Prostate cancer occurs in about one in seven of the male population and is fatal in about 20% of those cases, being the second most common cancer after lung cancer. Surgical intervention seeks to remove sufficient malignant tissue without leaving residuals that can lead to recurrence. At the same time new surgical techniques are emerging to minimise the impact on healthy tissue and preserve nerves and the quality of life. However, currently, the assessment of the success in removing all cancerous tissue depends on evaluation in a pathology lab and means that the surgery will not be curative or needs to be revisited. It is therefore crucial to develop technology that can allow the surgeon to make decisions during surgery that can reduce the chances of recurring disease. One well established indicator of cancerous tissue is the injection of a radioactively labelled tracer that differentiates between malignancy and normal tissue. This tracer can be imaged using positron emission tomography, but this is not a technology that can be utilized within a surgical setting. Recently a new methodology has been developed which allows the radioactive tracer to be imaged using ordinary cameras, by exploiting the emission by radioactive particles of Cerenkov light, in the visible spectrum. This phenomenon opens the possibility to place cameras on endoscopes and combine them with existing methods for robotic assisted surgery. In this project, we will pursue this idea, and make use of techniques for tracking movement of the cameras and the patient, including them in a model of light emission and detection, and realizing a real-time dynamic imaging system assisting the surgeon to excise all cancerous tissue while preserving as much healthy tissue as possible.

Our EPSRC CDT in Advanced Engineering for Personalised Surgery & Intervention will train a new generation of researchers for diverse engineering careers that deliver patient and economic impact through innovation in surgery & intervention. We will achieve this through cohort training that implements the strategy of the EPSRC by working across sectors (academia, industry, and NHS) to stimulate innovations by generating and exchanging knowledge. Surgery is recognised as an "indivisible, indispensable part of health care" but the NHS struggles to meet its rising demand. More than 10m UK patients underwent a surgical procedure in 2021, with a further 5m patients still requiring treatment due to the COVID-19 backlog. This level of activity, encompassing procedures such as tumour resection, reconstructive surgery, orthopaedics, assisted fertilisation, thrombectomy, and cardiovascular interventions, accounts for a staggering 10% of the healthcare budget, yet it is not always curative. Unfortunately, one third of all country-wide deaths occur within 90 days of surgery. The Department of Health and Social Care urges for "innovation and new technology", echoing the NHS Long Term Plan on digital transformation and personalised care. Our proposed CDT will contribute to this mission and deliver mission-inspired training in the EPSRC's Research Priority "Transforming Health and Healthcare". In addition to patient impact, engineering innovation in surgery and intervention has substantial economic potential. The UK is a leader in the development of such technology and the 3rd biggest contributor to Europe's c.150bn euros MedTech market (2021). The market's growth rate is substantial, e.g., an 11.4% (2021 - 2026) compound annual growth rate is predicted just for the submarket of interventional robotics. The engineering scientists required to enhance the UK's societal, scientific, and economic capacity must be expert researchers with the skills to create innovative solutions to surgical challenges, by carrying out research, for example, on micro-surgical robots for tumour resection, AI-assisted surgical training, novel materials and theranostic agents for "surgery without the knife", and predictive computational models to develop patient-specific surgical procedures. Crucially, they should be comfortable and effective in crossing disciplines while being deeply engaged with surgical teams to co-create technology solutions. They should understand the pathway from bench-to-bedside and possess an entrepreneurial mindset to bring their innovations to the market. Such researchers are currently scarce, making their training a key contributor to the success of the UK Government's "Build Back Better - our plan for growth" and UKRI's "five-year strategy". The cross-discipline collaboration of King's School of Biomedical Engineering & Imaging Sciences (BMEIS, host), Department of Engineering, and King's Health Partners (KHP), our Academic Health Science Centre, will create an engineering focused CDT that embeds students within three acute NHS Trusts. Our CDT brings together 50+ world-class supervisors whose grant portfolio (c.£150m) underpins the full spectrum of the CDT's activity, i.e., Smart Instruments & Active Implants, Surgical Data Science, and Patient-specific Modelling & Simulation. We will offer MRes/PhD training pathway (1+3), and direct PhD training pathway (0+4). All students, regardless of pathway, will benefit from continuous education modules which cover aspects of clinical translation and entrepreneurship (with King's Entrepreneurship Institute), as well as core value modules to foster a positive research culture. Our graduates will acquire an entrepreneurial mindset with skills in data science, fundamental AI, computational modelling, and surgical instrumentation and implants. Career paths will range from creating next generation medical innovators within academia and/or industry to MedTech start-up entrepreneurs.

Medical imaging has transformed clinical medicine in the last 40 years. Diagnostic imaging provides the means to probe the structure and function of the human body without having to cut open the body to see disease or injury. Imaging is sensitive to changes associated with the early stages of cancer allowing detection of disease at a sufficient early stage to have a major impact on long-term survival. Combining imaging with therapy delivery and surgery enables 3D imaging to be used for guidance, i.e. minimising harm to surrounding tissue and increasing the likelihood of a successful outcome. The UK has consistently been at the forefront of many of these developments. Despite these advances we still do not know the most basic mechanisms and aetiology of many of the most disabling and dangerous diseases. Cancer survival remains stubbornly low for many of the most common cancers such as lung, head and neck, liver, pancreas. Some of the most distressing neurological disorders such as the dementias, multiple sclerosis, epilepsy and some of the more common brain cancers, still have woefully poor long term cure rates. Imaging is the primary means of diagnosis and for studying disease progression and response to treatment. To fully achieve its potential imaging needs to be coupled with computational modelling of biological function and its relationship to tissue structure at multiple scales. The advent of powerful computing has opened up exciting opportunities to better understand disease initiation and progression and to guide and assess the effectiveness of therapies. Meanwhile novel imaging methods, such as photoacoustics, and combinations of technologies such as simultaneous PET and MRI, have created entirely new ways of looking at healthy function and disturbances to normal function associated with early and late disease progression. It is becoming increasingly clear that a multi-parameter, multi-scale and multi-sensor approach combining advanced sensor design with advanced computational methods in image formation and biological systems modelling is the way forward. The EPSRC Centre for Doctoral Training in Medical Imaging will provide comprehensive and integrative doctoral training in imaging sciences and methods. The programme has a strong focus on new image acquisition technologies, novel data analysis methods and integration with computational modelling. This will be a 4-year PhD programme designed to prepare students for successful careers in academia, industry and the healthcare sector. It comprises an MRes year in which the student will gain core competencies in this rapidly developing field, plus the skills to innovate both with imaging devices and with computational methods. During the PhD (years 2 to 4) the student will undertake an in-depth study of an aspect of medical imaging and its application to healthcare and will seek innovative solutions to challenging problems. Most projects will be strongly multi-disciplinary with a principle supervisor being a computer scientist, physicist, mathematician or engineer, a second supervisor from a clinical or life science background, and an industrial supervisor when required. Each project will lie in the EPSRC's remit. The Centre will comprise 72 students at its peak after 4 years and will be obtaining dedicated space and facilities. The participating departments are strongly supportive of this initiative and will encourage new academic appointees to actively participate in its delivery. The Centre will fill a significant skills gap that has been identified and our graduates will have a major impact in academic research in his area, industrial developments including attracting inward investment and driving forward start-ups, and in advocacy of this important and expanding area of medical engineering.

In a consortium led by Heriot-Watt with St Andrews, Glasgow, Strathclyde, Edinburgh and Dundee, this proposal for an "EPSRC CDT in Industry-Inspired Photonic Imaging, Sensing and Analysis" responds to the priority area in Imaging, Sensing and Analysis. It recognises the foundational role of photonics in many imaging and sensing technologies, while also noting the exciting opportunities to enhance their performance using emerging computational techniques like machine learning. Photonics' role in sensing and imaging is hard to overstate. Smart and autonomous systems are driving growth in lasers for automotive lidar and smartphone gesture recognition; photonic structural-health monitoring protects our road, rail, air and energy infrastructure; and spectroscopy continues to find new applications from identifying forgeries to detecting chemical-warfare agents. UK photonics companies addressing the sensing and imaging market are vital to our economy (see CfS) but their success is threatened by a lack of doctoral-level researchers with a breadth of knowledge and understanding of photonic imaging, sensing and analysis, coupled with high-level business, management and communication skills. By ensuring a supply of these individuals, our CDT will consolidate the UK industrial knowledge base, driving the high-growth export-led sectors of the economy whose photonics-enabled products and services have far-reaching impacts on society, from consumer technology and mobile computing devices to healthcare and security. Building on the success of our CDT in Applied Photonics, the proposed CDT will be configured with most (40) students pursuing an EngD degree, characterised by a research project originated by a company and hosted on their site. Recognizing that companies' interests span all technology readiness levels, we are introducing a PhD stream where some (15) students will pursue industrially relevant research in university labs, with more flexibility and technical risk than would be possible in an EngD project. Overwhelming industry commitment for over 100 projects represents a nearly 100% industrial oversubscription, with £4.38M cash and £5.56M in-kind support offered by major stakeholders including Fraunhofer UK, NPL, Renishaw, Thales, Gooch and Housego and Leonardo, as well as a number of SMEs. Our request to EPSRC for £4.86M will support 35 students, from a total of 40 EngD and 15 PhD researchers. The remaining students will be funded by industrial (£2.3M) and university (£0.93M) contributions, giving an exceptional 2:3 cash gearing of EPSRC funding, with more students trained and at a lower cost / head to the taxpayer than in our current CDT. For our centre to be reactive to industry's needs a diverse pool of supervisors is required. Across the consortium we have identified 72 core supervisors and a further 58 available for project supervision, whose 1679 papers since 2013 include 154 in Science / Nature / PRL, and whose active RCUK PI funding is £97M. All academics are experienced supervisors, with many current or former CDT supervisors. An 8-month frontloaded residential phase in St Andrews and Edinburgh will ensure the cohort gels strongly, and will equip students with the knowledge and skills they need before beginning their research projects. Business modules (x3) will bring each cohort back to Heriot-Watt for 1-week periods, and weekend skills workshops will be used to regularly reunite the cohort, further consolidating the peer-to-peer network. Core taught courses augmented with specialist options will total 120 credits, and will be supplemented by professional skills and responsible innovation training delivered by our industry partners and external providers. Governance will follow our current model, with a mixed academic-industry Management Committee and an independent International Advisory Board of world-leading experts.

The unique properties of light have made it central to our high-tech society. For example, our information-rich world is only enabled by the remarkable capacity of the fibre-optic network, where thin strands of glass are used to carry massive amounts of information around the globe as high-speed optical signals. Light also impacts areas of our society as diverse as laser-based manufacturing, solar energy, space-based remote sensing and even astronomy. One area where the properties of light open up otherwise-impossible capabilities is medicine. In ophthalmology for example, lasers are routinely used to perform surgery on the eye through corneal reshaping. This involves two different lasers. In the first step, a laser producing very short pulses of infrared light cuts a flap in the front surface of the eye to provide access. In the second step, another laser producing longer pulses of ultraviolet (UV) light sculpts the shape of the cornea and correct focusing errors. The flap is then folded back into place so that the cornea can heal. The two very-different laser systems in that example illustrate an important point: the effects of light on human tissues are highly-dependent on the specific properties of both the light and the tissues involved. To sculpt the cornea, the laser wavelength of 193 nm is in the deep UV region of the electromagnetic spectrum, much shorter than the visible range (380 - 740 nm) we are familiar with. This is because (unlike visible light) it is very efficiently absorbed by the cornea, so that essentially all the energy of the light is deposited at the surface. Thus only a very thin layer of tissue (a few microns thick) is removed, or "resected", with each pulse of light, facilitating very-precise shaping of the cornea and accurate adjustment of its focusing properties. 193 nm light can be generated by an ArF excimer gas laser, a >40 year-old technology producing a poor-quality low-brightness beam of light. This is suitable for corneal reshaping, but not for a range of other important therapies requiring higher-quality deep UV beams. Unfortunately, alternative ways to generate such short wavelengths are non-trivial, resulting in complex and expensive laser systems not suitable for widespread clinical uptake. U-care aims to address this gap by exploiting cutting-edge techniques in laser physics. We will develop new sources of deep UV light which will be highly compact, robust and low cost. We will develop ways to deliver this light precisely to tissues, and work to understand in detail the biophysical mechanisms involved. Our efforts will focus on new therapies that target some of the biggest challenges facing medicine: cellular-precision cancer surgery, and the emergence of drug-resistant "super-bugs". Importantly, U-care will involve engineers and physical scientists working in close collaboration with clinicians and biomedical scientists to verify that the therapies we develop are effective and safe. By doing so in an integrated manner, we will drive our deep-UV light therapies towards healthcare impact and widespread use in the clinic by 2050.