The broad aim of our research project is to develop techniques that use medical images and computers to help doctors to improve the treatment of patients with certain types of long-term heart problems. Doctors can not only use medical imaging, such as x-ray and magnetic resonance imaging (MRI), to look inside the body to detect disease but can also use imaging to guide the treatment of disease. Our project specifically concerns the treatment of patients with an irregular heartbeat, called an arrhythmia. This is a common problem affecting 3-5% of people that are over 40 years old and puts these patients at an increased risk of serious problems, such as stroke. Many famous people, such as Tony Blair and Alex Ferguson, have suffered from arrhythmias. Doctors commonly treat these patients with pills that try to prevent the arrhythmia. The patients must take the pills for the rest of their lives since this is not a cure. Moreover, as with any medication, there are unwanted side effects that can be difficult for the patient to tolerate. More recently, doctors are using a new technique to try to cure these patients. The irregular heart rhythm is thought to be caused by abnormal areas within the heart itself. It is possible to destroy these areas, and therefore, to cure the problem by applying a small burn within the heart called an ablation. Doctors apply these burns without actually cutting the patient open by using wires called catheters that are inserted through blood vessels in the legs and threaded up into the heart. These new techniques are very promising, but are less successful than Doctors would like. For some types of disease, between 30% and 40% of patients are no better after the ablation. Doctors use x-ray images to help them see inside the body so that they can place the catheters in the correct position in the heart. X-rays are very penetrating and pass through the body easily. However, the catheters block the x-rays so that they appear different to the patient's body in the x-ray pictures. Therefore, the doctors can see the catheters easily but cannot see the patient's heart on the x-ray pictures. It is thought that one reason that these arrhythmia treatments are unsuccessful is that the doctor cannot see the patient's heart clearly. Another reason, is that the x-rays are only two dimensional shadows of the patient, and don't give any information about depth. MRI and x-ray CT imaging on the other hand has the ability to make three-dimensional pictures of the heart without the need for any harmful x-rays. In our project we aim to allow doctors to use the three-dimensional images of the heart from MR or CT imaging to help to place the catheter inside the heart. Our technique combines MR or CT pictures with x-ray pictures to allow easier treatment of patients with arrhythmias. We will focus on accurate combination of these two different types of images. We will also overlay electrical measurements made inside the heart with this image information. This integrated image and electrical information can be used to build a computerized model that simulates the heart. Just as engineers can create a computer model of a bridge or aeroplane before it is actually built, so we will create a computer model of the human heart. Heart models have been created before, but we will generate models customized to each individual patient, which we will be able to test using measurement made during the treatments. In this project we will use these models to help doctors plan treatments before actually carrying them out on patients.

The broad aim of our research project is to develop techniques that use medical images and computers to help doctors to improve the treatment of patients with certain types of long-term heart problems. Doctors can not only use medical imaging, such as x-ray and magnetic resonance imaging (MRI), to look inside the body to detect disease but can also use imaging to guide the treatment of disease. Our project specifically concerns the treatment of patients with an irregular heartbeat, called an arrhythmia. This is a common problem affecting 3-5% of people that are over 40 years old and puts these patients at an increased risk of serious problems, such as stroke. Many famous people, such as Tony Blair and Alex Ferguson, have suffered from arrhythmias. Doctors commonly treat these patients with pills that try to prevent the arrhythmia. The patients must take the pills for the rest of their lives since this is not a cure. Moreover, as with any medication, there are unwanted side effects that can be difficult for the patient to tolerate. More recently, doctors are using a new technique to try to cure these patients. The irregular heart rhythm is thought to be caused by abnormal areas within the heart itself. It is possible to destroy these areas, and therefore, to cure the problem by applying a small burn within the heart called an ablation. Doctors apply these burns without actually cutting the patient open by using wires called catheters that are inserted through blood vessels in the legs and threaded up into the heart. These new techniques are very promising, but are less successful than Doctors would like. For some types of disease, between 30% and 40% of patients are no better after the ablation. Doctors use x-ray images to help them see inside the body so that they can place the catheters in the correct position in the heart. X-rays are very penetrating and pass through the body easily. However, the catheters block the x-rays so that they appear different to the patient's body in the x-ray pictures. Therefore, the doctors can see the catheters easily but cannot see the patient's heart on the x-ray pictures. It is thought that one reason that these arrhythmia treatments are unsuccessful is that the doctor cannot see the patient's heart clearly. Another reason, is that the x-rays are only two dimensional shadows of the patient, and don't give any information about depth. MRI and x-ray CT imaging on the other hand has the ability to make three-dimensional pictures of the heart without the need for any harmful x-rays. In our project we aim to allow doctors to use the three-dimensional images of the heart from MR or CT imaging to help to place the catheter inside the heart. Our technique combines MR or CT pictures with x-ray pictures to allow easier treatment of patients with arrhythmias. We will focus on accurate combination of these two different types of images. We will also overlay electrical measurements made inside the heart with this image information. This integrated image and electrical information can be used to build a computerized model that simulates the heart. Just as engineers can create a computer model of a bridge or aeroplane before it is actually built, so we will create a computer model of the human heart. Heart models have been created before, but we will generate models customized to each individual patient, which we will be able to test using measurement made during the treatments. In this project we will use these models to help doctors plan treatments before actually carrying them out on patients.

Radiotherapy kills cancerous cells by repeatedly targeting a tumour with high energy radiation. Although image assisted pre-treatment planning based on CT is performed to minimise the amount of healthy tissues being irradiated, the planned treatment is delivered in a manner that is effectively blind, because there is no monitoring of the patient motion and internal anatomy during radiation treatment delivery and no, dynamically modelled, consideration of possible body change during treatment period. This uncomfortable state of affairs persists worldwide, despite complex new treatments and image guided radiotherapy (IGRT) which members of the consortium helped to develop. Furthermore, there is a concern on the additional imaging radiation dose to the patient from the IGRT. Hence, the MEGURATH project was proposed to introduce metrology guided radiotherapy (MGRT), where the patient is measured, imaged and modelled during treatment delivery via optical sensing to provide non-invasive, radiation-free, real-time 3D patient position monitoring, and dynamic deformation modelling to determine the internal anatomical changes. The project is considered as a significant one with a leap forward approach for a grand challenge, and has attracted interest from Elekta Oncology Systems, Philips Medical Systems, VisionRT and NHS-IP.The MEGRATH programme consists of not only comprehensive research activities with diverse theoretical topics, but also translation of science and technology to the first purpose built IGRT research facility in the UK at the Christie Hospital, and the support of clinical studies selected from breast, lung, bowel, prostate and bladder cancers. The project is expected to make a world class contribution to radiotherapy by increasing our understanding of tumour target and organ at risk behaviour, treatment delivery and control of their impact on cure and complications. The marriage of anatomical modelling and dynamic 3D measurement on demand 'in-treatment', using light rather than ionising radiation like X-rays, will offer the opportunity to gain the pole position in engineering and computational science for oncology. The Collaborating for Success through People call is a valuable opportunity to support, complement, utilise and extend the MEGURATH project, thereby enabling the consortium to maintain, defend and widen its lead.The proposed programme of people-based activities starts with exploratory mutual visits by the PIs and group leaders for exchange of knowledge, creation of ideas and development of active collaboration, followed by two-way investigative short visits and relatively long research visits by researchers for synergistic development, cross application and performance evaluation of promising approaches, and finished by a workshop to provide a venue for the consortium to lead the development of a joint EU project proposal with the participating partners. To provide significant added value to the MEGURATH project in terms of scientific knowledge and new clinical applications, 7 eminent research groups and 1 leading 3D equipment company are selected for participation in the proposed people-based activities:-Two from Poland: Telemedicine Group from AGH University of Science and Technology, and Department of Scientific Information from Jagiellonian University Collegium Medicum;-Three from France: one from the French National Institute for Research in Computer Science and Control (INRIA), and the other two from National Centre for Scientific Research (CRNS), namely, Lyon Research Centre for Images and Intelligent Information Systems (LIRIS) and Signal and Image Processing Research Laboratory (ETIS);-One from Germany: Institute for Electronics Signal Processing and Communications (IESK) at Otto von Guericke Universitt Magdeburg; -One from Italy: Signals and Images Laboratory from the National Research Council (CNR); and-3dMD with the company headquarters in the USA.