Imaging

Children come to GOSH with rare and complex conditions. Sometimes asking them and their families questions and carrying out tests simply can’t give the answers healthcare teams need, and we need to take a look inside their body to see if we can work out what is going on. For this, GOSH has a host of options that can look ‘inside’ the body called imaging.

Imaging encompasses a range of different techniques, from X–rays for looking at broken bones to Magnetic Resonance Imaging (MRI) for examining the brain and ultrasound for examining the abdomen. Most children in our care require a scan as part of their clinical care and most research trials require imaging to see whether treatment is working. But Radiology at GOSH is now a world–leader in its own research.

Radiographer Dr Ian Simcock has shown how to use non–invasive imaging to help families following miscarriage and still birth, a painful topic that can sometimes be overlooked. To find answers, families are usually offered an autopsy but, in most cases, this requires an incision in their child that some feel is just too much to consider.

To address this, the team has developed imaging techniques to perform an examination without incisions. In their experience, imaging like this can give answers to around half of the families who choose this method, which is similar to a full autopsy. GOSH uniquely offers an Imaging Autopsy (or Non–invasive autopsy) to parents of children of all age ranges – from babies all the way up to older teenagers who have sadly died.

Non–invasive imaging research is also shedding light on how to best look after children who have broken bones or suffered suspected abuse and give them the best care. Children’s fractures are hard to spot, are different to adult fractures and what sometimes looks like a fracture may actually just be a child’s growing bone.

A new research project led by Radiologist Dr Susan Shelmerdine, and working with the GOSH Young Person’s Advisory Group for Research, is studying whether artificial intelligence can help find fractures so that patients receive the best care at the right time. This will allow children’s radiologists around the country to access the best healthcare, even when they don’t have immediate access to specialist centres.

When it comes to the heart, we are using imaging to explain complex heart conditions to patients, families and even doctors in training. Led by Professor Silvia Schievano at UCL Institute of Cardiovascular Science, a team of medical engineers have 3D–printed personalised hearts so doctors can use these models to explain surgery to young children and their families. They now regularly use virtual reality to train budding heart surgeons and have also used complex computer modelling to work out how the blood flow in major arteries and veins may be affected by an intervention like surgery or a stent, before the patient has the operation.

Making our way up to the brain and we are driving innovation in MRI – particularly in complex neurosurgery (for example, conjoined twins), brain tumours and in epilepsy. The team at GOSH and UCL GOS ICH, led by Professor Chris Clark, are exploring a kind of MRI - called diffusion tensor imaging and tractography - that carefully maps the ‘white matter’ of the brain. This allows them to reconstruct important structures in the brain responsible for learning, memory and language and work out what is happening when something goes wrong, such as during an epileptic seizure.

Magneto encephalography (MEG) scans allows hospital teams to look for regions of high electrical activity in the brain and can help healthcare teams locate the source of epileptic seizures. The standard machine requires children to stay very still for prolonged periods of time and, as this often isn’t realistic for small children, general anaesthetic to take the MEG scan needs to be used. Now, working with the Institute of Neurology, Nottingham University and the charity Young Epilepsy, a project led by Professor Helen Cross at GOSH is developing the first ‘wearable’ (MEG) machine. While a child can play and move around in a specially–designed room, the device – which looks like a large helmet – can be taking detailed scans of the electrical activity in their brains to help specialists understand more about the child’s condition. The Children's Cancer Centre includes an imaging floor which will include highly specialist imaging equipment, including a whole body PET-CT, enabling sophisticated diagnostic and treatment planning. This will support our research ambitions and provide additional capacity.