Professor Jeff Bamber (pictured above) presenting at the BMUS's Ultrasound 2017 conference
“Like many of us in research, I was that nerdy kid doing chemistry, physics, biology and electronics experiments at home,” he recalled. “I remember travelling on the bus across London at the age of 14 to purchase and become the proud owner of a coil reflux condenser to add to the rest of my chemistry set, which included a Bunsen burner hooked up to the gas cooker in my mother’s kitchen.”
As a child who was always interested in science and experimentation, it seems Professor Jeffrey Bamber's career and transition from that “nerdy kid” to a research scientist was inevitable.
“For me, medical physics was natural. I’ve always been interested in waves: acoustic and optics. Medical ultrasound physics seemed the perfect combination but after doing a degree in Physics I felt I needed a bridging qualification, so I did an MSc in Biophysics and Bioengineering, and what I learnt there has been immensely valuable ever since.”
Professor Bamber joined the Physics Department at The Institute of Cancer Research, London, before it became a joint department with The Royal Marsden NHS Foundation Trust in 1986, which he believes is an invaluable asset to the organisation - describing it as “a great example of the translation of laboratory work from the ICR to the clinic in The Royal Marsden.”
He counts himself incredibly lucky to have started in medical ultrasound at a time when it was just beginning to take off as a valuable new medical imaging method.
Key studies from 2017
Professor Bamber described three of the papers he had published last year, all of which have the potential to change the face of cancer imaging and drastically improve patient outcomes. He emphasised that science is, and should be, fun – inspired by discovery, invention and innovation.
“I love teasing through data and results of experiments or simulations, figuring out what it all means and how we can take advantage of the physical or biological phenomena to provide new information that will help us diagnose cancer, monitor its treatment, detect changes in normal tissues and directly assist treatment in various ways.”
Measuring tissue stiffness to assess cancer progression
The first paper, published in Scientific Reports, describes how using non-invasive methods to measure tissue stiffness, the elasticity of a tissue, can be used as an indicator of a tumour’s progression. This is particularly relevant as most types of cancer are associated with altered tissue elasticity, including breast and prostate.
In the study, Professor Bamber and his team used a technique known as ultrasound shear wave elastography, or US SWE, to examine pathological changes that occurred in colorectal adenocarcinoma mouse models that were being treated with the cytotoxic drug irinotecan.
They found that prior to irinotecan treatment, an increase in tumour elasticity occurred alongside an increase in the tumour volume. However, tumours that contained dead cells, including those for which the tumour growth rate was found to slow when the mice were treated with the drug, had decreased elasticity.
This discovery of a link between the growth of tumours and their elasticity is a significant step forward in our understanding of tumour pathology and dynamics, demonstrating potential changes in tumour mechanics, which can in turn indicate the stage of tumour development.
Globally, research is showing that the elasticity of tumours is also associated with their aggressiveness and how well they respond to treatment, with ultrasound elastography providing complementary information to biopsy, which could increase the reliability and accuracy of cancer tests.
“I have always particularly liked the fact that with ultrasound we can gather useful information non-invasively and without endangering the patient or increasing cancer risk, with the ability to quickly translate research findings to the clinic and eventually to the medical equipment manufacturing sector.”
Enabling future breast cancer screening methods
Professor Bamber also worked closely with the ICR’s Professor Anthony Swerdlow on the second study published in Investigative Radiology, which examined the use of ultrasound tomography (UST) in determining the breast density in female volunteers from the Breast Cancer Now Generations Study.
Breast density, normally assessed by mammography, is our strongest predictor of the risk of developing breast cancer. UST is an emerging whole-breast 3D imaging technique which uses a water bath in which the breast lies during scanning, acquiring images of the whole breast that show various tissue characteristics related to breast density.
They, along with radiologist Dr Elizabeth O'Flynn from The Royal Marsden, found that UST has huge potential as a method to provide a surrogate measure of breast density in younger women, who are under mammographic age or of screening age. Although there are many other contributing factors that also need to be taken into account, this technique could enable future breast screening methods to be tailored according to the individual woman’s breast density.
Detecting low oxygen levels in tumours
Another paper, published this year in Photoacoustics by Professor Bamber’s team, showed that combining two imaging techniques – optoacoustic spectral imaging with dynamic contrast enhanced ultrasound (DCE-US) imaging – can help identify areas of low oxygen, or hypoxia, within tumours. This aides the prediction of the effectiveness of radiation or drug treatments and potentially enables the ultrasound to guide treatment of hypoxic tumours.
The technique is expected to be extremely useful as hypoxia is prevalent in most malignant human cancers because the blood vessels in tumours do not work as they should. This can lead to several compensatory biological processes that result in altered genetic profiles, enabling metastasis and the progression of cancer. The process is also responsible for tumours developing resistance to chemotherapy and radiotherapy.
Therefore, there is an urgent requirement for a diagnostic tool to identify if a tumour is hypoxic or not, especially when the tumour is located too deep for optoacoustic imaging alone to be used.
By combining optoacoustic spectral imaging with dynamic contrast ultrasound imaging on a pancreatic ductal adenocarcinoma model, Professor Bamber’s team were able to determine if a region that lacks an optoacoustic blood signal lacks oxygen or not, and showed that DCE-US can be used as an alternative to optoacoustic imaging with greater clinical use.
If the potential of this technique to predict low blood oxygen levels is confirmed by future studies, it could enable the personalisation of hypoxia-based treatment which could increase the chance of successful treatment. Due to the higher cost of other imaging methods such as MRI or PET scans, using ultrasound for this treatment would benefit a wider range of people.
Looking to the future
When I asked him what he saw as the future potential for ultrasound, Professor Bamber explained:
“The range of physical phenomena yet to be exploited to achieve improved diagnosis and treatment is large, and the accelerating march of microelectronics, computers and micromechanics, as well as knowledge generation in cancer biology, are continuously making it possible to exploit more of these phenomena for patient benefit.”
He believes that the increasing cost-effectiveness of very high performance computing, combined with micromachining methods for making ultrasound sources and sensors with integrated electronics as part of them and high bandwidth wireless communication, will eventually enable flexible, wearable, operator-independent, intelligent ultrasound systems.
In the future this technology could be used in not just the developed world, but perhaps even more so in the developing world, to monitor our health, provide early indicators of disease, measure risk, monitor response to treatment, or even locally assist treatment delivery - all as we go about our daily lives.
Clearly, with continued progress, Professor Bamber’s childhood passion for science and continued enthusiasm for new discoveries, will lead to further positive impacts for people with cancer in the UK, and all over the world.
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