Clara Mok, the recipient of Cystic Fibrosis WA’s (CFWA) George Jones Family Foundation Golf Classic PhD top up Scholarship, gives us an insight into her research.
Clara forms part of the AREST CF research team and her research is targeted at understanding the characteristics of trapped air on CT scans in children with cystic fibrosis (CF)
So Clara what first got you interested in CF research?
Clara Prior to joining AREST CF, I worked as a research assistant with the Metabolic Research Centre at Royal Perth Hospital (RPH) and became interested in clinical research. My fascination with CF research actually began after joining AREST CF. I particularly love how medical imaging in paediatric CF is a rapidly advancing field and I have been constantly impressed by the way AREST CF works with CF patients and their families to achieve a common goal – to improve children’s health and wellbeing. I’m really grateful for the opportunity to join this awesome team.
The title of your PhD is “Characterising the trapped air appearance on CT scans in children with CF.” What’s it all about in lay terms?
Clara My project is based around four propositions. We call these hypotheses in research. You start off with a supposition and then carry out investigations to rule out other possibilities and hopefully what you are left with, having discounted all other probabilities, is right or alternatively your propositions are debunked!
My first proposition or hypothesis is that I can reliably use MRI images to measure abnormalities in children’s lungs in much the same way as CT images have been used in the past.
That’s interesting. We know that the AREST CF team have been pioneers in using CT scans to measure otherwise undetectable changes in lung disease progression, so what’s the advantage of using MRI scans over CT scans?
Clara There are two main advantages of using MRI in CF. First, MRI can be performed without the risk of radiation exposure associated with CT. This is highly beneficial to children with CF because their respiratory health status can be monitored more frequently, enabling early treatment to be pursued.
Unlike CT, MRI can independently assess how well the lung ventilates and how evenly blood flows through different areas of the lung. Not only will this lead to a greater understanding of the disease, but treatments that specifically target these aspects of lung function based on the MRI results may be developed in the future and used for increased treatment personalisation.
What are your other hypotheses?
Clara My second hypothesis is that I will be able to match MRI observable changes to other clinical measures of CF lung disease to see how they relate. We want to validate functional MRI in children with CF because we know that lung disease can manifest before it is detectable by techniques such as spirometry. We also know that the sooner we intervene, the better our chances are of keeping young lungs healthy for longer.
My third hypothesis is that persistent trapped air (trapped air which persists into the next CT scan) is more clinically relevant than transient trapped air on CT scans (trapped air seen on the initial CT scan but not the next). Lastly, I’ll investigate whether the trapped air appearance on CT is caused by an uneven blood supply throughout the lungs.
That sounds very technical and in some ways, it’s a real eye opener. There is clearly a huge amount of knowledge being gathered in CF research and I guess that much of the research today is incremental building on that knowledge rather than the Eureka moments we are used to seeing in the movies. So, how’s it going?
Clara Yes that’s right. Eureka moments are few and far between and more likely to start off with a “mm that’s interesting” sort of response than leaping up and down in the lab. I’d like the leaping up and down bit but I suspect that comes later. It’s obviously early days but I’m making good progress thanks in part to the financial support raised by CFWA’s George Jones Family Foundation Golf Classic.
I have now completed the specialised training for CT analysis and I’m learning to use the software for statistical analysis whilst getting up to speed with the literature surrounding structural lung damage and early surveillance. The next step of my project is to validate the use of functional MRI in childhood CF.
At the moment, I am assisting in the collection of CT scans, lung function measurements and sputum samples. These are just some of the clinical measures I’ll compare to the functional MRI outcomes. We hope that by recruiting 50 children in the study, we will be able to determine even the slightest correlation between functional MRI outcomes and clinical measures of CF lung disease.
As part of my research, I’ll be spending 8 months with the Erasmus Lung Imaging Group in Rotterdam, Netherlands to gain more hands-on experience in CT and MRI techniques. This group is world-renowned in the field of paediatric lung imaging and our group (AREST CF) has ongoing collaborations with them.
OK so what will that mean for children involved?
Clara This research will improve our understanding of CF lung disease in childhood, leading to better clinical management and consequently, improved lifespan and quality of life for patients with CF.
So how do parents find out more and sign up their children for this important research?
Clara I’ll be looking to recruit school aged children from the AREST CF group who will undergo a single MRI scan in addition to their normal clinical management. Eligible children will be identified in the AREST CF database and parents will be sent a letter with detailed information about what the study involves. We will contact parents a few weeks before their child’s next annual review appointment to discuss the study and find out if they are willing to participate. If they are interested, then we’ll arrange the research appointments.
The 2018 George Jones Family Foundation Golf Classic will be held on Friday 26 October at Lake Karrinyup Country Club. For details contact our Business Development Manager via email (marketing@cfwa.org.au) or on 08 6457 7333.