Hats off to Sir Peter Mansfield (1933-2017)

13-sir-peter-mansfield-2003

Sir Peter Mansfield left school with no qualifications to become one of the most eminent scientists in the world of physics. Here, Dr Adrian Thomas pays tribute to the man who lived through World War Two and with dogged determination forged his way in science to become a distinguished and recognised physicist who played a major part in the story of MRI.

 

Sir Peter Mansfield was born on 9 October 1933 in Lambeth in London, and grew up in Camberwell. His mother had worked as a waitress in a Lyons Corner House in the West End of London, and his father first worked as a labourer in the South Metropolitan Gas Company, and then as a gas fitter. Mansfield recounted being sent with other children on a holiday to Kent for disadvantaged London children by the Children’s Country Holiday Fund.

Peter Mansfield was 5 years old when the war broke out in 1939. He remembers standing with his father at the entrance of an air raid shelter watching anti-aircraft shells exploding around German bombers caught in the searchlights. As the Blitz intensified he was evacuated from the dangers of the capital, as were so many other London children. With his brother he was sent to Devon, where he was assigned to Florence and Cecil Rowland who lived in Babbacombe, Torquay. The Rowlands were called Auntie and Uncle, and Mansfield  attended the nearby junior school. Cecil Rowland was a carpenter and joiner by trade, and encouraged Peter to develop his practical skills by giving him a toolbox, and tools were slowly acquired. He obviously obtained some proficiency since with some guidance he made several wooden toys which he was able to sell at an undercover market and a toyshop in Torquay. His life was not without danger even outside London, and in early 1944,whilst out playing, he saw a German twin-engined Fokke-Wulf plane flying at rooftop level. The tail gunner was spraying bullets everywhere, and he rapidly took shelter behind a dry-stone wall.

On his return to London his secondary schooling was at Peckham Central, moving  to the William Penn School in Peckham. Shortly before he left school at 15 he had an interview with a careers adviser. Peter said that he was interested in science, and the adviser responded that since he was unqualified that he should try something less ambitious. He was interested in printing and so took up an apprentice in the Bookbinding Department of Ede and Fisher in Fenchurch Street in the City of London, and whilst there he took evening classes.   Developing an interest in rockets he was offered a position at the Rocket Propulsion Department (RPD) at Westcott, near Aylesbury.

In 1952 he was called up into the Army for his National Service, where he joined the Engineers. The Army allowed him to develop his interest in science. On demobilization he returned to Westcott and completed his A levels. This enabled him to apply for a special honors degree course in physics at Queen Mary College in London. In 1959 he obtained his BSc, and three years later he was awarded his PhD in physics. From 1962 to 1964 he was Research Associate at the Department of Physics at the University of Illinois, and in 1964 was appointed Lecturer at the Department of Physics at the University of Nottingham.

During a sabbatical in Heidelberg in 1972 Mansfield corresponded with his student, Peter Grannell in Nottingham, and became interested in what became MRI, presenting his first paper in 1973 at the First Specialized Colloque Ampère. Mansfield developed a line scanning technique, and this was used to scan the finger of one of one of his early research students, Dr Andrew Maudsley. The scan times required for these finger images varied between 15 and 23 minutes. These were the first images of a live human subject and they were presented to the Medical Research Council, which in 1976 was reviewing the work of various groups including those in Nottingham and Aberdeen.

13-terry-baines-peter-mansfield-and-andrew-maudsley-c1974

In 1977 the team at Nottingham, which included the late Brian Worthington, successfully  produced an image of a wrist. The following year Mansfield presented his first  abdominal image. In 1979 Peter Mansfield was appointed Professor of Physics at the University of Nottingham. As the Nobel Committee emphasized, the importance of the work of Peter Mansfield was that he further developed the utilization of gradients in the magnetic field. Mansfield demonstrated how the signals could be mathematically analyzed, which resulted in the development of  a practical  imaging technique. Mansfield also demonstrated how to achieve extremely fast imaging times by developing echo-planar imaging. This is all very impressive for a boy who left school at 15 with no qualifications.

13-sharing-an-amusing-tale-with-paul-lauterbur-2003

Peter Mansfield was awarded many prizes and awards including:

the Gold Medal of the Society of Magnetic Resonance in Medicine (1983); Fellow of the Royal Society (1987); the Silvanus Thompson Medal of the British Institute of Radiology (1988); the International Society of Magnetic Resonance (ISMAR) prize (jointly with Paul Lauterbur)(1992);  Knighthood (1993); Honorary Fellow of the Royal College of Radiology and Honorary Member of the British Institute of Radiology (1993);  the Gold Medal of the European Congress of Radiology and the European Association of Radiology (1995);  Honorary Fellow of the Institute of Physics (1997); the Nobel Prize for Medicine together with Paul Lauterbur (2003);   Lifetime Achievement Award presented by Prime Minister Gordon Brown (2009).

His autobiography The Long Road to Stockholm, The Story of MRI was published in 2013. This is an interesting read, particularly in relation to his early years, and is recommended reading for everyone interested in the radiological sciences. This is a revealing account of a remarkable life. Whilst we may discuss the complexities of the development of MRI and exactly who should have received the Nobel Prize, there can be no doubt about his major contributions. MRI has made, and is making major contributions to health care. He died age 83 on 8 February 2017.

The University of Nottingham has set up an online book of condolence http://www.nottingham.ac.uk/news/sir-peter-mansfield/

About Dr Adrian Thomas, Honorary Historian BIR

Dr Thomas was a medical student at University College, London. He was taught medical history by Edwin Clarke, Bill Bynum and Jonathan Miller. In the mid-1980s he was a founding member of what is now the British Society for the History of Radiology. In 1995 he organised the radiology history exhibition for the Röntgen Centenary Congress and edited his first book on radiology history.

He has published extensively on radiology history and has actively promoted radiology history throughout his career. He is currently the Chairman of the International Society for the History of Radiology.

Dr Thomas believes it is important that radiology is represented in the wider medical history community and to that end lectures on radiology history in the Diploma of the History of Medicine of the Society Apothecaries (DHMSA). He is the immediate past-president of the British Society for the History of Medicine, and the UK national representative to the International Society for the History of Medicine.

See more on the history of radiology at http://www.bshr.org.uk

 

 

Advertisements

MRI safety: Putting staff and patients first

 

Darren Hudson

 

Darren Hudson

 

To mark MRI Safety week (25 – 31 July), Darren Hudson, MRI Clinical Lead at InHealth highlights his top tips for making the MRI environment safe for both patients and staff.

He also explains how InHealth are ensuring their multidisciplinary teams get timely reminders about MRI best practice.

 

 

 

 

MRI Safety week marks the 15th anniversary of a terrible accident.  Six-year old Michael Colombini was killed by a portable oxygen cylinder when it was inadvertently brought into the MR scan room of Westchester Hospital, in America. This tragedy sparked important discussions in the US around safety in MR. In the UK, the MHRA produced their first guidance in 1993  [1][2] produced around the requirements and training needed to safely operate MR scanning facilities. This was last updated in 2015.

What’s the danger?

The static magnetic field in which MRI staff work is over 30,000 times stronger than the earth’s own magnetic field. It is always on, 24/7, regardless of whether scanning is being performed.

MRI safety imageThe greatest impact this can have is a missile effect on ferromagnetic items which may be
taken into the MRI scan room, causing them to be accelerated at very high speed towards the centre of the scanner. Depending on the nature and size of the object, whether it’s an earring or a wheelchair, the consequences can be very dangerous, and at worst catastrophic.

InHealth safety

InHealth logo

To mark the week InHealth are sending out some daily reminders to staff covering specific MR safety topics to help serve as a refresher around some keys aspects of MR safety and to raise awareness of good practice.

Key themes covered are object management and labelling, positioning of patients to prevent burns, communication with patients to ensure they alert staff to any discomfort or concerns, keeping patients cool, protecting patients from noise,  best practice on how to get feedback from patients and making sure all medical devices and implants are regularly checked for safety in accordance with guidelines.

As corporate members to the BIR we are working together to raise awareness of, and share support for MR safety within the wider imaging community.

Radiographers and clinical support staff play a key role in implementing the safety framework established across MRI services, with their knowledge and experience of the procedures and policies in place helping to ensure we maintain the safety of patients, visitors and staff.

Importantly, it has been shown that the most significant MR accidents are as a result of a cascade effect from a number of apparent minor breaches of safety procedures rather than from a single mistake. It is therefore essential we all remain vigilant and adhere accurately to the safety policies and procedures. Any potential breach of procedure or near-miss is a warning and as such these instances should be reported to ensure lessons can be learnt and acted upon to avoid more serious untoward events.

Reporting

Reporting of incidents and near misses is vital so that we can anticipate and prempt problems that may be arise so they can be addressed before more serious incidents may occur – today it may only be some coins, tomorrow it could be something more serious!

The human factor

Our fallibilities as human beings, both as staff and our patients, can adversely impact on MRI safety. To help promote MR safety InHealth staff are encouraged to undertake e-learning modules to highlight the hazards in MRI.

By working together and maintaining a cycle of safety procedures we can ensure that the MRI room is the safest environment it can be for both patients and staff.

[1]  Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use

[2]   ACR Guidance Document on MR Safe Practices: 2013

InHealth logo

https://www.inhealthgroup.com/

Has imaging become too effective?

Adrian Dixon

Professor Adrian Dixon has a worldwide reputation as an academic and a radiologist and has published extensively on body and musculoskeletal CT and MR imaging.

He will deliver the BIR Toshiba Mayneord Eponymous Lecture called “Has imaging become too effective?” at UKRC on 7 June 2016 at 13:00.

Read this fascinating interview with him and get a taster of this “not-to-be-missed” presentation.

You will be delivering the BIR Toshiba Lecture at UKRC this June. Your lecture is called “Has imaging become too effective?” Can you give us a “taster” of what you mean by this?

“You should say what you mean!” as the March Hare said in “Alice’s Adventures in Wonderland”.

What do people mean by “effective”? Effectiveness is only an appropriate term if qualified. Modern imaging certainly is effective at increasing the diagnostic confidence about a diagnosis and excluding certain diagnostic possibilities. It has taken a long while to prove that it is effective in saving lives. It has become so effective that, in many conditions, an image can be rendered to make the diagnosis obvious to the man in the street.

And clinicians now tend to refer for imaging without stopping to think! It has also become so effective in demonstrating probably innocuous lesions that the worried well can become even more of a hypochondriac! In some societies this can lead to over usage, excessive radiation exposure and increased costs.

If imaging is “too effective” – is radiology still a worthwhile career choice?

Yes! It is the most fascinating of all medical careers and every day a radiologist should see something that he or she has never quite seen before. The radiologist is the ultimate medical detective and cannot conceivably get bored. Indeed radiologists get reimbursed to solve crossword puzzles on elaborate play stations!

What have been the three biggest challenges for you in your career?

Radiologists have had to learn and relearn their skills at frequent intervals during their careers. Radiology will only survive as a specialty if the radiologist knows more about the images, the technical aspects and the interpretative pitfalls than their clinical colleagues.

Did you ever meet Godfrey Hounsfield (inventor of CT imaging) and what were your memories of him?

opening of scannerI did indeed meet Sir Godfrey on numerous occasions. His humility and “boffin style” of science greatly appealed. Some of the stories at the numerous events surrounding his memorial service were truly fascinating, including his inability to accept any machine which he could not understand without taking it to bits and then reassembling it!

 

Given the financial pressures on healthcare, will the required investment in the latest imaging technology be affordable?

Some of the developments in personalised medicine may be unaffordable. Generic contrast agents will continue to be used in large volumes. The cost of creating “one off” agents may prove unjustifiable.

Why would you encourage someone to join the BIR?

Because of the fun of interdisciplinary discussion and the pride of being a small part of the oldest radiological society!

Does spending more money on equipment mean a better health service?

I passionately believe that prompt access to imaging makes a major contribution to excellent healthcare. But that does not necessarily mean that every hospital has to have every machine at the top of the range. A rolling programme of equipment replacement is an essential part of delivering a high-quality radiological service.

The most difficult thing I’ve dealt with at work is…

An electrical power cut during the middle of a tricky adrenal CT-guided biopsy!

If Wilhelm Roentgen could time travel to Addenbrooke’s hospital, what would he be most impressed with?

The sheer size and the number of staff of the radiology department!

When its 2050, what will we say is the best innovation of the 21st century in healthcare?

Data mining and health statistics.

Who has been the biggest influence on your life? What lessons did that person teach you?

All my previous bosses have influenced my career. I have learnt something from each of them. All of them stimulated me to ask the question “why are we doing things this way”? “Can it be done better”?

My proudest achievement is…

Helping to make the Addenbrooke’s Radiology department one of the most modern in the UK.

What advice would you pass on to your successor?

Never give up, try, try and try again and remember “the more you practice, the luckier you get”.

What is the best part of your job?

That I have been lucky to have had a succession of challenges in the various roles that I have held, all of which have kept me on my toes.

What is the worst part of your job?

Leaving salt of the earth friends as I have moved from role to role.

If you could go back 20 years and meet your former self, what advice would you give yourself?

Do not worry so much – it will all be alright on the night.

Adrian Dixon

Adrian Dixon

What might we be surprised to know about you?

That I support Everton Football Club.

How would you like to be remembered?

For influencing the careers of younger colleagues – hopefully to their benefit!

260215 opening

Professor Dixon will deliver the BIR Toshiba Mayneord Eponymous Lecture called “Has imaging become too effective?” at UKRC on 7 June 2016 at 13:00.

Book your place at UKRC (early bird rate ends 15 April 2016)

 

Toshiba-leading-innovation-jpg-large Thank you to Toshiba for supporting the BIR Mayneord Eponymous Lecture

 

 

Looking back on the life of Professor Robert Steiner

image Robert Steiner

Professor Robert Steiner

Robert Emil Steiner CBE MD FRCP FRCR
BIR Past President
(born 1 February 1918, died 12 September 2013)

As the world of medical imaging moves on with great rapidity, we mustn’t forget those great pioneers who helped us achieve the breakthroughs we take for granted today.

Here, Professor Graeme Bydder of the University of California, San Diego, reflects on the life of the man he knew and admired.

Robert Steiner, former professor of Radiology at the University of London and chairman of the Department of Radiology at the Royal Postgraduate Medical School, Hammersmith died after a long illness on September 12, 2013 at the age of 95.

Professor Steiner established and ran the leading academic Department of Radiology in the UK for many years. He was president of both the British Institute of Radiology and the Royal College of Radiologists and had a major role in the development of cardiac and pulmonary angiography as well as that of magnetic resonance (MR) imaging.

He was born in Prague in 1918 which was then part of the Austro-Hungarian empire, and moved with his family to Vienna at the age of three. He began studying medicine at the University of Vienna in 1935. He was about to complete his preclinical studies at the time of Anschluss, the political annexation and military occupation of Austria by Nazi Germany on March 12, 1938. Members of his medical class who expressed an objection to this simply disappeared. He needed a further two months to complete the first part of his medical degree, and after doing this, escaped through Italy to Dublin in May 1938.
He finished his medical training in Dublin in 1941 and worked in the Emergency Medical Service in the UK from 1941 to 1945. He trained in radiology at the United Sheffield Hospitals from 1944 to 1950.

He was appointed Assistant Director of Radiology at Hammersmith Hospital, London in 1950. At that time much of the equipment in the department was of pre-war vintage and the Director had radiation damage to his hands. Over the next 10 years, Professor Steiner became Director, recruited new staff, replaced equipment and established a very active teaching program.

He was appointed the first professor of Diagnostic Radiology in the University of London in 1961. He established a research program concentrating on cardiac and pulmonary angiography. This was essential for the assessment of valvular disease in the newly developing speciality of cardiac surgery. He also encouraged senior faculty within the department such as Peter Lavender, David Allison, John Laws, and Thomas Sherwood to develop their own areas of expertise to international level.

Tutorials were held on Monday evenings often with radiologists from around London bringing problem films. They were also held on Friday afternoons at 5pm in case any trainees had the idea of going home early. Private practice was banned. This meant that there was generally more consultant time available for teaching and research than at other London teaching hospitals where this was not the norm.

Professor Steiner helped train a succession of radiologists who went on to occupy senior positions in departments throughout the world. These included John Laws (Kings College), Thomas Sherwood (Cambridge), Lenny Tan (Singapore), Constantine Metreweli (Hong Kong), Andy Adams (Guy’s and St. Thomas’s), Brian Ayers (Guy’s and St. Thomas’s), Maurice Raphael (the Middlesex), John Stevens (St. Mary’s and Queen Square), Dennis Carr (the Brompton), Gary Lawler (Melbourne), Tony Leung (Sydney), Nandita deSouza (the Royal Marsden), Peter Dawson (UCH), Walter Curati (Ealing), Derek Kingsley (Queen Square), Rolf Jager (Queen Square), Takayuki Ouchi (Chiba), Alina Greco (Monaco), David Robinson (Abergavenny), Adrian Thomas (Bromley), Mary Ann Johnson (Edmonton), Susan Peterman (Atlanta) and Steven McKinstry (Belfast).

There were also paediatricians (Lilly Dubowitz, Francis Cowan, Mary Rutherford, Linda de Vries and David Edwards), and physicians (John Brown, Mark Doran, Maria Barnard, Simon Taylor-Robinson) who benefited from his training. He strongly supported research radiographers (Jackie Pennock, Linda Banks, Di Spencer, Janet Sargentoni, Anne Case, Angela Oatridge, Susan White, Elaine Williams, and Serena Counsell), scientists (Jane Cox, Jimmy Bell, David Gadian, Richard Iles, Louise Thomas), psychiatrists (Basant Puri, Eve Johnstone, David Owens), and anaesthetists (David Menon, Carol Peden, David Harris), who worked within his department as well as Margaret Kirk, Patricia Hamilton and Dulcie Rodriguez.

Professor Steiner established very fruitful collaborations and exchanges with faculty of leading radiology departments in the United States, British Commonwealth and elsewhere in the world. He hosted numerous senior radiologists on sabbatical leave including Richard Greenspan (Yale), John Doppman (National Institutes of Health), Robert Fraser (Birmingham, USA), Ian MacKay (Hartford), Michael Vermess (NIH), Harold Davidson (Oklahoma), Bob Berk (University of California, San Diego) and Moshe Graif (Tel Aviv). These visitors made a substantial contribution to the department.

He was elected president of both the British Institute of Radiology (1972-73) and the Royal College of Radiologists (1977-80), as well as the Fleischner Society (1973) an international multidisciplinary society dedicated to the diagnosis and treatment of diseases of the chest. It was named after Felix Fleischner a chest radiologist who also left Austria after Anschluss, and worked at Massachusetts General Hospital.

During the 1950s and 1960s there was what seemed an inevitable shift in radiological leadership from Sweden to the US, but quite unexpectedly Sir Godfrey Hounsfield FRS produced the first head clinical computed tomography (CT) scanner in 1971. It was a spectacular success. This was followed by body CT scanners in 1974 and 1975, and the beginning of the modern era of radiology. Britain was at the centre of it, led by a company, EMI (Electric and Musical Industries Ltd) with a remarkable record in acoustics, electronics, TV and radar going back to Alan Blumlein in the 1930s, but no previous experience in the medical field or in x-ray technology.

This was followed by the initial development of MR imaging heralded by the first image published by Paul Lauterbur in 1973. Much of the subsequent development of the technique was performed by groups in the UK based in Aberdeen, Nottingham and London (EMI). There were many difficulties and the first international conference on MR imaging held at Vanderbilt University, Nashville on October 26-27, 1980 was only a limited success mainly due to the lack of convincing clinical results. What was necessary for MR imaging to receive the large scale investment needed for future progress was a major medical application in which the new technique had a substantial advantage over state of the art CT. This Professor Steiner achieved with Ian Young FRS and his team from EMI, in the MR imaging of plaques in the brain in multiple sclerosis (MS). These were shown on a scale not previously seen except at post mortem. MS was a disease that had not previously received significant radiological attention and it seemed an improbable starting point, but MS has since become the single disease of the body most studied with MR. The system the work was done on used the first whole body cryomagnet built by Oxford Instruments, a university spin-off company founded by Lady Audrey and Sir Martin Wood FRS.

The work was remarkable in other ways. During this period EMI sold its CT business to General Electric at a knock down price following its unsuccessful venture into the US, and was trying to sell its MR business. The Medical Research Council (MRC) closed down its CT operation at Northwick Park Hospital, London in 1980 and soon after closed down its ultrasound research there. The MRC would not support clinical MR work at Hammersmith and the leader of the Hammersmith MR group, Frank Doyle suffered a catastrophic stroke before clinical studies began, and never worked again. The only significant outside support came from Gordon Higson, Director of the Scientific and Technical Services Branch of the DHSS.

The success with MS was followed by other major applications of MR including diagnosis of disease in the posterior fossa (where CT was degraded by beam hardening artefacts, 1982-3), use of the heavily T2-weighted spin echo sequence which provided very high soft tissue contrast (1982), paediatrics (no ionizing radiation, 1982-3), the first clinical study with gadolinium-DTPA (opening up the MR study of intracranial tumours, where previously the use of intravenous iodinated agents had given CT a major advantage (1984), high contrast fat signal suppressed sequences for body and musculoskeletal applications (1985). These developments helped keep the UK at the forefront of clinical MR research until, and beyond the ISMRM (International Society for Magnetic Resonance in Medicine) meeting at the Barbican, London in 1985. It also provided time for other groups to mobilise including those led by Donald Longmore (the Royal Brompton), Ian Isherwood (Manchester), Donald Hadley (Glasgow), Ian McDonald, George du Boulay and David Miller (Queen Square), Ian Kelsey Fry (St. Bartholomews, London), Jonathan Best (Edinburgh), Paul Goddard (Bristol), Adrian Dixon (Cambridge), Peter Cavanaugh (Taunton), Stephen Golding (Oxford), Philip Robinson (Leeds) and others to add to the radiological work already done by Frank Smith (Aberdeen) and Brian Worthington FRS (Nottingham). Oxford Instruments expanded rapidly and captured most of the world market for whole body cryomagnets.

The success with MR showed that the earlier success with CT could be repeated, and major developments in other areas of radiology followed including remarkable advances in ultrasound, nuclear medicine, interventional radiology, PACS and digital radiography. These helped transform the speciality of radiology and create the modern era of imaging.

Professor Steiner contributed in many different ways to these developments. He brought to the many tasks he undertook very high standards, and a wide ranging strategic vision, but it was his sense of fairness and justice that endeared him to people at all levels, and led them to trust him without reservation on personal and professional matters.

He was appointed CBE and was the recipient of the gold medals of the Royal College of Radiologists and the European Society of Radiology. He also received honourary degrees, fellowships and memberships from universities and radiological societies around the world.

He was strongly supported by his wife Gertie. She is remembered with great affection as a gracious hostess as well as a source of encouragement and wise counsel by generations of staff, faculty and visitors to the department. Gertie and Robert met in Dublin and married in Sheffield in 1945. They had two daughters, Hilary and Ann. Hilary has two children Christopher and Sarah, and one grandchild. Ann has three boys Tim, Will and Bertie. Robert had two sisters, who together with their families escaped from Vienna to Australia where they settled, and a brother Herbert who studied physics at Cambridge, and remained afterwards in England. Robert’s father and stepmother spent the war years in France, then went to England before returning to Austria.

About Professor Graeme Bydder

Graeme Bydder was born in New Zealand in 1944 and trained in medicine at the University of Otago, Dunedin. He graduated in 1969. He subsequently trained in medicine in New Zealand under Keith Macleod before receiving a Nuffield fellowship to train in CT under Louis Kreel at the MRC Clinical Research Centre, Northwick Park Hospital, London in 1978. His main work was on CT attenuation values in fatty disease of the liver, iron overload, and bone disease.

He worked at the Royal Postgraduate Medical School, Hammersmith Hospital under Frank Doyle and Professor Steiner from 1981 onwards. His main research activity was technical development and clinical application of magnetic resonance (MR) imaging in conjunction with Ian Young FRS and his team.

Professor Steiner provided strategic and tactical direction for clinical MR imaging at Hammersmith from its inception in 1981 to his final retirement in 1998.

Graeme moved to the University of California, San Diego (UCSD) in 2003 and since then has worked on MR imaging of short T2 components in tissues, qualitative and quantitative approaches to MR imaging, and MR microscopy of the musculoskeletal system.

In addition to the benefitting from working under Professor Steiner, Graeme was fortunate enough to work for two of the “three wise men” (Louis Kreel, Frank Doyle, and Jamie Ambrose) who did early experimental work on Godfrey Hounsfield’s prototype CT system and advised the DHSS to proceed with development of the technique in 1969.