We would like to take this opportunity to share the proceedings form first meeting on Structured Light Plethysmography held at Trinity College on March 20th. To those who attended, thank you for you time and enthusiastic inputs. It was a great mix of clinical thought leaders from the UK and Europe and I felt that we all gained a lot of additional insight by the participants. We hope that the detailed explanations of the new SLP technology and review of existing clinical work was educational and has driven your desire to be a part of the future collaborative work. For those on copy that could not attend, we hope that you will review the attached overview and notes from the meeting and that you will join us for the 2nd meeting in 6 months. Our goal is to grow the clinical group and identify new areas where SLP can aid you in your clinical practices.

1. Structured Light Plethysmography Clinical
Partners Network Meeting 2012
20 March 2012
Trinity College
Cambridge University
Cambridge
United Kingdom
A PneumaCare Limited Sponsored Meeting

2. SLP meeting 20 March 2012, Trinity College, Cambridge
Trinity College Cambridge
Wolfson Seminar Room
20 March 2012
10:00 Coffee and registration
10:30 Welcome – Dr Richard Iles / Dr Ward Hills
10:40 Introduction to Structured Light Plethysmography – Dr Richard Iles
11:00 Current research – Ms Jenny Conlon / Dr Irisz Levai
To include: Correlations with conventional measurements of lung function
and regional analysis
11:30 Higher methodology and statistical processing – Dr Joan Lasenby
11:50 Future directions – Dr Richard Iles
12:00 Open discussion and questions
12:30 Tour of Trinity College
13:00 Lunch
14:00 Demonstration of PneumaScan™ P2 – Dr Simon Baker / Ms Jenny Conlon
14:30 Workshop: Developing realistic research with SLP – an opportunity to
discuss research ideas with the PneumaCare team (Facilitators: Dr Richard
Iles, Ms Jenny Conlon, Dr Simon Baker, Dr Stuart Bennett, Dr Joan Lasenby)
15:00 Refreshments
15:30 Feedback from the Workshop
16:30 Developing funding strategies – Dr Simon Crick
17:00 Close – Dr Joan Lasenby / Dr Ward Hills
19:30 Dinner at Browns
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3. SLP meeting 20 March 2012, Trinity College, Cambridge
Introduction
Dr Richard Iles, in collaboration with Dr Joan Lasenby, hosted the first annual Structured Light
Plethysmography (SLP) Clinical Partners Network (CPN) Meeting at Trinity College, Cambridge
University, on 20 March 2012. The purpose of the meeting was to provide a forum for discussion of
recent developments and potential future explorations of SLP technology.
SLP is a novel completely non-contact and non-invasive lung function assessment and imaging
technology. The technology was pioneered by Drs Iles and Lasenby, and commercialised by
PneumaCare Limited. SLP works by observing a grid of light projected onto the anterior chest wall of
a patient, and interprets this movement during breathing as respiratory volume. The 3D motion
allows standard spirometric lung function parameters to be calculated in addition to providing novel
information on chest wall movement. Such information could have many interesting applications for
diagnostic medicine.
The meeting brought together key opinion leaders from Cambridge, Glasgow, Aberdeen, Belfast,
Birmingham and Paris. Interest in SLP technology and in this meeting was also received from Oxford,
Berne in Switzerland, France, and Great Ormond Street Hospital in London.
The day was divided into presentations on current clinical research in the morning, and a wide-
ranging discussion in the afternoon that included participants from around the UK and France, and
also members of the National Institute of Health Research, an NHS organisation with a mandate to
facilitate research funding within the NHS.
The morning presentations
Presentations of clinical data gathered in the past nine months at Addenbrooke’s and Papworth
Hospitals, Cambridge, were given. These were followed by a talk from Dr Joan Lasenby who outlined
some of the mathematical analysis techniques that have been applied to SLP data. Then Dr Richard
Iles speculated on the future clinical applications of SLP and opened up a general discussion about
the potential clinical utility of SLP. This led into a demonstration of the instrument by PneumaCare’s
Product Director, Dr Simon Baker, and Head of Software, Willem H de Boer.
Dr Richard Iles, Addenbrooke’s Hospital
Dr Richard Iles presented a history of spirometry and lung function tests, followed by an explanation
of the need for 21st century technology, such as SLP, to augment 40-year-old spirometry technology.
Richard overviewed current technologies and their limitations, including spirometry and
optoelectronic plethysmography. It was his frustration with the limitations in current clinical
capability that led to the development of SLP in this regard, in cooperation with Joan Lasenby and
her group in the Engineering Department of Cambridge University in 2009. Joan’s team took a skill
set developed in computer graphics and gaming, and applied it to the clinical requirements of lung
function imaging.
Richard then gave an overview of early work done with prototype SLP devices in both the
Engineering Department and later in Addenbrooke’s Hospital. He highlighted the unique aspects of
SLP data, primarily the fact that being an imaging technique, SLP is able to analyse a patient’s
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4. SLP meeting 20 March 2012, Trinity College, Cambridge
regional lung function. SLP is also able to measure the differential anterior chest wall movement
between the left or right sides of the abdomen and chest wall.
Jenny Conlon, Addenbrooke’s Hospital
Ms Jenny Conlon, respiratory physiologist and research associate at Addenbrooke’s Hospital,
presented an ongoing study at Addenbrooke’s in which SLP data is being collected simultaneously
alongside traditional spirometry data. In this study the commercial SLP device, the PneumaScanTM, is
being used throughout. Jenny
described in detail the
methodology and key factors
involved in using the
PneumaScanTM as a spirometry
equivalent device. As the SLP
approach is entirely non-
invasive, data can be collected
on the same patient on the
same breath, allowing for a
direct comparison.
The study has been in place
since October 2011, recruiting
a wide range of subjects from
patients attending the general
lung function clinic.
Data have been collected on
adults and children (under 18
years old) in different disease
types (COPD, asthma,
pneumonia, bronchiectasis, cystic
fibrosis and other). Correlations
between SLP output and
spirometry have been
demonstrated.
Findings
The work has shown that in a
direct comparison between SLP
and traditional spirometry, there
is a strong agreement in
quantitative outputs. Correlations
between spirometer and SLP data
were presented for respiratory
rate (r = 0.999), Vt (r = 0.967), and
forced expiration (r = 0.98). Results for FEV1, FVC and TV were also presented (see slides).
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5. SLP meeting 20 March 2012, Trinity College, Cambridge
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6. SLP meeting 20 March 2012, Trinity College, Cambridge
Outcomes
The outcome of the work at Addenbrooke’s has been the optimisation of grid sizes and positioning
the patient, which is important for both accurate and reproducible quantitative measurements.
Operator procedures have also been much improved as the instrument is used on a daily basis.
Future projects
Jenny also presented other recent and planned research projects including validation of SLP in non-
invasive ventilated COPD patients, and validation of SLP in non-ventilated neonates. Some of these
projects have already begun collecting data, while others will start in the coming months.
The first study will be a validation of SLP in non-invasive ventilated COPD patients. Patients will be
monitored for 24 hours following COPD exacerbation and admission, and at 3-day intervals until
discharge. Tidal breathing measurements will be taken both on and off non-invasive ventilation (NIV)
where possible. The tidal breathing data will be compared to measurements recorded from NIV
machine during measurements (i.e. respiratory rate, tidal volume), along with ratings of perceived
breathlessness.
The next study already underway will record the breathing pattern of newborn infants and progress
to validation of SLP in ventilated and non-ventilated neonates
The results of these projects will be available at forthcoming Clinical Partners Meetings.
Jenny's presentation can be found at URL: http://www.slideshare.net/PneumaCare/research-in-
progress-clinical-trial-correlations-with-conventional-measurements-of-lung-function-12204244
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7. SLP meeting 20 March 2012, Trinity College, Cambridge
Dr Irisz Levai, Papworth Hospital
Dr Irisz Levai, an honorary observer, presented data collected at the Thoracic Surgery Department at
Papworth Hospital. Irisz collected data
pre- and post-operatively on 49 patients
undergoing thoracic surgery between
November 2011 and February 2012. She
stressed that measurements were done
on the post-operative wards.
Findings
Irisz showed the potential for the Thora-
3DI to observe and record the relational
movements of the left and right side of
the chest, and also the phase angle
between chest and abdomen. In the top
right slide, images of the chest wall are
divided into colour-coded regions. The
movement of each region is plotted to
show the differential motion.
Several potential uses of this regional
analysis were presented, as was a
demonstration of the 3D viewer
software that will be released by
PneumaCare in May.
Outcomes
The non-invasive imaging of SLP allows
patients to be assessed in situ. This may
allow a more rapid assessment of post-
operative respiratory function and
possibly gives early correlation with
functional recovery and discharge.
SLP seems to correlate well with other
imaging approaches but without the
potentially harmful irradiation. The
bottom right slide shows data from a
pneumonectomy patient 8 days post-
surgery. The x-ray shows a build-up of
fluid that is also clearly visible with the
Thora-3DI instrument via the reduced
chest wall movement on the side of the pneumonectomy.
The data collected at Papworth may also show that SLP has a role in predicting the post-operative
recovery time. Patients who experience little trauma and have good pain control show only small
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8. SLP meeting 20 March 2012, Trinity College, Cambridge
differences between the pre- and post-operative SLP images. These patients tend to be discharged
much earlier than those with large differences and poor pain control.
Future projects
In the coming months Irisz will be working with three hospitals (Addenbrooke’s, Papworth, and
Heartlands Hospital in Birmingham) to explore further the use of SLP in pre- and post-thoracic
surgery imaging.
Irisz’s presentation can be found at URL: http://www.slideshare.net/PneumaCare/research-in-
progress-slp-for-the-noncontact-estimation-of-chestabdominal-motion-changes-after-thoracic-
surgery-feasibility-study
Joan Lasenby, Cambridge University Engineering Department
Dr Joan Lasenby gave an overview of some of the statistical methods used to analyse the 3D data set
that is created from a Thora-3DI observation. Joan explained how the instrument tracks the
movement of many points defined by a grid projected onto the patient. The Thora-3DI can provide
very rich information about the dynamic movement of the chest wall during breathing manoeuvres.
It is this dynamic 3D imaging that allows the Thora-3DI to provide information that is inaccessible via
normal spirometric measurements.
Richard Iles, Addenbrooke’s Hospital
Dr Richard Iles summed up the morning’s presentations, focusing on clinical trials data obtained
from respiratory clinics at Addenbrooke’s and thoracic surgery at Papworth, which were presented
and discussed by the group of key opinion leaders. Research methodology to generate the highest
quality measurements using the Thora-3DI™ and the PneumaScanTM and future possible studies
using SLP technology were discussed.
Discussion topics
The first three presentations generated a good discussion, focusing on three key questions.
Q: The accuracy of the device
A: A highly accurate method of volume measurement, when used correctly, with respect to the area
covered by the grid and movement generated by the patient.
Q: The environment from which data could be collected
A: The current tracker is being upgraded, and will be able to handle most lighting conditions found
within the hospital environment.
Q: The reproducibility and repeatability of data
A: This is currently being reassessed using the new tracking system. However, it must be
remembered that the P2 measures volume and a pneumatach measures flow. The more accurate
device is potentially the P2 / volume assessment.
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9. SLP meeting 20 March 2012, Trinity College, Cambridge
Q: The focal length and equipment changes required to monitor infants
A: Minimal adjustments in focal length, etc, need to be made to the P2 to allow data collection in
neonates. These can be made by opening the device; once made, they are fixed for that particular
instrument.
Afternoon workshop
The afternoon workshop was introduced by Dr Simon Crick from the National Institute for Health
Research (NIHR). The goal of the NIHR is to assist individuals, working in world-class facilities, to
conduct leading edge research focused on the needs of patients and the public. The aim of the
workshop was to developing realistic research proposals to explore the potential of SLP.
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10. SLP meeting 20 March 2012, Trinity College, Cambridge
Participants
Name Interest/Experience Contact Details
Johanna Acosta Thoracic Research Academic Department of Anaesthesia, Critical
Physiotherapist Care, Pain & Resuscitation, Heartlands Hospital,
Birmingham
Stuart Bennett PhD student Cambridge University Engineering Department,
Signal Processing and Communications Laboratory,
Cambridge
Aman S Coonar Consultant Thoracic Papworth Hospital NHS Foundation Trust, Thoracic
Surgeon Surgery Department, Papworth, Cambridge
Jenny Conlon Respiratory Cambridge University Hospitals NHS Foundation
Physiologist/Research Trust, Addenbrooke’s, Cambridge
Assistant
Simon Crick Research Adviser NIHR RDS for the East of England, Lockton House,
Clarendon Road, Cambridge
Theodore Dassios Senior Registrar, will Cambridge University Hospitals NHS Foundation
collect neonatal data on Trust, Addenbrooke’s Neonatal Intensive Care,
SLP Cambridge
Colin Forster Project Manager Plextek Limited, London Road, Great Chesterford
Jonathan Fuld Respiratory Physician Hinchingbrooke Hospital, Hinchingbrooke Park,
Huntingdon
Neil Gibson Consultant in Paediatric Royal Hospital for Sick Children, Yorkhill NHS
Respiratory Medicine Trust, Glasgow
Richard Iles Consultant in Respiratory Cambridge University Hospitals NHS Foundation
Paediatrics Trust, Addenbrooke’s Neonatal Intensive Care,
Cambridge
Joan Lasenby Senior Lecturer Cambridge University Engineering Department,
Signal Processing and Communications Laboratory,
Cambridge
Irisz Levai Honorary Observer Papworth Hospital NHS Foundation Trust, Thoracic
Surgery Department, Papworth, Cambridge
Kim Parker Thoracic Research Academic Department of Anaesthesia, Critical
Physiotherapist Care, Pain & Resuscitation, Heartlands Hospital,
Birmingham
Claudine Peiffer Paediatric Researcher Laboratoire de Physiologie–EFR, Hôpital Saint-
Vincent-de-Paul 82, Avenue Denfert Rochereau,
75014 Paris
Jonathan Scales Research Advisor School of Health and Human Sciences, University
of Essex, Colchester
Mike Shields Consultant Respiratory Queen’s University Belfast & Royal Belfast Hospital
Paediatrician Sick Children, Belfast
Steve Turner Clinical Senior Lecturer Royal Aberdeen Children's Hospital, University of
Aberdeen, Aberdeen
Mark Williams Reader in Clinical University of Glamorgan, Faculty of Health, Sport
Physiology and Science, University of Glamorgan, Pontypridd
Mark Sanders Distributor Clement-Clark
Todd Austin Distributor McGraphics
Ward Hills CEO PneumaCare Limited
Eric Stewart Commercial Director PneumaCare Limited
Simon Baker Product Director PneumaCare Limited
Willem H de Boer Head of Software PneumaCare Limited
Development
David Mair Senior Support Engineer PneumaCare Limited
Gabriela Durcova- CPN Meeting Coordinator PneumaCare Limited
Hills
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