The bone density scanner: the alumnus behind a world-changing historical research breakthrough

 

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Professor Christian Langton

Professor Christian Langton is the alumnus who led on research into the assessment of osteoporosis by ultrasound which was recognised by Universities UK (EurekaUK) as one of the “100 discoveries and developments in UK Universities that have changed the world”. The list covered the whole academic spectrum from the arts and humanities to science and technology, and includes only one other Hull research innovation: liquid crystal display (LCD). His research was also one of only 11 stories within a National Institute for Health Research publication titled ’60 years of research in the NHS benefitting patients’. The bone density scanner has been in use in hospitals throughout the world for many years. In this piece written for our alumni blog, Professor Langton tells the story of how he came to Hull, the chance events that led to his groundbreaking research, how intrigues from competitors led to lawsuits and the impounding of his PhD thesis, and, now that he calls Australia home, discloses a particularly Australian nickname.

I have never considered myself to be ‘intellectual’. The nearest I’ve got to ‘string theory’ was when my step-son Michael explained the ‘Trucker’s hitch’ knot during our recent camping trip to Mt Barney over Easter! I do however have the occasional ‘new idea’ that miraculously appear in my head in the middle of the night.

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Professor Langton presents the EurekaUK entry to Professor David Drewry, then Vice-Chancellor, 2006

I must have been somewhat precocious as a teenager, breeding ornamental pheasants and peacocks, (as one does!) as well as delivering lectures on different nuclear power approaches in Year  9 at school (4th year in ‘old money’). I initially considered a career in hotel management as my mum ran a small private hotel and I always enjoyed cooking. Fortunately the world was saved from a combination of Basil Fawlty, Manuel and Gordon Ramsey. I applied for a vacation position at the Crown Hotel in Bawtry, but wasn’t appointed. Noting that my two A-Level school projects were ‘the dependence of the mechanical strength of concrete upon composition’ and ‘the dependence of bicycle braking upon road conditions’, my career path has taken me full circle, back to being an engineer!

 

When considering my university degree options, I couldn’t decide between physics and chemistry, so mum suggested doing both. Hull was one of only three universities that offered a joint BSc. Being the only student from Edlington Comprehensive, near Doncaster, who went to University of Hull, my first recollection was a lonely walk through the campus admiring (as I still do), the architecture and gardens. Leigh Goodman and I were the only two students taking this degree. David Calver was another good friend throughout, studying Joint Chemistry and Maths. My advice to students, whether they be school, undergraduate or postgraduate is 1) grasp fortuitous opportunities throughout life, 2) everyone is good at something, everyone is important, we’re all part of a team, 3) be your best, this is all that anyone can expect of us, 4) it’s all about people and personalities, be respectful of others as you travel through life, and 5) you have to enjoy what you’re doing!

One of my first academic recollections was a Chemistry Practical Class where we experienced a poor student’s report being ‘mauled’. That gave Dave and me the incentive not to suffer the same experience. My only disappointment with the degree course was that there wasn’t much of an interaction between chemistry and physics until the second term of my final year, when we studied physical-chemistry and chemical-physics. An Australian colleague mischievously suggested recently that ‘chemistry is simply physics of the outer electron shell’.

I spent three happy years living at Needler Hall. I thought this was a sensible option for my first year, was glad to get anything in my second, and it meant I could concentrate on my exam revision in the third. I recall organising sold-out charity concerts with Roman Logush to support the Bioengineering Research Unit at Doncaster Royal Infirmary. My performance contributions were ‘Two Ronnies’ and Bob Newhart sketches. I played tennis most days in the summer and was a member of the ‘water bomb’ raiding parties to nearby Halls of Residence. Occasionally someone returned to their room, allegedly, to find the hinges of their door had been removed when they unlocked it, or woke to find a bucket of water had been strategically tilted against their door.

My ‘life changing’ moment came in 1977, when at the end of my first year, my nan required a replacement hip and went to see Richard Porter, a Doncaster-based Orthopaedic Surgeon. During her consultation she asked whether he could offer her grandson (me) a summer job. I subsequently worked with Richard for two summer vacations on backpain research, primarily ultrasound measurement of the size and shape of the spinal canal. Richard highlighted the large number of old ladies on the Orthopaedic Wards who had suffered a hip fracture and wondered whether ultrasound could be used to identify, at an earlier age, those at risk of osteoporosis. Often termed the ‘silent epidemic’, osteoporosis affects 1 in 3 women and 1 in 5 men, resulting in fractures mainly of the wrist and hip along with multiple compressions of the spine, (granny gets shorter!). a quarter of hip fracture patients die within 12 months, and a quarter of those remaining never regain independent living. At this time there was very little public awareness of osteoporosis and neither Hull nor Doncaster had any expertise in Bone Densitometry. I returned to Hull University in the autumn and contacted Stuart Palmer in the Applied Physics Department, an expert in industrial applications of ultrasound. Stuart, Richard and myself thought that investigating the potential to develop an ultrasound technique to identify osteoporosis would be an interesting project and searched for research funding. In the meantime, I completed my first degree and studied for an MSc in Medical Physics at Aberdeen University, primarily to obtain a background in anatomy and physiology plus a knowledge foundation in physics applied to medicine.

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Initial BUA research system, 1983

A two year research grant was obtained from the Medical Research Council and three years later, a prototype system had been built incorporating the measurement of ‘broadband ultrasound attenuation’ (BUA) in the calcaneus within the heel, the subject of my PhD, awarded by the University in 1985. This work is credited as being the first to demonstrate the clinical utility of ultrasound for the detection of osteoporosis. Our initial paper has approaching 700 citations.

 

Most of my research studies were performed at the previously mentioned Bioengineering Research Unit in Doncaster. During the early days, I acquired a Commodore CBM 8032 computer (1MHz with 32k RAM), complete with cassette tape data storage, and taught myself computer programming. I decided to write an intellectually relevant program, Space Invaders! One day I was so engrossed that I didn’t hear Richard enter the room until he looked over my shoulder and asked what the program was simulating. I explained that it was showing an ultrasound beam interacting with a cancellous bone structure!

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UBA1001 ultrasound bone analyser, 1985

Since the initial research system incorporated a water bath containing a 25kg foot-plate and a 25kg expensive spectrum analyser, there was a defined need for a more portable system. Stuart suggested collaborating with a Danish Company, PAR Scientific. The outcomes were Stuart, Richard and myself forming the company Osteosonics, and the UBA1001 ultrasound bone analyser.

 

The system attracted quite a lot of media attention including ‘Tomorrow’s World’, Maggie Philbin’s first awareness of her own osteoporosis. PAR Scientific’s MD, Adil Al Kassim, wrote an article on their work in a popular magazine. This was read by Paul Sternkopf, MD of a steel paint-printing company within the Walker Magnetics Group, who contacted the owner, John Engelsted, a committed Danophile based in Worcester, Massachusetts.

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Walker Sonix UBA575, 1989

A new company was formed, Walker Sonix Inc, its UK office based on the University’s Newland Science Park, for which I worked for a couple of years developing their UBA575 system. When we were establishing initial clinical collaborations, we visited Dr Dan Baran at the local Massachusetts General Hospital. We measured the heels of a number of subjects, noting that one lady had a particularly low BUA value. As she walked down the corridor, she sadly, but perhaps fortunately for us, suffered a spontaneous hip fracture without a prior fall. Although totally unscientific from a statistical perspective, this anecdote gave everyone confidence that the technique may indeed work! I had many enjoyable trips to Walker Sonix, staying in the Engelsted family home, and going to the Worcester Club, where ladies still had to use the side entrance – so we all did. There were many happy weekends spent sailing off Cape Cod.

 

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Sailing off Cape Cod during the development of Walker Sonix, 1987

Once the Walker Sonix venture became predominantly marketing and sales orientated, I was attracted back to the academic world, securing Senior Lectureships in London and Sheffield. It was during my time in London that I was contacted by Chris Riggs, who was studying for his PhD at the Royal Veterinary College in London. Chris was interested in identifying fracture risk in thoroughbred racehorses and had read my initial BUA paper, with the correspondence address of Doncaster Royal Infirmary. Although working in London, my home address was still Doncaster and hence contact was made.

It was Chris Riggs, then based at Liverpool Veterinary School, who I later contacted when my young showjumping horse ‘Mistral’ suffered a severe arterial aneurysm, successfully operated upon for the first time ever in collaboration with Consultant Radiologists at Hull Royal Infirmary, Tony Nicholson and Chris Rowland-Hill.

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The problem with measuring the bones of thoroughbred racehorses is that they are not too keen at standing still in a bath of water for ten minutes, a requirement of the early commercial BUA systems, and neither were the Vets happy at sitting near these excitable animals for this length of time. Several months of new development ensued, as well as two second-mortgages on my home. The result was a completely new concept where the ultrasound transducers were placed in direct contact with the skin, thereby removing the need for a water-bath. Fortunately I had my own horse to practice on, Jak (official name Ferryhill). We did everything from dressage to show-jumping  and even a team-chase, the day I thought I was going to die!

The equine system was re-directed to the human field, evolving into the CUBAclinical system (Contact Ultrasonic Bone Analyser) which was subsequently commercialised by McCue plc based in Winchester.

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McCue CUBAclinical, 1993

This involved Technology Transfer and Royalty agreements along with creation of a pre-production prototype system. My brother designed the actual device, the mechanical and electrical components were created by my brother-in-law and a colleague respectively, I wrote the control and analysis software.

 

 

I returned to University of Hull in 1994 at a time when McCue were working towards obtaining FDA approval in order to sell in the lucrative US market. This work brought sponsorship to University of Hull for equipment, technical support and a travel bursary. After extensive clinical studies, resulting in several publications from our research group in Hull, FDA approval was awarded in 1999.

Sadly, I didn’t make any money. Once McCue started selling in the US, a large competitor filed a bogus patent infringement lawsuit. In US Law, even if you win the case you don’t even get your costs paid. McCue won the case but then advised me that there was a clause in our Technology Transfer Agreement that stated that I underwrote all costs associated with protecting the patent! Ian McCue and I amicably tore-up both agreements: no legal fees but no royalties.

A later development was the invention of a unique device for the calibration and quality assurance of BUA measurements in clinical systems, the behaviour of ultrasound through bone being mimicked by an electronic circuit. The device was patented through Hull University and a royalty contract signed with McCue Ultrasonics.

The development of the ‘contact’ system facilitated a world-wide expansion of both utility and the number of similar commercial systems being offered. Of particular impact has been bone assessment in locations where there isn’t access to conventional dual-energy X-ray absorptiometry (DXA), such as the Asia-Pacific rim. In an initiative sponsored by the dairy company Fonterra, over five million free bone scans across Asia and the Middle East have been performed using the portable ultrasound technology that I developed.

There have been some interesting episodes along the journey, such as the person who ran off with the blueprints of the CUBA system and established a company in Canada. He approached an electrical engineer who just happened to be my brother’s brother-in-law. The same person also borrowed the University Library’s copy of my PhD Thesis and was caught photocopying it at his local library in the UK on behalf of the patent lawsuit company. The end result was that my Thesis was impounded, a story that made the Hull Daily Mail in 2001. I went on a ‘world tour’ between 1995-96, sponsored by McCue and hosted by their local Distributors, taking me to locations throughout Europe (including Iceland, the CUBAclinical being their only bone analyser), North America and Asia.

I have developed a number of medical devices in addition to the BUA technique for assessment of osteoporosis. FEXI (finite element analysis of X-ray images) was aimed at predicting the mechanical integrity of a bone, based upon a single DXA (dual-energy X-ray absorptiometry) bone mineral density (BMD) image. In the initial concept, an image of a distal radius was converted into a 2D finite element analysis (FEA) computer simulation model of a mechanical test, a defined loading aligned along the bone’s central axis. GB and US Patents were filed through McCue, although they subsequently decided not to pursue the project long-term since it effectively competed with our ultrasound technique. I further-developed the FEXI technique by implementing Procrustes analysis and thin-plate splines to morph the shape and bone density of a single 2D DXA image into a subject-specific 3D hip bone model. FEA was again applied, under a defined loading scenario such as standing or a fall. 3D-FEXI increased the prediction of failure load by more than 50% compared to conventional DXA-derived bone mineral density (BMD). I am currently implementing FEA into an ultrasound computed tomography scan of the hip, the best of both worlds!

 

A Clinical Engineering trainee once required a research project so I contacted one of the orthopaedic surgeons at Hull Royal Infirmary, who suggested that walking-crutches hadn’t improved much over the years. I realised that ‘under-arm’ devices necessitated the user to lift their body-weight due to the arc motion about the fixed-point base. I hypothesised that by utilising a cam-mechanism, the movement-profile of the top of the crutch could be horizontal, thereby significantly reducing the physical effort. A prototype device was designed and manufactured, the concept winning the 2007 Medipex Innovation award.

Professor Barry Hull was a mechanical engineer, who happened to leave Sheffield Hallam University for a new position at Bradford University on the day I joined in 1990. He had an interest in identifying recycled polymers, particular items from the automobile industry. We developed a new ultrasound characterisation parameter, the Hull-Langton Index, defined as ‘BUA / transit-time’, being a dimension-less parameter, only requiring physical access from one side of the component under test. The concept was patented in 1996 through Bradford University. I’ve recently been approached by a company in Scotland, being informed by them that the concept was ‘way ahead of its time’.

I developed the concept of an ultrasound flat-bed scanner, initially aimed at assessing the skeletal status of premature very-low birthweight neonates. The system has recently had a new lease of life, aimed at providing a means to predicting tissue breakdown associated with diabetic ulceration as well as assessing mammographic density in young asymptomatic subjects.

My role in Hull was exciting but convoluted, serving both the University and local Hospital Trust. Within the University I served as Senior Lecturer in Medical Physics and Sub-Dean for Research and Reach-Out within the Postgraduate Medical School (later titled Institute). John Greenman and I coordinated the 2008 Research Assessment Exercise (RAE) submission under Allied Health Professions and Studies (UoA12), which achieved the highest rating within the university, being 6th out of 68 submissions nationally. From a Reach-Out perspective, I served on Medilink and Medipex Steering Groups and was appointed Yorkshire Forward’s Knowledge Transfer Champion for the healthcare technologies sector in Hull, being the first academic to have a KnowledgeRich keynote interview published.

I also served as a Clinical Scientist within the Medical Physics Service of Royal Hull Hospitals (later titled Hull and East Yorkshire Hospitals NHS Trust). My roles included coordinating nationally accredited training and leading the Technology Development Group. We created medical devices for both clinical research (such as the Hull stabilometer to predict propensity to fall) and patient care (such as assistive technology aids for disabled subjects). I also gained the interesting title within the Trust of Director of Research Performance, and contributed to creation of both the Hull York Medical School and the Comprehensive Local Research Network, bringing together four universities along with primary, community and acute health services throughout the region. I remember a hospital clinical scientist colleague once humorously suggesting that I can’t have been in the Boy Scouts since I was still collecting ‘badges’ in the form of Fellowships: six so far.

By 2007, I had been promoted to the title of ‘Professor’ and been awarded a DSc (Doctor of Science) degree by University of Hull, I believe the first in ten years. I decided however to seek a new challenge. My colleague and good friend Linda Shields was Professor of Nursing at Hull University at this time, originating from Brisbane in Queensland, Australia. Over a coffee in the Derwent café she suggested “why not move to Australia?”; which I did!, taking the position of Professor of Medical Physics at Queensland University of Technology (QUT) in Brisbane on 1st February 2008 QUT paid for a visit to Brisbane in June 2007. Whilst in the taxi from the airport to the apartment, the driver pointed out the plaques on the side of the old Pilot House that marked the height of the various major floods over the years, at which point my mobile phone rang. It was the Humberside Police informing me that our home in Leven had been severely flooded!

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2007 post-flood Leven

Returning to find a ‘ghost town’ and all local builders had been signed-up by neighbours,  I hired a few skips, removed all ground-floor furniture and flooring then 3 foot of internal walls before installing dryers. I decided to honour my QUT job offer and by the time the house renovation was completed, we had moved to Australia. Although the insurance company was great during this difficult time, the UK mortgage system collapsed the week after we placed the house on the market. We had no choice but to hand the house back to the bank.

I’d first met my then wife and her son when he was 3 months old, so he was brought up with me as his ‘Dad’. Sadly she didn’t settle in Australia and returned to the UK in 2010. I was informed by my Dean that the VC’s instructions were that QUT “had to do anything and everything to keep me at QUT, even if it was only a part of me”. I had never felt so valued or valuable. We agreed that I would ‘commute’, returning to the UK every three months, establishing research collaborations, particularly in Germany, for my visits.

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Professor and son

Six years later, my son and I continue to skype every 1-2 days, play FIFA16 and Forza computer games over the internet at the weekend, and I still visit him every three months, each time, 4 days of ‘boys stuff’, priceless!

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Fourier analysis presentation during Professor Langton’s groom’s speech

I subsequently met Jan. Our families are totally different, she has 4 married ‘children’ and 9 grandchildren – I was offered the titles of ‘Grampy’ and ‘Gramps’ but went for ‘Grumpy’! We’ve nearly completed renovation of an old fishing shack on the mangrove waterfront in the village of Jacobs Well.

Jan and I married two years ago on the small beach next to our home, and my Groom’s speech incorporated a lecture of Fourier Image Processing, again, as one does. This was particularly aimed at impressing Jan’s engineer father. Most of the guests were somewhat shocked to see me on the dancefloor pogo dancing to my signature song (Chumbawamba’s Tubthumping) – “I get knocked down but I get up again!

 

A group of friends meet each Saturday for breakfast in Jacobs Well. One day I incorrectly announced that I would 58 next year, and a dear friend said “you know Christian, for a professor, you’re a dumb bugger at times” – again, priceless, particularly when total strangers come up to me and say “aren’t you Professor DumbBugger?

I’ve always had a fascination with cars. My first was a stately Rover 3 Litre, bought from my dad for £400.

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At Needler Hall, 1978

When at Needler Hall, I had a yellow VW jacket and decided to complement it with a similarly coloured Beetle.

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I spotted one at a local service station and asked the owner if he would sell it, which he did! Probably my best ‘driver’s’ car was a Mitsubishi ‘Tommi Makinen Evo VI’. After buying it in 2000 I went straight off to a rally school to learn how it handled at the limit. I once caught the Hull-Rotterdam ferry, drove through Germany and Austria and down to Lake Garda in Italy. The primary aim was to spend a whole day going up and down the alpine passes in the snow.

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Professor Langton and his 1976 Porsche

My favourite car is a 1976 Porsche 911 3-litre Targa. I bought this in 2006, and the only reason I still have it is that its gearbox was being re-built at a specialist garage when the house in Leven was flooded.

We once drove to a Country Show at Burton Constable, aiming for the public carpark we were diverted to the Classic car section. My son was two at the time and everytime someone came over, he shouted “move away, daddy’s racing car!”, QUT kindly brought the car over to Australia. My ‘day car’ is a 2006 Porsche Cayenne, probably the best car on the planet, it does everything! I hadn’t told my son that I was buying the Cayenne. I dropped him off at school in the previous Toyota Rav4, so when we returned to the pick-up bays in the afternoon, I said “Oh dear, where is the car? How about taking this one”. I suggested he walk over to the Cayenne, wave his hands and say “abracadabra”. Miraculously, the doors unlocked and various lights flashed. As we drove off, he said “have we stolen this daddy?

 

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Sunset over the mangroves

During my 8 years at QUT, I’ve held numerous posts including Head of Physics (2010-12), Assistant Dean for Research and Research Training (2012-14, with over 1100 postgraduate research students), and one of three Theme Leaders and Head of the Industry Engagement and Commercialisation Portfolio within the Institute of Health and Biomedical Innovation (2014-16). I was also invited by Queensland Health to address recruitment and retention of radiation oncology medical physicists, forming the Queensland Cancer Physics Collaborative, membership being open to anyone who applied physics to the diagnosis and treatment of cancer, whether they be based within a hospital or university, a radiation oncologist, physicist, or radiation therapist, or be based within the public or private sector.

 

I feel honoured that my research into the assessment of osteoporosis by ultrasound was recognised by Universities UK (EurekaUK) as one of the “100 discoveries and developments in UK Universities that have changed the world”, covering the whole academic spectrum from the arts and humanities to science and technology. It was also one of only 11 stories within a National Institute for Health Research publication titled ’60 years of research in the NHS benefitting patients’. I’ve been fortunate to meet a couple of members of the Royal family.

 

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Visit by Duchess of Cornwall to Hull’s Metabolic Bone Centre, 2007

When the Duchess of Cornwall visited the Metabolic Bone Unit in Hull in 2007, I recall the extensive preparations by various security agencies. Only a week after moving to Australia, I was invited to attend a function at St James’ Palace, at a promotional event for Action Medical Research, the charity who had funded my research project to develop an ultrasound flat-bed scanner to assess premature very low birth-weight neonates.

So I flew to London for the day, met with Jonathan Thorpe who had kindly brought the scanner down on the train, and  had a fascinating ten-minute conversation with Prince Phillip about my ultrasound bone research, as well as speaking to another Patron, Fiona Bruce. In March last year, the ultrasound bone analyser was listed with the Hull Daily Mail’s list of ’Made in Hull: 10 Great Inventions’.

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Discussing bone structure with HRH Prince Phillip, 2008

Last June, I was one of 12 people awarded an Honorary Doctorate by University of Eastern Finland, in recognition of my numerous contributions to their own bone ultrasound research.

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Honorary Degree Citation in Finland, 2015

The event was extremely formal, taking place over three days and incorporating a Ball, Gala Dinner, Banquet, City Procession, Ecumenical Service and Cruise. No wonder such events take place only every 5 years!

 

Regarding my current research activities, I lead the Quantitative Ultrasound Imaging & Characterisation (QUIC) research group within IHBI. The three Programs are Ultrasound-Guided Robotic Intervention (particularly tracking tumour motion during radiotherapy), Quantitative 3D Imaging (detecting tissue breakdown associated with diabetes and post-amputation prosthesis), and Ultrasound Transit Time Spectroscopy (UTTS). This latter program has taken me full circle. It started with trying to solve the 35 year-old problem of explaining ultrasound propagation through bone from a perspective of osteoporosis detection, but has led to a parallel application of optimising diagnostic and therapeutic ultrasound interventions of the brain by removing the impediment associated with transcranial wave degradation.  As associate in the US recently commented on my invited presentation at the 2015 conference of the Acoustical Society of America, stating “this recent, cutting-edge research demonstrates that Professor Langton shows no signs of slowing down”.

I frequently return to the University and meet the VC when he is available. I particularly recall our philosophical discussion on ‘the role of a university within a community’. Most recently, I met up with old colleagues from Engineering, Michael Fagan and Catherine Dobson, who has kindly agreed to serve as an external supervisor to one of my PhD students at QUT.

An interesting anecdote linking Hull and QUT came from a recent research seminar presented by Lyn Griffiths (IHBI’s Executive Director) on her study of the genetics of Pacific Norfolk Islanders, a high proportion of whom are descendants of mutineers from HMS Bounty (built at Blaydes’ shipyard in Hull) and native Tahitians. Lyn mentioned that bone density measurements were routinely taken. Thinking that only ultrasound, and not DXA, could be used in such a remote location, I investigated further and it transpires that the system she uses is, yes, the CUBAclinical!

Taking artistic licence with the iconic song ‘I still call Australia home’. I would happily add ‘Hull’ to the lyrics.

Professor Christian Langton, April 2016

 

Are you a Hull alumnus or alumna with a story to tell? Email us at alumni@hull.ac.uk

5 thoughts on “The bone density scanner: the alumnus behind a world-changing historical research breakthrough

  1. What an awesome record! It is good to be reminded, assuming we were minded in the first place, that behind most of the wonderful procedures and treatments for which the doctors accept the credit we offer there are engineers and chemists who make them possible.

    Liked by 1 person

  2. Hi Christian. That was a great yarn. You managed to squeeze everything from Basil Fawlty to 32k ram to low birthweight neonates? The family is proud of you (even if you don’t know when your birthday is) & your contribution to medical treatment is truly magnificent. Salute.

    Liked by 1 person

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