F I O N A M E L L O R

R E S E A R C H R A D I O G R A P H E R / N I H R C L I N I C A L A C A D E M I C F E L L O W

A N G L O - E U R O P E A N C O L L E G E O F C H I R O P R A C T I C . B O U R N E M O U T H . U K

USING MEDICAL IMAGING IN YOUR RESEARCH

LEARNING OBJECTIVES

Appreciation of the variety of

modalities and techniques

(ionising and non ionising)

Understanding of risks associated with

medical imaging in research

(incidental findings and ethical

considerations)

DEFINITION

Medical imaging: the technique, process

and art of creating visual representations

of the interior of a body for clinical

analysis and medical intervention.

Medical imaging seeks to reveal internal

structures hidden by the skin and bones,

as well as to diagnose and treat disease

http://en.wikipedia.org/wiki/Medical_imaging

‘DEPARTMENTS’MODALITIES/PROFESSIONS AND TECHNIQUES

Radi-ology

Clinical imaging

Diagnostic imaging

Radi-ography

CT/MRIX-ray

Medical

ImagingPET/CT

Endoscopy

Nuclear (unclear)

medicine

Isotope

scanning

Angiography

fMRI Breast

screening

MammographyFluoroscopy

Sonography

"An ology means you're a scientist“ Maureen Lipman 1980’s

Ultrasound

IONISING OR NON IONISING

IONISING

X Ray

Radiographs/

mammograms

CT

Fluoroscopy

Nuclear

medicine

NON IONISING

Ultrasound(2D/3D/4D)

Doppler

Elastography

MRI MRI sounds

fMRI/kinetic

MRI/contrast MRI

ETHICAL CONSIDERATIONS IONISING RADIATION

FREE RESEARCHER TRAINING for IRAS form completion

http://www.hra.nhs.uk/hra-training/training/

ETHICAL CONSIDERATIONS

• Research involving or using ionising radiation or

injection of contrast media requires NRES approval:

• Clinical radiation expert (CRE) and medical

radiation expert (MRE) (registered Dr or dentist)

• Understanding of legislation/ guidelines (IR(ME)R

2000/ARSAC/IRR99)

• Estimation and communication of radiation dose

and potential risk

• Consideration of incidental findings (retrospective

and prospective)

• http://www.hra.nhs.uk/documents/2013/10/approval-of-research-

involving-ionising-radiation-2.pdf

INCIDENTAL FINDINGS

• How are they defined?

• Are participants

informed?

• Who interprets the

images and for what

reasons?

• Who pays for extra

treatment costs?

http://www.rcr.ac.uk/docs/radiology/pdf/BFCR(11)8_Ethics.pdf

SUMMARY

• Medical imaging is frequently used in research as

an outcome measure

• Research into new medical imaging techniques

and procedures (is it better than existing techniques?)

• Using ionising radiation or contrast agents will

require central NRES approval

• Using existing images will require departmental and

trust R&D approval

• The increased ethical considerations are based on

risk

QUESTIONS AND COMMENTS?

OTHER CONSIDERATIONS

• Prospective/retrospective studies and accessing

existing data

• Participant safety (metal objects such as aneurysm

clips and MRI)

• Operator dependency (ultrasound)

• Tolerance of the procedure

• Remuneration/service support costs

• Involvement of the imaging (radiologist and

radiographers) and medical physics department

from the very beginning