Centre for Biomechanics Research Spotlight – Interview with Dr. Alexander Breen

AECC University College’s Dr. Alexander Breen, Senior Research Fellow and Technology Lead for Quantitative Fluoroscopy, is currently working on a fascinating new research project looking at segmental spine biomechanics using advanced medical imaging techniques. The aim of the study is to develop a detailed biomechanical understanding of the spine that can be used in relation to diagnosing and treating patients with lower back pain or neck pain.

Alex explains: “Here at the AECC University College Centre for Biomechanics Research (CBR), we have a program of work which focuses on the mechanics of the spine at the level of the joints themselves, investigating the topics of biomechanics, joint degeneration and neck/low back pain, both separately and with an eye to find out where they interact. The only way to investigate this with high accuracy is using advanced medical imaging techniques.”

Starting out

“My story is like that of many academics, I kind of just fell upwards into it. Back in the dark ages, before the advent of the iPhone or even Facebook, I was studying Physics at the University of Exeter. One of the elective modules was ‘Medical Applications’. I found this fascinating, so I decided to change the focus of my whole degree.

“In 2005 I graduated with a degree in ‘Physics with Medical Applications’. The degree was amazing!  Not only did I learn about the fundamental ticking of the universe and such, I also gained insights into the human body. We learned about the body’s structure at the tiniest of levels and also about medical imaging (X-ray, MRI and Ultrasound). And since we also did a fair portion of mathematical programming in the degree, when a job opened up at AECC University College seeking someone who had knowledge of anatomy, medical imaging and computer programming I was in an ideal position to join the AECC family.”

Quantitative Fluoroscopy

“Over the years I took my education further through doing research in the Centre for Biomechanics Research, investigating spinal biomechanics and how it related to low back pain using Quantitative Fluoroscopy (QF).  At the same time I did a part-time Master’s Degree in Medical Physics. Over the last 13 years, I have been working on the further development of the QF technology into a diagnostic tool. In 2016 I completed my PhD at Bournemouth University investigating the mechanical causes of low back pain in lower limb amputees.  

“QF is becoming more recognised as the gold standard for measuring inter-segmental spine mechanics, but this does require the use of x-rays to create our image sequences. Now however, with advancements in MRI technologies, there are exciting opportunities to use this to view the anatomy in motion too. Unfortunately, capturing MR images is a slow process, meaning a live video output cannot be created. So, researchers and technology companies have come up with the novel solution of stitching together a lot of still images into an animation of the anatomy in motion. They call this dynamic MRI.

“While not a live video like fluoroscopy, dynamic MRI is able to visualise the motion of both hard and soft tissues within the body. We found that we could apply some of the QF procedures to the MRI techniques, so it may be possible to use Dynamic MRI in the future instead of QF.  However, due to low image resolution and the high scanning times needed to produce dynamic MRIs, QF remains a more patient friendly technique for biomechanical diagnosis.”

Industry leading research

“Low Back pain is the number one cause of disability in the world. The Centre for Biomechanics Research’s focus is to develop a very detailed biomechanical understanding of the spine and if/how this relates to painful conditions. By first studying this in people with no pain, we now have a deep understanding of what is normal and we have applied this in the investigation of patients with chronic, treatment-resistant spinal pain that could not be diagnosed. 

“We have found that some of the biomechanical changes that we can measure are strongly associated with pain. These are called ‘biomarkers’. By investigating what they have to do with the pain we are opening the way for practitioners to use them in the treatment of difficult spinal pain conditions.

“We are keen to work with the School of Radiology to expose students at all levels to these new concepts. We are fortunate to have many Imaging modalities on site (all of which is used in both research and education) which may equip our undergraduate students with a unique educational experience. So our students can be exposed to the latest advances in functional spinal imaging, which is naturally the province of radiographers.”

Upcoming research projects

“At AECC University College’s Centre for Biomechanics Research, we work in many collaborations, across universities in Alberta, Toronto, Newfoundland, Hongkong, Cardiff, Bournemouth, Exeter, Aalborg and more. Each collaboration provides a different insight into aberrant spinal mechanics in people who are in pain. It is our hope that these studies will provide useful knowledge for practitioners and patients alike and reduce the burden of low back pain.

“One of our recent studies was in collaboration with Aalborg University in Denmark. This aimed to measure intervertebral motor control in the neck against which symptomatic patients can be compared.  This may help to improve the treatment of people with whiplash-associated disorders in the future. Another, in collaboration with Canadian Memorial Chiropractic College in Toronto, is about to be published. It established that our latest biomarker has good reliability for use in low back pain clinical studies.   

“I am also currently working with three PhD students from different backgrounds (Kinesiology, Chiropractic and Osteopathy) who are endeavouring to expand our knowledge into the field of spine mechanics and its relation to pain as well as to treatment response.”

You can find out more about how AECC University College is shaping the future of healthcare through research here.