New imaging method for measuring lung damage in the small airways

When Meghan Koo submitted her abstract to the Canadian Organization of Medical Physics (COMP) in March 2022, she hoped to become one of ten graduate students across Canada to be selected to present at the annual J.R. Cunningham Young Investigator Symposium competition. The CAMPEP medical physics PhD student had been working under the supervision of Dr. Miranda Kirby on developing quantitative imaging biomarkers for lung diseases, combining radiomics and machine learning to extract information from CT images. The abstract she submitted to COMP focused specifically on a new biomarker for assessing what is called the “quiet zone” in chronic obstructive pulmonary disease (COPD), which refers to the small airways where the disease initiates.

Not only was her work accepted for presentation, it won first place in the competition, making Koo the first woman in 11 years to win this award, the first woman of colour ever to win, and the first TMU student to even place in the top three spots. Altogether, it was history in the making.

“I didn’t think I was going to win,” says Koo, reflecting on her achievement. “I can be my own biggest critic and doubt myself. So it’s validating to have earned the top award. It tells me that my research is on the right track. Unfortunately, there is no cure for COPD, but the work we are doing at TMU could lead to earlier and better detection of the disease, thus leading to earlier and better treatment.”

A chronic and progressive condition characterized by gradual airway obstruction, COPD is the third leading cause of death worldwide and an umbrella term that includes lung diseases such as chronic bronchitis and emphysema. It is also often underdiagnosed in people under 45 years old, at a time when structural changes in the small airways initiate and accumulate before airflow limitation is detected in the larger airways.

In her presentation titled “Expiration CT Texture-Based Radiomics: A New Biomarker for Assessing the ‘Quiet’ Zone in COPD?”, Koo first explained the phenomenon of gas trapping in COPD patients, which refers to an abnormal increase in the volume of air remaining in the lungs at the end of exhalation. She then demonstrated how texture-based radiomics features on expiration CT images may be able to better quantify the heterogeneous structural changes that occur due to small airways dysfunction than the more conventional CT gas-trapping measurements used in COPD.

“This is a really novel application of some quantitative imaging to better understand a disease feature,” says Dr. Kirby. “Meghan’s work shows not just the extent but the spatial distribution of the disease, which is more meaningful than conventional methods of measurement. In addition, her first-place award positions Meghan at the top of the top among her peers doing medical physics research. Past winners of this competition are leaders in the Canadian medical physics community.”

In addition to leading her peers in research, Koo is also a leader in service. She is co-chair of the Canadian Organization of Medical Physicists—Women’s Committee & Inclusion, Diversity, Equity and Accessibility (IDEA) Committee, which aims to address professional issues of women in medical physics and to integrate IDEA into both the profession and COMP in order to engage the full potential of all members. She is also a member of the Equity, Diversity and Inclusion Committee and the Working Group on Equity Diversity and Inclusion Survey Creation and Demographic Data Collection Improvement, both of the American Association of Physicists in Medicine. 

“There are gender and racial inequities in medical physics as well as barriers to those with both visible and invisible disabilities,” says Koo. “I’m as passionate about equity, diversity, inclusion and accessibility—about how diversity in thought and perspective leads to better science—as I am about my research and the career I hope to have in a clinical setting.”

“Meghan’s first place award brings important visibility to underrepresented groups in the medical physics field,” adds Dr. Kirby. “She deserves this recognition for scientific excellence and will continue to be a leader in her profession.”