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Trial registered on ANZCTR
Registration number
ACTRN12620001159943
Ethics application status
Approved
Date submitted
29/06/2020
Date registered
4/11/2020
Date last updated
4/11/2020
Date data sharing statement initially provided
4/11/2020
Type of registration
Retrospectively registered
Titles & IDs
Public title
MRI for investigating airway clearance techniques in adults with cystic fibrosis
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Scientific title
The use of novel magnetic resonance imaging techniques to investigate lung structure and ventilation pre- and post-airway clearance techniques in adults with cystic fibrosis
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Secondary ID [1]
301649
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Cystic fibrosis
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Condition category
Condition code
Respiratory
316097
316097
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0
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Other respiratory disorders / diseases
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Human Genetics and Inherited Disorders
316392
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0
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Cystic fibrosis
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This is a single visit, proof of concept study investigating the use of a novel outcome measure (magnetic resonance imaging [MRI]) to measure changes in lung structure and ventilation following airway clearance techniques in adults with CF. Each participant will complete three MRI scans (each lasting approximately 20 minutes): firstly at the commencement of the visit, then after airway clearance techniques or washout period (25 minutes) and then again after airway clearance techniques or washout period (25 minutes), conducted in randomised order (i.e. one period of airway clearance and one washout period per participant in a randomised order). The total study visit is expected to last no more than 2 hours. The participant will complete their usual airway clearance technique, supervised by an experienced CF physiotherapist. The MRI scans will be completed by an experienced MRI technician.
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Intervention code [1]
317953
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Treatment: Other
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Comparator / control treatment
The participant is being used as their own comparator/control during the washout period in the study design. During this period, the participant will sit in a quiet room and be instructed to breathe normally/rest.
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Control group
Active
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Outcomes
Primary outcome [1]
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1) Lung structure
We will use a version of the PRAGMA-CF scoring system (widely used in CF CT scan studies), adapted for use in MRI, for assessment of structural lung abnormalities.15 In brief, PRAGMA-CF involves overlaying a square grid over the MRI images and annotating grid cells for the presence of CF-related structural lung disease. The total proportion of the lung with disease, %Disease, is reported and represents the extent of structural disease. Additionally, the extent of mucus plugging, %MucusPlugging, will be reported.
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Assessment method [1]
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Timepoint [1]
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On day of MRI
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Primary outcome [2]
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2) Lung ventilation
The same PRAGMA-CF process will be used to determine the severity of hypoventilation in the lung, from the Fourier Decomposition scans (%Hypoventilated).
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Assessment method [2]
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Timepoint [2]
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On day of MRI
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Secondary outcome [1]
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Nil
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Assessment method [1]
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Timepoint [1]
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Nil
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Eligibility
Key inclusion criteria
Diagnosis of CF; aged 18 years or older; under the care of the SCGH CF team; no signs of a respiratory exacerbation in the preceding four weeks.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Previous lung transplantation; inability to perform ACT; inability to expectorate mucus; type 1 respiratory failure requiring supplemental oxygen therapy; pneumothorax in the previous 3 months; current haemoptysis; pregnancy; failing to comply with standardised pre-MRI safety checklists; potential intolerance to MRI environment due to severe claustrophobia.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
All scans will be retrieved and de-identified before analysis. Assessment of MRI scans will be performed in random order, blinded to clinical and research outcomes. The PRAGMA-CF scoring system, adapted for use in MRI, for assessment of structural lung abnormalities. This involves overlaying a square grid over the MRI images and annotating grid cells for the presence of CF-related structural lung disease. This will be performed by a scientist blinded to group allocation, who is experienced in using this scoring system.
The total proportion of the lung with disease, %Disease, is reported and represents the extent of structural disease. Additionally, the extent of mucus plugging, %MucusPlugging, will be reported. The same process will be used to determine the severity of hypoventilation in the lung, from the Fourier Decomposition scans (%Hypoventilated).
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
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Actual
30/06/2020
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Date of last participant enrolment
Anticipated
18/12/2020
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Actual
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Date of last data collection
Anticipated
18/12/2020
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Actual
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Sample size
Target
12
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Accrual to date
8
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Final
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Recruitment in Australia
Recruitment state(s)
WA
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Recruitment hospital [1]
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Sir Charles Gairdner Hospital - Nedlands
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Recruitment postcode(s) [1]
30655
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6009 - Nedlands
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Funding & Sponsors
Funding source category [1]
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Hospital
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Name [1]
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Sir Charles Gairdner Hospital
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Address [1]
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Hospital Avenue, Nedlands, Western Australia 6009
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Country [1]
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Australia
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Primary sponsor type
Hospital
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Name
Sir Charles Gairdner Hospital
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Address
Hospital Avenue, Nedlands, Western Australia 6009
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
306547
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Country [1]
306547
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Sir Charles Gairdner and Osborne Park Health Care Group Human Research Ethics Committee
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Ethics committee address [1]
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Hospital Avenue, Nedlands, Western Australia 6009
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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29/10/2019
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Approval date [1]
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31/05/2020
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Ethics approval number [1]
306303
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Summary
Brief summary
We aim to investigate new techniques in magnetic resonance imaging (MRI) pre and post airway clearance techniques (ACT). Adults with CF will be invited to participate, and to perform their usual ACT (i.e. breathing exercises to clear mucus from their airways) within the MRI under the guidance of an experienced physiotherapist. This will allow for innovative cutting edge imaging to be performed before and after the ACT are performed, to provide information on airway structure and function; specifically in regard to the movement of mucous (sputum) and trapped air, and well as dynamic function of the larger airways.
This is important, as ACT are one of the cornerstone daily treatments undertaken in CF, yet to date no modern ACT has been shown to be superior, largely due to limited outcome measures. While lung imaging is appealing, until recently only computed tomography (CT) has been available to provide the necessary imaging. Unfortunately, CT exposes the patient to ionising radiation exposure which limits its use for especially functional imaging. Using MRI provides avoids radiation risk, therefore is an excellent option for structure and function imaging in relation to ACT. This is the first study of its kind, utilising novel MRI techniques.
The experienced and capable research team will investigate the use of novel MRI techniques to objectively quantify lung structure and ventilation during ACT in adults with CF, providing new data in this area to assist in the understanding of ACT in the future. The MRI techniques used have the potential to also be used in other lung diseases such as bronchiectasis, COPD and asthma, and therefore this study is the beginning of a much larger research focus in this field.
Aims
In adults with CF:
1) Establish a protocol for the use of MRI to detect changes in lung structure and ventilation in relation to mucus movement during ACT;
2) Conduct a series of three MRI in adults with CF (n = 12) of varying disease severities before and after different ACT to explore the obtainable information including mucus movement and static and dynamic airway ventilation.
Hypothesis
MRI is a novel and suitable tool for the assessment of lung structure and ventilation during ACT in adults with CF, which will provide a new outcome measure for use in future larger clinical trials in this area.
Each participant will complete three separate MRI scans, lasting approximately 20 minutes each, interspersed throughout the visit. They will also complete a 25 minute control period of resting breathing, and a 25 minute intervention period consisting of performing their usual ACT. The order of the intervention and control periods will be determined by randomisation. The ACT performed at each visit will be supervised by Jamie Wood and ACT will be performed according to International Physiotherapy Group for CF guidelines.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Mr Jamie Wood
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Address
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Sir Charles Gairdner Hospital
Physiotherapy Department
Ground Floor A Block
Hospital Avenue Nedlands WA 6009
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Country
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Australia
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Phone
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+61 432 954 790
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Mr Jamie Wood
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Address
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Sir Charles Gairdner Hospital
Physiotherapy Department
Ground Floor A Block
Hospital Avenue Nedlands WA 6009
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Country
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Australia
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Phone
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+61 432 954 790
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Mr Jamie Wood
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Address
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Sir Charles Gairdner Hospital
Physiotherapy Department
Ground Floor A Block
Hospital Avenue Nedlands WA 6009
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Country
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Australia
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Phone
103432
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+61 432 954 790
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Fax
103432
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
The raw line data regarding the PRAGMA MRI scoring will be made available on request.
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When will data be available (start and end dates)?
Unknown start date at present - following publication of the manuscript and until the proposed end of the HREC approval (31/12/2021)
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Available to whom?
Available to those who request the information via contacting the principal investigator.
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Available for what types of analyses?
Only to achieve the aims in the approved proposal and case-by-case at discretion of the Principal Investigator.
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How or where can data be obtained?
Via the principal investigator (
[email protected]
) and following HREC approval at the site the research is being undertaken.
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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