The Leeds Biomedical Research Centre (BRC) sits within the leafy setting of Chapel Allerton Hospital. Funded by a National Institute of Health Research (NIHR) grant in 2007, it was established to promote and undertake research into all musculoskeletal diseases, with the focus on all forms of arthritis. Further grant from the NIHR in 2012 and 2017 have secured the short-term future of the centre and have been instrumental in the progress we have made.
The Magnetic Resonance Imaging (MRI) scanner is the jewel in the crown of the BRC’s imaging department. The £2 million system was procured with the original NIHR grant in 2009 and is still providing researchers and clinicians with unparalleled anatomical and pathological information 8 years on. MRI is used most commonly to produce biomarkers for studies, which can provide researchers with vital information about disease-processes within various joints/muscles or other body parts.
The scanner is a Siemens “Verio” system, which is a 3-Tesla magnet, and was the first of its kind in West Yorkshire. As compared to the more common 1.5-Tesla systems, our 3T machine can produce better quality images, all in a faster time. The actual hole (or bore) in the machine is significantly wider than most too (70cm versus 60cm), which makes things much easier for claustrophobic patients and others who find it difficult to physically fit in.
The front-line staff in the BRC imaging department are all experts in their fields, are supremely well qualified (with NVQs, Degrees and PhDs) and have been hand-picked as shining lights in their chosen professions. Billy (Imaging Unit Assistant), Rob and Brian (MRI Radiographers) will meet/greet all-comers with a smile, put all patients at ease and conduct each examination with the utmost professionalism and efficiency. We also factor in more time to spend with patients for research scans (as compared to clinical scans) as we appreciate that a vast majority of them are volunteering their time for little personal benefit and for the “greater good”.
8am to 12pm – bleary-eyed but bushy-tailed, all staff slowly make their way in to the unit from various destinations across the area. The first patient is normally booked for 8.30am each day, but the scanner takes 20 minutes to “warm-up”, therefore an early start is required. Although there may not be much to see from the outside, some examinations require extensive and sometimes meticulous preparation before commencing, which adds to the time allotted to each individual patient. At any one time we will have at least 10 studies on-going, each one requiring a completely different imaging “protocol”, varying in length from 30mins up to 1hr 15mins. In all of our on-going studies we scan numerous body-parts, including spines, hands, feet, knees & shoulders. Basically anything that comes under the terms “musculo” or “skeletal”!! Some require the patient to have an intravenous cannula inserted (for mid-examination MRI contrast injections), whilst others are simple and need no prep at all. All patients (and staff) are safety-screened before entering the MRI environment as the extremely powerful magnet can turn everyday items into potentially lethal projectiles. The magnetic field can also interfere with the functionality of pacemakers, even from several metres away. But don’t panic though, as all the radiographers are extensively trained and ensure the patient’s safety at all times. If there are any doubts, we will not allow people entry into the scanner room.
On a Thursday morning we attempt to scan 3 “VEDERA” study patients. This study is our most time-consuming and requires extensive preparation so we arrive early to make sure we are here in good time. For this, we spend at least 15 minutes preparing the magnet room (with all the correct coils and comfort aids) and fully briefing the patient as to what to expect. This particular study requires the patients to be on their front with their arm out above their head for 40mins, so we can scan the hand/wrist in the middle of the magnet. We call this the “Superman” position for obvious reasons. Not everybody can achieve this so we offer numerous sponge-based comfort aids to assist because if the patient is not comfortable then they won’t stay still for the scans. Also, ultimately we have the long-term health of our patients as a priority and whilst we do strive to acquire the required pictures, we will not torture anybody in the process!! Most studies involve multiple visits (with VEDERA it is five), therefore if we are to expect patients to return we want the experience to be as least traumatic as possible.
Each examination also requires roughly 10mins post-processing of the images, where we re-construct some scans into different imaging planes and do some other complicated measurements. Therefore, each scan is given at least 1hr 15mins in the diary.
12pm to 1pm – lunch. Time to reflect on the morning’s activities and re-fuel for a busy afternoon.
1pm to 5pm – As an NIHR-funded centre, one of our priorities is on staff progression. Therefore, we actively promote further involvement in the research, other than just scanning patients. As a radiographer, we are not only encouraged to help develop focused MRI scanning protocols and analyse data for other researchers but also to lead our own research projects. As a result, both of our radiographers, have studied towards a Masters degree. Therefore, we always apportion time for study and personal development as this not only helps with career progression, but also directly impacts on the research that is completed in the Centre. Thursday afternoons are often used for this.
Any MRI requests that come in for a Thursday afternoon are given priority. We often scan one of our numerous “Whole Body” examinations during this time. Whether we can scan “Whole Bodies” is probably the most commonly asked question we encounter. The answer to this is “Yes, but No”!!
Basically, a whole body scan is possible but very time-consuming and is never really of high enough quality to rule out small diseases/pathologies as it would take several hours to complete a good quality examination. Therefore this is never undertaken in the NHS clinical environment. For our (research) whole body examination we scan virtually all the joints in the body plus the spine, but not the head , chest or abdomen so we have an artistic licence when we describe it as “Whole Body”. Most new scanners (both CT and MRI) have the capability (from the exam table) to scan the entire body, head to toe without moving the patient in-between areas, but ours doesn’t. Despite this, our whole body protocol is the one we are most proud of as developing it takes several hours of work to make sure it is both reproducible and achievable for our often immobile patients.
Each day is different in the BRC and our role(s) here are so varied day-to-day that it is impossible to describe everything that occurs in this unique environment. However, this hopefully provides an insight into what goes on behind those security doors with the mirrored-glass!