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Medical imaging is a multidisciplinary specialty, combining clinical expertise from medical physics, radiography, and radiology, and plays a key role in patient care. Research is vital to ensure the care delivered to patients is evidence-based, and is a core component of clinical governance; however, there are pressures on the imaging workforce, which are significantly impeding imaging research. This commentary presents a research gap analysis pertaining to the multidisciplinary imaging workforce on behalf of the National Institute for Health Research (NIHR) Imaging Workforce Group. Data were summarised from membership surveys of the Royal College of Radiologists, Society and College of Radiographers, and Institute of Physics and Engineering in Medicine; national reports; and feedback from NIHR Clinical Research Network Imaging Champions meeting in 2020/2021. Common barriers to delivering research were found across the multidisciplinary workforce. The key issues were lack of staff, lack of time, and lack of funding to backfill clinical services. Given the ongoing workforce shortages and increasing clinical demands on radiologists, diagnostic radiographers, and medical physicists, these issues must be tackled with a high priority to ensure the future of clinical research within the NHS.

When the National Health Service (NHS) acquired a statutory duty of care for quality in 1998, clinical governance became a mandatory and intrinsic part of modern medicine. Defined as “a framework through which NHS organisations are accountable for continuously improving the quality of their services and safe-guarding high standards of care by creating an environment in which excellence in clinical care will flourish”,1 the vehicle for NHS consultants to enact clinical governance was supporting professional activity (SPA). All activities that underpin direct clinical care (DCC) are encouraged during SPA time, including professional development, research, audit, teaching, clinical management, appraisal, and job planning.2,3 Adequate time for SPAs alongside DCC is therefore crucial for NHS consultants to maintain excellence in clinical care.3 The recently published Royal College of Radiologists (RCR) Survey on Radiologists’ SPA4 has demonstrated three recurring themes, which are widely recognised to be growing concerns for our specialty.

Objectives To evaluate the ability of post-chemo-radiotherapy (CRT) diffusion-weighted-MRI apparent diffusion coefficient (ADCmean) and 18F-FDG PET maximum standardized uptake value (SUVmax) to predict disease-free survival (DFS) in head and neck squamous cell carcinoma (HNSCC), and to determine whether this ability is influenced by human papillomavirus oropharyngeal cancer (HPV-OPC) status. Methods This prospective cohort observational study included 65 participants (53 male, mean ± SD age 59.9 ± 7.9 years, 46 HPV-OPC) with stage III or IV HNSCC. Primary tumour and nodal ADCmean (pre-treatment, 6- and 12-weeks post-CRT) and SUVmax (12-weeks post-CRT) were measured. Variables were compared with 2-year DFS (independent t-test/Mann–Whitney test) and overall DFS (Cox regression), before and after accounting for HPV-OPC status. Variables were also compared between HPV-OPC and other HNSCC subgroups after stratifying for DFS. Results Absolute post-CRT ADCmean values predicted 2-year DFS and overall DFS for all participants (p = 0.03/0.03, 6-week node; p = 0.02/0.03 12-week primary tumour) but not in the HPV-OPC subgroup. In participants with DFS, percentage interval changes in primary tumour ADCmean at 6- and 12-weeks were higher in HPV-OPC than other HNSCC (p = 0.01, 6 weeks; p = 0.005, 12 weeks). The 12-week post-CRT SUVmax did not predict DFS. Conclusion Absolute post-CRT ADCmean values predicted DFS in HNSCC but not in the HPV-OPC subgroup. Amongst participants with DFS, post-CRT percentage interval changes in primary tumour ADCmean were significantly higher in HPV-OPC than in other HNSCC. Knowledge of HPV-OPC status is crucial to the clinical utilisation of post-CRT DWI-MRI for the prediction of outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03662-y.

AIM To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as “optimal”, “sub-optimal” or “degraded”. A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as “optimal” quality, 39.5% (n=45) “sub-optimal”, and 14.9% (n=17) as “degraded”. In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.

Since the inception of the National Institute for Health Research (NIHR) in 2006, the landscape for the delivery of clinical research within the National Health Service (NHS) has been transformed. Clinical radiology has benefitted from funding opportunities for primary imaging research as well as improvements to the supporting research infrastructure to provide imaging for many clinical trials; however, in an increasingly challenging NHS environment, the NIHR and clinical radiology have to evolve an effective working partnership to ensure imaging research is sustainable and will make an impact. A number of initiatives have arisen from discussions between the NIHR, the Royal College of Radiologists (RCR), and stakeholders that will be discussed in this article. It is hoped that these initiatives will be embraced by the imaging community and create a more dynamic sustainable imaging workforce, driving and supporting research and innovation towards future sustainability.

To examine the performance ofConsecutive subjects with MPM undergoing pre-operative staging with10 subjects (9 male, mean age 68 years) with biopsy-proven MPM (9 epithelioid tumours, 1 biphasic) were included. One subject underwent neo-adjuvant chemotherapy between imaging and surgery and was excluded from the clinical versus pathological stage analysis. Pathological staging was concordant with staging byClinical MPM staging by

Large-scale cancer genome studies suggest that tumors are driven by somatic copy number alterations (SCNAs) or single-nucleotide variants (SNVs). Due to the low-cost, the clinical use of genomics assays is biased towards targeted gene panels, which identify SNVs. There is a need for a comparably low-cost and simple assay for high-resolution SCNA profiling. Here we present our method, conliga, which infers SCNA profiles from a low-cost and simple assay.

Background The aim was to define the pathological response in lymph nodes following neoadjuvant chemotherapy for oesophageal adenocarcinoma and to quantify any associated survival benefit. Methods Lymph nodes retrieved at oesophagectomy were examined retrospectively by two pathologists for evidence of a response to chemotherapy. Patients were classified as lymph node-negative (either negative nodes with no evidence of previous tumour involvement or negative with evidence of complete regression) or positive (allocated a lymph node regression score based on the proportion of fibrosis to residual tumour). Lymph node responders (score 1, complete response; 2, less than 10 per cent remaining tumour; 3, 10–50 per cent remaining tumour) and non-responders (score 4, more than 50 per cent viable tumour; 5, no response) were compared in survival analyses using Kaplan–Meier and Cox regression analysis. Results Among 377 patients, 256 had neoadjuvant chemotherapy. Overall, 68 of 256 patients (26·6 per cent) had a lymph node response and 115 (44·9 per cent) did not. The remaining 73 patients (28·5 per cent) had negative lymph nodes with no evidence of regression. Some patients had a lymph node response in the absence of a response in the primary tumour (27 of 99, 27 per cent). Lymph node responders had a significant survival benefit (P < 0·001), even when stratified by patients with or without a response in the primary tumour. On multivariable analysis, lymph node responders had decreased overall (hazard ratio 0·53, 95 per cent c.i. 0·36 to 0·78) and disease-specific (HR 0·42, 0·27 to 0·66) mortality, and experienced reduced local and systemic recurrence. Conclusion Lymph node regression is a strong prognostic factor and may be more important than response in the primary tumour.

Summary The earth exhibits physical properties that attenuate and disperse the seismic waves as they travel through the subsurface. A case study is presented that uses waveform inversion to invert for the quality factor Q on a marine dataset from offshore Malaysia. To illustrate the effects of attenuation and dispersion, we model data in acoustic and in visco acoustic models with and without low Q anomaly. The amplitude spectrum of the visco- acoustic data shows a drop in amplitude compared to the acoustic dataset. This reduction in amplitude is seen even at the low frequencies commonly used for waveform inversion and is greater in magnitude than the amplitude change due to the presence or absence of the Q anomaly. This illustrates that both amplitude and dispersion effects are measurable on the data. The relevance of visco-acoustic inversion is highlighted by comparing the results of inversion for acoustic, visco-acoustic with fixed Q and visco-acoustic with variable Q anomalies. All three waveform inversions improve the velocity model over the initial model. The visco-acoustic inversions are however an improvement over the acoustic only inversion, as illustrated by the better stack and flatter gathers. The Q anomaly retrieved by the inversion delimits the gas zone.

Acoustic full waveform inversion is nowadays an established technology to determine velocity background images from low-frequency and long-offset data sets with a focus on the diving waves. The depth of investigation can vary from a few hundred meters to a few kilometres. While anisotropy is often accounted for, dispersion and absorption effects are more often ignored. We propose a visco-acoustic time-domain full waveform inversion formulated. To reduce the numerical cost, we employ only one memory variable per stress field but distribute the different relaxation mechanisms over adjacent cells in the finite difference scheme. Through an effective medium approach, we here take advantage of the diffusive nature of the absorption and dispersion phenomena which can be discretised over a coarser grid than the propagation phenomenon, although this introduces some scattering effects as shown with a small numerical example. The visco-acoustic inversion is parameterized with the NMO velocity, eta-parameter, one inverse quality factor and density. We illustrate the trade-off between velocity and quality factor through sequential and simultaneous inversions of a synthetic example. We then apply the visco-acoustic full waveform inversion on a narrow azimuth data set to show the potential benefit of accounting for dispersion and absorption effects.

Dust samples (n=75) were collected from shopping malls, hotels and libraries in Singapore and then analyzed using Mold Specific Quantitative Polymerase Chain Reaction (MSQPCR) for the 36 molds that make up the Environmental Relative Moldiness Index (ERMI). Most of these molds (23/36) occur at similar rates in Singapore and the United States. A Singapore Environmental Relative Moldiness Index (SERMI) is proposed which might be divided into low (18), medium (18 to 28) and high (28) mold burden categories but more samples will help to refine these categories.

The present study examined the dose-response effects of eCG treatment alone and in combination with various doses of hCG on early embryonic development in vivo and viable pregnancy rate in rats. Mated female Wistar rats were treated with eCG alone (0, 10, 20 or 40 iu), or with 20 iu eCG in combination with various doses of hCG (10, 20, 40 or 80 iu) administered 48 h later. The animals were killed on days 2, 3, 4, 5 or 14 of pregnancy and the numbers of embryos and fetuses recovered were scored. All rats treated with 0 or 10 iu eCG were pregnant. The pregnancy rate was reduced from 62.5% on day 2 to 25% on day 14 and from 31% on day 2 to 10% on day 14 in the groups treated with 20 and 40 iu eCG, respectively. The reduction in pregnancy rate induced by 20 iu eCG was negated by the increasing doses of hCG used. A 100% pregnancy rate was noted on days 2 and 3 in the groups treated with doses of hCG between 10 and 80 iu and from day 2 to day 4 in the groups treated with doses of hCG between 20 and 80 iu. However, a higher viable pregnancy rate was observed only in the group treated with 10 iu hCG compared with the group treated with 20 iu eCG and 0 iu hCG. These results imply that hyperstimulation of rats with high doses of eCG compromises pregnancy rate and markedly reduces litter size and that the addition of hCG is required for complete ovulation, which results in higher embryo yield and a delay in early embryo demise.

To assess the changes in computed tomography (CT) tumor heterogeneity following neoadjuvant chemotherapy in esophageal cancer. Thirty-one consecutive patients who received neoadjuvant chemotherapy for esophageal cancer were identified. Analysis of primary tumor heterogeneity (texture) was performed on staging and post-chemotherapy CT scans. Image texture parameters (mean grey-level intensity, entropy, uniformity, kurtosis, skewness, standard deviation of histogram) were derived for different levels of image filtration (0-2.5). Proportional changes in each parameter following treatment were obtained. Comparison between pathological tumor response and texture parameters was analyzed using Mann-Whitney U-test. The relationship between CT texture and overall survival) was estimated using the Kaplan-Meier method. Tumor texture became more homogeneous after treatment with a significant decrease in entropy and increase in uniformity (filter 1.0 and 2.5). Pretreatment (filter 1.5, P = 0.006) and posttreatment standard deviation of histogram (filter 1.0, P = 0.009) showed a borderline association with pathological tumor response. A proportional change in skewness0.39 (filter 1.0) was associated with improved survival (median overall survival 36.1 vs. 11.1 months; P0.001). CT tumor heterogeneity decreased following neoadjuvant chemotherapy and has the potential to provide additional information in primary esophageal cancer.

Most advances in conventional diagnostic imaging techniques have focused on improving the spatial resolution and speed of acquisition of images or on new contrast agents. However, tumors are extremely complex biological models with a series of characteristics like hypoxia, metabolism, cellularity, angiogenesis, and functionality of the lymph nodes that are very important in oncology but cannot be adequately studied with these diagnostic imaging methods. In this article, we discuss the possible contributions of different functional imaging techniques based on computed tomography, magnetic resonance imaging, or positron emission tomography to obtain information about different biological processes and characteristics that are very important for diagnosing, staging, planning treatment, evaluating the response to treatment, and monitoring the evolution of cancer patients, as well as for the development of new drugs.

Most advances in conventional diagnostic imaging techniques have focused on improving the spatial resolution and speed of acquisition of images or on new contrast agents. However, tumors are extremely complex biological models with a series of characteristics like hypoxia, metabolism, cellularity, angiogenesis, and functionality of the lymph nodes that are very important in oncology but cannot be adequately studied with these diagnostic imaging methods. In this article, we discuss the possible contributions of different functional imaging techniques based on computed tomography, magnetic resonance imaging, or positron emission tomography to obtain information about different biological processes and characteristics that are very important for diagnosing, staging, planning treatment, evaluating the response to treatment, and monitoring the evolution of cancer patients, as well as for the development of new drugs.

We have described previously in the Finnish population an inactivating point mutation (566C--T) in the human FSH receptor (FSHR) gene. In women, this mutation causes hypergonadotropic ovarian failure with arrest of follicular maturation and infertility, whereas in men, there is variable suppression of spermatogenesis, but no absolute infertility. To determine whether the same FSHR mutation occurs in other populations, its frequency was determined in Finland, Switzerland, Denmark, and the Chinese population of Singapore. The mutation was screened for using genomic DNA extracted from whole blood or dried blood spots. Exon 7 of the FSHR gene was first amplified using a pair of biotinylated primers. The PCR products were then immobilized on streptavidin-coated microtitration wells and hybridized using short allele-specific oligonucleotide probes labeled with europium. Time-resolved fluorometry was used for europium signal detection. To test the reliability of this method, 40 isolated DNA samples and 35 dried blood spot samples were blindly tested for the 566C--T FSHR mutation. The analyses yielded identical results with denaturing gradient gel electrophoresis and allele-specific restriction enzyme digestion of the same samples, thus demonstrating the reliability of the tested method. Automation of this procedure allows the screening of large numbers of samples, which was subsequently carried out to investigate the frequency of the 566C--T mutation in the study populations. A total of 4981 samples from the above-mentioned 4 countries were analyzed. The frequency of the 566C--T mutation was 0.96% for all Finnish samples (n=1976), with a strong enrichment of the mutant allele in the northeastern part of the country. Only 1 mutation carrier was identified in the samples from Switzerland (n=1162), whereas none was found in samples from Denmark (n=1094) and the Singapore Chinese (n=540). These results suggest that the 566C--T mutation of the FSHR gene is enriched in Finland, but is uncommon in other populations.

The wait for an oocyte donor is highly unpredictable and stressful. The recipients may have to remain contactable at all times. Even when a donor is present, their reproductive cycles may not be in synchrony to enable gamete or embryo replacement, and embryo freezing is required for the transfer of embryos in the subsequent cycle. After the release of the Guidelines for Assisted Reproductive Technique by the Ministry of Health we have established a simplified oocyte donation programme with which the need for synchronisation, embryo freezing and the disruption to the recipient couple's social life are eliminated. To illustrate, we report the first report of oocyte donation pregnancy home bred and delivered in Singapore.

Two clomiphene-human menopausal gonadotropin regimes were assessed for our in vitro fertilization and embryo replacement (IVF and ER) program since September 1983. Clomiphene, 50 mg bd, was taken from day 2 for 5 days. Human menopausal gonadotropin (hMG) was given from day 6; for the first regime, 75 IU/day was given for the first 3 days, and for the second, 150 IU/day. The subsequent dosages were dependent on the estradiol response. There were 9 cases for the first regime and 10 cases for the second. The mean number of hMG ampoules given was 16.5 and 19.25, respectively. The number of follicles seen on ultrasound was 3.0 +/- 0.5 and 3.4 +/- 1.2 (mean +/- SD), respectively. There was no statistical difference in the estradiol response up to the day of laparoscopic ova recovery for the two regimes. However, a spontaneous luteinizing hormone (LH) surge was observed in 4 of 9 cases in the first group and 6 of 10 cases in the second group. When a comparison was made between cases that had a spontaneous LH surge and cases that were given human chorionic gonadotropin (hCG), there was a higher estradiol level on the day of the laparoscopy in the hCG group with the lower hMG regime (P less than 0.05). There were no other differences. Our small series shows a 52.6% incidence of spontaneous LH surge with clomiphene-hMG. Hence such stimulated regimes can result in a high proportion of spontaneous LH surges; this may be an index of satisfactory endocrinological control in spite of an increase in the number of follicles.

In vitro fertilization and embryo transfer (IVF and ET) is becoming an important technique in the treatment of subfertility. It is the method of choice in irreversibly damaged Fallopian tubes, and is gaining widespread use in oligospermia and idiopathic subfertility.

138 treatment cycles of GIFT were carried out in couples with mainly unexplained infertility, endometriosis and male factor. The overall pregnancy rate was 24.6%, abortion 29.2%, multiple pregnancy 20.6% and ectopic pregnancy 0%. Four oocytes seem to be the optimal number of oocytes to be transferred. Patients with male factor infertility fared the worse in comparison with the other groups. Successful in-vitro fertilization of excess eggs did not correlate with a positive outcome of the GIFT procedure.