Secondee’s Report University of Dundee/Guerbet Paris D Cassidy

Overview Background Secondee ReDVA overview Workpackage 2 &3 Future work in WP 2 & 3 Courses, training & challenges Summary

Background BSc Physics with Medical Physics Ultrasound research project FOCUS Institute, Dublin Student placement in diagnostic department St James’s Hospital, Dublin PhD Research University of Dundee Cardiac MRI I'm just going to start off with some background. My undergraduate degree was in medical physics, which represented 80% physics and 20% biology I got the opportunity to work in the largest medical physics group in Ireland in St James’s Hospital in diagnostic radiology. It was here I first got experience of the purpose of a medical physicist, the research they generate and the problem solving role they uphold. After this placement, I was pretty confident about working in medical physics and selected a final year project in medical ultrasound, investigating the twinkle aretefact in colour doppler imaging. This project was successful and continued onto a research assistant position and then I started a PhD in medience in cardiac MRI in the university of dundee. IAPP ESR Fellowship Guerbet Paris (12 Months)

Transferable Skills for ReDVA Background in imaging science Experience in working in diagnostic imaging: ultrasound, interventional radiology, CT & MRI PhD research in optimistation and validation of MRI techniques for macrovascular disease Aortic flow- phase contrast MRI Clinical markers of CV disease- arterial stiffness Translating and correlation to other vascular tests Before submission of PhD, took up early stage researcher position in ReDVA My research interest has been in medical imaging and have a background in physics- and this work has been a hybrid of both. The challenges proposed by this PhD has included validation and implementation of a new technique as well as developing how to process/analysis the data to make a robust measure of arterial stiffness. This slide represents the order of my thesis including a bit of background on PWV, validation of PWV and the different methods used to derive PWV. In this chapter, we investigated how we could estimate the temporal shift between, what was the most repeatable measure. Which method had the least intra and interoperator error. Ensuring a robust technique is essential before implementing it in a patient cohort especially if there is future follow up in this group. The second part was the first application of the conventional PWV methods (as selected through the previous chapter) to an observational pilot study that included a mix patient cohort of CVD and T2DM, a subset of a much larger clinical study Summit and included patients well phenotyped patients (Dr. Khans vascular imaging assessment) Moving on from the previous study, subsequent study looked at developing the conventional PWV technique into multi-site approach to assess the flow changes throughout the aorta. This was again validated and tested for robustness and repeatability. All the parameters were optimised to ensure that the sequence could deliver the same quality of information as the conventional method. This then got applied in a clinical cohort of peripheral vascular disease patients to test its robustness clinically. The final part is for future work and summery. We will discuss some area of ongoing research and future directions for this project.

The ReDVA Project Birmingham: Dr Zaib Khawaja & Dr Julien Alshakarchi Joint academic and industrial partnership - workpackage 2 & 3 Seconded from University of Dundee to industrial partner Guerbet group- April 2014 to April 2015 Supervised by Dr Eric Lancelot, Prof Graeme Houston & Mr Nick Inston Other ESR secondees include: Birmingham: Dr Zaib Khawaja & Dr Julien Alshakarchi Guerbet colleagues: Javaad Ayub & Catarina Ramos

ReDVA Workpackages WP2: Data Mining and Prospective Data Sharing Systematic reviews UK questionnaire and survey ERPB guideline update VA guideline appraisal KDOQI, CNS, CARI, ERBP & UK renal

WP3: Imaging ‐ Ultrasound, CT, MRI Systematic reviews (Preoperative imaging….) Cochrane diagnostic test accuracy review The accuracy of MRA versus ‘gold standard’ DSA in a failing fistula Title officially registered MRA DSA

WP2 & WP3- Future work? WP3: Imaging ‐ Ultrasound, CT, MRI > Literature background from reviews WP2: Data Mining and Prospective Data Sharing Clinical data mining – UK wide (renal registry) Retrospect data collection -QEB, UoD WP3: Imaging ‐ Ultrasound, CT, MRI Further validation of imaging techniques Clinical study?

Training and Benefits of the Fellowship Courses in Systematic reviews Cochrane training modules on systematic reviews and meta-analysis of DTA studies (University of Amsterdam and University of Birmingham). Author training modules (University of Birmingham) Training with the European guidelines group Seminar and meeting with ERBP guidelines group Data extraction from scientific literature Guerbet Training Medical and regulatory affairs training Theory of MRI and contrast agents

IAPP network Benefits of IAPP network: Literature data mining & data sharing Questionnaire development & dissemination Guideline appraisal & literature review Insights into Industry: Guerbet International, Medical & Regulatory Affairs meeting Strengthening collaborations: Regional & National UK Centres European Renal Association Cochrane renal group- Australia and Birmingham

Challenges Distance between clinical environment and work base Regular teleconferences, updates, progress reports Difficulties explaining the relationship between the industrial partners and universities – Cochrane review Resolved by explaining the purpose of the EU IAPP projects Coordination of other ESR secondees Ensured regular meetings, and ensured time was planned and efficiently used

Publications WP 2&3 ESR’s AGREE instrument for assessment of current vascular access guidelines Preoperative imaging in vascular access Assessing UK trends in vascular access imaging for haemodialysis patients – Results from ReDVASQi Re-visiting the risks of contrast enhanced MRI in vascular access imaging Non-invasive three dimensional imaging for hemodialysis vascular access using magnetic resonance Current tools for prediction of arteriovenous fistula outcomes Vascular imaging to detect dialysis fistulas at risk of failure

Future directions ReDVA provided an unique opportunity for a placement in HQ of an international pharmaceutical company Transferable skills working between industry and academia Useful time management, project planning skills Living in a new environment, networking with new organisations and career development