Shining a light inside the body

Medical Imaging is the term given to the way in which we can image the body. Think X-rays of your teeth, big MRI machines, or ultrasounds. All these forms of imaging use small doses of radiation to see inside the body.

Charlotte Maughan Jones and Liam Collins-Jones (no relation!) are working to see the light. They're using medical imaging to scan the body for tendon damage, as is the case with Charlotte, and autism, as is the case with Liam. You might be wondering how they're doing this because isn't x-rays just for bones so how are we able to see the small, fleshy tendons? And how do we use medical imaging to diagnose autism? They're all questions that we'll be answering in this podcast.

About Charlotte and Liam

Charlotte is a qualified veterinary surgeon and a medical physics research scientist. In the lab, she looks for signs of tendon injury using x-rays and outside of the lab she’s a passionate science communicator spending a lot of time teaching primary school children about the fascinating world of “visible light”.

Liam and Charlotte know each other because CHarlotte was Liam’s undergraduate supervisor! Liam’s research involves seeing into the human brain. Liam's work straddles several different research areas, including engineering, physics, psychology and neuroscience. Outside of research, Liam likes to talk about being Welsh and teach other people how to speak Welsh. He does our outro for us at the end of this episode!

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Transcript

Ferdouse Akhter  00:05

Hello and welcome to Health in a Handbasket, your podcast about the sexy world of Healthcare Engineering. I'm Ferdouse Akhter and I'll be your host. I'm the Marketing and Community Manager at UCL's Institute of Healthcare Engineering. And although I don't always understand what's written in the research papers published by academics, I know that what we're doing in the world of healthcare engineering is important and impactful. And I want to share that with you by speaking to those who know a bit more about him than me. In today's handbasket, we'll be picking out the topic of medical imaging - so how we can see inside the body., I once had an x ray and that was because I used to be such a little headache for my mom, I did this thing where I thought I could fly and say I stood on the top flight of stairs and just jumped and thought that would be a good thing. Anyway, I broke my arm is like you know, hanging off my arm, went to the hospital got an x ray done and had a really ugly looking kind of cast like it wasn't cool like it wasn't in TV shows. There's just like this ugly fabric sling. So that's my little experience of medical imaging, and X rays. But we're gonna find out a lot more about medical imaging with the help of Charlotte and Liam who are here with me today and who were semi laughing at my little olive, Charlotte and Liam. So Charlotte is looking for the light, I guess. She's a qualified Veterinary Surgeon and a Medical Physics Research Scientist in the lab, she looks for signs of tendon injury using X rays. And outside the lab, you're passionate about science, communicating and spending a lot of time teaching primary school children about visible light and Liam and Charlotte, So Liam is in the room with us as well, They know each other because Charlotte was Liam's supervisor,

Charlotte Maughan Jones  01:58

Great supervisor at that.

Liam Collins - Jones  02:00

Yeah, he has to say that.

Ferdouse Akhter  02:03

And Liam's in research involves seeing into the human brain. So Liam's work straddles several different research areas, including engineering, physics, psychology, and neuroscience. And outside of research, Liam likes to talk about being Welsh, and teaching other people how to speak Welsh. So you're going to speak a few words of Welsh at the end of this, aren't you?

Liam Collins - Jones  02:21

I'm looking forward to it.

Ferdouse Akhter  02:22

Yes, it's gonna be the highlight of the show, you know, nothing else matters.

Charlotte Maughan Jones  02:25

I've not heard him speak Welsh so I'm excited too.

Ferdouse Akhter  02:29

Seeing into the body sounds very science fiction, but it's not really because I'm sure a lot of our audience will be familiar with a lot of these terms, like I mentioned, X rays and ultrasounds. So what are some of the ways that we can see into the body?

Charlotte Maughan Jones  02:40

So I work with X rays, and like you said, you were clearly an accident prone child, I can relate my mom can probably also relate to the anxiety of your mom, in terms of me constantly falling over and having X rays all the time. And most of us are probably reasonably familiar with at least what an x ray looks like. Most of us understand that if a doctor sends us for an x ray, in general, it's because they want to see our bones. And the reason that we can see bones on X rays when we go to a hospital is because bones are really really good at stopping X rays from travelling through the body in the same way as if you were to imagine holding a torch and putting your hand in front of it, you can make shadow puppets, which is one of my five year olds favourite pastimes is to make crocodiles and birds on the wall as a shadow puppet and X rays work in the same kind of way in that they can travel through certain materials and certain things and parts of our body, but they can't travel through other parts of the body. So that's how a general X ray works in a hospital. And that's certainly one of the ways that we currently use to look inside of the body. Now the research that I do, we also recognise that X rays as well as being stopped by certain parts of the body also change direction, a really, really teeny tiny bit, and we are talking tiny, tiny, tiny amounts that you just cannot see with the naked eye, you need specialist equipment to be able to detect that. And if we can, with our research, what we're trying to do is work out how much that X Ray has changed direction as it travels through your body and try and make a picture out of that. And the reason we want to do that is because we want to understand bits of the body that we can't normally see on an x ray. So a normal X ray, we get to see bones and hard things. So if you were to and this is one thing I did not do like swallow a coin or something like that, you'd be able to do that because it's made of metal and that metal was super good at stopping those x rays, but we can't really see a lot of the kind of soft squishy stuff that's inside of us. So that's what my research says. But there are loads of other ways to look inside the body and certainly ultrasound is one of them. Again, super familiar. I'm currently sat here like eight months pregnant, so I've had plenty of ultrasounds In the past few months to look at my baby. MRI is another and Liam works with some really interesting novel ways of looking inside the body.

Liam Collins - Jones  05:08

Yeah, I think the sort of the techniques I work with, you wouldn't find them in a clinic certainly not just yet. If you've ever got a torch, and you've put it next your hand or a bright torch, now put it next to your hand or next to your finger, you can see that your hand with light up red will basically glow red, what's happened in there is the lights go in into your hand, that light is being absorbed, except the red bit white light basically contains all the different colours all the colours of the rainbow, let's say and what blood does is it absorbs all the colours that aren't red. That's why Blood is red. Now what happens as well, when we shine light into human tissue is it does what we call scatter in general force, sort of conventional X ray imaging, you can think that the X rays travelled in a straight line. That's why Charlotte's research is so cool, because it looks at slight deviations in how the X rays travel. But by and large, you can think they travel in a straight line visible light goes into the hand, and the light is basically a huge scramble. So what happens is blood can absorb light relatively well when we're thinking of visible light. And also like this just beyond the visible spectrum, bit of GCSE physics there into what we call the near infrared range, which is between the visible, visible wavelengths of light and the infrared wavelengths of light. So what my research looks at is how we can use light to see changes in blood flow in the brain. Now, this is really important, because when a region of the brain is activated, it uses more oxygen. So to cope with that increase in the amount of oxygen that's being used, more oxygenated blood is shunted towards that activated part of the brain, what that means is more light will be absorbed in an activated part of the brain, compared to when we're at rest. So if we put a load of mini torches, where we call sources of light and detectors of light on the head, we can see where in the brain has been activated by seeing these changes in oxygenated blood in the brain. So that's what my research looks at.

Ferdouse Akhter  07:02

Okay, so how does that look like, like, give me practical, like, let me see it in my head.

Liam Collins - Jones  07:08

So for the for the method, I've been working on the method I've been developing, I've built a cap, and it's made out of neoprene. So that's the same material as a wetsuit, if you've ever been surfing. And this, this neoprene has many sources, you can think of them as like mini torches and mini senses of light stitched into it. And so when you shine light on to the scalp, that light will travel through the skin and the skull and into the brain. And this concept of of looking at changes in blood flow in the brain that's very similar to what something like functional MRI would look at. But what my research tries to do is get the information we could get from a very expensive restrictive MRI scanner, but do that in an environment where it's unrestricted, where we can see people do interesting, natural things. And that's why a lot of my research finds big applications in looking at the baby brain. Babies don't want to stay still, they don't want to lie down. So what I do in my work is put this cap on a baby's head, get them to sit in their parents. And watch some videos on a screen. Now one day, I hope to do more interesting things rather than just showing videos on a screen. But that's the basic setup, you put a cap on, it shines light into the head. And that's how you get information back.

Charlotte Maughan Jones  08:25

And as a parent whose child has been involved in research that has used the technology that Liam is using, my son was three at the time that we did the experiment, and he found it really comfortable. And we have some very funny pictures of him in this. It looks a bit like a swimming cap, almost like a spotty swimming cap almost. And he was having an absolute whale of a time. So the kids weirdly, I imagine adults would probably think that it's a lot more uncomfortable than it is.

Liam Collins - Jones  08:56

Well my niece came in when she was about six months old. And yeah, she had a she had a great time. She you know, she I and most of the most of the babies that I've worked with, you know, they tolerate the cap very well. And so yeah, so that's really so that's really cool that we've got a way to look at the baby brain that is also Baby Friendly, which can't be said for some other methods to look at the brain.

Ferdouse Akhter  09:20

So I guess Charlotte, what do your experiments look like?

Charlotte Maughan Jones  09:22

So those of you who've had X rays before in the past, what would normally happen is you would be invited to either sit up on the table or put your arm on the table or put a finger on the table or whatever it is that the doctor is trying to look at. And the X rays would come down from above from the source go through whatever they're trying to look at, and be detected by some sort of detector which will sit underneath or within the table somewhere but that's sort of a basic setup. So we're very used to in these situations just walking into a room sticking a body part on a table there becoming an x ray ten mins later.

Ferdouse Akhter  09:58

So the X rays on top of your head?

Charlotte Maughan Jones  10:00

Yeah, so they're above now when we take it into the laboratory, things look a little bit different. If you were to again have an x ray in a clinic, it's not unreasonable to think that a doctor could X ray, pretty much like half of your leg or your whole arm in 1 x Ray. So ours is very small, we're looking at about four ish centimetres squared. And instead of having the X rays coming from above the sample, they come from the sides at the left hand side, travelled through my sample and go to the detector. But we also have extra bits and pieces to help us detect these tiny changes in direction of the X rays. All of those modifications are there purely so that we are able to try and work out how much the X rays have changed direction, and they give us a better idea and make it a little bit easier for us. But essentially, the kit is very similar to what you would see in a hospital. But with a few modifications that make it hopefully a little bit more useful to see some of the soft, squishy stuff inside our body.

Ferdouse Akhter  11:00

And all of that kind of helps you see all the bits in your hand apart from bone.

Charlotte Maughan Jones  11:05

So we can still see the bone because the X rays do still get absorbed, we can't stop them getting absorbed, at the end of the day, unless we were to massively change the energy, what we want to do is to be able to also detect some of the things that are a little bit trickier. So for me, I'm specifically looking at tendons which are the soft parts of your body that connect your bones to your muscles and essentially make you move but other things that other people in my group have looked at our things like a breast cancer diagnosis, and seeing whether we can better identify how that is invading into the normal tissue around it. Other people have looked at a oesophagus is apparently also correct to say oesopho guy.

Liam Collins - Jones  11:46

I was gonna ask

Charlotte Maughan Jones  11:47

I can't decide which I prefer, they both sound ridiculous. Oesopho guy I'm gonna say some people have looked at a oesophagi to see whether we can see different layers in those. But also we've used the technique for things like security scanning has been done in the past, I think that was published and one of my colleagues looked at what we call composite materials. So things that like I think she was looking at, like aircraft materials and things like that, but sort of layered materials to see whether you can see various cracks and things. So it's not just got use in the medical field, but my interest is specifically in the medical field. And I like a bit of tendon.

Ferdouse Akhter  12:29

Charlotte, why do you why do you look into tendons?

Charlotte Maughan Jones  12:32

So tendon disease is one of the most widely presented problems to a GP. But actually currently, we don't really have a great and easily accessible way of diagnosing it. And also, it's round about 50% of athletes in their life will injure their tendons. So it's a huge, huge problem. And we don't really have a great way of detecting really tiny bits of damage within the tendon. So that's essentially what I'm trying to do is is there a better way to detect tendon damage much earlier on in the disease process, or detect tiny damage that we thought healed through treatment, but actually hasn't. So that's the main reason that I do, what I do is that it's just an incredibly common condition that we still don't have a perfect way of diagnosing.

Ferdouse Akhter  13:25

And you, Liam, so you're looking into baby's brains, which is quite interesting...

13:30

Yeah. What I'm interested in is neurodiversity. So one condition might have heard of is autism. And that's it's a condition that affects about 1% of the population. And what's important. Autism is basically a condition that affects how people communicate and interact with the world and getting an autism diagnosis is really important. So the autistic people can get the right support from from an early age. What my work is looking at is how autistic people can get an earlier diagnosis. So at the moment, you need to show behavioural signs of autism, which don't begin to show until about two years of age or later. But we know there are differences that are there are differences in brain activity between babies who go on to go on to have an autism diagnosis and those who those who don't. So what I'm interested in my research is finding a marker of autism so that the support can be put in place much earlier for babies so that we can make sure that autistic people are supported from the earliest possible point in life. And I think this is important. I've just got some statistics from the National Autistic Society, it's important to support autistic people, because autistic children are three times more likely to be excluded from school and only one in six autistic people in the UK have a full time job. So it's really important to support autistic people. And what I'm trying to do my work is find an early marker of autism so that we can put support in place from the earliest possible point.

Ferdouse Akhter  15:03

Sounds commendable.

Liam Collins - Jones  15:04

Why it's, I was interested in is, it's the difference between talking about why I do what I do and what I actually do on a daily basis. What motivates me is thinking, right? How can we make a make this brain imaging technique? How can we get it? How can we translate it? How can we do this? How can we make this a useful thing, but on a day to day basis, that's what I do is much more technically focused.

Charlotte Maughan Jones  15:29

I think that's an important distinction as well, that I think a lot of people think that research can move quite quickly. And in certain at certain situations, of course, it can, but in a lot of situations, it's really slow stepwise processes, because you have to be meticulous, and you have to make sure that stuff works before you take it to the wider audience. And especially when it comes to technology, it's not just a case of making sure that it works from a scientific point of view. But is it user friendly? Could a doctor use it? Will a patient tolerate it? Will a parent tolerate having this done to their child, there are so many different things that have to factor in that it's not always that linear journey of I've got an idea. And this is the this is my major aim is it's a very stepwise process. So I think as Liam said, having that end goal to what you would love it to become is so important for a lot of researchers to really help maintain your focus and your drive to get to that.

Ferdouse Akhter  16:37

Charlotte, how did you end up in this field? How did you end up doing what you do?

Charlotte Maughan Jones  16:41

Yeah, as I think you said at the beginning, I come from an unusual background in that I trained as a veterinary surgeon, and I had the best time at that school, I found the first two years very tricky, and did something called intercalate, which means that after your first two years, you are able to go and do another course for a year. And in that year, I came to UCL and I did an integrated degree in Medical Physics and bioengineering for you. And ironically, as Liam's research, first experience of research was in my research group, my first experience of research was actually in Liam's current research group. So we both have an understanding of what each other do, because we've actually both done research in that field as an undergraduate, which is quite nice as well. So I went back to vet school finished my degree, and in 2011, I qualified and went into equine practice. So equine encompasses essentially horses and donkeys and zebras. But as you can imagine, most of what I did was was horses with the odd spattering of a donkey, I do love it. And I had a great time in practice, but I realised, probably within a couple of years that it wasn't necessarily what I wanted to do for the rest of my life, and that I wanted to do something a bit different. And I spent some time volunteering in a biomedical research lab. So again, I just thought, Well, I'm a biologist, so I'll do biology. And then this research PhD position came up at UCL in medical physics. And I thought, That sounds really interesting. And they wanted someone with a physics and a math background. And I thought I have neither of those things. But this still sounds interesting, somewhere in the title of the PhD, I think mentioned biological tissue, and I thought I can do I can do that bit. So I spoke to the supervisor, thinking they are just going to laugh me away. And they said, I mean, there's no reason why not. So I applied and much to my absolute shock, I got offered the position. And I guess you could say the rest is history, and that I've carved my way through this slightly unusual physics background from I still consider myself a biologist, I still find it very difficult to call myself anything other than a biologist. I'm a biologist who does a bit of physics on the side, I suppose this thing that's what I love about this field, is that we work with such a breadth of people like in my group, we've got we've had in the past material scientists, we've had physicists, we've got engineers, I think we've got a civil, I think one of those is civil, he's gonna listen to this and be like, I'm not a civil engineer. I'm pretty sure one is a civil engineer, and we've got pure physicists. We've got people from like an astrophysics background. You've got me as a cell biologist, we had a medical student before. We've had so many different people from so many different backgrounds that everyone brings something unique to the table. And that's what's so wonderful about Healthcare Engineering, I think is that it is such an open box of ideas and thoughts that all amalgamate together to create these amazing solutions.

Ferdouse Akhter  19:45

Liam, we've heard of Charlotte's kind of background into getting into this field, what was your kind of background

Liam Collins - Jones  19:50

My background into baby's brains? Well I was a baby once. I bring this up because I had surgery as a baby. Basically what happened I was about seven weeks old, and I was quite sick. Turns out there I had what's called intestinal irritation. Basically, my guests are twisted, and I couldn't eat anything, couldn't digest anything. And I had to have surgery and that everything went fine. That was great. But I've got half of my seven week old waste etched on me now. And I've had that for life. And that, and that is something that has really sort of inspired like, I don't want to use it, or that really inspired me because that's just cheesy. But I think it's what sparked my interest in, in science, in biology in how bodies work. And that sort of got me interested in science in general as well. So that's why I applied to do medicine and I ended up doing medicine when I left school. I think what I enjoyed about it was it was very sciency. But we weren't really going in depth into the science whereas sort of my contemporaries were not happy because we've gotten into too much science and not going into how you actually apply that how do you do this in a clinic. So I intercalated as well, in the medical physics department at UCL. When I was in my third year of medical school, I went to the Medical Physics Department to study the final year of a medical physics and biomedical engineering degree. What I loved about that was it completely changed my mindset that medical school, it was all very memorise, memorise memorise memorise whereas you can, yeah, I went out when I was doing my intercalated year I was I was thinking, what we're actually trying to derive these equations, how that can tell us how we image a body part, I think it went, it went from medical imaging being something that's magic to I can, I can see what's going on here. I really, I really enjoyed studying Medical Physics. And then a few months later, an opportunity came up to do a PhD. So we applied and got the funding for that. So I did my PhD looking at similar field looking at a baby's brains, but a bit more technically focused on what I'm doing now. And fast forward to when I finished my PhD in 2021. I didn't know if I really wanted to go back into medicine. And I think the two reasons I went into medicine, I wanted to do something sciency. And I also wanted to do good for the world, I was thinking, I can do this through research. And I feel like it's meant that I could marry physics and medicine, which is sort of a headache I had before applying for university,

Charlotte Maughan Jones  22:20

I think that it can be quite a difficult thing to for people to get their head around when you walk away from something clinical, because it's always, it's always seen as like a lifelong dream to be a vet or to be a doctor. And for some people, it can be a really hard thing for them to get their head around. And certainly I was accosted at a wedding by a drunk person who came up to me and when you've totally wasted your veterinary degree, what a waste of space, someone else who wanted to be a vet could have done that. And to those kinds of people, I've not wasted my degree at all. I'm just doing something slightly different with it. First and foremost, I'm a scientist, and I'm a clinical scientist. Yes, I'm a clinically trained scientist, but I'm a scientist. And I absolutely wouldn't be where I am today with the thought processes that I have with the unique research ideas that I have with the ability to work through problems in a unique very me way that I have if I hadn't have done the training. So no, I don't think that people like us who have maybe taken a sidestep are wasting a space or have wasted a degree or anything like that. I think we're just using it in a slightly more unique way, I suppose unusual is probably the better word I prefer.

Ferdouse Akhter  23:43

I would say that you guys are making an complete difference in the world. Like, you know, with tendons, like I think you were saying how much money we save the NHS, if we can find more viable ways of looking at tendons and tendon injury. Yeah, so and with autism, like that's a way of living, that's a way of life, like completely making a difference in the world.

Charlotte Maughan Jones  24:04

It's just a different way, instead of making a difference to an individual person who has stood in front of me and that animal, which I had an amazing time doing for three and a half, four years, I'm hopefully making a bit more of a difference on a smaller difference maybe, but on a mass scale. And so it's just a different way of making a difference, and neither is better or worse than the other. They are both very different. Without clinicians, I couldn't do my job, because the problem is wouldn't be there. And without scientists, clinicians couldn't do their job because the solutions wouldn't be there. So one provides the problem and the other provides the solution

Ferdouse Akhter  24:41

That guy needs to listen to this podcast.

Charlotte Maughan Jones  24:42

He really does.

Ferdouse Akhter  24:45

So I guess what I've learned from this is that you don't need to fit the traditional mould to be a healthcare engineer. And also super interesting to know how many different ways there are to look into our bodies, especially with the human brain. And with ligaments like things that we don't really think about really at all. So thank you guys. Thank you guys for introducing me to a lot of ways of looking into the body and blowing my mind in different ways.

Charlotte Maughan Jones  25:11

Alright, Liam can look into that for you.

Ferdouse Akhter  25:14

I think of it too old for your research, right?

Liam Collins - Jones  25:18

Yeah, I think your brains a bit too big.

Ferdouse Akhter  25:21

I like to think that that's a good way of saying it. Yeah. So thank you guys for joining us. And Liam, you said you speak fluent welsh. Well, I do say do you want to do that true for us.

Liam Collins - Jones  25:42

[Outro in Welsh] it sounded really nice.

Charlotte Maughan Jones  26:00

Beautiful.

Ferdouse Akhter  26:02

I understood the Liam, Charlotte bit.

Charlotte Maughan Jones  26:05

I understand my name.

Ferdouse Akhter  26:12

Health in a handbasket is produced by UCLA Institute of Healthcare Engineering and edited by Charisse Bradley, the Institute of Healthcare Engineering brings together leading researchers to develop the tools and devices that will make your life better. Were using this podcast to share all their amazing work taking place. You can learn more by searching UCL health in a handbasket, or following the link in the show notes. So share with your friends and family if you found this interesting. Were available everywhere, especially where you just listen to us