Respiratory Imaging Program

The London Lung Imaging Research Team is partnered with local, national and international collaborators to discover and translate to commercial and clinical use novel pulmonary imaging methods in order to predict, prevent, and manage lung diseases, and improve patient outcomes.

3He MRI static ventilation images

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) affects over 300 million adults worldwide and over 3 million Canadians.  COPD is progressive, debilitating and chronic, and the disease course is punctuated by sudden, acute worsening of symptoms or “exacerbation” that require immediate medical care – most often requiring hospital admission.  COPD exacerbation or “lung attack” accounts for the vast majority of Canadian urgent hospital admissions and represents a staggering healthcare and societal burden that is under-appreciated. The enormity of this cost becomes apparent by recognizing that, in 2008-2011, 1 of every 4 Ontario hospital beds was occupied by a COPD patient, equivalent to filling 250 of the 1000 hospitals in Canada with only COPD patients.  The hospital beds alone cost our health care system over $1.5B/year and this estimate does not include other health care costs, nor the impact on bed shortages and on patients and their families.

Despite these dismal statistics and alarming costs, there is no reliable way to prospectively identify respiratory disease patients at high risk for disease worsening or exacerbation. Current lung disease diagnostic measurement tools provide no information about the site and pathology responsible for airflow limitation, symptoms and disease worsening.   To decrease the staggering burden of lung disease on patients and the health care system, new tools are required.  We think that pulmonary structure-function imaging measurements can be used to address this critical gap.  

Asthma

Asthma is a chronic inflammatory disease of the lungs is typically diagnosed and characterized by a measurement of airflow obstruction using spirometry.

To better understand the root causes of asthma attacks, MRI tools and measurements have been developed by our team.  We recently showed that lung on abnormalities are related to abnormally remodeled airways, age, inflammation and airways resistance. The overarching goal for this research is to identify new imaging endpoints of asthma to help better measure disease progression and treatment response.  To this end, we have embarked on a randomized controlled clinical trial whereby asthmatics that are scheduled for endobronchial thermoplasty are randomized to image-guided versus standard of care therapy.  In this way, we hypothesize that MRI can be used to shorten the therapy period, decrease costs and adverse side effects and improve outcomes.

Cystic Fibrosis

Cystic fibrosis lung disease is characterized by the inability of the lung to effectively clear the abnormal mucus secretions.  This results in chronic lung infection which is the dominant risk factor for lung worsening and premature disability and death. Despite decades of research into the genetic, molecular, physiological, and cellular aspects of CF, new treatment improvements over the last 10 years have focused only on secondary approaches, including a class of treatments that promote mucus degradation and clearance. However the response to these (often expensive) therapies is both variable and unpredictable. One potential cause of the variable response to treatment (which is so far untested) is the regional heterogeneity of the disease. The respiratory team's goal for CF research is to identify new measurements of the disease that can be used in clinical trials of new treatments as well as longitudinal and post exacerbation therapy studies.

Radiation-Induced Lung Injury

Lung cancer is still the leading cause of cancer death in women and men. The vast majority of lung cancers and treated using radiation but radiation-induced lung injury (RILI) limits the efficacy of treatment and is the major dose-limiting toxicity of lung cancer radiation therapy. One BIRC team has identified new imaging measurements that are predictive of RILI development, severity, and progression. The team also recently completed a pilot study of 3He MRI in patients with clinically confirmed RILI and showed the important clinical impact of MRI phenotypes. These results led to our current plan to use hyperpolarized 3He and 129Xe MRI in a randomized controlled trial to use MRI to guide radiation therapy and measure patient outcomes. This trial once completed has the potential to have a profound effect on patient care allowing for radiation treatment planning evaluation in identified high risk patients and proper application of RILI mitigating therapies.

Pre- and Post-salbutamol static ventilation images, ventilation gradient maps and pre-and post-salbutamol image addition

Investigators
James Lewis, MD, Cystic Fibrosis, Asthma
Christopher Licskai MD Asthma
David G McCormack, MD, Lung MRI
Marco Mura MD Pulmonary hypertension in COPD
David Palma, MD, Radiation-induced Lung Injury
George Rodrigues MD, Radiation-induced lung injury
Grace Parraga, PhD, COPD, Asthma
Nigel Paterson, MD, Asthma, Cystic Fibrosis
Param Nair MD (McMaster) Asthma
Harvey Coxson PhD (UBC) COPD
Geoff Maksym PhD (Dalhousie) Asthma
Gerard Cox MD (McMaster) Asthma