The role of Magnetoencephalography (MEG) technology, its clinical use in the UK, and a vision for the future
MEG technology could have a vital role to play in non-invasive brain imaging if more-widely adopted by the UK healthcare system
Magnetoencephalography (MEG) technology is a non-invasive, innovative brain imaging technique that provides real-time, highly-detailed measurements of brain activity.
It is clinically used in epilepsy and presurgical mapping.
But, despite offering unprecedented details of brain function and comfort for patients, MEG is still mostly used only in research settings in the UK.
And, of the dozen or more MEG machines currently in use in the UK, only one – based at the Aston Institute of Health and Neurodevelopment (IHN) in Birmingham – provides a clinical service with a long-standing steady number of referrals.
Stefano Seri, emeritus professor of clinical neurophysiology at the IHN (pictured below), said the technology could help to support thousands of patients in the UK if uptake was increased.
He told BBH: “Other neuroimaging technologies – including MRI, PET and EEG – are far more common clinically, as they have been around slightly longer, with 171 MRI systems and 78 PET scanners in UK hospitals.
“Although MEG is yet to be widely adopted in the UK, in the US 45 MEG machines are being used for a mixture of clinical and research work.
“The busiest clinical sites see between 100-375 cases per year, mostly examining patients with epilepsy.
“With such a significant difference between adoption of MEG technology in the UK and US, the barriers to clinical adoption in the UK have to be questioned in order to bridge the gap between research and clinical settings.”
MEG systems are designed with patient comfort in mind.
Unlike MRI scanners, they are entirely silent and do not require applying magnetic fields, radiation, or injections, making MEG a far-more-user-friendly option than other functional brain imaging techniques, such as those based on MRI, which can be claustrophobic and uncomfortable.
For adults and children with sensory processing difficulties, MEG is beneficial as it takes place in a stress-free environment.
And, unlike other technologies such as EEG, where sensors need to be placed on the patient’s head, a MEG scan can be performed without any physical contact between the patient and the physician.
The patient simply sits or lies in the chair in their preferred position, with no need to undergo sedation in most cases.
Seri said: “MEG can also have a significant advantage in spatio-temporal accuracy compared to other brain imaging technologies, like MRI or EEG.
“MEG measures brain activity on a millisecond-by-millisecond basis, and from these measurements we can localise where in the brain the activity is generated.
“With EEGs, for example, electrodes must be consistently positioned on the patient, which can be uncomfortable.
“Localisation accuracy is also more challenging, due to the conduction properties of skull and scalp through which the EEG signal travels.
“With MEG, greater accuracy of source localisation is possible, as the skull and scalp are transparent to magnetic signals, meaning MEG is excellent for examining patients with epilepsy, as propagation of epileptic activity from one area of the brain to another can be accurately monitored.”
According to Seri, in the UK there remains several challenges to widespread adoption; including the perception that MEG is a complex technology and one that can only be used by researchers and scientists in the UK, rather than clinicians, which prevents it being championed as an innovative technology suitable for clinical settings.
With such a significant difference between adoption of MEG technology in the UK and US, the barriers to clinical adoption in the UK have to be questioned in order to bridge the gap between research and clinical settings
“This gap in this knowledge and experience has subsequently led to a lack of adoption of MEG in UK hospitals, which is limiting patients from accessing a treatment pathway which may add significant value.”
This problem is exacerbated by the limited exposure to MEG for those it was designed to be used by, including clinical physiologists and consultant clinical neurophysiologists.
“Although MEG is an imaging technique, radiographers and radiologists are not currently trained to use it,” said Seri.
“As a result, neither professional body develops full ownership and clinical adoption is stunted.”
The lack of medically trained professionals equipped to use MEG in the UK has also been exacerbated by the unintended consequences of Brexit, with many European professionals who can use MEG clinically choosing to work outside of the UK.
Seri said: “Training a new generation of medical professionals in the UK to gather and analyse MEG data is likely to be the most-effective solution in the long-term.
“This would mean upskilling the neurophysiology and radiology community to provide them with the same level of understanding that researchers using MEG currently have.”
The cost associated with MEG devices has also limited commissioning by NHS trusts.
To drive increased adoption of MEG in hospitals, we need to continue to grow focus on proving its validity and its value for money through clinical trials and health technology assessments in the UK
However, says Seri, NHS, academic, and private institutions could consider collaborative models where patients requiring brain imaging scans – such as those with epilepsy – are referred to nearby research centres that are ready to accommodate them.
“Adopting more MEG systems into NHS trusts across the UK is the logical answer, but to get there we need more champions and younger clinicians – who understand the benefits of MEG and see it as a truly-useable and valuable technology for the treatment of conditions such as epilepsy – to push forward its use in clinical settings,” said Seri.
“To encourage this, MEG training could be added in relevant curricula such as neurophysiology and radiology for medics and clinical scientists.
“Ultimately, what we need to bridge the gap is innovation.
“To drive increased adoption of MEG in hospitals, we need to continue to grow focus on proving its validity and its value for money through clinical trials and health technology assessments in the UK.”