Proceedings cpn meeting_2012-03-20


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We would like to take this opportunity to share the proceedings form first meeting on Structured Light Plethysmography held at Trinity College on March 20th. To those who attended, thank you for you time and enthusiastic inputs. It was a great mix of clinical thought leaders from the UK and Europe and I felt that we all gained a lot of additional insight by the participants. We hope that the detailed explanations of the new SLP technology and review of existing clinical work was educational and has driven your desire to be a part of the future collaborative work. For those on copy that could not attend, we hope that you will review the attached overview and notes from the meeting and that you will join us for the 2nd meeting in 6 months. Our goal is to grow the clinical group and identify new areas where SLP can aid you in your clinical practices.

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Proceedings cpn meeting_2012-03-20

  1. 1. Structured Light Plethysmography ClinicalPartners Network Meeting 201220 March 2012Trinity CollegeCambridge UniversityCambridgeUnited KingdomA PneumaCare Limited Sponsored Meeting
  2. 2. SLP meeting 20 March 2012, Trinity College, Cambridge Trinity College Cambridge Wolfson Seminar Room 20 March 201210:00 Coffee and registration10:30 Welcome – Dr Richard Iles / Dr Ward Hills10:40 Introduction to Structured Light Plethysmography – Dr Richard Iles11:00 Current research – Ms Jenny Conlon / Dr Irisz Levai To include: Correlations with conventional measurements of lung function and regional analysis11:30 Higher methodology and statistical processing – Dr Joan Lasenby11:50 Future directions – Dr Richard Iles12:00 Open discussion and questions12:30 Tour of Trinity College13:00 Lunch14:00 Demonstration of PneumaScan™ P2 – Dr Simon Baker / Ms Jenny Conlon14:30 Workshop: Developing realistic research with SLP – an opportunity to discuss research ideas with the PneumaCare team (Facilitators: Dr Richard Iles, Ms Jenny Conlon, Dr Simon Baker, Dr Stuart Bennett, Dr Joan Lasenby)15:00 Refreshments15:30 Feedback from the Workshop16:30 Developing funding strategies – Dr Simon Crick17:00 Close – Dr Joan Lasenby / Dr Ward Hills19:30 Dinner at Browns 2
  3. 3. SLP meeting 20 March 2012, Trinity College, CambridgeIntroductionDr Richard Iles, in collaboration with Dr Joan Lasenby, hosted the first annual Structured LightPlethysmography (SLP) Clinical Partners Network (CPN) Meeting at Trinity College, CambridgeUniversity, on 20 March 2012. The purpose of the meeting was to provide a forum for discussion ofrecent developments and potential future explorations of SLP technology.SLP is a novel completely non-contact and non-invasive lung function assessment and imagingtechnology. The technology was pioneered by Drs Iles and Lasenby, and commercialised byPneumaCare Limited. SLP works by observing a grid of light projected onto the anterior chest wall ofa patient, and interprets this movement during breathing as respiratory volume. The 3D motionallows standard spirometric lung function parameters to be calculated in addition to providing novelinformation on chest wall movement. Such information could have many interesting applications fordiagnostic medicine.The meeting brought together key opinion leaders from Cambridge, Glasgow, Aberdeen, Belfast,Birmingham and Paris. Interest in SLP technology and in this meeting was also received from Oxford,Berne in Switzerland, France, and Great Ormond Street Hospital in London.The day was divided into presentations on current clinical research in the morning, and a wide-ranging discussion in the afternoon that included participants from around the UK and France, andalso members of the National Institute of Health Research, an NHS organisation with a mandate tofacilitate research funding within the NHS.The morning presentationsPresentations of clinical data gathered in the past nine months at Addenbrooke’s and PapworthHospitals, Cambridge, were given. These were followed by a talk from Dr Joan Lasenby who outlinedsome of the mathematical analysis techniques that have been applied to SLP data. Then Dr RichardIles speculated on the future clinical applications of SLP and opened up a general discussion aboutthe potential clinical utility of SLP. This led into a demonstration of the instrument by PneumaCare’sProduct Director, Dr Simon Baker, and Head of Software, Willem H de Boer.Dr Richard Iles, Addenbrooke’s HospitalDr Richard Iles presented a history of spirometry and lung function tests, followed by an explanationof the need for 21st century technology, such as SLP, to augment 40-year-old spirometry technology.Richard overviewed current technologies and their limitations, including spirometry andoptoelectronic plethysmography. It was his frustration with the limitations in current clinicalcapability that led to the development of SLP in this regard, in cooperation with Joan Lasenby andher group in the Engineering Department of Cambridge University in 2009. Joan’s team took a skillset developed in computer graphics and gaming, and applied it to the clinical requirements of lungfunction imaging.Richard then gave an overview of early work done with prototype SLP devices in both theEngineering Department and later in Addenbrooke’s Hospital. He highlighted the unique aspects ofSLP data, primarily the fact that being an imaging technique, SLP is able to analyse a patient’s 3
  4. 4. SLP meeting 20 March 2012, Trinity College, Cambridgeregional lung function. SLP is also able to measure the differential anterior chest wall movementbetween the left or right sides of the abdomen and chest wall.Jenny Conlon, Addenbrooke’s HospitalMs Jenny Conlon, respiratory physiologist and research associate at Addenbrooke’s Hospital,presented an ongoing study at Addenbrooke’s in which SLP data is being collected simultaneouslyalongside traditional spirometry data. In this study the commercial SLP device, the PneumaScanTM, isbeing used throughout. Jennydescribed in detail themethodology and key factorsinvolved in using thePneumaScanTM as a spirometryequivalent device. As the SLPapproach is entirely non-invasive, data can be collectedon the same patient on thesame breath, allowing for adirect comparison.The study has been in placesince October 2011, recruitinga wide range of subjects frompatients attending the generallung function clinic.Data have been collected onadults and children (under 18years old) in different diseasetypes (COPD, asthma,pneumonia, bronchiectasis, cysticfibrosis and other). Correlationsbetween SLP output andspirometry have beendemonstrated.FindingsThe work has shown that in adirect comparison between SLPand traditional spirometry, thereis a strong agreement inquantitative outputs. Correlationsbetween spirometer and SLP datawere presented for respiratoryrate (r = 0.999), Vt (r = 0.967), andforced expiration (r = 0.98). Results for FEV1, FVC and TV were also presented (see slides). 4
  5. 5. SLP meeting 20 March 2012, Trinity College, Cambridge 5
  6. 6. SLP meeting 20 March 2012, Trinity College, CambridgeOutcomesThe outcome of the work at Addenbrooke’s has been the optimisation of grid sizes and positioningthe patient, which is important for both accurate and reproducible quantitative measurements.Operator procedures have also been much improved as the instrument is used on a daily basis.Future projectsJenny also presented other recent and planned research projects including validation of SLP in non-invasive ventilated COPD patients, and validation of SLP in non-ventilated neonates. Some of theseprojects have already begun collecting data, while others will start in the coming months.The first study will be a validation of SLP in non-invasive ventilated COPD patients. Patients will bemonitored for 24 hours following COPD exacerbation and admission, and at 3-day intervals untildischarge. Tidal breathing measurements will be taken both on and off non-invasive ventilation (NIV)where possible. The tidal breathing data will be compared to measurements recorded from NIVmachine during measurements (i.e. respiratory rate, tidal volume), along with ratings of perceivedbreathlessness.The next study already underway will record the breathing pattern of newborn infants and progressto validation of SLP in ventilated and non-ventilated neonatesThe results of these projects will be available at forthcoming Clinical Partners Meetings.Jennys presentation can be found at URL: 6
  7. 7. SLP meeting 20 March 2012, Trinity College, CambridgeDr Irisz Levai, Papworth HospitalDr Irisz Levai, an honorary observer, presented data collected at the Thoracic Surgery Department atPapworth Hospital. Irisz collected datapre- and post-operatively on 49 patientsundergoing thoracic surgery betweenNovember 2011 and February 2012. Shestressed that measurements were doneon the post-operative wards.FindingsIrisz showed the potential for the Thora-3DI to observe and record the relationalmovements of the left and right side ofthe chest, and also the phase anglebetween chest and abdomen. In the topright slide, images of the chest wall aredivided into colour-coded regions. Themovement of each region is plotted toshow the differential motion.Several potential uses of this regionalanalysis were presented, as was ademonstration of the 3D viewersoftware that will be released byPneumaCare in May.OutcomesThe non-invasive imaging of SLP allowspatients to be assessed in situ. This mayallow a more rapid assessment of post-operative respiratory function andpossibly gives early correlation withfunctional recovery and discharge.SLP seems to correlate well with otherimaging approaches but without thepotentially harmful irradiation. Thebottom right slide shows data from apneumonectomy patient 8 days post-surgery. The x-ray shows a build-up offluid that is also clearly visible with theThora-3DI instrument via the reducedchest wall movement on the side of the pneumonectomy.The data collected at Papworth may also show that SLP has a role in predicting the post-operativerecovery time. Patients who experience little trauma and have good pain control show only small 7
  8. 8. SLP meeting 20 March 2012, Trinity College, Cambridgedifferences between the pre- and post-operative SLP images. These patients tend to be dischargedmuch earlier than those with large differences and poor pain control.Future projectsIn the coming months Irisz will be working with three hospitals (Addenbrooke’s, Papworth, andHeartlands Hospital in Birmingham) to explore further the use of SLP in pre- and post-thoracicsurgery imaging.Irisz’s presentation can be found at URL: Lasenby, Cambridge University Engineering DepartmentDr Joan Lasenby gave an overview of some of the statistical methods used to analyse the 3D data setthat is created from a Thora-3DI observation. Joan explained how the instrument tracks themovement of many points defined by a grid projected onto the patient. The Thora-3DI can providevery rich information about the dynamic movement of the chest wall during breathing manoeuvres.It is this dynamic 3D imaging that allows the Thora-3DI to provide information that is inaccessible vianormal spirometric measurements.Richard Iles, Addenbrooke’s HospitalDr Richard Iles summed up the morning’s presentations, focusing on clinical trials data obtainedfrom respiratory clinics at Addenbrooke’s and thoracic surgery at Papworth, which were presentedand discussed by the group of key opinion leaders. Research methodology to generate the highestquality measurements using the Thora-3DI™ and the PneumaScanTM and future possible studiesusing SLP technology were discussed.Discussion topicsThe first three presentations generated a good discussion, focusing on three key questions.Q: The accuracy of the deviceA: A highly accurate method of volume measurement, when used correctly, with respect to the areacovered by the grid and movement generated by the patient.Q: The environment from which data could be collectedA: The current tracker is being upgraded, and will be able to handle most lighting conditions foundwithin the hospital environment.Q: The reproducibility and repeatability of dataA: This is currently being reassessed using the new tracking system. However, it must beremembered that the P2 measures volume and a pneumatach measures flow. The more accuratedevice is potentially the P2 / volume assessment. 8
  9. 9. SLP meeting 20 March 2012, Trinity College, CambridgeQ: The focal length and equipment changes required to monitor infantsA: Minimal adjustments in focal length, etc, need to be made to the P2 to allow data collection inneonates. These can be made by opening the device; once made, they are fixed for that particularinstrument.Afternoon workshopThe afternoon workshop was introduced by Dr Simon Crick from the National Institute for HealthResearch (NIHR). The goal of the NIHR is to assist individuals, working in world-class facilities, toconduct leading edge research focused on the needs of patients and the public. The aim of theworkshop was to developing realistic research proposals to explore the potential of SLP. 9
  10. 10. SLP meeting 20 March 2012, Trinity College, CambridgeParticipantsName Interest/Experience Contact DetailsJohanna Acosta Thoracic Research Academic Department of Anaesthesia, Critical Physiotherapist Care, Pain & Resuscitation, Heartlands Hospital, BirminghamStuart Bennett PhD student Cambridge University Engineering Department, Signal Processing and Communications Laboratory, CambridgeAman S Coonar Consultant Thoracic Papworth Hospital NHS Foundation Trust, Thoracic Surgeon Surgery Department, Papworth, CambridgeJenny Conlon Respiratory Cambridge University Hospitals NHS Foundation Physiologist/Research Trust, Addenbrooke’s, Cambridge AssistantSimon Crick Research Adviser NIHR RDS for the East of England, Lockton House, Clarendon Road, CambridgeTheodore Dassios Senior Registrar, will Cambridge University Hospitals NHS Foundation collect neonatal data on Trust, Addenbrooke’s Neonatal Intensive Care, SLP CambridgeColin Forster Project Manager Plextek Limited, London Road, Great ChesterfordJonathan Fuld Respiratory Physician Hinchingbrooke Hospital, Hinchingbrooke Park, HuntingdonNeil Gibson Consultant in Paediatric Royal Hospital for Sick Children, Yorkhill NHS Respiratory Medicine Trust, GlasgowRichard Iles Consultant in Respiratory Cambridge University Hospitals NHS Foundation Paediatrics Trust, Addenbrooke’s Neonatal Intensive Care, CambridgeJoan Lasenby Senior Lecturer Cambridge University Engineering Department, Signal Processing and Communications Laboratory, CambridgeIrisz Levai Honorary Observer Papworth Hospital NHS Foundation Trust, Thoracic Surgery Department, Papworth, CambridgeKim Parker Thoracic Research Academic Department of Anaesthesia, Critical Physiotherapist Care, Pain & Resuscitation, Heartlands Hospital, BirminghamClaudine Peiffer Paediatric Researcher Laboratoire de Physiologie–EFR, Hôpital Saint- Vincent-de-Paul 82, Avenue Denfert Rochereau, 75014 ParisJonathan Scales Research Advisor School of Health and Human Sciences, University of Essex, ColchesterMike Shields Consultant Respiratory Queen’s University Belfast & Royal Belfast Hospital Paediatrician Sick Children, BelfastSteve Turner Clinical Senior Lecturer Royal Aberdeen Childrens Hospital, University of Aberdeen, AberdeenMark Williams Reader in Clinical University of Glamorgan, Faculty of Health, Sport Physiology and Science, University of Glamorgan, PontypriddMark Sanders Distributor Clement-ClarkTodd Austin Distributor McGraphicsWard Hills CEO PneumaCare LimitedEric Stewart Commercial Director PneumaCare LimitedSimon Baker Product Director PneumaCare LimitedWillem H de Boer Head of Software PneumaCare Limited DevelopmentDavid Mair Senior Support Engineer PneumaCare LimitedGabriela Durcova- CPN Meeting Coordinator PneumaCare LimitedHills 10