of 

bone remodelling reduction. Comput Method 

Biomech 2010; 13: 819–27. 

8 Wirth AJ et al. Implant stability is affected by 

local bone microstructural quality. Bone 2011; 

49: 473–8. 

9 Schiuma D, Brianza S, Tami AE. Development 

of a novel method for surgical implant design 

optimization through noninvasive assessment 

of local bone properties. Med Eng Phys 2011; 

33: 256–62. 

10 Brianza S, Röderer G, Schiuma D, Schwyn R, 

Scola A, Gebhard F, Tami AE. Where do 

locking screws purchase in the humeral head 

Injury 2011. 

11 Griffith JF, Engelke K, Genant HK. Looking 

beyond bone mineral density: imaging 

assessment of bone quality. Ann NY Acad Sci 

2010; 1192: 45–56. 

12 Huber MB et al. Proximal femur specimens: 

automated 3D trabecular bone mineral density 

analysis at multidetector CT – correlation with 

biomechanical strength measurement. 

Radiology 2008; 247: 472–81. 

▼ 


SCOPE | MEETING REPORTS 

ENGINEERING WORLD HEALTH’S WORK IN 

DEVELOPING WORLD HOSPITALS 

EMMANUEL AKINLUYI King’s College Hospital and King’s College London 

DURHAM, NORTH CAROLINA, USA 2nd–8th June 2011 

ON THE EVENING OF THURSDAY 2ND JUNE, at a 

‘TED’* event in Chapel Hill, North Carolina, USA, entitled 

‘Global health: what’s technology got to do with it’, Robert 

A. Malkin (Duke University, Durham, NC, USA) opened 

his talk with a strong line: ‘If you have donated medical 

equipment to a developing world hospital, you have 

probably hurt that hospital’. The statement was of course 

controversial, since anyone in the know will tell you that ‘80 

per cent of healthcare equipment is funded by international 

donors or foreign governments’. 1 This statistic shows a 

dependence on donors, which could understandably be 

taken for a need, but Malkin argued otherwise. This 

opening was perhaps more startling, when one considers 

that Professor Malkin serves on the World Health 

Organization’s subcommittee on medical equipment 

donations, and is a founder of the decade-old non-profit 

Engineering World Health (EWH), which originally had the 

vision of refurbishing and repurposing retired medical 

equipment from US hospitals. Though this statement might 

seem radical to some, the sentiment behind it mirrors what 

has been recognised by the WHO (as evidenced by the 

content of the WHO guidelines for equipment donation 1 ) 

and biomedical engineering NGOs the world over; that just 

sending equipment is not enough. This talk was the 

beginning of a thought-provoking 6-day visit to the 

‘Durham Research Triangle’ – an innovation hub, which 

has arisen from the network of Duke, North Carolina and 

North Carolina State Universities, together with their 

associated hospitals and local business enterprises. 

Other than this talk, other speakers covered a number 

of topical issues: for example, Josh Nesbit (Medic Mobile, 

San Francisco, CA, USA) spoke about connectivity and coordination 

in health systems, using mobile phones, and 

Jon Gosier (Appfrica) spoke on an innovation developed 

in Africa, whereby mobile technology could be used in 

crisis mapping. As well as hearing from some prominent 

thinkers from the Triangle at the TED event, I was 

fortunate enough to have access to EWH’s key people for a 

series of interviews and open discussions. These included 

interviews with EWH’s Founder Robert Malkin, CEO and 

Executive Director Melissa Beard (a daunting prospect 

considering her previous interview was with Time 

magazine) and Technology Development Manager Julien 

Benchetrit (see figure 1). My hosts were incredibly 

welcoming, and made sure that I had opportunities to 

experience the famed southern hospitality, food and 

scenery of North Carolina. I am particularly grateful to 

IPEM, who made this experience possible by agreeing to 

offset the costs of travel and accommodation with a 

bursary award. 

FIGURE 1. 

Myself, Melissa 

Beard (Director, 

CEO) and Julien 

Benchetrit 

(Technology 

Development 

Manager). 

▼ 


MEETING REPORTS | SCOPE 

FIGURE 2. 

The ‘iceberg 

syndrome’ of 

lifecycle costs for 

healthcare 

technology. 4 

▼ 

THE STRUCTURAL BURDEN OF DONATED 

EQUIPMENT: THE ‘VICIOUS CYCLE OF AID’ 

During his TED talk and later in my interview with him, 

Professor Malkin referred to a book by best-selling author 

and economist Dambisa Moyo, entitled Dead Aid: Why Aid 

is Not Working and How There is a Better Way For Africa. 2 In 

this book, Moyo describes how ‘overreliance on aid has 

trapped developing nations in a vicious circle of aid 

dependency, market distortion, and further poverty, 

leaving them with nothing but the need for more aid’ 

(http://www.dambisamoyo.com). Moyo is an economist 

and not an engineer, but Malkin remarked that the issues 

dealt with in the book essentially reflect the problems that 

he has observed certain equipment donations to cause. In 

my interview with him, Malkin cited the example of how a 

large-scale donation of wheelchairs and other mobility 

equipment to an area in Tanzania met an immediate need, 

but on the other hand put capable local craftsmen out of 

business. The subsequent lack of local support and the loss 

of skills meant that it was only a matter of time until the 

area became fully dependent on intermittent and 

unpredictable foreign donations; a clear example of the 

‘vicious circle’ that Moyo describes. 

WORKLOAD BURDEN OF DONATED EQUIPMENT: 

SUSTAINING INAPPROPRIATE TECHNOLOGY 

Equipment donations can also create a set of challenges 

that are faced throughout their life in the clinic, particularly 

with their practical up-keep. These problems arise from a 

mismatch between medical technology and the 

circumstances of hospitals in resource-poor settings. 

Discussions with Julien Benchetrit highlighted the 

following statistics, taken from a webcast by Clinical 

Engineer Ismael Cordero on the Drexel BIOMED website: 3 

n ‘80 per cent of the world’s population is unable to afford 

£60 (US$100) per head per year on health. In many sub- 

Saharan countries, that figure drops to ~£9 (US$15). 

n The vast majority of medical equipment is designed in 

countries that spend over £1,240 (US$2,000) per head per 

year on health. 

n Thus, the standards and technology set by the medical 

equipment manufacturing nations are not sustainable for 

over 80 per cent of the world’s population.’ 

Fundamentally the global majority who need healthcare 

technology are rarely even an after-thought in equipment 

design and delivery. As such, supplies of spares and 

consumables are difficult to sustain, conventional technical 

support is impractical and the lack of skilled maintenance 

personnel means that even easily preventable device faults 

render equipment unusable. 

FINANCIAL BURDEN OF DONATED EQUIPMENT: 

ACCOUNTING FOR THE LIFETIME COST OF 

MEDICAL EQUIPMENT 

The workload burden of managing donated equipment is 

significant, but donations often create more direct, 

financial burdens. In the past, large equipment donations 

have been thought to be beneficial because they remove 

the purchasing costs of technology acquisition for the 

recipient. However, in what has been termed the ‘iceberg 

syndrome’ of lifecycle costs for healthcare technology, 4 

operating, management, maintenance, transportation and 

decommissioning costs are often overlooked (shown in 

figure 2). 

The structural, financial and workload burdens of 

donations have culminated in growing stockpiles of 

underused medical equipment. In a recent study carried 

out by Lora Perry and Professor Malkin, ‘inventory 

reports were analyzed from 1986 to 2010, from hospitals 

in sixteen countries across four continents’. They found 

that about 40 per cent of medical equipment is out of 

service in the developing world. Of the hundreds of 

thousands of devices surveyed, not one donated item 

(new or used) was found to be fully functioning and inuse 

after 6 months. 

EWH’S TURNING POINT 

Professor Malkin and his associates steered EWH’s 

mission away from donation 3 years ago, after he 

witnessed a shocking example of the mounting 

equipment storage costs that can be caused by poorly 

targeted donations. Malkin visited a Nicaraguan hospital 

where a container full of medical equipment had been 

shipped 6 months earlier, only to find the equipment 

absent from the operating theatres and intensive care 

units. He recalls: ‘I spoke to a colleague and he took me 

across town to a nondescript building and I saw a sea of 

donated medical equipment. This hospital had received 

so much donated medical equipment (including that from 

EWH) that they had to rent this enormous building just to 

house it all. It probably would have been cheaper for 

them to buy the few pieces of equipment they were using, 

than to rent this huge facility. In essence our donation had 

hurt this hospital.’ 

At that point, EWH stopped donating, cleared its 

warehouses in the US, and 3 years on the decade-old 

organisation has moved from being a prominent 

equipment donor to becoming the world’s largest postdonation 

provider of medical equipment servicing. 

EWH’s development work aims to reverse donordependence 

and assist in implementing sustainable 

resources. This is achieved through a number of 

programmes. 

EWH’S DOMESTIC PROGRAMMES 

Through the open publishing of carefully researched 

design briefs under the ‘Projects that matter’ list at 

ewh.org/ptm, and through the ‘Kits programme’, EWH 

encourages large-scale participation in both the 

development and construction of appropriate 

technologies (such as the EWH electrosurgery unit tester 

kit, available through the website). EWH’s university 

‘Chapters’ specifically engage students, raising awareness 

of challenges in technology provision and support in 

resource-poor settings. In EWH Chapters across the US 

and more recently in the UK and mainland Europe, 

▼ 



▼ 

multidisciplinary networks of students and academics 

are galvanised to enter the EWH design competition, 

where they compete for financial backing to implement 

their business plans. 

EWH OVERSEAS: THE ‘SUMMER INSTITUTE’ 

The EWH Summer Institute programme is a significant 

contributor to EWH’s status as one of the world’s largest 

suppliers of working medical equipment to the 

developing world. Each year on the Summer Institute, 

between 50 and 60 student volunteers travel to either 

Tanzania or Central America where they spend 2 months 

‘on the ground’ assisting in the management, 

maintenance and repair of damaged/disused medical 

equipment. In 2009 I participated in the Summer Institute 

as a volunteer at Salvador Paredes Hospital in Trujillo, 

Honduras; this experience exposed me to the issues 

discussed earlier in this article, and gave me a platform to 

contribute to the remarkable collective efforts of all the 

students. When I asked EWH CEO Melissa Beard about 

the impact the Summer Institute has had on the work of 

the organisation, she replied: ‘The volunteers’ 

contribution is huge – and difficult to do justice to: I 

could quantify it and say that in 10 years they’ve repaired 

over 7 million dollars worth of equipment, but the impact 

goes far beyond that’. Melissa then went on to describe 

the type of impact engineering support can have on 

resource-poor settings: ‘The trickle-down into the 

community, that even one piece of repaired equipment 

can parlay into can be amazing. It’s often life and death; 

in Tanzania we’ve had students working in a hospital 

that didn’t have any working incubators. Around 

Kilimanjaro it gets very cold and all the babies had were 

swaddling cloths – no body warmers or infant warmers. 

Newborns were dying from hypothermia and the 

students were horrified. They ended up modifying an old 

space heater, fixing it to the wall and improvising a 

thermostat. That little bit of ingenuity – as old fashioned 

as it was – is saving babies’ lives.’ 

EWH OVERSEAS: THE BIOMEDICAL EQUIPMENT 

TECHNICIAN (BMET) PROGRAMME 

Of EWH’s programmes, the BMET scheme (of which 

International Aid is the originator) perhaps shows the 

most potential for sustainable development of healthcare. 

According to Melissa: ‘The most pervasive needs really 

aren’t the pieces of equipment themselves – they are the 

training, the spare parts, the manuals and the engineering 

logic required to make a lot of those repairs.’ The purpose 

of the BMET programme is to meet these needs during 

the course of six intensive 2-month training sessions, held 

in-country (to avoid brain-drain issues) and spread over 3 

years** (figure 3). The courses enrol secondary school 

leavers and take them through to BMET certification, 

where they themselves can train others and share 

experiences through growing professional societies of 

engineers and technicians; it’s about as close as one could 

get to ‘teaching a man to fish’ in this context. 

A unique strength of the BMET programme is that the 

course curricula have been carefully researched over 

years and balanced to suit the needs of each country’s 

hospitals, based on research through the Summer 

Institute and evaluations of similar programmes. A 2010 

paper from Duke University analysed 3,000 repair records 

from 60 hospitals in 11 countries and identified a set of 

120 ‘technical skills’ that could be used to bring the 

majority of donated equipment back into service. 5 These 

skills included ‘tricks’ like replacing a fuse with an 

improvised alternative and repairing a blood pressure 

cuff with a bicycle repair kit. With these skills embedded 

FIGURE 3. 

BMET 

programme 

students in 

Ghana inspecting 

an incubator. 

▼ 



FIGURE 4. 

View from the 

bridge in the 

Asiatic 

Arboretum in the 

sprawling ‘Sarah 

P. Duke Gardens’ 

at Duke 

University – I 

particularly 

enjoyed this part 

of my local tour 

at the weekend. 

▼ 

Notes 

* 

A set of events run 

globally, and owned by 

the private non-profit 

Sapling Foundation, 

intended to gather 

leading thinkers from 

diverse backgrounds, 

to disseminate ‘ideas 

worth sharing’, to 

inspire and change 

attitudes. It started out 

(in 1984) as a 

conference bringing 

together people from 

three worlds: 

technology, 

entertainment and 

design. 

** 

The duration and 

number of training 

sessions varies in 

some cases, depending 

on the country and the 

local situation. 

into the course along with tuition in healthcare 

technology management, computer skills, principles of 

medical device operation and professional development, 

this model has shown early signs of success: Professor 

Malkin reports that early data from a matched study 

soon to be published from his lab shows that ‘EWH 

BMET technicians have 35 per cent less out-of-service 

equipment in their hospitals, compared to matched 

hospitals’ (details of the study have yet to be released). I 

asked Melissa for examples of the BMET programme’s 

success: ‘One of the best stories I’ve heard is from a 

hospital director in Rwanda, where a donated x-ray 

machine which was supposed to see about 25 people a 

day was out of service. The doctors were trying to put 

bones back into place blindly. In severe cases, they’d put 

people in an ambulance and take them 120 miles away to 

the nearest scanner. A lot of resources were being spent 

on transportation, and some people were making 4-day 

journeys on foot, giving up their ~$1.50 a day (average) 

income to do so. One BMET used what he’d learned to 

identify that three fuses were blown and promptly 

replaced them without needing to wait weeks for a 

service engineer. All things considered, the effect on 

those communities was tremendous.’ 

BMET technicians are currently being trained in 

Honduras, Cambodia, Ghana and Rwanda (with 

significant backing from the GE Foundation), but it is the 

aim of EWH to see this kind of sustainable growth 

expanding into more communities and nations. In my 

interview with Melissa, it was on this subject of 

expansion that I asked how it might be possible for other 

organisations with similar mandates to benefit from the 

evidence-based curricula developed by EWH. To give 

one example of where the benefit might be felt, the 

Amalthea Trust (amaltheatrust.org.uk) here in the UK 

held a Medical Engineering Forum 6 early in 2011 where, 

amongst other things, they highlighted a lack of 

biomedical engineering training at universities in certain 

African nations. They are endeavouring to develop a new 

course with Kyambogo University in Uganda and based 

on my correspondence with Mike Hilditch of the charity, 

they might well consider using a similar model to EWH. 

Based on my discussion with Melissa, EWH is in talks 

about how their curricula might be shared, and 

ultimately she as CEO ‘would like to establish EWH as 

the very best resource for biomed training, study/service 

programmes, advice, instruction and expertise’ and 

would ‘want [EWH] to be the organisation people come 

to in any of those areas’. 

FURTHER THOUGHTS ON THE EXPERIENCE 

On this trip to North Carolina (some of the beautiful 

scenery is shown in figure 4), I was afforded numerous 

opportunities to interview and spend time with the 

people that make EWH work. Although I had been 

involved with EWH previously, this trip was invaluable 

in providing a bigger picture of what the organisation is 

up against and how it is meeting its goals. In particular 

the BMET programme stood out as a programme to 

watch, as it continues to inspire development in 

equipment management, and engineering communities 

in developing countries. There are numerous 

organisations who work in the area of global technology 

provision in the UK, and some who focus on the 

provision of technical training. For those who haven’t 

already, it would be worthwhile to explore the model 

that EWH has developed in its BMET scheme. 7 

As highlighted within this article, the fact that 

medical equipment manufacture is economically 

opposed to access by the poor majority is a major issue – 

but one which can be addressed by appropriate design. 

While I have only touched briefly on how EWH 

supports the development of appropriate technologies 

(sadly the full range of topics touched on at the TED 

event and during interviews are far too many to gather 

into a single article), this is some of the most interesting 

work of the organisation. Fortunately, EWH is certainly 

not alone in this endeavour. For anyone interested, the 

likes of EWH and other remarkable organisations have 

been known to feature at the IET at the biennial 

‘Appropriate healthcare technologies for developing 

countries’ seminars (see conferences.theiet.org/aht/ for 

more details), which I strongly recommend. 

Once more I would like to thank IPEM for making 

this trip possible, and also to thank my hosts at EWH for 

their hospitality despite being a surprisingly small 

organisation, with a large workload. n 

REFERENCES 

1 World Health Organization. Donation guidelines, 

http://www.who.int/medical_devices/en/ 

2 Moyo D. Dead Aid: Why Aid is Not Working and How 

There is a Better Way For Africa. New York: Farrar 

Straus Giroux, 2009. 

3 Cordero I. Challenges and Rewards of Building 

Capacity to Support Healthcare technologies around 

the Globe: a Webcast. http://www.biomed.drexel.edu, 

2011. 

4 Dammann V, Pfieff H. Hospital Engineering in 

Developing Countries. Eschborn, Germany: Z Report, 

1986. 

5 Malkin R, Keane A. Evidence-based approach to the 

maintenance of laboratory and medical equipment in 

resource-poor settings. Med Biol Eng Comput 2010; 

48: 721–6. 

6 Amalthea Trust. Medical Engineering Forum, March 

2011, http://www.amaltheatrust.org.uk/ 

7 Engineering World Health. http://www.ewh.org/ 



CAREER PROMOTIONS FOR TECHNOLOGISTS/ 

RADIOGRAPHERS IN NUCLEAR MEDICINE 

KIM HOWE Royal Victoria Infirmary, Newcastle Upon Tyne 

IPEM OFFICES, FAIRMOUNT HOUSE, YORK 14th July 2011 

THIS ONE-DAY MEETING was organised by the IPEM 

Nuclear Medicine Special Interest Group in 

collaboration with the Society and College of 

Radiographers (SCoR). The main organisers were Anil 

Vara, Kim Howe (Technologist Representatives) and 

Sean Kelly (Professional Officer for SCoR). Anil Vara 

and Sean Kelly chaired the sessions. The purpose of the 

day was to show practitioners (technologists/ 

radiographers) and advanced practitioners (band 7 or 

above) what they could achieve in their careers and to 

provide attendees with updates on the changes on 

entering a career via Modernising Scientific Careers and 

educational enhancement. The meeting was well 

attended, filling the lecture theatre, but there were issues 

with hearing certain presenters. There was an informal 

feel and participation in discussions was actively 

encouraged. 

CLINICAL REPORTING AND MYOCARDIAL 

PERFUSION STRESSING (MPS) 

The first presentation was given by Ian Jones (Royal 

Derby Hospital). This was about his experience of 

reporting as a technologist and the knowledge and skills 

he needed to perform this role. His view was that a 

recognised qualification in nuclear medicine is required 

with in-house training, using local skills/expertise with 

knowledge of national guidelines. The only issue is 

whether these skills will be recognised both by 

employers and professionally. Therefore there is a need 

for a scope of practice for advanced practitioners. 

For MPS, the practitioner has to be appropriately 

trained adhering to national guidance, e.g. ECG 

recognition and advanced life support. 

ADVANCED PRACTICE AND SERVICE 

DEVELOPMENT – A MANAGER’S PERSPECTIVE 

Bernadette Cronin (Royal Marsden Hospital, Sutton) 

gave an inspirational presentation on her personal 

journey from basic grade radiographer to becoming a 

service manager, along with the challenges experienced 

as well as the rewards. Career progression requires 

knowledge and experience but with commitment and 

drive. Bernadette explained how varied her role was, 

encompassing nuclear medicine, PET/CT, radioisotope 

therapy, dexa scanning, clinical R&D and ad hoc 

projects. Her responsibilities involve a mix of strategy, 

operational, organisational and human resources. The 

message was to strive to improve as individuals and also 

in service development. 

A large section of the day had representatives based 

at different universities involved in the role of higher 

education in supporting advanced practice. The 

presentations advised and encouraged practitioners to 

progress in their careers educationally, especially as 

nuclear medicine is always evolving; for example hybrid 

imaging or developing as a researcher, etc. 

The collaboration of technologists/radiographers was 

very successful. The feedback received was extremely 

positive with a view to the collaboration continuing on a 

yearly basis. n 

APEN AND ATEN AT THE EUROPEAN MEDICAL 

PHYSICS AND ENGINEERING CONFERENCE 2011 

SARAH HIGGINS University Hospital of North Staffordshire, RUTH RUDDLESDEN 

Royal United Hospital, Bath, RICHARD AXELL Cambridge University Hospitals, 

NATHAN RIVERS Cambridge University Hospitals 

TRINITY COLLEGE, DUBLIN, IRELAND 1st–3rd September 2011 

THIS YEAR IPEM JOINED forces with the Irish 

Association of Physicists in Medicine (IAPM) and the 

European Federation of Organisations for Medical 

Physics (EFOMP) to host the European Medical Physics 

and Engineering Conference 2011 (EMPEC), held in 

September in the spectacular location of Trinity 

College, Dublin. 

The Associate Physicist and Engineering Network 

(APEN) and the Associate Technologist Network 

(ATeN) of IPEM once again had a strong presence at 

this conference. We organised six young scientist 

sessions, allowing nearly 40 early career scientists to 

present their work in a friendly yet professional 

environment. In addition, APEN and ATeN organised a 

pre-conference social which was well attended, and 

provided trainees with an opportunity to begin 

networking with colleagues from across Europe before 

the conference had even started. Throughout the 

conference itself APEN and ATeN also held drop-in 

sessions on the IPEM stall, to allow trainees to meet 

panel members and browse through example Part I and 



Part II portfolios. 

The first trainee session kicked off a very varied set 

of talks. Given the recent advances in PET/MR 

systems, a talk by Andrew Aiken (King’s College 

Hospital, London) on investigating how to 

attenuation correct PET images using MRI was highly 

topical. Pete Lally (Royal Free Hospital, London) also 

gave a very interesting talk on his efforts to develop a 

suitable lung phantom for simulating pulmonary 

embolism. 

Below, APEN members Ruth Ruddlesden and 

Richard Axell present their experience of EMPEC 

2011, and Nathan Rivers presents a technologist’s 

experience of the conference. 

Sarah Higgins, APEN Chair, University Hospital of 

North Staffordshire 

CO-CHAIRING THE REHABILITATION 

ENGINEERING II SESSION 

I WAS LUCKY ENOUGH to be given my manager’s 

ticket to the gala dinner after a David Beckhamesque 

broken fifth metatarsal meant he could not join us in 

Dublin. However, for his benefit I forced myself to 

have an extra Guinness or two on his behalf. For those 

of you who were not able to join us, the gala dinner 

was held at the Alexander Hotel along the road from 

Queen’s University, Dublin. The dinner was preceded 

by a drinks reception where the conversation was 

very varied given the range of specialities and 

countries represented. 

It was nice to see the variety of delegates who 

had travelled to Dublin. I met people from America, 

Holland and the Czech Republic, to name but a few 

places. After taking our seats and enjoying the 

opening speech it was on to the food. The meal was 

excellent and certainly impressed our European 

counterparts. 

I co-chaired the ‘Rehabilitation engineering II’ 

session. It was opened by the inventor of the term 

bioengineering, the Emeritus Professor Heinz Wolff 

(Brunel University, Uxbridge). A predominantly 

engineering audience was presented with his talk 

‘Crunch and care’. This is a ‘care for the elderly’ 

scheme which Professor Wolff has created, whereby 

you provide, for example, an hours’ worth of care to 

an elderly member of the community and that hour 

gets banked, giving you an hour of care in the 

future. Professor Wolff suggested that about 5 hours 

of care a week should suffice to cover the care you 

would need after retirement. 

After taking some time to absorb the concept, my 

initial bemusement turned into an understanding of 

what he is trying to achieve. However, I just cannot 

see how he is going to turn it into a reality. Could 

you see yourself providing 5 hours of care each 

week on top of a full-time job I am not sure I can. 

He has however managed to convince a county 

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council to pilot his scheme but he would not specify 

which one … maybe it is yours 

As a consequence of Professor Wolff opening the 

session, the five trainees whose talks followed had 

an exceptionally packed theatre to present to. The 

trainees’ talks were diverse, as always, and made for 

an interesting hour’s listening. The talks presented 

ranged from pressure mapping bespoke wheelchair 

seating surfaces to what appeared to be an 

incredibly complex computer program which had 

been written to model the mechanical demand on 

lower limb muscles during gait. It was refreshing to 

see trainees considering key performance indicators 

(KPIs) and how these can be used within a clinical 

engineering department to monitor performance 

and customer service. As an engineer myself, I hope 

to see further talks on this topic at next year’s 

meeting. 

Richard Axell, APEN, Medical Physics and Clinical 

Engineering Department, Cambridge University 

Hospitals NHS Foundation Trust 

THE TRAINEE SOCIAL AND THE WOOLMER 

LECTURE 

THE TRAINEE SOCIAL WAS held on the 

Wednesday before the conference at Café en Seine in 

central Dublin. Being an ornately decorated French 

themed bar it didn’t exactly have an Irish theme but 

the night was definitely good craic. At least 30 

earlier career scientists from all over Europe 

gathered for drinks, food platters provided by 

APEN and some musical entertainment. It was 

enjoyable to mingle in a relaxed atmosphere and 

meet new people from across the continent. As the 

music got louder some of the party moved on to 

some of the more traditional Irish bars found in the 

city. The trainee social was a memorable start to 

EMPEC 2011. 

The Woolmer lecture was this year delivered by 

Willi Kalender (University of Erlangen, Germany), 

inventor and developer of spiral computed 

tomography. Those of us who had made good use of 

his excellent textbook on CT could not help but feel 

somewhat starstruck. Professor Kalender gave a 

comprehensive overview of recent developments in 

CT, focussing on the potential for sub-millisievert 

dose. He explained how use of a lower kV 

appropriately modulated the mAs and iterative 

reconstruction could lead to dose reductions of up 

to 80 per cent. This was an informative and 

inspirational lecture from a true expert in his field. 

The second trainee and junior scientist session 

included seven trainee presentations on a diverse 

range of topics including MRI, ultrasound, 

physiological measurement, diagnostic radiology 

and radiotherapy. Particular highlights for me were 

Naomi Hogg (King’s College London) who outlined 

very successful optimisation work on a wireless 

digital detector and Sarah Higgins (University 

Hospital of North Staffordshire, Stoke-on-Trent) 

who was commended for her talk on speeding up 

gamma camera QC. 

Ruth Ruddlesden, APEN, Royal United Hospital Bath 

CHAIRING THE TRAINEE AND JUNIOR 

SCIENTIST SESSION 

I ARRIVED IN DUBLIN at midday on the Wednesday 

and once I had checked in to my hotel I ventured 

through the town and over the River Liffey on the 

O’Connell Bridge to arrive at the picturesque Trinity 

College. Once I had registered for the conference I then 

met up with my colleagues on the APEN and ATEN 

panel to help set up the IPEM stall ahead of the 

conference. After this we met for the pre-conference 

social, at the very cosmopolitan and stylish bar Café en 

Seine. Medical physicists and technologists turned up 

in their hoards to mingle and meet their fellow 

professionals from all over the world, and judging by 

the response in the morning the night was deemed to 

have been a real success. 

The conference officially opened on Thursday at 

9am, where we were welcomed with messages from 

Barry McMahon (Irish Association of Physicists in 

Medicine, Dublin), Stelios Christofides (European 

Federation of Organisations for Medical Physics, York) 

and Elke Anklam (Institute for Health and Consumer 

Protection, Ispra, Italy), three very prestigious names 

in the world of medical physics. In addition there was 

a performance from The Shannon Colleens which 

proved to be traditional and unforgettable. 

There were three main parts of the conference that 

really stood out as highlights for me. The first 

presentation to note was the Woolmer lecture 

presented by Willi Kalender (University of Erlangen, 

Germany). He talked about developments in CT, and 

whether a reduction in dose rate for CT is a realistic 

option. Professor Kalender is a world leader in his field 

and is credited with the invention and development of 

spiral scan computed tomography, so it was a real 

privilege to see him present his research and to hear 

him speak first hand. 

Another stand-out moment for me was the first 

nuclear medicine session on gastroenterology; with 

this being in my field of medical physics I paid close 

attention and it provided a lot of food for thought! We 

were treated with another three exceptional guest 

speakers: Alan Perkins (Nottingham University 

Hospitals), Mike Smith (Rotherham Hospitals NHS 

Trust) and Jervoise Andreyev (Royal Marsden 

Hospital, London). Dr Andreyev is a consultant 

gastroenterologist, and his talk about bile acid 

malabsorption being the ‘world’s most frequently 

missed, life-changing diagnosis’ has inspired my Part 

II project. 

Finally, to top off a truly brilliant conference, I 

chaired the final trainee and junior scientist session 

alongside Professor Patrick Horton. This was 

invaluable experience for me as a trainee. It was my 

first time being on the other side of the table, having 

done numerous presentations in the past, and it was 

truly an unforgettable experience. I hope it won’t be 

the last. 

Overall the conference organisation and content was 

exceptional and we look forward to seeing you all 

again next year. 

Nathan Rivers, ATeN, Department of Nuclear Medicine, 

Addenbrookes Hospital, Cambridge University Hospitals 

NHS Foundation Trust 



EUROPEAN MEDICAL PHYSICS AND 

CLINICAL ENGINEERING CONFERENCE 

PAUL T. LEE Singleton Hospital, Swansea 

TRINITY COLLEGE, DUBLIN, IRELAND 1st–3rd September 2011 

I STARTED MY NHS career back in 1986 in Cardiff Royal 

Infirmary and never once did I expect to be publishing 

articles or presenting professional papers, let alone 

representing my professional colleagues at the most 

prestigious event in IPEM’s calendar for 2011. I vividly 

remember meeting the team that first day and being 

introduced to staff and patients in the ITU department with 

what appeared to be hundreds of wires, transducers and 

tubes all connected to a vast range of sophisticated medical 

equipment all flashing, binging and beeping in unison. 

I did not realise how the role of clinical 

technologists/engineers, or medical physics technicians 

(MPTs) as we were known back then, would become so 

intertwined with the other sectors of the medical physics 

departments and how we could be at the forefront of 

patient services, design and development. Managing 

medical devices, teaching staff how to use them and 

designing systems to improve safety now seem part of 

everyone’s role, and this must be a good thing for clinical 

technologists of the future. 

EMPEC 2011 

The decision to combine IPEM’s annual conference, AGM 

and European Medical Physics and Engineering Conference 

was a break with tradition but Barry McMahon (Irish 

Association of Physicists in Medicine, Dublin) and the 

organising committee should be extremely proud of their 

achievements in planning, hosting and delivering one of 

the biggest and best conferences of the 2011 season. 

When James Yorkston penned the words and sang 

about Dublin’s fair city and its streets broad and narrow, 

he wasn’t underestimating the beauty of the location of 

the 2011 EMPEC conference. The splendid Trinity 

College, founded in 1592, with its attractive grounds, 

plethora of lecture theatres, facilities and attractions was 

chosen as the location of the event, and the organising 

committee well exceeded everyone’s expectations with 

such a well-attended event, spread across two floors of 

the Arts and Social Science Building, opened in 1978, at 

this fantastic college steeped in history. 

The conference was opened by The Shannon Colleens, 

an Irish a capella female group, bringing their own 

particular earthy brand of harmonies to some of James 

Joyce’s best-loved popular songs, which reminded the 

delegates of the richness and history of Ireland and the 

welcome that awaited us in their fair city. Over 600 

delegates attended 80 separate sessions over 3 days, 

ranging from the Woolmer lecture on CT history and 

developments to Heinz Wolff’s (Brunel University, 

Uxbridge) keynote presentation on ‘Crunch and care’, 

The stunning 

scenery of 

Dublin. 

▼ 

▼ 



▼ 

suggesting we make a cultural shift towards a reorganisation 

of society and the way it cares for its lessable 

members. 

This was my first ever European conference and it 

would not have been possible without the generosity of 

the IPEM bursary committee who, at very short notice, 

agreed to cover a substantial part of the cost of 

attendance. To this end I am eternally grateful, and wish 

to remind others of the fantastic opportunity offered as a 

result of the IPEM scheme which is open to all members 

of the Institute. 

I was very impressed by the expert level of abstract 

submissions across all disciplines (337 abstracts are now 

available at www.empec.ie), not to mention the plethora 

of posters on display in the exhibition hall. I was on the 

look out for posters and sessions focussed on clinical 

technology and clinical engineering, but was initially 

disappointed that my own professional group seemed to 

be lacking behind the other areas of the profession when 

it came to abstracts, posters and exhibitors. I made myself 

a promise to encourage as many colleagues as possible to 

participate in research, publication and submission of 

abstracts for the 2012 conference upon my return. 

Thursday’s proceedings quickly developed pace and 

the packed itinerary meant that people were hastily 

moving between the lecture theatres and seminar rooms. I 

spent a good 20 minutes thumbing through the 

conference programme trying to pencil in as many 

sessions of interest as possible in a short space of time. 

The main conference rooms were clearly signposted 

and relatively easy to pronounce: 

n the Edmund Burke Theatre; 

n the Samuel Beckett Theatre; 

n Thomas Davis Theatre; 

n JM Synge Theatre; 

n Robert Emmet Theatre; 

but we all struggled with the ‘Téatar Mhairtin Ui 

Chadhain’, named after the writer and professor Máirtín 

Ó Cadhain (1906–1970), one of Gaelic Ireland’s most 

important writers. 

All of the seminar rooms were in very close proximity 

and this made for an almost seamless transition from one 

session to another. Unfortunately, some excellent sessions 

ran in parallel and difficult choices had to be made. One 

of my own oral presentations clashed with Professor 

Wolff’s presentation, but I did manage to get a quick 

photograph before I ran back for my own session. 

The true benefit of this conference was clear to see 

when speakers from the USA, Malta, Poland, Sweden and 

Italy, to name just a few countries, delivered sessions on 

the future of education and training for the medical 

physics profession. The international collaborative work 

on developing a standard training programme and 

standard professional job titles was also shared and 

discussed. 

The future of medical physics and how this can be 

affected in different countries was apparent when 

speakers from Poland discussed the changes and 

influences from internal government and cost pressures 

for individual staff members. Sweden is lobbying at 

government level and Finland is developing roles and 

work systems for medical physics assistants. The USA has 

a qualified medical physics registry with bioengineers up 

and running as a separate entity. This conference only 

goes to support the notion of international sharing and 

information gathering, and sometimes it’s a sobering 

thought to discover that other people may be in a less 

well off position than your own. 

Chris Gibson (former IPEM President) and Justin 

McCarthy (IPEM Engineering Advisory Group Chair) 

presented their analysis on the history and future of our 

profession, its relationship to IPEM and the emergence of 

clinical engineering, and the importance of collaboration 

and how we can contribute to improving patient 

outcomes, our need to think differently to make change 

happen and the importance of research and innovation. 

Friday saw an early morning start to attend a lecture 

on human error and incident investigation and 

highlighted a number of key issues for me. An 

International Standard for incident type, cause and 

analysis was shared (ISO 19218:2005) and despite its age, I 

got to find out for the first time about yet another key 

document that is not widely publicised. 

A large number of exhibitors were spread around all 

areas of the conference centre and there seemed to be 

plenty of time to stop and chat at each table during the 

coffee and lunch breaks. The catering was managed with 

military precision and there always seemed plenty of food 

to go around. 

At the ‘Medical devices: training and patient safety’ 

session, the Oxford Radcliffe Hospital brought to the 

conference’s attention the staggering amount (£900 

million) settled in negligence claims in the UK and how 

their hospital group have tried to address training and 

medical device initiatives. It was pleasing to see that 

others have also trodden this path of ‘resistance to 

change’ and are beginning to tackle what appeared at first 

to be an insurmountable problem of reducing risk, 

managing training databases and empowering ward 

managers all at the same time. The team from NHS 

Ayrshire shared a practical approach to risk classification 

and incident analysis. I was pleased to see that other 

groups are beginning to identify no-fault-founds and are 

trying to drill down further by looking at design errors, 

interface errors and human factors, the newest branch of 

my research work. 

The presentation promoting Engineering World Health 

(EWH), who work to improve the quality of healthcare in 

hospitals that serve resource-poor communities, outlined 

the issues facing them in the area of better device 

management, including trying to address the over-supply 

of unused (and unrepairable) medical equipment donated 

from other countries. Furthermore, their training 

programmes, which provide needs-based training to 

technicians in countries such as Rwanda, Cambodia, 

Honduras and Ghana, can make a significant difference 

harnessing some of the experience of our own clinical 

engineers and technicians. 

IPEM ANNUAL GENERAL MEETING 

The advantage of having so many specialists in one city 

leant itself to holding the AGM for IPEM at the same 

time, and also gave the audience an opportunity to offer 

their grateful thanks to Dr Chris Gibson who stepped 

down as President, having led the organisation 

impeccably during his 4-year tenure. The incoming 

President, Dr Peter Jarritt, was introduced to the 

members. He thanked them for his nomination and 

promised to carry the flag forward for all groups within 

the Institute despite the obvious pressures ahead. 



Some photos 

of Dublin and of 

the conference. 

▼ 

▼ 



▼ 

Sue Hill (Department of Heath, London) presented a 

session of the progress of Modernising Scientific Careers 

and how developing voluntary quality assured 

professions might be the way forward for our profession. 

Lean healthcare models were also shared and it was 

explained how these can help tackle areas of waste. 

Sharing training models included the blended learning 

approach (e-learning, work-based training initiatives and 

distance-learning initiatives) and helped to reinforce the 

modern approach to continuous professional development 

that is at the forefront of our profession. 

I was extremely pleased to have been selected to 

present two oral presentations: 

1. ‘Developing safer systems for drug calculations in 

healthcare’ and 

2. ‘Infusion device error logs and their significance for 

healthcare staff’. 

The former, an important part of my own work-based 

research and developments, has led to three nominations 

for UK awards during 2010 and 2011, culminating in 

reaching the final stages in each case. The latter, already 

presented at two national conferences in the UK and 

submitted for publication in 2011, sees a new focus on 

human error in the clinical workplace and how nursing 

staff utilise devices. 

This helped me focus on how I see my role and how 

this can help contribute towards better design, improved 

interaction and the redesign of training programmes that I 

deliver on a regular basis. My two 15-minute slots seemed 

to fly by, and questions from the audience seemed to have 

stimulated a lot of interest. 

DUBLIN 

Dublin is steeped in history with its iconic buildings only 

a short walk from Trinity College. No sooner had I left the 

venue than I was walking along the banks of the River 

Liffey. A number of bridges span the river with tourists 

flocking to the ‘ha’penny’ bridge to take away their own 

landscape photograph to remember their visit. Across one 

of Europe’s widest road bridges was O’Connell Street, 

where its namesakes’ statue sits proud and welcomes 

shoppers across the bridge with the same name. 

The annual Liffey Swim saw hundreds of people 

swimming the mile-long race, raising thousands of euros 

for charity. The walkways and riverbanks were packed 

with well-wishers cheering on the participants as they 

took on the river’s tidal flow towards the finish line in the 

city centre. 

Just outside the entrance to Trinity College was the start 

of the shopping trail back to the hotel, which included 

Carroll’s Irish-themed shop where most of my family’s 

presents were purchased. The walk back led me through 

Temple Bar passing Dublin’s top hostelries. I promised 

myself, as I hadn’t been to Dublin in almost 5 years, that I 

would enjoy a pint of their most famous stout, and later that 

evening the staff at the infamous Church restaurant, across 

the river, served up, and helped take the photograph as 

evidence, to prove that I did actually participate in the 

mandatory procedure of drinking the country’s most 

popular beverage. 

The final Saturday seemed to arrive far too quickly and I 

had to deliver my second oral presentation at the Davis 

Lecture Hall to the medical devices: equipment management 

fraternity. I started with a simple maths test and tricked a 

number of delegates into making a simple error when 

adding up just a few four-digit numbers, highlighting how 

the pressures of work can lead to simple but catastrophic 

errors in drug therapy. The paper shared my latest research 

into error logs and the analysis of almost 22 million minutes 

of clinical use of these infusion devices and the vast range of 

alarms that occur. There was a last chance to visit the 

exhibition stands and make those last-minute appointments 

before the delegates converged on the main conference hall 

(Burke Hall) with final take-home messages, awards and 

closing remarks. 

When I reflect on my visit to Dublin and the European 

MPEC meeting I am reminded that; 

1. location, location, location is so important when 

organising this type of European/international event and 

Dublin ticked all the boxes, it will be a hard act to follow; 

2. an event of this magnitude is only possible with hard 

work and meticulous planning, and this is down, in no small 

part, to the organising committee, so thank you for such a 

fabulous event; 

3. clinical technologists and clinical engineers really need to 

raise their voices, share their work and embrace all that these 

sorts of events offer. The other professions seem well ahead 

of the game, but I’m sure we are only sitting in the slip 

stream, waiting to catch up and lead the way in patientcentred 

care and innovations. 

It would be remiss of me not to thank IPEM again for the 

bursary to help finance my attendance at this meeting. With 

increasing pressures on budgets and finance in all areas of 

our work, the funding committee made a special case to 

meet at very short notice and I was extremely pleased and 

grateful to accept their very kind offer of support. n 

24TH EUROPEAN CONFERENCE ON 

BIOMATERIALS, 2011 

RAECHELLE D’SA University of Ulster 

THE CONVENTION CENTRE, DUBLIN 4th–9th September 2011 

THE EUROPEAN SOCIETY OF BIOMATERIALS (ESB) 

hosts an annual 5-day meeting with the aim of bringing 

together scientists, engineers and clinicians working in the 

fields of biomaterial science, tissue engineering and 

regenerative medicine. This year the conference was held 

in Dublin on 4th–9th September. The ESB conference is 

viewed as one of the most prestigious in its field and 

attracts many academics, researchers and company 

representatives from across the world due to its 

reputation. The oversubscription to this conference is 

evidence that this field is thriving and growing. ESB 2011 

was attended by approximately 900 delegates from 



around the word. The meeting offered the delegates 

innovative and stimulating topics with a well-balanced 

programme of plenary speakers, oral presentations, 

rapid-fire-sessions, poster sessions and educational 

workshops. The crux of the conference was to highlight 

the fact that we are at the crossroads of making 

breakthroughs at the cellular and molecular levels with 

advances in nanotechnology and scaffolding 

technologies. Also, this field is driven by the ever-present 

need to take existing technologies towards clinical 

translation. Furthermore, as the biomaterials paradigm is 

ever-changing with new clinical targets and applications, 

the conference programme was designed to reflect these 

developments and challenges. Specific topics of the 

conference included recent advances in the use of 

biomaterials for therapeutics; vascularisation, 

innervations and tissue integration; advances in 

nanotechnology and materials science; host response, 

and lessons from translational research of the existing 

paradigms. 

The meeting started with a young scientist forum, 

which was intended to stimulate and engage the next 

generation of researchers by getting them to debate real 

issues facing young scientists today. Eileen Harkin-Jones 

(Queen’s University, Belfast) gave a very interesting talk 

entitled ‘Gender related issues in engineering and 

science-based research’. This was followed by a roundtable 

discussion chaired by all of the speakers of the day. 

A forum such as this was beneficial as it allowed younger 

scientists to interact and discuss real issues facing them 

in their career paths. 

The calibre of plenary speakers at this conference was 

superb. They included Frank Caruso (University of 

Melbourne, Australia), Oron Cats (University of Western 

Australia, Australia), Ruth Duncan (Cardiff University), 

Jean J. M. Fréchet (King Abdullah University of Science 

and Technology, Thuwal, Saudi Arabia), Phillip 

Messersmith (Northwestern University, Chicago, USA), 

Samir Mitragotri (University of California, Santa 

Barbara, USA) and David Mosser (University of 

Maryland, USA). 

One of the most interesting plenary talks was given 

by Professor Messersmith, entitled ‘Biologically inspired 

catechol biomaterials: from surgical adhesives to cancer 

drug delivery’. His research group is involved in trying 

to mimic the adhesive properties of mussels and geckos. 

Gecko foot pads adhere to surfaces temporarily, enabling 

them to move upside-down, while mussels attach 

permanently to surfaces by secreting a type of protein 

glue that sticks underwater. Messersmith’s team mimics 

the behaviour of mussels by developing synthetic 

adhesives that can be used to repair tissue during 

surgery. In fact, the materials are currently in pre-clinical 

stage testing as a medical adhesive for repairing amniotic 

sacs that can prematurely rupture or are damaged by 

surgery. Tears in amniotic sacs are potentially serious 

complications during pregnancy and post prenatal foetal 

surgery. The goal of mussel-inspired glues is therefore to 

▼ 



▼ 

seal these ruptures. The synthetic glue has been tested 

on intact amniotic sacs and on amniotic sac cells (for 

toxicity studies). They have also spread the glue over 

amniotic sac defects. The finding has been that it bonded 

efficiently and was non-toxic. The results are remarkable 

as they have achieved a seal that is leak-free and can 

withstand stretching in vitro. Messersmith and coworkers 

now aim to more comprehensively evaluate the 

mechanical strength of repaired defects and are 

planning in vivo pre-clinical studies. 

The conference also had an industrial day where 

there were speakers from industry and academics who 

had successfully spun out companies from a university 

setting. The speakers included Arshad Ahmed (Scientia 

Advisors, Cambridge, USA), Gaëlle Clermont 

(BIOMATECH/NAMSA, Chasse-sur-Rhone, France), 

Jennifer Elisseeff (John Hopkins University, Baltimore, 

USA), Mark Grinstaff (Boston University, USA), Heinz 

Gulle (Baxter Innovations GmbH, Austria), Barry 

Heavey (IDA, New York, USA), Jack Kennedy 

(Covidien, Mansfield, USA), John Milad (NBGI 

Ventures, London), John O’Dwyer (NSAI, Dublin, 

Ireland), Richie Paul (Elan, Dublin, Ireland), Philip 

Procter (Stryker Osteosynthesis, Geneva, Switzerland), 

Ena Prosser (Fountain Healthcare Partners, Dublin, 

Ireland), Kevin Shakesheff (University of Nottingham), 

Manus Ward (Science Foundation Ireland, Dublin, 

Ireland) and James Wong (NBGI Ventures, London). 

Of particular note were the academics who had 

successfully taken academic research into the 

marketplace. Talks given by these academics were 

exciting and inspiring as they showed the real-time 

translation from lab bench to clinical application. 

Professor Elisseeff co-founded Cartilix, Inc., a startup 

that is translating adhesive and biomaterial technologies 

for the treatment of orthopaedic disease. Professor 

Shakesheff’s research team at the University of 

Nottingham has successfully spun out two companies, 

RegenTec and Critical Pharmaceuticals, which deal with 

advancing tissue regeneration technologies and drug 

delivery applications, respectively. Professor Grinstaff is 

the founder of three university spin-outs: Accuity Bio, 

Hyperbranch Medical Technology and Flex Biomedical. 

They are commercialising his ideas and have four 

medical products being used in the clinic. 

In summary, the meeting covered most burgeoning 

topics in the field of biomaterials and regenerative 

medicine. Talks given by the plenary, keynote and 

industrial speakers were inspiring and stimulated the 

audience. Furthermore, many of the younger delegates 

were also given the opportunity to present their research, 

and thereby given the opportunity to network and build 

up collaborations with international academics, 

clinicians and industry. Overall this has been a very 

successful conference, and based on this year’s success 

will have many more fruitful years to come. n 

APPROPRIATE HEALTHCARE TECHNOLOGIES 

FOR DEVELOPING COUNTRIES, 2011 

EMMANUEL AKINLUYI King’s College Hospital and King’s College London 

IMECHE, BIRDCAGE WALK, LONDON 7th September 2011 

AS AN EXTENSION OF the biennial seminars held in the 

IET since 2000, September saw a rich collection of 

participants from a range of backgrounds gather at the 

Institution of Mechanical Engineers (IMechE) in central 

London for the first IMechE seminar on appropriate 

healthcare technologies (AHT) for developing countries. 

In response to growing participation, and the large 

number of innovative projects in this area, the conference 

marked the beginning of a new format, wherein the 

IMechE and IET will host the event on alternate years. 

The purpose of the AHT conferences is to publicise 

and cultivate engineering solutions to challenges of 

healthcare provision in the developing world, where 

currently ‘75 per cent of medical devices designed in 

industrialized countries fail to work’ (World Health 

Organization). This was achieved extremely effectively 

with a combination of presentations on prevalent issues 

in this area, and the presentation of examples of 

appropriate technologies that have been, are or will be 

deployed in resource-poor settings. 

The chair, Patrick Finlay (MediMaton Ltd, 

Beaconsfield), opened the programme with a brief 

address, before introducing keynote speaker Mark 

Lazarowicz MP (Shadow Minister for International 

Development), who gave an overview of some of the 

issues faced in building technical capacity for healthcare 

in developing countries. Following this, the concept of 

‘appropriate healthcare technology’ and its challenges 

was examined in a set of five presentations, delivered by 

highly experienced individuals, working within key 

organisations. 

David Balmforth (Institution of Civil Engineers, 

London) spoke on the healthcare challenges facing the 

developing world, first laying out the epidemiological, 

social and economic contexts of the AHT challenge, and 

finally highlighting the need for transparency and local 

participation in order to create economically and 

practically sustainable solutions. 

Revd Dr Brendan McCarthy (The Archbishops’ 

Council, London) looked in detail at ‘equipment 

requirements for use in a developing country’, 

emphasising the need for genuine partnership between 

users and providers, and gave some examples of good 

and bad practice. 

Continuing on this theme of considering the ‘user’s 

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using his experience of establishing hospitals across Africa 

for CURE International. 

Andrew Gammie (Chair of IET AHT 2010; Fishtail 

Consulting Ltd, Marshfield) spoke in detail on resourcing 


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▼ 

medical equipment maintenance in developing 

countries. Although this area is receiving an increasing 

amount of attention, and a number of training/technical 

resources (including online resources) are available, there 

is still much work to be done. Amongst other areas, Mr 

Gammie highlighted the importance of an effective 

workforce of in-house craftspeople and technicians, and 

gave an overview of the work being done by the likes of 

the NGO Engineering World Health in developing and 

delivering evidence-based curricula to this effect. 

The area of education and training was also 

addressed by Peter Matthews (Engineers against 

Poverty, London), who spoke about ‘technological 

learning’ (‘the process of accumulating the capability to 

innovate’ – SciDev) as a means of strengthening the 

engineering profession in African nations. 

The afternoon’s presentations came under the 

heading ’Ten ground-breaking technologies for the 

developing world’. These short presentations, both oral 

and poster, outlined remarkable innovations, and gave a 

taster of the intriguing stories behind them, in 

preparation for the networking period to follow: 

n ‘Just Milk’ is a nipple shield for HIV-positive mothers, 

that can potentially be used to deliver antiretroviral 

drugs and/or other medication to an infant. This project 

has the potential to impact approximately 200,000 infants 

per year who acquire HIV through breastfeeding. Arron 

Rodrigues and Stephen Gerrard (Engineering World 

Health, Cambridge) shared the vision of the project and 

their story, including how funding was secured in a 

meeting with Bill Gates. 

n The eRanger is a sidecar stretcher for a motorbike, 

which has been deployed successfully in 18 countries, 

where they facilitate timely care and are reported to have 

significantly influenced reductions in maternal mortality 

rates. Founder and designer Mike Norman (eRanger, 

Daventry) spoke about the product, its development and 

how the project developed under the patronage of 

Nelson Mandela. 

n In a similar vein, the MAT (motorcycle ambulance 

trailer) was presented by the charity Developing 

Technologies. This ambulance is designed for longdistance 

journeys, where a carer must travel to the 

hospital with the patient. 

n Olivia Comberti (Developing Technologies, London) 

presented her progress as the design engineer behind 

another mode of patient transport, a ‘donkey ambulance’ 

designed for emergency maternal transport in the rough 

terrain of Afghanistan. 

n Another mobility-based technology presented was the 

‘Skuta’. John Church (retired Orthopaedic Surgeon) gave 

a presentation on the development and refinement of this 

seated scooter for patients with use of a single lower limb. 

n The phone-based heart rate monitor, developed by 

Thomas Brennan (University of Oxford), is an example of 

how mobile phone technology, which is ubiquitous even 

in the poorer nations of the world, may be used to 

overcome the challenges of healthcare provision in remote 

areas. The phone’s microphone, used as a stethoscope, can 

be used as an early detector for deadly tuberculosis 

pericarditis. 

n Hearware is a hearing aid for the developing world. 

Andrew Carr (Glasgow University) developed this 

adaptable, solar-powered, bone-conduction hearing aid, 

which may be constructed from off-the-shelf parts. 

n Practical Action (a UK NGO) has produced a number of 

low-cost cooking solutions that have the potential to 

reduce indoor air pollution, which kills 1.5 million people 

per year. 

n Qasid Safir (Engineers without Borders, Swansea) 

presented the company’s progress in the development of a 

solar-powered fridge that could prevent the wastage of 

life-saving vaccines. 

n Jack Rose (Engineers for Overseas Development) 

presented the experiences of his team, building a De 

Montfort incinerator (designed by Professor Jim Picken) 

in Uganda for the disposal of medical waste. 

The event culminated in a round-table discussion, 

entitled ‘Where do we go from here’. The innovative 

format of a panel of judges discussed the merits and 

prospects of the projects that caught their attention. 

Questions highlighted the requirement not just of 

technical feasibility, but also of marketability of a final 

device. 

Year on year the AHT conferences continue to offer 

more and more, and this was no exception. The 

conference was attended by clinical scientists, clinicians 

and academics, as well as engineers, innovators, investors 

and government representatives from the UK and abroad. 

For those interested, the AHT events offer a rare and 

valuable opportunity to gain an overview of the great 

breadth of work that is being carried out in AHT 

development, and a chance to engage with other interest 

groups operating in this area. The next international AHT 

conference will be a 2-day event, and will again be held in 

London, on the 18th and 19th September 2012. The 

deadline for abstract submission is 28th March. More 

information is available at www.theiet.org/aht2012. n 

SPECIFYING, EVALUATING AND SELECTING 

MEDICAL EQUIPMENT 

JOHN AMOORE NHS Ayrshire and Arran 

NATIONAL RAILWAY MUSEUM, YORK 13th September 2011 

SELECTING THE BEST POSSIBLE medical equipment 

for clinical care is a key aspect of medical physics and 

engineering. Responding to the need to improve 

understanding of the process, the Clinical Engineering 

Special Interest Group (CESIG) of IPEM, supported by 

the IPEM office, organised a 1-day meeting on 

specifying, evaluating and selecting medical equipment. 

A wide range of proffered papers followed by lively 

questions and discussions resulted in an interesting 

meeting that was strengthened and supported by 



exhibits from (in alphabetical order) ECRI Institute, 

Huntleigh and Ultramedic. 

ACQUIRING MEDICAL TECHNOLOGY 

John Amoore (NHS Ayrshire and Arran, Kilmarnock) 

opened the meeting by summarising the ingredients of 

selecting the best equipment possible for the task. The 

clinical requirements need to be clear. The resultant 

specification will be revised by examining what is possible 

(technically, financially, with staff availability and 

supporting infrastructure) and best (efficacy, patient 

needs, staff considerations and post-purchase support). 

The specification should guide suppliers to offer their 

most appropriate product for the task and guide 

healthcare staff to objectively choose the best product to 

support patient care. 

‘Acquiring medical technology – art or science’, asked 

Alastair Deller (ECRI Institute, Welwyn Garden City) as 

he advocated a structured approach to equipment 

selection. The process requires a foundation of sound 

information and technology assessment (published 

evaluations, hazards and user experience). The traditional 

‘he or she who shouts loudest’ approach will not meet the 

rising expectations of clinicians and patients, particularly 

with current financial constraints. Technology assessment 

practically tests the technology’s value, its safety, efficacy 

and effectiveness. It relies on data, facts and evidence, not 

anecdote. It recognises that a technology’s success 

depends on much more than whether it technically works. 

Medical technology does not exist in isolation but within a 

clinical environment (figure 1). The value of technology 

depends on empowering the clinician (typically not a 

doctor) to use it effectively. Rules of technology were 

pointed out, including: the value of many technologies is 

yet to be defined; no patient care technology reduces 

labour costs; technology results in more technology; new 

technologies are almost always over-used at first, and 

there is no best manufacturer for all technologies. 

Structured technology assessment requires identification 

of the clinical needs and selection criteria, and reviewing 

the alternatives including identifying, assessing and then 

finally selecting the best. But the process should not end 

with the purchase. Follow-up, including an annual review, 

is important to assess the equipment’s efficacy, its clinical 

utilisation and whether it satisfies the clinical 

requirements that prompted the procurement. The review 

can provide lessons for improving future evaluations. 

Principles of an ideal procurement process were outlined: 

sober objective assessment of alternatives based on data; 

lifecycle costs (which can vastly exceed initial costs); aftersales 

support; weighted criteria to combine different 

assessment aspects, and trying to reach a consensus. 

Finally, there is monitoring and following up. 

MEDICAL TECHNOLOGY ACQUISITION 

Medical technology acquisition is not the preserve of any 

particular IPEM special interest group, but it spans them 

all. Practical experiences were presented by Tina Jones 

(University of Birmingham NHS Foundation Trust) and 

Paul Webb (James Cook University Hospital, 

Middlesbrough). Tina described the successful major 

radiological equipment procurement for her Foundation 

Trust, meeting the challenges of equipping a new hospital 

development. The estimated procurement cost of £27 

million emphasised the project’s scale. She showed how a 

structured approach (as advocated in Alastair’s 

presentation) was put into practice and introduced the 

facilitation provided by NHS Supply Chain Imaging 

Council and its framework process. The Trust reviewed 

and updated NHS Supply Chain’s generic specifications 

FIGURE 1. 

Technology does 

not exist in 

isolation (Alastair 

Deller, ECRI 

Institute). 

▼ 

▼ 



▼ 

to reflect the Trust’s priorities. Mini-competitions were 

arranged to assess the equipment offered by different 

suppliers. Trust staff focussed on clinical, technical, 

training and support, and innovation and product 

development aspects. NHS Supply Chain scored the 

financial submissions, dividing the financial by the nonfinancial 

scores to determine a final score which was 

presented to the Trust for awarding contracts. The 

process reduced expenditure to £17 million, partly 

helped by transferring some existing equipment. Tina 

emphasised the significant staff time required, 

acknowledging the support available for equipment 

projects, including that from NHS Supply Chain. 

Paul Webb took us through the selection of a 

specialised item of equipment used for operative spinal 

cord monitoring. Justification of need was not 

contentious – expiry of the existing lease. But the 

processes take time, in Paul’s example it was over a year 

from identification of need to equipment delivery: 

assembling the team; researching alternatives (contacting 

suppliers, other users and arranging demos), and 

comparing them (based on assessment criteria, 

specification and making logical judgements). Key 

functional characteristics may emerge during the 

process, highlighting the need to fairly and openly 

include them in the assessment. This does not mean 

altering the specification or criteria to suit a preferred 

solution, a concern which was raised by the audience. 

The specification will develop and change during the 

initial research phase, but the tendered specification 

becomes a contractual document between the procurer 

and bidders. The procurement report is an important 

document that weighs up the evidence, leading to a 

recommendation. Who should play a leading role The 

speaker argued that the skills and experiences of 

scientists and engineers make them well placed to 

specify and assess medical equipment, working with 

procurement officers. 

ADOPTING HEALTHCARE TECHNOLOGIES 

Susan Peirce (Cardiff University) addressed the 

adoption of innovative healthcare technologies. Susan 

noted that ‘innovation’ is a concept with a lot of 

desirability, supported by a variety of recent reports. But 

the take-up of innovative technologies is still 

problematic, with multiple agencies and processes 

involved (the ‘innovation landscape’). Just because 

something works well does not mean it will be 

successful. Technology does not exist in isolation; it has 

users, environment, accessories and patients. The human 

and organisational influences on the decision(s) to adopt 

something novel are many and varied. Sociological 

research methods are needed to examine and explain 

them, for example interviews, focus groups, document 

analysis and surveys. Such research indicates that 

concepts such as ‘evidence’ and even the technology 

itself, considered to be relatively defined and fixed, are 

actually highly variable and dependant on individual 

perceptions or viewpoints. ‘Evidence’ is usually 

interpreted as meaning peer-reviewed papers, but these 

are often not available for new devices. Clinicians want 

high-quality data, but tend to value personal experience 

(e.g. free samples) or recommendations from trusted 

colleagues more highly than the available publications, 

and may even ignore evidence for newly recommended 

practices where they lack confidence in their use. The 

same piece of technology takes on different ‘identities’ 

depending on the background and priorities of the 

person considering: an expensive toy, a Trust’s marketing 

opportunity, a useful surgical tool. The ‘reality gap’ 

FIGURE 2. 

Evidence-based 

specifications 

enable 

comparison of 

apples with 

apples, rather 

than apples with 

oranges (Angela 

Dunigan, NHS 

Supply Chain). 

▼ 



between these different perceptions could result in 

misunderstandings between participants in the 

procurement process. Good team work and consensus 

building requires valuing and recognising the different 

perceptions of members of an evaluation team. 

EQUIPMENT PROCUREMENT 

NHS Supply Chain supports medical equipment 

procurement by carrying out background research and 

presenting purchasers with frameworks comprising a 

shortlist of suppliers who have met core generic 

specifications and whose suitability has been tested by 

OJEU (Official Journal of the European Union) tender 

processes. NHS Supply Chain gave three presentations. 

Leah Lockwood (NHS Supply Chain, Normanton) 

introduced the company and its origins, and their target 

savings – £1.6 billion over 10 years, an important 

contribution to achieving efficiencies within the NHS. 

The framework agreements support open competition 

and compliance with financial regulations, providing 

robust and long-term solutions for NHS Trusts. An 

example is the patient monitoring framework, currently 

being retendered incorporating lessons learnt from its 

predecessor. Jenny Lockwood and Angela Dunigan 

(NHS Supply Chain, Normanton) addressed the 

development of standard specifications. Specifications 

were illustrated with the development of a framework 

for operating lights, pendants and associated equipment. 

The research phase opened a can of worms of different 

processes and tangled webs of interested groups. Key 

considerations needed to be clarified, a process 

involving open consultations, considering generic 

requirements, viewing product examples, remembering 

to keep things simple and focussing on the end goal. 

Keys to success include a taskforce of clinical and 

technical expertise developing a process that enables 

comparison of apples with apples (figure 2). Referring to 

the current equipment maintenance tender, Angela 

issued a challenge: ‘They have said it can never be done. 

Combine all our experience and it can be done. The NHS 

needs this to be done’. 

THE TENDER PROCESS 

Brian de Francesca (TBS GB, Southend-on-Sea) with 

Lorraine Dowell and Peter O’Connor (RTKL) discussed 

the ‘Tender process as a step in acquisition of medical 

equipment’. Brian, with a background in hospital 

administration around the world, introduced a simple 

but comprehensive measurement tool for assessing 

appropriate equipment volumes. His logic is as follows. 

Medical equipment is only required if there are patients. 

Thus, there should be a correlation between the volume 

of patients and volume of equipment. Thus, no patients 

results in no need for equipment; many patients require 

more equipment. From this elegant concept a measure of 

how well a hospital utilises equipment emerges, namely 

the ‘total cost of medical capital employed’ (TCMCE) 

relative to ‘patient volumes’ (PV). Using this metric, 

when different institutions are compared (normalised 

for facility type and acuity), a range of figures emerge, 

with hospitals divisible into two groups: 

1) Those with high or low total costs to patient volumes 

(figure 3). High-cost hospitals were associated with 

physician preference buying, a lack of standardisation, 

low equipment utilisation and high failure rates. 

2) A robust process of equipment specification, 

evaluation and selection leads to lower, more effective 

total cost-to-patient ratios. 

Lorraine and Peter described how RTKL, using a 

strategic process, ensures effective equipment selection 

FIGURE 3. 

A measure of 

equipment 

utilisation. Ranges 

of total cost of 

medical capital 

employed 

(TCMCE) to patient 

volume (PV) for 

different 

healthcare 

facilities (Brian de 

Francesca, TBS 

GB). 

▼ 

▼ 



▼ 

and adoption, integrating equipment procurement with 

infrastructure design. The process considers the 

equipment lifecycle, the current inventory and the 

clinical needs (not the traditional ‘I want’) to develop a 

multi-year capital plan. The planning requires a multidisciplinary 

approach, with input from potential 

suppliers. The process was illustrated with an operating 

theatre development. 

LIFECYCLE PLANNING 

Edward Grainger (NHS Supply Chain, Normanton) set 

an agenda of ‘not just procurement and whole of life 

considerations but lifecycle planning’. Strategy is 

required. Purchasing processes involve: long-term 

planning; pipeline planning – based on equipment 

lifecycle and clinical capacity predictions, and ad hoc 

procurements. The processes must consider the funding 

mechanisms. He illustrated the challenge by focussing 

on the large sums required for CT and MRI replacement. 

The gap between planning and requirements across 

England is £130 million. He illustrated a typical Trust’s 

projected imaging requirement with peaks and troughs 

over a 10-year cycle. Improved planning can increase the 

savings, with careful consideration of the asset lifecycle: 

identify need; procure; install; manage; dispose/replace. 

The National Audit Office has recently reviewed 

equipment procurement, encouraging collaboration to 

ensure best prices. We must review and ensure 

utilisation of existing resources and plan strategically for 

the future. 

SUMMARY 

The meeting gave much food for thought. Equipment 

selection requires a structured approach, objectively 

assessing needs that support the strategic healthcare 

objectives. Data, information and support are available. 

Decisions must be evidence based, not made on 

personal prejudices, anecdotes and opinions. Time, 

effort and team work that recognises and values the 

different perceptions of individuals within the team are 

required. Procurement can be supported by 

collaboration and national frameworks. Lessons need to 

be learnt, a process facilitated by a structured annual 

review process. n 

24TH ANNUAL CONGRESS OF THE EUROPEAN 

ASSOCIATION OF NUCLEAR MEDICINE (EANM) 

KIMBERLEY SAINT Royal Liverpool University Hospital 

BIRMINGHAM 15th–19th October 2011 

IN OCTOBER 2011 I attended the 24th Annual Congress 

of the European Association of Nuclear Medicine 

(EANM) held in Birmingham, having been awarded an 

IPEM bursary. It was a week of ‘firsts’ for me. This was 

my first experience of a European conference and my 

first experience of presenting my own research in a 

poster presentation. 

The event was split between the International 

Convention Centre (ICC) and the National Indoor Arena 

(NIA) in Birmingham city centre. The organisers had 

kindly built a covered walkway between the two venues, 

clearly envisaging the worst that the British autumn 

weather could offer. Thankfully this was not required 

until the end of the week, allowing the many delegates 

to enjoy the canalside location of the event without 

needing to use the free umbrella received in our 

conference bags. Another example of the expected 

British weather The opening ceremony and drinks had 

a distinct British feel, with lamb hotpot and roast beef 

with Yorkshire puddings being the main food served. 

Despite the mild weather the hearty food seemed to be 

enjoyed by all. 

There were around 5,000 delegates in attendance, 

hundreds of posters and countless presentations 

covering every aspect of the nuclear medicine field, from 

all across the world. The sheer size of the event was a 

little overwhelming to begin with; it took me over half 

an hour to find the allotted stand for my poster! 

LOOKING TO THE FUTURE 

The opening presentation of the EANM congress is 

always the Marie Curie Lecture. Each year an individual 

is invited to present the Marie Curie Lecture in 

recognition of their excellent scientific accomplishment. 

This year Sandy McEwan (University of Alberta, 

Edmonton, Canada) spoke on ‘The future of molecular 

imaging in enhancing cancer care’. Dr McEwan 

expressed his view that we should have a paradigm shift 

in the molecular imaging of cancer; moving away from 

the current paradigm of simply identifying the presence 

of a tumour. The future, he said, lies in biologically 

characterising the tumour and the patient, thereby 

allowing the patient’s response to therapy and their 

prognosis to be better estimated. This approach will 

require the consolidation of many technologies that are 

already available and collaborative working within and 

between centres. This is the first step in developing a 

truly personalised approach to cancer care and, as Dr 

McEwan said, the only way that the image will become 

a true molecular biomarker. 

This theme continued in the following talk by 

Richard Baum (Zentralklinik Bad Berka, Germany), 

‘Theranostics: from molecular imaging of 

neuroendocrine tumours using PET/CT to personalised 

radionuclide therapy’; theranostics being the term used 

to describe the use of diagnostics in informing patientspecific 

therapy. 

WORK ON NEUROENDOCRINE TUMOURS 

I have recently started working in the nuclear medicine 

department of the Royal Liverpool University Hospital, 

which is a Centre of Excellence for neuroendocrine 

tumours. The department completes many peptide 

receptor radionuclide therapies every year and therefore 



I also wanted to attend this congress to learn about the 

current research that was being completed in this area. I 

particularly enjoyed the talk given by Christiane 

Schuchardt (Zentralklinik Bad Berka, Germany). Entitled 

‘Serial dosimetry in peptide receptor radionuclide 

therapy using lutetium-177 dotatate or lutetium-177 

dotatoc in the same patient’, her talk was rich in the 

physics behind dosimetry and has piqued my interest. 

Another excellent speaker, whom I enjoyed listening to 

two talks from, was John Buscombe (Addenbrooke’s 

Hospital, Cambridge). His talk on ‘Single photon 

imaging in neuroendocrine tumours in 2011’, which 

included many clinical examples, has greatly increased 

my knowledge in this area. This SPECT talk was 

followed by ‘PET imaging in neuroendocrine tumours’ 

by Damian Wild (University Hospital Freiburg, 

Germany). The two together were a ‘one-stop-shop’ in 

the different nuclear medicine methodologies being used 

at different centres to diagnose, stage and treat patients 

with neuroendocrine tumours. 

EVALUATING DOSE DISTRIBUTIONS 

One of the most insightful presentations I attended was 

given by Marta Sans-Merce (University Hospital Center 

of Lausanne, Switzerland), who is part of the 

Organisation of Radiation Protection of Medical Staff 

project (ORAMED). ORAMED is a collaborative 

European project aimed at developing methods for better 

assessing and reducing exposures to medical staff for 

procedures, such as those in nuclear medicine. Dr Sans- 

Merce reported back on work to evaluate and optimise 

extremity doses and dose distributions across the hands 

of staff, with the results of an extensive measurement 

programme in 32 nuclear medicine departments in 

Europe. The data from the 124 staff monitored 

demonstrated that the most exposed positions of the 

hand are the tip of the index finger and the thumb of the 

non-dominant hand. Simple knowledge like this will 

greatly help me in completing further dose 

measurements in my own department. From this work 

guidelines were given based on the results combined 

with Monte Carlo simulations. The sheer volume of data 

collected was very impressive in itself. 

PERSONAL HIGHLIGHTS 

The highlights session on the last day was well attended 

and gave everyone a whistle-stop tour of the key 

presentations of the congress. There were a number of 

personal highlights for me. At a GE Healthcare event I 

was given the chance to hold, and of course I simply had 

to wear, an Olympic gold medal won by Rowley Douglas 

in the 2000 Sydney Olympics in the coxed eights rowing 

(see the photo below). Then there was the opportunity to 

attend my first European conference and network with 

people from all over the world. However the high point 

for me was the pride I felt seeing my poster hung up 

after all the work I put into my MSc research project and 

the effort to formalise it into a poster (photo below). As 

the proverb goes, ‘from small beginnings come great 

things’. Well, I certainly hope so anyway. 

ACKNOWLEDGEMENTS 

I would like to extend my thanks to IPEM for awarding 

me a bursary to attend the EANM Annual Congress. I 

would also like to take the opportunity to thank my MSc 

project supervisor, Part I training supervisor and former 

manager Dr Nigel Williams (University Hospital 

Coventry), for all his help and support. I would also like 

to extend this thanks to my other colleagues that 

contributed to this work. n 

Wearing the 

Olympic gold 

medal and 

presenting my 

poster. 

▼ 



ELECTRONS: DOSIMETRY, 

PLANNING AND TREATMENT 

JAMES WILLIAMS AND SUSAN BUCKLEY ABM University Health Board 

AUSTIN COURT, BIRMINGHAM 10th November 2011 

AROUND 80 DELEGATES FROM across the UK and 

Ireland gathered on a misty autumn morning for an IPEM 

meeting on electron dosimetry, planning and treatment. 

Electrons can sometimes seem to be the Cinderella 

modality of radiation treatment, with the difficulties of 

accurate computerised treatment planning restricting 

many clinical users to relatively simple calculations. 

However, the excellent range of speakers and the number 

of delegates at this meeting shows there is much interest 

in electrons and their clinical applications. 

After welcoming remarks from meeting organiser 

Nina Burton (Cheltenham General Hospital), the opening 

session took the theme of the clinical use of electron 

beams and each talk highlighted the unique challenges 

presented by electrons in providing accurate and precise 

treatment. Gareth Baugh (Arden Cancer Centre, 

Coventry) presented the results of an investigation into 

the different techniques of delivering total skin electron 

therapy to a specially designed phantom across 10 

national radiotherapy centres. The variation in dose 

uniformity discovered by his work led him to recommend 

the adoption of the Stanford technique by all centres. 

One of the most common clinical applications of 

electrons is to provide a boost dose to the tumour bed in 

breast treatments. Amanda Welsh (Royal Shrewsbury 

Hospital) highlighted how new surgical techniques have 

meant that using the surgical scar to locate the tumour 

bed is no longer sufficiently accurate. Instead, a new 

technique uses surgical clips visible on planning CT 

images and virtual simulation. An audit of 30 patients 

planned with both techniques showed that the extra time 

spent planning and setting up with the new technique is 

more than worth the gain in treatment accuracy. 

Geometrical accuracy is one challenge, accurate 

dosimetry is another, and Pavel Dvorak (The London 

Clinic) presented a very interesting talk examining 

monitor unit calculations for breast boosts using the 

electron Monte Carlo (eMC) algorithm in the Eclipse 

planning system, conventional flat phantom 

measurements and a purpose-built breast-phantom 

(figure 1). The results demonstrated the effect that surface 

curvature has on electron measurements, such that 

applying flat-surface measurements to curved-surface 

clinical sites may lead to significant underdosing. This 

provoked a discussion on whether doses should be 

reported in terms of the technique or algorithm used to 

calculate them, which continued into the short coffee 

break held in the exhibitor’s room. 

ELECTRON BEAM TREATMENT PLANNING 

After the mid-morning break, the second session 

contained three talks examining electron beam treatment 

planning. Monte Carlo modelling has long promised to 

improve accuracy in electron planning, and several 

commercial systems are now available. Ralph Roberts 

(Oxford Radcliffe Hospitals NHS Trust) examined the 

eMC algorithm in Eclipse for lung and bone 

inhomogeneities, Martin Green (Clatterbridge Centre 

for Oncology, Wirral) examined the macro Monte Carlo 

algorithm in Eclipse for lung and nose phantoms and 

Louise Gately (Clatterbridge Centre for Oncology, 

Wirral) compared clinical dose distributions calculated 

using the electron pencil beam algorithm in the Plato 

system to the eMC model in Oncentra MasterPlan. Each 

talk investigated the accuracy of the different algorithms 

and models against measured data and other systems 

(figure 2). Each algorithm has its own strengths and 

weaknesses which may affect their accuracy in clinical 

use. Clinical decisions need to be made with an 

understanding of the accuracy of the predicted dose 

distributions, and each talk highlighted the importance 

of commissioning measurements in developing local 

understanding of the accuracy of planned doses. The 

talks and following questions gave those attending from 

centres not using computerised planning an opportunity 

to discover more about the time and effort needed to 

commission electron planning. A more general 

discussion on the future for computerised planning 

followed the morning session and took delegates into 

lunch, with a longer opportunity to browse the 

exhibitor’s stands. 

Any postprandial lethargy following a delicious lunch 

buffet was soon dispersed by Mark Bailey’s (National 

Physical Laboratory, Teddington) entertaining tour of 

electron beam dosimetry and the 2003 IPEM Code of 

Practice. As previous talks had shown, standardisation 

of technique is an important method of maintaining 

treatment accuracy, and the grandaddy of 

standardisation must be the Code of Practice, ensuring 

all UK centres trace their dosimetry back to the national 

standard set at NPL. The effectiveness of the Code of 

Practice could be demonstrated by the national variation 

in dose measurements. Fortunately the UK has one of the 

most robust national and regional audit programmes for 

radiotherapy, with excellent evidence to show that all 

departments are meeting the standard. Much of the 

credit for the strong audit programme is due to Steve 

Bolton (The Christie NHS Foundation Trust, 

Manchester), Chair of the National Interdepartmental 

Audit Group, who presented a talk discussing the results 

of the most recent National Electron Audit (2009–2010). 

In each participating centre, three parameters (beam 

energy, output and measured dose for a planned 

treatment) were measured for three clinical beam 

energies. Results were very encouraging, with beam 

energy measurements largely within ±3 per cent and 

output within ±2 per cent. The planned cut-out fields 

saw greater variation and the results of three 

departments which saw an underdose of >10 per cent 

were discussed. Each department reinvestigated their 



FIGURE 1. 

Purpose-built wax 

breast phantom (P. 

Dvorak). 

▼ 

FIGURE 2. 

Variation in 

calculated 

isodoses between 

(left) Oncentra 

Monte Carlo and 

(right) Plato pencil 

beam algorithms 

(L. Gately). 

▼ 

▼ 



▼ 

results in light of the audit and were able to discover the 

contributing factors in their techniques which led to 

dose variations. The talk concluded with an outline of 

future planned audits for other treatment modalities. 

ELECTRON DOSIMETRY EQUIPMENT 

Two talks highlighted innovative electron dosimetry 

equipment designed and built ‘in-house’. Katie 

Hillman (Kent Oncology Centre, Maidstone) presented 

a talk on a design study for an electron beam energy 

checking device consisting of ten individual ion 

chambers set in a ‘spiral staircase’ pattern. A large 

amount of development work was presented, including 

the design of the chambers and the calculation of the 

optimal chamber positions using water tank data. 

Future work will examine a prototype phantom before 

the final device is constructed. Mark Osborne (Kent 

Oncology Centre, Maidstone) highlighted the 

difficulties of accurate dose measurement in small 

electron fields and his project to design and construct a 

parallel plate ion chamber with a 2 mm-diameter 

collecting electrode to overcome these problems. The 

ideal characteristics of an ion chamber were discussed, 

the chamber design presented and comparisons 

between measurements made with the chamber and 

commercially available chambers and diodes were 

made. The chamber showed excellent agreement with 

the diode at high energies and further work is to be 

undertaken to improve its performance at low energies. 

All delegates would have been familiar with the 

problems that inspired Oliver Delamont’s (University 

Hospital of North Staffordshire, Stoke-on-Trent) project. 

Measuring electron output factors for new cut-outs can 

be time consuming and difficult to fit around the clinical 

schedule. The talk presented the results of an 

investigation of the effects on output factor values of 

applicator, field and cut-out size. By keeping applicator 

and jaw settings constant, it was possible to predict the 

variation in output for square cut-outs to within 1 per 

cent. With more investigation into rectangular and 

circular cut-outs, it was hoped to develop a system of 

calculating output factors, thereby saving the time 

required for measurement. 

This talk concluded what was a very interesting 

meeting with a diverse range of speakers highlighting 

how electron treatment is developing across the UK. It 

was an opportunity for delegates to see how the 

difficulties and uncertainties they faced were also faced 

by other centres, and often solutions were presented. 

Overall, the meeting showed how electron beam 

radiotherapy is being accurately and safely delivered 

across the UK. n 

EUROPEAN SCHOOL OF MEDICAL PHYSICS – 

14TH SESSION 

LEILA NICHOL Royal Surrey County Hospital 

ARCHAMPS, FRANCE 13th October–22nd November 2011 

I HEARD ABOUT THE European School of Medical 

Physics (ESMP) through an IPEM communication. I was 

delighted when I found out I had won the European 

Federation of Medical Physics (EFOMP) ESMP Bursary 

for Beginning Physicists to attend one week of the 

programme. The school runs various week-long courses 

in different areas of medical physics over 6 weeks. As I 

have now decided to specialise in radiotherapy for my 

Part II, I chose to attend week 4, ‘The physics of modern 

radiotherapy’. The field of radiotherapy is rapidly 

developing so I thought this course would be highly 

relevant and valuable, as well as providing me with the 

opportunity to meet a diverse range of colleagues from 

around the world. 

The ESMP is based at the European Scientific Institute 

on the border between France and Switzerland at the 

Centre Universitaire de Formation et de Recherche in 

Archamps, close to Geneva (figure 1). It is a beautiful 

setting surrounded by mountains. Lessons ran from 

Thursday to Tuesday, with a free day on Sunday to 

explore the area. 

After a warm welcome by director Yves Lemoigne 

(ESMP, Archamps) and supervisors Steve Webb (Royal 

Marsden Hospital, Sutton) and Uwe Oelfke (Deutsches 

Krebsforschungszentrum (DKFZ), Heidelberg, Germany), 

day 1 began with lessons in radiobiology by Francesca 

Buffa (Gray Labs, Oxford), conformal radiation 

techniques by Steve Webb and inverse planning by 

FIGURE 1. 

The city of Geneva. 

▼ 



FIGURE 2. 

The week 4 group 

visiting CERN. 

▼ 

FIGURE 3. 

Visiting one of the 

linear 

accelerators at 

CERN. 

▼ 

▼ 



▼ 

Simeon Nill (DKFZ, Heidelberg, Germany). This was 

mostly a refresher for me but was nevertheless beneficial, 

especially to those who didn’t have the same level of 

clinical experience. 

Day 2 began with lectures in IGRT and moved on to an 

overview of hadrontherapy. I was very interested to learn 

about hadrontherapy as this is something not currently 

available in the UK. The day finished with an equipment 

exhibition by PTW, with particular emphasis on the new 

rotating Octavius phantom. 

The main theme of day 3 was quality assurance, with 

lectures from Brendan McClean (St Luke’s Hospital, 

Dublin) on quality standards and radiation incidents, 

followed by an introduction to stereotactic field 

techniques by Simeon Nill. The morning session 

concluded with a round-table discussion session with 

Steve, Uwe, Brendan and Simeon. There were many 

questions on a broad range of topics from radiobiology to 

the benefits of IMRT versus conformal treatments, to in 

vivo dosimetry. I think this session was really useful to 

everyone in the audience. 

On Saturday afternoon we visited CERN (figures 2 and 

3). Yves began the tour by giving us a background into the 

research carried out at CERN and the projects currently 

underway. The site was very impressive and it was 

amazing to get up close to the linacs and see behind the 

scenes. Each street on the site is named after a famous 

physicist and there is a museum filled with impressive 

displays. It was a privilege to visit such a renowned and 

prestigious centre of research. 

Sunday was our free day, with the opportunity to visit 

a quaint little French town called Annecy. With its canals, 

castle and cathedral, Annecy is stunning. We spent the 

morning in the market stalls sampling lots of French 

cheese, saucisson, fruit, tapenades and pastries, and the 

afternoon admiring the views from the castle and walking 

WEST MIDLANDS REGIONAL 

SCIENTIFIC MEETING 

down by the lake. We had an amazing lunch of authentic 

French cheese fondue washed down with some French 

wine. Parfait! 

Back to work on day 4, with a day dedicated to 

dosimetry. Gunter Hartmann (DKFZ, Heidelberg, 

Germany) did a mammoth session covering dosimetry for 

photon and electrons, radiotherapy strategy, accuracy 

requirements and ICRU 50. The students then performed 

a virtual calibration of a linac using a program on the PCs 

which involved measuring appropriate correction factors, 

then performing quality index and PDD measurements in 

a very convincing virtual water tank. The evening session 

was spent visiting Geneva University Hospital’s 

Radiotherapy Department. We were taken on a tour of 

their department consisting of two Varian linacs and a 

Novalis, and it was very interesting hearing about their 

IMRT and RapidArc techniques. 

The theme of day 5 was the clinical application of 

imaging in 3D conformal radiotherapy. Peter Remeijer 

(The Netherlands Cancer Institute, Amsterdam, The 

Netherlands) discussed uncertainties in radiotherapy, 3D 

image registration and electronic portal imaging. He also 

touched on using the EPID in vivo verification of dynamic 

IMRT which is an area I am particularly interested in. 

Raymond Mirabell (Geneva University Hospital, 

Switzerland) concluded our busy week by expressing the 

impact of 3D conformal radiotherapy techniques from a 

clinical point of view which was very interesting. A short 

exam followed and the week was over! 

The farewell party was a great night, with everyone 

brining a dish from their own country. It was quite a feast 

with dishes from places such as Romania, Italy, Bulgaria, 

Russia, Germany, Turkey, and a token Eton Mess 

representing the UK. The night was nicely rounded off 

with Camembert and some wine from Bordeaux. A 

fantastic end to a great week! n 

MARK BAKER University Hospital of North Staffordshire, DAVID LINES University 

Hospital of North Staffordshire, SARAH HIGGINS University Hospital of North 

Staffordshire, ZOE ADEY University Hospitals Coventry and Warwickshire, JIM PHILIPS 

University Hospitals Birmingham, REBECCA CAIN New Cross Hospital, Wolverhampton 

QUEEN ELIZABETH HOSPITAL, BIRMINGHAM 17th November 2011 

THE 2011 WEST MIDLANDS Regional Scientific Meeting 

was held in the newly built Queen Elizabeth Hospital in 

Birmingham. Despite being held outside of normal 

working hours, a full lecture theatre provided a perfect 

opportunity for trainees from different disciplines to 

present the results of projects that they had completed. 

The first session was chaired by Jon Paine (University 

Hospitals Birmingham) and Craig Edwards (University 

Hospital of North Staffordshire, Stoke-on-Trent). 

Although this session was predominately radiotherapy 

themed, the first speaker Kirsty Hodgson (RRPPS, 

University Hospitals Birmingham) was from a diagnostic 

radiology background. Kirsty succinctly summarised 

some of the problems arising when using the CD-MAM 

phantom in routine QC of mammography systems, viz. 

variability in results on the same system using different 

phantoms. Kirsty adduced data showing that interphantom 

inconsistency was due to a combination of 

variability within the analysis software, and physical 

variation between phantoms. 

The next talk was by Andrew Dumbill (University 

Hospitals Birmingham), who presented the work he had 

carried out into in vivo dosimetry. This provided a useful 

insight into the methods applied to predict the mid-point 

dose to the patient using an electronic portal imaging 

device. This involved the use of field size, source-skin 

distance and patient thickness-dependent calibration 

factors. One hundred and forty patient images had been 



FIGURE 1. 

Presentation to 

Kirsty Lee by 

Professor Stuart 

Green, Director of 

Medical Physics, 

University 

Hospital 

Birmingham. 

▼ 

FIGURE 2. 

Presentation to 

Sarah Higgins. 

▼ 

▼ 



▼ 

acquired during prostate treatments and the mean 

difference between the planned and predicted mid-point 

dose was found to be −0.4 ± 2.5 per cent (1σ). 

Zoe Adey (University Hospitals Coventry and 

Warwickshire, Coventry) gave an informative 

presentation on how the displacement of clinical fluence 

maps affected the pass rates of gamma index tests. These 

tests are used to ascertain the accuracy of IMRT plans. In 

a clear and concise manner, Zoe discussed her method of 

displacing fluence maps in 1 mm increments in each of 

the A, B, G and T directions. The effect these 

displacements had on the gamma index test results was 

discussed, as was a noted asymmetry in pass results in 

both the AB and GT directions. 

David Lines (University Hospital of North 

Staffordshire, Stoke-on-Trent) gave an interesting talk on 

optimising beam angles for IMRT of prostate tumours. 

Plans using standard beam algorithms and Varian’s beam 

angle optimisation algorithm were compared. This was 

achieved by analysing doses to the planning target 

volumes and organs at risk, dose homogeneity and low 

dose splash. The average number of monitor units 

delivered per field and the average planning time were 

also compared. Due to the similarity of the plans using 

both methods, it was concluded that the use of the beam 

angle optimisation algorithm was unnecessary for 

prostate plans. 

A thorough overview of proton therapy and its future 

applications was provided by Dan Kirby (University 

Hospitals Birmingham). This talk comprised largely of his 

experience completing a PhD in this area, along with 

additional work carried out by his colleagues. Using 

calibrated GafChromic film for dosimetry of cell 

irradiations, Dan showed that the high instantaneous 

dose rate (~10 9 Gy) caused by the ultra-short burst of 

laser-driven protons gave comparable radiobiological 

effects as demonstrated by the existing low dose-rate 

data. As proton therapy has re-emerged as a promising 

candidate in the treatment of cancer, but is not yet 

commonly available, it provided the perfect opportunity 

for its benefits and drawbacks to be outlined. 

The second session was chaired by Greg James (City 

Hospital, Birmingham) and James Cullis (University 

Hospitals Coventry and Warwickshire, Coventry). This 

session kicked off with a talk from Helen Davies (West 

Midlands Rehabilitation Centre, Birmingham). Although 

her talk on gait analysis was not an area which most of 

the audience were familiar with, the presentation was 

clear and interesting. The aim and procedure was clearly 

outlined with understandable results. Helen attempted to 

improve the accuracy of the Helen Hayes Model for 

skeletal movement tracking. This involved marking the 

knee in a flexed and extended position, which is known 

as a double calibration. This has previously been used in 

the CAST method of gait analysis. 

Kirsty Lee (University Hospitals Coventry and 

Warwickshire, Coventry) presented a very informative 

project based on residual activity within injection 

apparatus used for GFR (glomerular filtration rate). This 

involved quantifying the residual activity along with its 

distribution amongst the components used during 

administration. This project deduced that the largest 

remaining activity was in the dispensing needle, and 

minimal activity was left in the butterfly and three-way 

tap. She therefore proposed that the protocol could be 

improved by replacing the dispensing needle with a luer 

cap, and discarding the butterfly immediately after use to 

minimise the risk of needle stick injury. 

A presentation on the issues associated with sentinel 

lymph node probe QC was presented by Sarah Higgins 

(University Hospital of North Staffordshire, Stoke-on- 

Trent). Her talk focussed mainly on comparing spatial 

and angular resolution, but also included a summary of 

the QC protocol as a whole. This presentation was of 

particular interest as it allowed other hospitals in the 

region to compare the QC programme used at UHNS to 

their own. 

The final talk of the day was given by Tim Watts (New 

Cross Hospital, Wolverhampton). Tim gave a wellconstructed 

presentation on his studies on the Astonish 

iterative reconstruction algorithm in myocardial 

perfusion scintigraphy (MPS). Tim competently 

demonstrated that using this algorithm, patient scan 

times could potentially be halved with no significant loss 

of clinical information. 

The meeting finished with an award ceremony. The 

prize for the best technologist talk was awarded to Kirsty 

Lee (figure 1), for her clear and practical talk on 

improving the GFR protocol. The best talk from a scientist 

or engineer was awarded to Sarah Higgins (figure 2). Her 

presentation was clearly given and deserving of the 

award presented. n 

IPEM MR-SIG / BC-ISMRM JOINT SESSION: 

GRADIENTS AND THEIR BEHAVIOUR 

MIKE HUTTON Sheffield Teaching Hospitals NHS Foundation Trust 

UNIVERSITY OF MANCHESTER 7th September 2011 

THIS 2-HOUR WORKSHOP preceded the Annual 

Conference of the British Chapter of the International 

Society of Magnetic Resonance in Medicine (BC-ISMRM). 

It was a joint session, aimed at bringing together the 

shared interests of both IPEM and ISMRM members and 

trainees. It was organised by Iain Wilkinson (University 

of Sheffield), who is both an academic and a clinical 

scientist. 

The venue of the workshop held in September was the 

impressive Martin Harris Centre for Music and Drama at 

the University of Manchester – with its fantastic acoustic 

properties. Iain introduced the session, telling us about his 

long-standing interest in gradient coil technology 

stretching back to his heady days as a PhD student 

studying the unwanted induction of eddy currents and 

gradient coil geometries, undoubtedly one of the most 



important considerations in the quest to achieve 

geometric accuracy in MRI. With the use of MRI 

becoming increasingly common in areas such as 

radiotherapy treatment planning, the need for geometric 

accuracy in MRI has perhaps never been greater. 

GRADIENTS IN MRI 

The first speaker of the workshop was Richard Bowtell 

(University of Nottingham) with a general overview of 

gradients in MRI. Professor Bowtell guided us through 

the basics of gradient coil design, highlighting the 

requirements of a coil that provide the performance 

demanded in modern MRI systems, which include the 

need for large, uniform and rapidly switching gradient 

fields. The need for active coil shielding to minimise 

eddy current-induced image distortions was also 

covered as well as ways of assessing gradient coil design 

given the trade-offs between optimum performance and 

limiting unwanted physiological effects such as 

peripheral nerve stimulation. 

Following on from Professor Bowtell was Jennifer 

McFarlane (NHS Tayside, Dundee) with an interesting 

review of the test objects currently available for the 

assessment of geometric accuracy. This was followed by 

an overview of the experience of NHS Tayside working 

as part of SINAPSE (Scottish Imaging Network: A 

Platform for Scientific Excellence) in assessing geometric 

distortion as part of the quality assurance in multi-centre 

MRI research. 

CLINICAL ASPECTS 

The session then moved on to the clinical aspects of 

‘gradient behaviour’ and the use of MRI in radiotherapy, 

with a talk by Martin Leach (Institute of Cancer 

Research, Sutton). Starting with a brief introduction to 

radiotherapy in general, Martin then focussed on the 

requirement for increasingly geometrically accurate 

imaging with the advances in radiotherapy such as 

intensity modulated radiotherapy, the Cyberknife and 

the technique of dose painting. 

The final speaker of the workshop was Paul Harvey 

(Philips Medical Systems, Best, Eindhoven, The 

Netherlands) with a talk on the manufacture of gradient 

systems and in particular manufacturing tolerances and 

calibration. Paul explained how the classical approach to 

gradient system design that required zero field (and 

therefore zero eddy currents) outside of the coils has 

been replaced by a more efficient approach which seeks 

to minimise the effect of the eddy currents on the 

imaging volume. 

SUMMARY 

Professor Wilkinson closed the session with a brief 

summary of the proceedings and the take-home 

message that the design of gradient systems is a tradeoff 

between performance and the unwanted effects 

resulting from large, rapidly switching gradient fields. It 

is a balancing act that is important to all scientists 

involved in MRI. n 



ADVANCED CLINICAL MR IN ONCOLOGY: 

TECHNIQUES FOR TREATMENT PLANNING 

SARAH BACON AND DANIEL WILSON St James’s Institute of Oncology, Leeds 

LEEDS METROPOLITAN UNIVERSITY 19th July 2011 

THIS MEETING, ORGANISED BY the Magnetic 

Resonance Special Interest Group, aimed to provide 

medical physicists with an overview of the latest 

research and developments involving MRI for 

treatment planning and response assessment in 

oncology applications. The meeting attracted just over 

70 attendees. 

OPENING SESSION 

The meeting was opened with a quick introduction by 

Daniel Wilson (Leeds Teaching Hospitals), who also 

chaired the first session. John Brunt (Clatterbridge 

Centre for Oncology, Wirral) was invited to give an 

overview of the use of MR in radiotherapy treatment 

planning (RTP) covering the benefits that MR has over 

CT as well as some of the problems and issues that 

arise. MR has the potential to be used in many areas of 

RTP and is currently primarily used by co-registering 

MR images with CT planning images. The first of the 

proffered papers of that session was by Keith 

Langmack (Nottingham University Hospitals) who 

followed on from the previous talk by showing 

various solutions that his centre have come up with to 

facilitate the use of MR in RTP. These include flat 

couch tops, scanning patients in the treatment position 

and the use of cardiac coils for head and neck imaging 

of patients in their treatment shells. Sophie Riches 

(Royal Marsden Hospital, London) gave the next 

paper on functional MR (fMRI) methods for RTP in 

the prostate. The functional MR methods include 

diffusion-weighted (DW) MRI, dynamic contrast 

enhanced (DCE) MRI and 3D-MR spectroscopic 

imaging (MRSI). These methods can work well in 

identifying prostate cancer but there are some issues 

associated with the use of hormone therapy in 

prostate cancer patients that can cause degradation of 

the functional MR results and shrinkage of the 

prostate. 

THE IMPORTANCE OF SETUP 

Scott Hanvey (Beatson West of Scotland Cancer 

Centre, Glasgow) presented work on the importance 

of setting up prostate patients in the treatment 

position for a planning MRI scan. They found that 

registering CT with MRI significantly reduced the 

target volume and the registration was of higher 

quality for patients who were scanned in the 

treatment position. The last talk of the session was 

given by Joshua Mason (Leeds Teaching Hospitals), 

who presented results of a feasibility study on using 

MRI to guide prostate high dose rate brachytherapy 

boost. He found that it was possible to identify boost 

volumes using T2-weighted (T2W), DW and DCE 

MRI, although there are issues associated with 

registration and the effects of hormone therapy. 

The second session of the day, after a coffee break, 

was chaired by Gary Liney (Queen’s Centre for 

Oncology, Castle Hill Hospital, Hull) and started with 

an invited talk by Laura Mancini (University College 

London Institute of Neurology) on using fMRI for 

surgical planning of brain tumours. Particular 

applications include avoiding critical functional 

structures within the brain which are identified using 

fMRI. This technique is based on the change in 

oxygenation of the blood in activated brain areas. 

Geoff Charles-Edwards and Marium Naeem (Guy’s 

and St Thomas’ NHS Foundation Trust, London) 

presented Robert Johnstone’s talk on commissioning 

MRI for high dose rate brachytherapy planning. They 

covered multiple aspects of this process including 

checking that the applicator did not result in excessive 

heating during the MRI scan, choice of T2W MRI 

protocol and measurement of MRI distortions due to 

the applicator. 

David Manton (Yorkshire Cancer Research Centre 

for MRI Investigations, Hull) presented work on 

improving metabolite ratio mapping in MRSI to 

improve its use in RTP. Different methods for 

improving the accuracy of the metabolite ratios were 

presented. Jill McKenna (Northern Centre for Cancer 

Care, Newcastle upon Tyne) described work 

performed to streamline the treatment of patients who 

require radiotherapy for the treatment of metastatic 

spinal cord compression. The initial work looks 

promising if a dedicated diagnostic and radiotherapy 

planning MR study can be performed. This may 

remove the need for an additional planning CT in 

those patients. Before the lunch break, Ruhenna 

Mendes (University College, London) gave the final 

paper of the session on the role of co-registration in 

target definition in head and neck cancers. MRI offers 

some distinct advantages over CT for RTP, including 

superior tumour delineation and better identification 

of organs at risk. MRI must currently be co-registered 

with CT and this requires particular attention to be 

paid to identical patient setup for good rigid body 

image registration results. Improvements in non-rigid 

body image registration may lead to larger setup 

variations being tolerated. 

AFTERNOON SESSION 

The first session of the afternoon was chaired by 

David Buckley (University of Leeds) and the talks had 

more emphasis on treatment response. Ferdia 

Gallagher (University of Cambridge) gave an invited 

talk on monitoring response with MRI. He focussed on 

current techniques such as DW and DCE-MRI and 

then gave an overview of work involving 

hyperpolarised 13 C which has several promising 

applications in the field of response assessment. The 



first proffered paper of this session was given by 

Jonathan Sykes (Leeds Teaching Hospitals), who 

talked about an ongoing study looking at target 

definition and treatment response assessment in head 

and neck cancer. Problems and proposed solutions to 

imaging in the treatment position and registering 

images with those obtained in a diagnostic nontreatment 

position were highlighted and discussed. 

Maria Schmidt (Royal Marsden Hospital, London) 

kept to the theme of head and neck cancer showing 

some results of work done using functional MRI (DW 

and DCE-MRI) for RTP and response assessment. 

Utilising surface coils positioned laterally to the 

treatment shell enabled sufficient signal-to-noise to 

acquire both anatomical and functional MRI images in 

the treatment position. 

The final paper of the session was given by Hazel 

McCallum (Newcastle upon Tyne Hospitals NHS 

Foundation Trust) on assessing tumour response in 

external beam radiotherapy of the cervix using MRI 

and the possibility of utilising this modality for 

adaptive radiotherapy. MRI scans were acquired 

before treatment and 4 weeks into treatment, and 

changes in the gross tumour volume and changes in 

organ at risk volumes were measured. 

THE END OF THE DAY 

Geoff Charles-Edwards chaired the final session of the 

day. To start, David Buckley gave an invited talk on 

different models used to extract physiological 

parameters from DCE-MRI data. Following this, 

Stephanie Donaldson (The Christie Hospital, 

Manchester) spoke about the prognostic value for 

disease-free survival of different tracer kinetic 

parameters extracted from rapid DCE-MRI scans of 

cervical cancer patients. Patients with tumours with 

higher values of pre-treatment parameters relating to 

perfusion and permeability had better disease-free 

survival than those with lower values. Chris Rose 

(University of Manchester Biomedical Imaging 

Institute) discussed the use of a number of DCE-MRI 

biomarkers to predict the tumour shrinkage of 

colorectal liver metastases in ten patients in response to 

drug therapy. His team showed that post-treatment 

tumour volume can be predicted by pre-treatment 

imaging data and they hypothesise that tumour 

response is related to drug penetration and 

accumulation. The day finished with a paper from 

Simon Walker-Samuel (University College London) 

who presented work about an interesting novel 

technique called chemical exchange saturation transfer 

(CEST), which had been used to detect the 

accumulation of exogenously administered glucose by 

tumours in mice. 

Overall this proved to be an enjoyable meeting with 

a good mixture of applied and basic science talks, 

providing an opportunity for physicists and researchers 

to exchange ideas and present new results. n 

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INTERNATIONAL NEWS | SCOPE 

MEETINGS 2012 

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 

SSASRO 16th Annual Meeting 

Winterthur, Switzerland 

19th–21st April 

http://www.sasro.ch/2012/ 

First International Conference on Radiation 

and Dosimetry in Various Fields of Research 

(RAD 2012) 

Niš, Serbia 

25th–27th April 

www.rad2012.elfak.rs 

ESTRO 31 

Barcelona, Spain 

9th–13th May 

http://www.estro-events.org/Pages/ESTRO31.aspx 

World Congress of Brachytherapy 

Barcelona, Spain 


http://www.estro-events.org/Pages/WCB2012.aspx 

13th Congress of the International Radiation 

Protection Association (IRPA) 

Glasgow, UK 


http://www.irpa13glasgow.com/ 

5th Chaotic Modelling and Simulation 

International Conference (CHAOS2012) 

Athens, Greece 

12th–15th June 

13th International Symposium on Biological 

and Environmental Reference Materials 

(BERM 13) 

Vienna, Austria 


www.IAEA.org/meetings 

Computer Assisted Radiology and Surgery 

(CARS 2012) 

Pisa, Italy 


26th International Congress and Exhibition; Joint 

Congress of CAR / ISCAS / CAD / CMI / EuroPACS 

http://www.cars-int.org/ 

16th Conference on Medical Image 

Understanding and Analysis 

Appropriate Healthcare Technologies for 

Developing Countries (AHT2012) 

Swansea, UK 

9th–11th July 

London, UK 

18th–19th September 

http://miua2012.swansea.ac.uk/ 

7th International Conference – World Health and 

Wellbeing 

Call for papers deadline 28th March 

www.theiet.org/aht2012 

NORTH AMERICAN MEETINGS 

Clinical Proton Therapy Physics Conference 

with Emphasis on Spot Scanning Beams 

State of the Art Techniques: IMRT, IGRT and 

SBRT by ASTRO 

Society of Nuclear Medicine 2012 Annual 

Meeting 

Houston, TX 

26th–28th April 

Las Vegas, NV 

4th–6th May 

Miami, FL 


www.mdanderson.org/conferences 

https://www.astro.org/Meetings-and-Events/2012- 

IMRT-IGRT-SBRT-Meeting/index.aspx 

http://interactive.snm.org/index.cfmPageID=5933 

▼ 


SCOPE | INTERNATIONAL/MEMBERS’ NEWS 

▼ 



NORTH AMERICAN MEETINGS CONTINUED 

Workshop on Biomedical Image Registration (WBIR 

2012) 

11th International Workshop on Breast Imaging 

(IWDM 2012) 

Nashville, TN 


Philadelphia, PA 


http://wbir2012.org/ 

Formerly called International Workshop on Digital 

Mammography 

http://www.iwdm2012.org/tiki-index.php 

AAPM 54th Annual Meeting 

Charlotte, NC 

29th July–2nd August 

http://www.aapm.org/meetings/ 

NEW MEMBERS 2011 

Full name Job title Organisation Town 

Katie Howells Trainee Clinical Engineer Cardiff and Vale University Health Board Cardiff 

Ahmad Taufek Abdul Rahman Lecturer / Researcher Universiti Teknologi MARA Malaysia Kuala Pilah 

James Hollington Bioengineer NHS Lothian Edinburgh 

Victoria Michelle Tunbridge Trainee Clinical Scientist Abertawe Bro Morgannwg University Health Board Swansea 

James Gould Trainee Clinical Scientist The Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne 

Alexandra Backshall Trainee Dosimetrist The Royal Marsden NHS Foundation Trust London 

Stephanie Karis Trainee Dosimetrist The Royal Marsden NHS Foundation Trust London 

James Dominic Cauwood Health Science Practitioner Guy's and St Thomas' NHS Foundation Trust London 

Louisa Rose Hill Trainee Medical Physicist Cardiff and Vale University Health Board Cardiff 

Gareth William Jones Trainee Medical Physicist Cardiff and Vale University Health Board Cardiff 

Rada Zotova Radiotherapy Physicist in Clinical Trials Mount Vernon Hospital Northwood 

Rick Houghton Clinical Scientist Nuffield Orthopaedic Centre NHS Trust Oxford 

James Smyth Renal Technical Services Manager Southern Health and Social Care Trust Newry 

Martyn Farmer Chief Technologist Northampton General Hospital NHS Trust Northampton 

Christian French Radiotherapy Physicist University Hospitals Bristol NHS FT Bristol 

Helen Nelson Clinical Scientist King's College Hospital NHS FT London 

Anisha Patel Clinical Scientist Royal Wolverhampton Hospitals NHS Trust Wolverhampton 

Geraldine Revill Clinical Scientist Nottingham University Hospitals NHS Trust Nottingham 

Lorna Harper Clinical Scientist NHS Greater Glasgow and Clyde Glasgow 

James Blake Medical Physicist The Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne 

Christopher Hasler Radiotherapy Physicist Taunton and Somerset NHS FT Taunton 

Adele Stopforth Clinical Scientist Velindre NHS Trust Cardiff 

David Morgan Clinical Scientist The Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne 

Neil Robinson Radiotherapy Physicist Portsmouth Hospitals NHS Trust Portsmouth 

Mark Osborne Clinical Scientist Maidstone and Tunbridge Wells NHS Trust Maidstone 

Ian Claydon Radiotherapy Physicist Imperial College Healthcare NHS Trust London 

Joan Fitzpatrick Senior Clinical Physicist Harley Street Clinic London 

Nicholas Everdell Senior Research Associate University College London London 

Rhodri Lyn Smith Senior Nuclear Medicine Physicist The Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne 

Paul Schleyer Medical Physicist King's College Hospital NHS FT London 


INTERNATIONAL/MEMBERS’ NEWS | SCOPE 


REST OFTHE WORLD 


ISMRM (International Society for Magnetic Resonance 

in Medicine) 20th Scientific Annual Meeting 

51st Annual Meeting of the Particle Therapy Co- 

Operative Group (PTCOG 51) 

2012 World Congress on Medical Physics and 

Biomedical Engineering (WC2012) 

Melbourne, Australia 


Seoul, Korea 


Beijing, China 

26th–31st May 

http://www.ismrm.org/ 

http://www.ptcog51.com/welcome/welcome.asps 

Menu=wel 

www.wc2012.org 

Qualifications 

New member 

or transfer 

Category Date elected 

BEng Medical Engineering, Cardiff Transfer Associate 25 Oct 2011 

BSc (Hons) Physics & Mathematics, Kuala Pilah / MSc Health Physics, Kuala Pilah / PhD Medical Physics, Surrey Transfer Associate 25 Oct 2011 

BEng Mechanical Engineering, Newcastle / MSc Assistive Technology, London New member Associate 26 Oct 2011 

MPhys (Hons) Physics with Astrophysics and Cosmology, Lancaster / MSc Medical Radiation Physics, Swansea / PhD Physics, Bath New member Associate 26 Oct 2011 

MEng Mechanical Engineering, Birmingham New member Associate 26 Oct 2011 

BSc (Hons) Biochemistry, London / MRes Biomedical Research, London / PhD Biochemistry, London New member Associate 26 Oct 2011 

BSc Therapeutic Radiography, London New member Associate 26 Oct 2011 

BA (Hons, Cantab) Natural Sciences (Biochemistry) / MSci (Hons, Cantab) Natural Sciences (Biochemistry) / PhD Genetics, London New member Associate 26 Oct 2011 

BSc Physics with Medical Physics, Cardiff Transfer Associate 27 Oct 2011 

MPhys Physics with Astrophysics, Cardiff / PhD Physics with Astrophysics, Cardiff Transfer Associate 27 Oct 2011 

BSc Physics, Sofia / MSc Medical Physics, Sofia New member Corporate 4 Nov 2011 

BSc Engineering, Oxford New member Corporate 4 Nov 2011 

BSc (Hons) Clinical Physiology, Ulster New member Associate 11 Nov 2011 

MSci Medical Radiation Science, Sydney New member Associate 11 Nov 2011 

Transfer Corporate 10 Nov 2011 

MEng Medical Engineering, Cardiff Transfer Corporate 10 Nov 2011 

BSc (Hons) Physics, Swansea / MSc Medical & Radiation Physics, Birmingham Transfer Corporate 10 Nov 2011 


BSc Mathematics and Computer Science, Glasgow Transfer Corporate 10 Nov 2011 

BSc (Hons) Physics, York Transfer Corporate 10 Nov 2011 

BSc Applied Physics, Bath / MSc Radiation Physics and Medical Physics, London Transfer Corporate 10 Nov 2011 

MSci Physics, Nottingham Transfer Corporate 10 Nov 2011 


MSc Radiation Physics, London Transfer Corporate 10 Nov 2011 

MPhys Physics, Oxford / MSc Medical Physics, Surrey / PhD Physics, Cambridge Transfer Corporate 10 Nov 2011 

MSc Radiation Physics, London Transfer Corporate 10 Nov 2011 

MSc Medical Physics, Surrey Transfer Corporate 10 Nov 2011 

MA Engineering, Cambridge / MSc Biomedical Engineering, Surrey / PhD Bioengineering, London New member Corporate 10 Nov 2011 

BSc Physics with Medical Physics, Cardiff / MSc Medical Radiation Physics, Cardiff New member Corporate 14 Nov 2011 

BEng (Hons) Computer Science, Melbourne / MEng Electrical & Electronic Engineering, Melbourne New member Corporate 2 Dec 2011 


SCOPE | BOOK REVIEWS 

Welcome to this 

year’s first issue 

of Scope and a 

happy belated 

New Year! 

Thanks to all 

who contributed 

to reviews in 2011. I present you with six 

book reviews, three from each of the 

medical physics and popular science 

genres. 

Malcolm Sperrin has provided us with 

four book reviews: Practical MR Physics, 

Basic Health Physics, Science 1001 and 

How to Destroy the Universe. Angela 

Newing has supplied two reviews: 

Physics for Diagnostic Radiology and 

Sustainable Materials. 

There are a number of new books in 

the ‘Just Published!’ section, covering the 

various medical physics modalities. You 

will also find some interesting reports 

listed in the ‘New Reports’ section, such as 

the IPEM Report 106 (radiation protection 

issues with I-125 prostate implants) and 

the IAEA Standards, Applications and QA 

in Medical Radiation Dosimetry (Volume 

I). The latter Proceedings Series can be 

freely downloaded (~10 MB) directly from 

the IAEA website ( under ‘Publications’). 

For any readers interested in reviewing 

listed / unlisted books or even any of the 

new reports, then please do get in touch 

with me and I will get the publisher to 

send you the required material. You may 

also want to join our online workspace on 

Ubidesk, where you will find a list of all 

currently available books. 

Just so that our Scope readers are kept 

up-to-date regarding this section, some 

statistics on the reviewing work (based on 

the past 2 years) are shown in table 1. 

We would like to increase the number 

of reviewer submissions from an average 

of 5* to 8** reviews per quarter, so please 

do join the IPEM Scope book reviewing 

TABLE 1 

team. It sure will be one great way to 

build those CPD points! 

Special request! The ‘New Reports’ 

section contains a mixture of reports from 

various modalities. It would prove very 

useful to include more reports from 

modalities other than ionising radiation to 

balance the section. If you are aware of 

any relevant sources, I would be very keen 

to hear from you! 

Usman I. Lula (Usman.Lula@Poole.nhs.uk) 

Practical MR Physics 

It is worth saying from the outset that this 

book is well worth buying if you have any 

involvement with MRI but especially if you 

spend time teaching. The first chapter on 

basic MRI physics is probably too basic for 

medical physicists but the subsequent 

chapters are extremely useful. 

Chapter 2 concentrates on MR artefacts 

and not only are there a lot of them, but they 

are explained in a comprehensive, rigorous 

and clinically relevant manner. I have 

always found that an understanding of the 

origin of MR artefacts goes hand-in-hand 

with an understanding of the processes 

behind MR imaging and this is very well 

achieved with some of the more exotic 

artefacts being discussed. 

Chapter 3 presents pitfalls of MRI which 

is something I have not seen presented in 

Information Statistics Projected (2012 end) 

Total number of Ubidesk reviewers 30 35+ 

Number of active reviewers 10 15+ 

Total number of reviews submitted 41 65+ (running total) 

Genre split (medical physics : popular science) [3 : 2]* [4 : 4]** 

Lead time (book requests for review) 3–5 weeks 2–3 weeks 

this manner elsewhere. This is slightly more 

appropriate for the clinician where the 

appearance of features in an image can be 

seen to confound a definitive diagnosis but 

the physicist will also gain a lot from this 

since the relevance of TR, TE etc. are 

discussed in some depth. 

Chapter 4 is a presentation of ‘tests’ 

which is the icing on the cake for those who 

have carefully studied the previous 

chapters! 

This text is very highly recommended. 

Professor Malcolm Sperrin, Director of 

Medical Physics and Clinical Engineering at 

the Royal Berkshire Hospital NHS Trust, 

Reading 

PRACTICAL MR PHYSICS 

ALEXANDER C. MAMOURIAN 

Publisher: Oxford University Press 

ISBN: 978-0-19-537281-6 

Pages: 314 

“ 

” 

Chapter 3 presents 

pitfalls of MRI which is 

something I have not seen 

presented in this manner 

elsewhere 

Basic Health 

Physics: Problems 

and Solutions 

This is an immensely valuable book, both 

as a practical guide and also as a 

reference text. It is very useful to have a 

broad range of concepts covered in a 

rigorous scientific manner. One limitation 

is that the book is American in origin and 

as such uses slightly unfamiliar units 

such as the ‘erg’, but that aside, the 

discussion of the guidance and 

legislation from bodies like the ICRP are 

directly relevant to a generic scientific 

approach. 

Use of the word ‘basic’ in the title is a 

misnomer in that a significant proportion 

of the material is complex and advanced, 

but the title does infer that the reader 


BOOK REVIEWS | SCOPE 

rapidly proceeds from basic concepts to 

rigorous applications and this is certainly 

achieved. 

Any text that includes non-ionising 

radiation with ionising radiation runs the 

risk of trying to be all things to all people, 

but in this case the analysis of many 

disciplines is one of this book’s strengths in 

that it discusses a generic application to 

health physics and its management in 

numerous applications. 

A further aspect of this book is that it 

provides an ideal opportunity for trainees to 

develop their knowledge and this is 

enhanced by the liberal sprinkling of 

worked examples and testing questions. 

Furthermore, the use of references is 

rigorous and valuable in its own right. 

Finally the appendices are very helpful 

including subjects such as a mathematical 

review, data for gamma dose calculations 

and electromagnetic relationships. 

Overall, this text is very highly 

recommended. 





BASIC HEALTH PHYSICS: PROBLEMS AND 

SOLUTIONS (SECOND EDITION) 

JOSEPH JOHN BEVELACQUA 

Publisher: Wiley-VCH 

ISBN:978-3-527-40823-8 

Pages: 768 

to the minute in every respect. 

There is new material on PET and 

PET/CT, and revised information about 

doses to patients and the general public. 

Digital receptors and the differences 

between analogue and digital images are 

covered as well as image networking and 

PACS. Having recently had my wrist x- 

rayed, I have seen the advantages for a 

consultant of bringing up an image at the 

press of a computer key instead of putting 

a hard copy on a viewing box, although 

there is some lack of detail as a result. But 

the new chapter on digital storage and 

imaging will help readers to understand 

the problems of digital image quality. 

Perhaps a new generation of physicists 

may devise further improvements. 

The original purpose of this book was 

to instruct trainee radiologists. The 

questions at the end of each chapter are 

designed with the FRCR in mind, but a 

generation of trainee physicists has also 

found these to be an invaluable aid. I 

highly recommend this new edition to 

both of these groups. 

Professor Angela Newing, Gloucestershire 

NHS Foundation Trust (retired) 

PHYSICS FOR DIAGNOSTIC RADIOLOGY (THIRD 

EDITION) 

P.P. DENDY AND B. HEATON 

Publisher: CRC Press (Taylor & Francis) 

ISBN: 478-1-4200-8315-6 

Pages: 670 + index (25pp.) 

Popular Science 

starlight is a discussion on how energy from 

the sun is harnessed and used, and how to 

survive an earthquake discusses wave 

propagation and fracture mechanics. 

Whilst questioning the applicability of 

this book to the medical physics community, 

it never does any harm to review the 

broader applications of our core science 

training. 

I would have liked to have seen a less 

trendy title but having said that, I struggle 

to think of one that fits the nature of this 

book. 

This text is another one for the staff room 

or for someone with a scientific interest who 

may like a challenging read. 





HOW TO DESTROY THE UNIVERSE 

PAUL PARSONS 

Publisher: Quercus Publishing Plc 

ISBN: 978-1-84916-479-5 

Pages: 224 

“ 

The chapter on how to 

harness starlight is a 

discussion on how energy 

from the sun is harnessed 

and used 

” 

Physics for 

Diagnostic Radiology 

This textbook has now reached its third 

edition, indicating how useful and popular 

it has proved to be. Since its first edition in 

1987 and its second in 1999, radiology and 

imaging generally have continued to 

advance rapidly. This new edition has 

extra input provided by nine scientists 

active in the field of radiological physics as 

well as the two original authors. All of the 

chapters have been revised and updated. 

Some of the early ones might have 

benefitted from the addition of more upto-date 

references and book lists for 

further reading, but later chapters are up 

How to Destroy the 

Universe 

I am not really a major fan of ‘popular 

science’ books since they rarely achieve 

their stated aim of providing a digestible 

explanation of complex concepts. However, 

with that reservation in mind, I opened this 

book and was pleasantly surprised. For 

those who remember the traditional 

teaching of physics and other pure 

sciences, this book describes many of the 

applications of physics that often provided 

the illustrations for difficult concepts. So, 

for instance, the chapter on how to harness 

Science 1001 

The sub-title (Absolutely Everything You 

Need to Know About Science in 1001 Bitesized 

Explanations) may be a little 

ambitious but the content is a step-up 

from the familiar popular science titles 

that have become so familiar. The book 

reads as would an encyclopaedia but is far 

more digestible, providing considerable 

insight into concepts which often demand 

explanation. The book seems to bridge the 

gap for the novice reader between 

accurate explanations and accessible 

science across a variety of disciplines 

including physics, chemistry, earth science 

and many others. 

▼ 


SCOPE | BOOK REVIEWS 

▼ 

From the point of view of medical 

physics, there is relatively little directly 

relevant material but it is an interesting 

read nevertheless and I found it helpful to 

revisit some of the core science which I 

learnt many years ago. It is also an 

interesting exercise to challenge myself to 

see if I can recount some of the science 

prior to reading the text! 

I would suggest that this book is a 

useful addition to a library intended for 

trainees or for those who are considering 

scientific careers. I have also found that 

such texts inspire coffee-room discussions, 

thereby keeping less used parts of the 

brain active. 





SCIENCE 1001 

PAUL PARSONS 

Publisher: Quercus Publishing 

ISBN:978-1-84866-062-5 

Pages: 415 

“ 

I have also found that 

such texts inspire coffeeroom 

discussions, thereby 

keeping less used parts of 

the brain active 

” 

scraps. This is just one of the 

demonstrations of material efficiency in 

this comprehensive volume. 

The book’s authors are Julian Allwood, 

who leads the low carbon materials 

processing research group at Cambridge 

University, and Jonathan Cullen, a 

research associate in the same group. Six 

current PhD students in the group have 

also contributed, and the result is 374 

pages packed with well-written and 

lavishly illustrated material. 

In the UK and other developed parts of 

Europe, America, Japan and China, the 

annual consumption of materials is four 

times the global average. The book sets 

out to describe how wastefully we use 

minerals, metals, crops and all sorts of 

other things, and how we might do better 

in the future. The present generation has a 

comfortable and high-quality life at the 

expense of a rapidly deteriorating 

environment. Most of us are aware of this 

but are doing little to improve the 

situation for the future. 

A number of possible ways to change 

things for the better are suggested. For 

instance, if the contact surfaces of rails 

were made thicker, they would need less 

frequent replacement. A more radical 

solution would be to cast rails whose 

sections were in the form of a cross and set 

them in concrete beds instead of using 

sleepers. These could be quarter-turned 

three times when the contact surface 

became worn. 

I have always thought of myself as 

being ecologically ‘green’, using rainwater 

where possible and with solar-powered 

water heating and photovoltaic electricity 

generation. The authors like these energysaving 

features but favour the widespread 

use of nuclear power in the future for 

carbon-free universal energy. 

I recommend this book both as a good 

read and for the thought-provoking ideas 

it presents. 

and Australia, after more than 10 years of 

studies on radiation damage in 

biomolecular systems. 

Springer Handbook of Medical 

Technology by Klaus-Peter Hoffmann, 

Rudiger Kramme and Robert Steven Pozos 

(Springer Verlag) is a reference text offering 

a broad introduction to the world of 

medical technology in a simple and 

condensed form. 

Medical Equipment Management by 

Keith Wilson, Keith Ison and Slavik Tabakov 

(Taylor & Francis) offers an insight into the 

problems and challenges of managing 

medical equipment within a healthcare 

system. It details the equipment 

management process, need, funding, 

procurement, acceptance testing, 

maintenance, risk assessment and much 

more besides. 

Biohybrid Systems by Ranu Jung (Wiley- 

VCH) covers the principles of 

neuroscience to in vivo use and is 

accessible for engineers and physicists 

alike. It aims to bridge neural and 

electronic systems. 

Nucleus, 2nd Edition by Ray Mackintosh, 

Jim Al-Khalili, Bjorn Jonson and Teresa Pena 

(John Hopkins University Press) tells the 

story of the nucleus from the early 

experimental work of the quiet New 

Zealander Lord Rutherford to the huge 

atom-smashing machines of today and 

beyond. 

The Fundamentals of Imaging by Michael 

Mark Woolfson (Imperial College Press) 

discusses the wave phenomena covering 

the entire electromagnetic spectrum and 

ultrasound, and devices that vary from 

those that just detect the presence of 

objects to those that image objects in 

exquisite detail. 

Sustainable 

Materials: With Both 

Eyes Open 

I received this book for review in mid 

December and was pleased to find that the 

subject of Christmas is even included! If 

one uses a hexagonal cutter for the pastry 

for mince pies, waste is minimised. 

Hexagons tessellate; that is to say, they 

abut one another in a continuous pattern. 

The same sized sheet of pastry can make 

20 per cent more mince pies using 

hexagons rather than rounds without also 

wasting time and energy rolling out 

48 | MARCH 2012 | SCOPE 

Professor Angela Newing, Gloucestershire 

NHS Foundation Trust (retired) 

SUSTAINABLE MATERIALS: WITH BOTH EYES 

OPEN 

JULIAN ALLWOOD AND JONATHAN CULLEN 

Publisher: UIT Cambridge Ltd 

ISBN: 99781906860059 

Pages: 374 (paperback) 

Just Published! 

Radiation Damage in Biomolecular 

Systems by Gustavo Garcia Gomez-Tejedor 

and Martina Christina Fuss (Springer 

Verlag) summarises the advances 

achieved by multiple research groups 

from European countries, Canada, USA 

Proton Therapy Physics by Harald 

Paganetti (Taylor & Francis) goes beyond 

current books on proton therapy to 

provide an in-depth overview of the 

physics aspects of this modality. It totals 

contributions from 76 experts from around 

the world. 

“ 

The authors like 

these energy-saving 

features but favour the 

widespread use of nuclear 

power in the future 

”

BOOK REVIEWS | SCOPE 

Medical Radiological Physics I by Alexander 

Kaul (Springer Verlag) is intended to provide 

the scientific basis of diagnostics and 

therapy in medical radiology. This volume 

reviews radiation, biological effects, 

dosimetry, nuclear medical diagnostics and 

radiation protection. 

Biomedical Signals and Sensors I by 

Eugenijus Kaniusas (Springer Verlag) focuses 

on the interface between physiological 

mechanisms and diagnostic human 

engineering. This first volume is devoted to 

the interface between physiological 

mechanisms and arising biosignals. 

Acoustical Imaging: Volume 31 by Andrzej 

Nowicki, Jerzy Litniewski and Tamara Kujawska 

(Springer Verlag) is an excellent collection of 

papers presented at the International 

Symposium on Acoustical Imaging. 

The Essential Physics of Medical Imaging 

by Jerrold T. Bushberg, John M. Boone, Edwin 

M. Leidholdt and J. Anthony Seibert (Lippincott 

Williams & Wilkins) is a work that is derived 

from the authors’ acclaimed national review 

course (‘Physics of medical imaging’) at the 

University of California-Davis, USA, for 

radiology residents. 

New Reports 

n Quantification and Reporting of Low- 

Dose and Other Heterogeneous 

Exposures: ICRU Report 86. Journal of 

the ICRU (OUP Publishing) 2011; 

Volume 11, No. 2. 

n UK Guidance on Radiation Protection 

Issues following Permanent Iodine 

Seed Prostate Brachytherapy. IPEM 

Report 106; 2012. 

n Size-Specific Dose Estimates (SSDE) in 

Pediatric and Adult Body CT 

Examinations. AAPM Report 204; 

2011. 

n Standards, Applications and Quality 

Assurance in Medical Radiation 

Dosimetry (IDOS). 2010 Proceedings 

Series (Volume 1 of 2). IAEA, 2011. 

n Status of Computed Tomography 

Dosimetry for Wide Cone Beam 

Scanners. IAEA Human Health 

Reports, STI/PUB/1528; 2011. 

n Radiation Risks from Medical X-ray 

Examinations as a Function of the Age 

and Sex of the Patient. HPA-CRCE- 

028; 2011. 

n Review of Methodologies to 

Calculate A1 and A2 Values, and 

Exemption Values. HPA-CRCE-027; 

2011. 

n Systems and Software Engineering – 

Contents of Life-cycle Information 

Products (Documentation). 

ISO/IEC/IEEE 15289 ed1.0, IEC; 

2011. 

n Medical Electrical Equipment: 

Particular Requirements for the Basic 

Safety and Essential Performance of 

Electrocardiographs. IEC 60601-2-25 

ed2.0, IEC; 2011. 

n Medical Electrical Equipment: 

Particular Requirements for the Basic 

Safety and Essential Performance of 

Respiratory Gas Monitors. IEC 80601- 

2-55 ed1.0, IEC; 2011. 

n Radiotherapy Equipment – 

Coordinates, Movements and Scales. 

IEC 61217 ed2.0 (TC/SC 62C), IEC; 

2011. 

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A HISTORY OF MEDICAL PHYSICS 

MEDICAL PHYSICS IN NINETEENTH-CENTURY LONDON 

FRANCIS DUCK has the fifth instalment in his series on the history of medical physics 

On 16th October 1834, 

the old Houses of 

Parliament went up in 

flames. The fire 

resulted from an 

overheated stove, filled 

with tinder-dry elm tally-sticks, 

relics from an obsolete exchequer 

accounting system. A letter in that 

week’s Lancet recounted the rescue 

of papers from the Select Committee 

on Medical Education, by throwing 

them from the window of 

Committee Room 15, wrapped in 

green curtains. 

What has this event to do with 

medical physics In due course the 

Houses of Parliament were rebuilt as 

we know them today. Medical 

training was also reconstructed, 

though this took much longer. The 

testimony to the Select Committee, 

including that of Neil Arnott, 1 

resulted in changed approaches to 

medical education in Britain, and 

these, slowly, would add physics as 

a necessary core subject. This article 

tells the story of the impact of these 

changes in hospitals and medical 

FIGURE 1. 

Faraday’s 

laboratory at the 

Royal Institution 

(frontispiece 

from Bence 

Jones, The Life 

and Letters of 

Faraday, Volume 

II, 1870). 

▼ 

TABLE 1. 

Dates at which 

natural 

philosophy / 

physics courses 

started at London 

medical schools. 

(from Lancet 

annual reports). 

▼ 

schools in London through the lives 

and contributions of several key 

scientists and doctors. 

ST BARTHOLOMEW’S 

HOSPITAL 

By the end of the eighteenth century, 

lectures in natural philosophy were 

already available as an option to 

doctors who were training in 

London. By 1798, Charles 

Wilkinson, 2 a surgeon and lecturer 

in ‘Experimental philosophy’ at St 

Bartholomew’s Hospital, was giving 

a course of 25 lectures there and 

from his rooms near Leicester 

Square. The topics included skeletal 

mechanics; optics and the eye; 

fluids, acoustics and meteorology; 

electricity and magnetism, and 

astronomy. He was a pioneer in 

medical applications of electricity, 

publishing his experiences in his 

Elements of Galvanism (1804). He 

advertises his own apparatus thus: 

‘A battery consisting of fifty threeinch 

plates is of sufficient power for 

every medical purpose … Cost 5 

guineas’. 

By 1811, Wilkinson had left 

London to settle in Bath, where he 

took over and ran the thermal baths. 

Lectures in ‘Experimental 

philosophy’ lapsed, and another 20 

years would pass before the ideas by 

then being discussed by the 

governmental Select Committee 

would start to show effect. On 18th 

September 1834, the House 

Committee of St Bartholomew’s 

Hospital approved the appointment 

of Mr Thomas Griffiths, ‘an assistant 

of Professor Farraday (sic)‘ to be 

lecturer on natural philosophy, 

creating the post because the subject 

was ‘already taught in some other 

schools, especially those of recent 

origin’. A competitive market for 

medical students was developing, 

and each new medical school was 

looking over its shoulder to what 

others were doing. In reality, Bart’s 

was ahead of the game: annual 

reviews of medical courses published 

in the Lancet identify Bart’s as the 

first medical school in London to 

offer lectures in natural philosophy. 

Others quickly followed (table 1). 


HISTORICAL FEATURE | SCOPE 

THOMAS GRIFFITHS 

Thomas Griffiths’ life is not well 

documented, and the following brief 

biography has been drawn from a 

variety of sources. 

By the time Thomas Griffiths was 

born, in London, in about 1810, the 

Royal Institution (RI) in Albemarle 

Street had become its unchallenged 

centre for experimental chemistry and 

public awareness of science. Griffiths 

was drawn to this exciting new world 

of science while still very young. He 

later described how he had witnessed 

Faraday’s original demonstration of 

the liquefaction of chlorine in 1823. 3 By 

the time he was 14 he had been 

appointed by William Brande 

(1788–1866), Professor of Chemistry at 

the RI, as laboratory assistant under 

his and Faraday’s immediate direction 

(figure 1). 

Griffiths was involved with the RI 

just at the peak of Faraday’s career. 

This was when he initiated the 

programme of evening discourses and 

Christmas lectures. He published 

Chemical Manipulation, a book of 

detailed instructions on procedures 

and methods in a chemical laboratory. 

This was the only teaching text that 

Faraday ever wrote, and surely he 

must have had his young assistant in 

mind during its preparation. But of 

greatest importance, and during an 

intense period of investigation during 

the autumn of 1831, was Faraday’s 

discovery that endorsed his position as 

one of the greatest scientific 

discoverers of all time, electromagnetic 

induction 4 (figure 2). Griffiths was 

there throughout this period: in our 

modern age of big team science, it is 

difficult to appreciate the effect on the 

young Griffiths of this intimate 

association with such a dramatic 

scientific breakthrough. 

Before joining Bart’s in 1834, 

Griffiths made some minor scientific 

contributions on the alkalinity of glass 

and the boiling points of saturated 

salts. Two years later Griffiths was 

further appointed, jointly with his 

mentor Brande, as lecturer in 

chemistry. At this time Griffiths 

himself may have been more attracted 

towards physics, since he presented a 

course of 18 lectures called ‘Medical 

physics’ in the 1837 summer session 

(cost: 1 Guinea). But although he 

continued to give the natural 

philosophy course, his emphasis was 

certainly towards chemistry, and it 

was there that his work would 

subsequently develop. Now settled 

and with a good job, he married 

Martha Eliza Davis in December 1838. 

Griffiths lectured at Bart’s for over 

16 years, resigning in January 1851. 

During this time he gained a wider 

reputation as a lecturer in chemistry, 

giving courses as far afield as 

Liverpool and Edinburgh. Some 

lectures covered industrial chemistry, 

including the manufacture of soda 

water and materials used in 

construction. He published a number 

of popular books on chemistry, at least 

one also appearing in America. His 

Chemistry of the Four Ancient Elements 

(1842) was dedicated to the young 

Queen Victoria and ‘founded upon 

lectures delivered before her most 

gracious majesty’. 

In line with many at this time, 

Griffiths held a fundamental belief in 

Biblical truth, and saw the study of 

chemistry as one means to worship his 

Creator. This was a common and 

powerful motivation, but it could lead 

occasionally to the use of metaphors 

that now appear very strange. For 

example, looking for a numerical 

example equivalent to the tons of 

carbon dioxide in the atmosphere, he 

says ‘it vastly exceeds the number of 

seconds that have elapsed since the 

Creation’, which he gives as 5,287,305 

million. 5 But such flights of fancy are 

very rare in his writing. 

After leaving Bart’s he continued to 

give lectures, and revised several of his 

books. Otherwise there are very few 

records of his later life. It is possible 

that he intended to return to medical 

physics. In the 1851 census he declared 

his occupation to be Professor of 

Medical Physics, probably the first 

TABLE 1 

“‘It 

vastly 

exceeds 

the 

number of 

seconds 

that have 

elapsed 

since the 

Creation’ 

” 

time that such a title was used in an 

official entry in Britain. 

GUY’S HOSPITAL: GOLDING BIRD 

The significance of Faraday’s 

discovery of electromagnetic 

induction was rapidly understood by 

many ‘natural philosophers’. But 

Bart’s quite failed to capitalise on their 

appointment of Griffiths, who had 

been there at its birth. Meanwhile, 

south of the Thames, Benjamin 

Harrison, the autocratic treasurer of 

Guy’s Hospital, needed to compete for 

the best medical students and was 

willing to invest, especially in the 

‘collateral sciences’. The key lay, he 

decided, in the cutting edge new 

technology of Faradic electricity, 

combining scientific challenge with 

clinical potential. In 1836 he created a 

new post of lecturer in natural 

philosophy, and simultaneously he 

equipped the first hospital 

electromedical laboratory in Britain. 

The man he appointed as lecturer and 

to manage the ‘electrifying room’ was 

an outstanding young doctor, Golding 

Bird (figure 3). 

Golding Bird’s life (1814–1854) and 

work is well documented, 6 and will be 

described in outline only. He was born 

in Downham Market, Norfolk, on 8th 

December 1814, the son of an excise 

officer. Precociously talented, he was 

apprenticed to an apothecary in 

London when he was 15, and entered 

Guy’s as a medical student in 1832. By 

the time he entered the Apothecaries’ 

Hall examination in 1835, his personal 

reputation was so high that he was 

given a licence to practice without 

further examination. His lectureship 

Introduction of lectures in natural philosophy and physics to London medical schools 

Institution Start date First lecturer 

St Bartholomew’s Hospital 1834 Thomas Griffiths (approx. 1810–) 

Guy’s Hospital 1836 Golding Bird MD (1814–1854) 

Westminster Hospital 1841 Charles Brooke MD (1804–1879) 

Charing Cross Hospital 1841 Henry Watts (1815–1884) 

University College 1843 Richard Potter (1799–1889) 

St Mary’s Hospital 1855 Lindsay Blyth (1822–1858) 

King’s College 1870 William Adams (1836–1915) 

St Thomas’s Hospital 1871 William Stone MD (1830–1891) 

London (Royal Free) School of 

Medicine for Women 

1895 Edith Stoney (1869–1938) 

▼ 


SCOPE | HISTORICAL FEATURE 

▼ 


HISTORICAL FEATURE | SCOPE 

in natural philosophy at Guy’s 

followed immediately. For the next 2 

years he delivered a course, given on 

Mondays at 8.00 pm, called ‘Electricity, 

galvanism and other branches of 

natural philosophy applicable to 

medicine’. Other commitments then 

intervened, but he had time to 

complete the first edition of his 

Elements of Natural Philosophy, which 

would become the primary physics 

text for medical students for several 

decades. 7 In the introduction he cites 

several French and German physics 

texts, and refers to Arnott’s Elements of 

Physics 1 as ‘very elegant although as 

yet unfinished’. This was indeed true, 

and of particular importance to Bird, 

since Arnott did not add the section on 

electricity until his 6th edition, in 1864. 

By contrast, over one third of the 

sections in Bird’s book concern 

electricity and magnetism. 

Throughout, this is a thoroughly 

scientific text, with substantial crossreferencing 

to the contemporary 

scientific literature. Several later 

editions followed. In 1841 he again 

gave his course, which he now called 

‘Medical physics’. 

Bird was a workaholic. His 

scientific work included studies with 

electrolysis, chemical analysis of 

blood, milk and oxalates in urine, and 

photography. He described his own 

version of a flexible stethoscope. By 

1842, when he married Mary Ann 

Brett, his private practice was said to 

have been worth £2,000 per annum, a 

significantly large income at the time. 

The next year he was appointed 

Assistant Physician at Guy’s, and his 

colleague William Gull (1816–1890) 

took over the physics lectures. In 1844 

he became Fellow of the College of 

Physicians and finally FRS in 1846. 

ELECTROTHERAPY 

Throughout this whirlwind life, Bird 

developed and retained a critical 

interest in electrotherapy. During his 

time as a medical student he observed 

electrical treatments, then being 

applied unsystematically with older, 

static and voltaic machines. Bird made 

careful records of his clinical 

experience, documented in the Guy’s 

Hospital Reports. He initially 

expressed doubt that Faraday’s 

electromagnetic machine could give 

clinical benefit, but continued to 

gather clinical experience and improve 

the equipment. By 1836, only 5 years 

after Faraday’s original discovery, he 

constructed an electromagnetic 

machine of which he says ‘if the 

copper cylinders … be grasped with 

moistened hands, an almost 

insupportable shock will ensue on 

breaking connection with the battery’. 7 

A year later he described his own 

design of an electromagnetic circuit 

breaker, creating 400 pulses per 

minute, to replace the mechanical 

devices then in use. Over the next 

decade he continued his clinical 

evaluation of therapeutic electricity, 

and this culminated in a series of 

lectures at the Royal Society of 

Physicians in 1847, which he later 

published. 8 By this stage he had 

largely replaced batteries with 

electromagnetic machines, although 

he continued to use static machines as 

well. His equipment was supplied by 

William Neeves, 67 High Street, 

Holborn, an established instrumentmaker 

who also supplied Griffiths 

with his chemical glassware. Neeves 

had developed a more efficient and 

effective circuit-breaker (figure 4), 

which Bird found to have ‘the 

advantage of simplicity, facility of 

employment, quantity and intensity of 

the induced electricity, together with 

the additional recommendation of low 

price’. He identified indications and 

contra-indications, and reported 

success rates in paralysis (complete 

cure in 50 per cent of cases) and 

chorea, or involuntary muscular 

twitch (35/36 cured or relieved). He 

reports success in treating 

amenorrhoea with static shock. The 

numbers of patients in each group 

were not large, but the use of 

electricity and the outcomes were 

reported critically. Bird was also 

known for the so-called electrical 

moxa, a means of counter-irritation to 

combat pain, by creating blisters 

under zinc electrodes from the 

electrolytic formation of zinc chloride. 

These techniques, now seemingly 

crude and unsophisticated, formed the 

basis on which electrotherapy 

eventually evolved as an acceptable 

medical therapy. 

Throughout his life, Bird was 

afflicted by rheumatoid arthritis, 

finally resigning from Guy’s in August 

1853. He retired to Tunbridge Wells, 

where he died from cardiac 

complications on 27th October 1854. 

WESTMINSTER HOSPITAL: 

CHARLES BROOKE 

Of the ten lecturers listed in table 1, 

three were doctors – Bird, Brooke and 

Stone. These men were able to have an 

FIGURE 2. 

[TOP LEFT] 

Faraday’s first 

experiment in 

electromagnetic 

induction, 1831. 4 

▼ 

FIGURE 3. 

[TOP RIGHT] 

Golding Bird. By 

Alexander Craig 

(Wellcome 

Library, London). 

▼ 

FIGURE 4. 

[MIDDLE LEFT] 

Bird’s 

electromagnetic 

equipment for 

electrotherapy, 

1849. 

▼ 

FIGURE 5. 

[BOTTOM RIGHT] 

Charles Brooke 

(Wellcome 

Library, London). 

▼ 

FIGURE 6. 

[BOTTOM LEFT] 

The pelvis and leg 

of the Bengal 

Tiger. From 

Houghton’s 

Animal 

Mechanics. 10 

▼ 

impact in both medicine and 

science, difficult for those without 

medical qualification. Charles 

Brooke (1804–1879) (figure 5) was a 

Cambridge MD of considerable 

talent who continued his medical 

training at Bart’s. He became 

lecturer in natural philosophy at the 

Westminster Hospital Medical 

School in 1841 but, 2 years later, 

moved away from medicine to fill 

the vacant chair in natural 

philosophy at University College. 

This move was not a success, 

student power forcing his 

resignation before the end of the 

first term, following a petition from 

the senior mathematical class 

‘announcing their intention to 

withdraw… in consequence of his 

neglect of the higher parts of 

Analysis’. Nevertheless he 

continued his scientific activities, 

developing the self-recording 

meteorological instruments for 

which he is best remembered. His 

design allowed temporal variations 

of barometric pressure, magnetic 

field or temperature to be recorded 

photographically. George Airy, the 

Astronomer Royal, soon adopted 

the instruments for use at the Royal 

Observatory, Greenwich. Brooke 

was elected a Fellow of the Royal 

Society in 1847. During this period 

in his career he retained a strong 

interest in medical physics, and 

helped Golding Bird prepare the 4th 

edition of his Elements of Natural 

Philosophy during the last year of 

Bird’s life. Brooke later extended the 

work, publishing further editions in 

1860 and in 1867. By this time he 

had returned to the Westminster (in 

1852) to lecture in natural 

philosophy, remaining there until 

his death in 1879. 

ST THOMAS’S HOSPITAL: 

WILLIAM STONE 

Until 1860, there was no 

requirement for medical students to 

be examined in natural philosophy 

at London University, and it would 

be a couple more decades before the 

GMC made physics mandatory. 

Thus, the lectures of Griffiths, Bird, 

Brooke and others were optional, 

designed in part to enhance the 

reputation of the host institution. As 

a result, courses were not offered at 

all in several schools, and in others, 

including Bart’s, physics eventually 

merged with the chemistry course. 

The action of London University in 

▼ 


SCOPE | HISTORICAL FEATURE 

▼ 

1860 to make physics a mandatory 

examinable component of the 

preliminary MB did not necessarily 

improve matters. When William Stone 

(1830–1891) started his physics course 

at St Thomas’s Hospital in 1870, he was 

particularly critical of the neglect of 

applied physics teaching in medicine. 

Later, in 1887, he developed this topic 

in a lecture at the Royal College of 

Surgeons. 9 Noting that the London 

University examination paper in 

physics was the same for medical 

students as for the Bachelor of Science, 

he says that it ‘bristles with 

conundrums, set by pure physicists, 

who know nothing and probably care 

little for the problems which interest us 

as medical men’. By then, he could cite 

specialist texts in medical physics from 

other countries, particularly from 

France and the USA. The one British 

text to meet his standards was 

Haughton’s Animal Mechanics. 10 This is 

indeed a remarkable book on 

biomechanics, containing detailed 

analysis of musculo-skeletal 

movements and forces (figure 6). But it 

was hardly appropriate as a first-year 

teaching text. 

Stone, an Oxford graduate, was no 

stranger to controversy. In 1873, he had 

been severely criticised by both the 

Lancet and the British Medical Journal for 

giving medical advice freely in a 

medical column he wrote in the 

popular magazine English Mechanic and 

World of Science. Such an affront to the 

closed world of medical mystique and 

fees must be stopped at all costs! 

LONDON SCHOOL OF MEDICINE 

FOR WOMEN: EDITH STONEY 

The 1876 Medical Act allowed medical 

examining authorities to grant 

registration to women. The London 

School of Medicine for Women, 

established in 1874 as the first medical 

school for women in Britain, soon 

became part of the University of 

London, with clinical teaching at the 

Royal Free Hospital. Following the 

discovery of x-rays in 1895, the School 

sought to recruit a woman of high 

ability as a lecturer in physics. Edith 

Stoney (1869–1938) thus became the 

first woman lecturer in physics 

applied to medicine. She was born in 

Dublin into a scientific family: her 

physicist father, George Stoney FRS 

(1826–1911), is credited with coining 

the word ‘electron’, and George 

FitzGerald (1851–1901) 

(FitzGerald–Lorenz contraction) was 

her older cousin. Edith Stoney 

excelled as an undergraduate at 

Newnham College, Cambridge, 

graduating BA Part I (Class I) in 1893 

with Part II the following year: 

although, as a woman, she was not 

awarded the degree, since this was 

still restricted to men only. In London, 

she was actively involved in the early 

days of radiology, assisting her sister 

Florence, newly-qualified as a doctor, 

to set up the x-ray department in the 

Royal Free. At the outbreak of 

hostilities in 1914, she joined the 

Scottish Women’s Hospitals. Serving 

in Serbia under French command, she 

established and operated the x-ray 

facilities in military field hospitals, a 

contribution for which she was 

awarded the Croix de Guerre. She 

returned to physics lecturing after the 

war, in the social science department 

at King’s College, until her retirement 

in 1925. Thereafter she worked 

actively for the British Federation for 

University Women. When she died in 

“ 

Such 

an affront 

to the 

closed 

world of 

medical 

mystique 

and fees 

must be 

stopped at 

all costs! 

” 

1938, obituaries were published in 

both The Times and Nature. 11 

NINETEENTH-CENTURY 

LONDON MEDICAL PHYSICS 

Medical interest in physics flared 

briefly during the 1830s and 1840s, 

largely stimulated by Faraday’s 

discovery of electromagnetic 

induction. A few individuals 

recognised the existence of an 

independent discipline of medical 

physics, and attempted to promote it 

where they could. But, in truth, 

vested interests in both medicine and 

academic science were too strong to 

allow the embryo subject room to 

develop. No sooner did the term 

‘medical physics’ appear than it 

disappeared again, preventing a clear 

development of the subject’s wider 

content. By the latter part of the 

century the term ‘natural philosophy’ 

had widely been replaced by 

‘physics’, and the subject had become 

part of the medical curriculum. So at 

least, by 1900, a structure had begun 

to exist formally in British medicine, 

within which the revolutionary new 

discoveries in physics, radioactivity 

and x-rays, might be exploited, 

embedding physics into medicine in 

a way that electricity alone had never 

managed to do. 

ACKNOWLEDGEMENTS 

Helpful guidance from archivists at St 

Bartholomew’s Hospital and King’s 

College is gratefully acknowledged. 

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: f.duck@bath.ac.uk 

REFERENCES 

1 Earlier articles in this series may be found at 

www.scopeonline.co.uk. 

2 Thornton JL. Charles Hunnings Wilkinson (1763 or 

1764–1850). Ann Sci 1967; 23: 277–86. 

3 Griffiths T. Recreations in Chemistry (Non-Metallic 

Elements). London: Parker, 1850: 125. 

4 Faraday M. Experimental Researches in Electricity, Vol. I. 

1839. 

5 Griffiths T. Chemistry of the Four Seasons; An Essay, 

Principally Concerning Natural Phenomena Admitting of 

Interpretation by Chemical Science, and Illustrating 

Passages of Scripture. London: Churchill, 1846: 90. 

6 Coley NG. The collateral sciences in the work of Golding 

Bird (1814–1854). Med Hist 1969; 13: 363–76. 

7 Bird G. Elements of Natural Philosophy; Being an 

Experimental Introduction to the Physical Sciences. 

London: Churchill, 1839. 

8 Bird G. Lectures on Electricity and Galvanism. London: 

Longmans, 1849. 

9 Stone WH. The Harveian Oration. Delivered at the Royal 

College of Surgeons, 1887. Also see The Times, 19th 

October 1887. 

10 Houghton S. Principles of Animal Mechanics. Longmans 

Green, 1873. 

11 Obituary. Miss Edith Stoney. Nature 1928; 3583, 16th July: 

103–4. 


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