Department of Diagnostic Radiology

Location: Royal Marsden

Section: NHS Clinical Research Programme

Head of Departments: Dr David MacVicar 

Introduction

• The Department of Diagnostic Radiology incorporates all aspects of oncological imaging including CT, MRI, ultrasound, radiology, nuclear medicine, and PET/CT. The department benefits from strong research links with the Joint Physics Department and with the clinical units within the the Royal Marsden NHS Trust. This enables us to maintain a unified research strategy across both sites
• Members of The Department of Diagnostic Radiology also undertake research in Nuclear Medicine/PET CT and within the Cancer Research UK and EPSRC Cancer Imaging Centre at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust structure (please see separate entries).
• The clinical imaging department has been able to make use of the latest state-of-the-art technology available for research and 2006 has seen the completion of several major research projects, many of which have been undertaken in conjunction with other centres in the UK and Europe, including The Institute's Department of Academic Radiotherapy and have enabled these innovations to be embedded into improved clinical practice. 

Relevance to the NHS Research and Development Programme

Imaging research at both branches of the Hospital is aimed at the development of innovative approaches to address clinical problems in diagnosis, staging and monitoring tumour response to therapy. In addition, the Department plays a central role in the evaluation of clinical trials within the Hospital.

Recent Highlights

• The RMH-wide PACS network was launched in 2006 and our PACS team was recognised with the prestigious staff achievement award for its successful implementation. The team has also led software upgrades which have been rolled out for the benefit of patients nationally to other PACS networks. This has revolutionised our practice enabling us to be responsive to patient need irrespective of location. The department is now virtually filmless and images can be accessed throughout the hospital, allowing simultaneous review and discussion between clinic and department. Expertise and experience can be shared, and communication and use of resources have improved as a result of PACS
• In 2006 a 32-slice multi-detector CT was installed at the Chelsea site complementing our existing multi-detector CT at Sutton. This has given us the opportunity to develop specific cancer imaging protocols, making use of the sub-millimetre slice thickness technology for diagnosis, staging and treatment. Specific research tools include functional imaging, 3D imaging, multi-planar reconstructions (MPR) and ‘fly-through’ applications, such as virtual colonoscopy. These major advances will be incorporated into research projects across both sites
• A 1.5T Siemens state of the art AVANTO MRI scanner was installed at the Sutton site. By supporting the activities of the Clinical Magnetic Resonance Research Group on this instrument continued development of pioneering research work imaging the biology of tumours and multinuclear spectroscopy has been possible. Other advances in MR imaging on all our cross-site platforms include development of motion compensation software to improve radiotherapy planning for patients and clinically validated diffusion weighted imaging giving unique information about the cellularity of tumours for assessing tumour stage, response to treatment and early detection of recurrence
• Research highlights of 2006 include a number of successful translations of research innovation to clinical practice
• • MRI to improve localisation of aggressive prostate cancer (led by Dr A Sohaib)
  • Refining patient selection for surgery in oesophageal cancer using MRI (Dr A Riddell, Clinical Research Fellow, supervised by Dr G Brown and Mr WH Allum)
  • Final needle aspiration of inguinal nodes to improve surgical management of patients with vulval carcinoma (led by Dr EC Moskovic)
  • Liver specific contrast agents and diffusion weighted imaging to improve sensitivity and specificity in detecting liver metastases prior to hepatic resection (Dr DM Koh, Dr G Brown)
  • Disseminating improvements in imaging assessment of paediatric tumours into clinical practice (led by Dr AD MacVicar through CCLG)
  • Establishing MRI as the standard for predicting curative surgery in patients with rectal cancer (BMJ 2006, MERCURY Study Group)
  • Melanoma imaging (Dr DM King)
• As President of the Royal College of Radiologists and Vice-President of the Academy of Medical Royal Colleges, Professor Husband has driven a number of imaging-based initiatives to improve clinical practice in the UK, for example the UK PET-CT strategy and the introduction of a state-of-the-art national e-learning programme in Radiology

Future Aims

• Our recent success in securing funding for imaging research will enable us to further develop cutting edge imaging innovations for RMH-led clinical trials
• We supported the successful application of funding led by Clinical Magnetic Resonance for a 3 TESLA MRI scanner for clinical research. This will provide the ICR and RMH with an exciting opportunity to develop sophisticated biological imaging of tumours and improved multi-nuclear spectroscopic imaging
• We are looking forward to developing exciting breast imaging projects e.g. PET/CT breast imaging and quantification of breast density measurements, following the recent appointments of breast imaging consultants Dr Romney Pope and Dr Steve Allen
• We will continue to collaborate with colleagues in nuclear medicine to enable further development of PET/CT and 3D CT imaging in clinical algorithms

This investment in advanced technology will allow us to maintain our position at the leading edge of clinical research and practice.