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The origins of Hallmarq

Where did it all begin?

MRI BACKGROUND

In 1989 Nick Bolas was driven out of a fledgling academic career in the Biochemistry department of Oxford University by the first negative equity crunch in the UK property market. He took a “real job” with a new company, Surrey Medical Imaging Systems (SMIS), spun out of the Surrey University physics department and founded by physics professor Dr. David Taylor.

His research in Oxford used magnetic resonance spectroscopy to investigate energy metabolism. This was in the very early days of MR technology, and the job involved not only using the world’s strongest human-size magnets of the time, but also developing, personally, everything from non-magnetic equipment and RF coils to some of the very first imaging sequences. Nick was at that time a very infrequent horse rider but first came across the concept of live horse MR as an ambition of one of the American labs in the same research field - an ambition never realised.

SMIS developed the specialist pulse programming, data processing and image display technology necessary to turn one of the newly invented desktop IBM-compatible PCs into an MRI system. This dramatically reduced the cost of MR and stimulated a wide range of new applications in research and industry. For several years Nick’s main role was in matching the wishes of potential customers to the specifications of an MR system, working together with an exceptional team of engineers (several of whom are now with Hallmarq). One new application was in veterinary MRI, and in the mid-1990’s SMIS supplied the UK’s first dedicated veterinary MRI to the Animal Health Trust in Newmarket, with Nick on site with a screwdriver during some of the commissioning period.

HORSES

Though the AHT never used their 0.5T scanner for horses it was always designed with equine MRI in mind - the limiting factor was finding a suitable non-magnetic patient bed. The potential for standing horse MR was discussed at the time, but it was considered unlikely to work. The ideas remained in Nick’s mind though, and toward the end of the 1990’s his own thoughts moved back toward the possibility.

By this time Nick had become a horse owner and regular rider, and in the year 2000, his horse became ill (with an ovarian tumour, nothing to do with lameness). As a result, he spent a considerable time at the Bell Equine Veterinary Clinic. He took the opportunity to discuss the idea of standing equine MRI with Richard Jones, Tim Mair and the other vets at Bell, and clearly remembers Tim’s comment “if you can do that, you’ll be killed in the rush”.

This was in the early days of mobile phones, and many furtive car-park phone calls later, to the likes of Leo Jeffcott, Peter Webbon, and Kent Allen, he was convinced there was a strong demand for MRI of the horse, focussed on the foot. A chance meeting with Prof Kees Dik while in Utrecht for an MR conference and many hours spent exploring horse handling possibilities at Bell Equine, and with John Walmsley at the Liphook Equine Hospital, put some flesh on the bones.

While the idea of a standing horse MRI was not new, previous efforts had been conceived by engineers, not horsemen, and working with vets convinced Nick that the trick would be in the ergonomics (and modern sedative drugs). In particular, an open, C-shaped magnet was critical, with a safe route for the horse to escape freely. Placing a C-shaped magnet with its centre at the level of a floor solid enough to make a horse feel secure led to a new design approach, and in time to Hallmarq’s first patent.

THE FOUNDATION OF HALLMARQ

The final piece of the jigsaw came at the International Society of Magnetic Resonance in Medicine meeting in Denver, in the spring of 2000. Here Nick Bolas met David Taylor, who had left SMIS some years previous but had recreated another company and licensed the original technology. Recognising that David had some key components, and Nick had the market, the two got together with third founder Richard Stoner to establish Hallmarq Veterinary Imaging Ltd. The name comes from Horse Leg MR.

The first hurdle was to avoid the “Dragon’s Den” trap of giving away a high proportion of the company equity for seed funding - as much of a challenge as the engineering of the product. But horses have their own special following, and the founders raised sufficient funds from small, horse passionate investors to get the company off the ground.

THE FIRST SCANNER

The first system was a 0.21T magnet installed at Bell Equine in January 2002. Not only was the magnet a new development, but Hallmarq also needed to tackle building costs. MRI systems must be installed in a metal screened room to exclude RF interference, but the cost of a standard RF room was prohibitive. With RF screening based on aluminised thermal insulating material used in the building industry Hallmarq and Bell Equine put together the first scanner room on a (long) shoestring. Reducing the building cost was a necessary step in enabling the first unit, but RF rooms to this design were not reliable in the long term unless kept absolutely dry, and were phased out before long.

The first RF room under construction, using novel screening based on thermal insulation materials. Current installations use conventional metal-lined rooms.

The very first magnet delivery

The first magnet on delivery, watched by Tim Mair and Julien Samuelson at Bell Equine. This magnet was later replaced with the current, larger model.

The 0.21T magnet proved that standing equine MR was feasible, but the imaging volume was too small to cover the critical part of the foot. Work, therefore, moved on to developing a bigger magnet, and the additional space gave room for enough permanent magnet material to increase the field strength to 0.27T. The design was a challenging stand-off between the magnet engineers, who were crying out for a thicker pole, and the vets who demanded less bulk between the horse’s legs. With a few mm trimmed here and there the Hallmarq team created the basic magnet design which remains to this day.

EQ2

The order book rapidly filled up, and Hallmarq installed the first ten systems within a year. However the demands on performance went up too, and in particular, the TB racehorse vets needed better performance in the fetlock region. Key development engineers Steve Roberts and Mat Hass (both still with Hallmarq today) with others worked closely with leading clinics to meet the demand.

Their efforts led to three major innovations, to the magnet, the RF coils and the pulse sequences, and a rebranding of the product as EQ2. Improvements to the magnet allowed better compensation for field changes due to temperature (themselves exacerbated by the minimal thickness of steel in the magnet poles) and together with new sequences led to much faster imaging. RF coils, which had initially been made using “gas pipe” copper tubing were made instead from copper sheet, allowing a “clip around” design that better fitted the smaller diameter of the fetlock and improved performance dramatically.

Specialised RF coils for optimised image quality and improved performance

MOTION COMPENSATION

Without motion compensation, imaging a standing, swaying horse would be almost impossible. Taking clues from both nuclear scintigraphy and cardiac MRI the first motion correction algorithm for the standing horse was developed in the early 2000s but took many hours to correct even a single image.

In the hands of pulse sequence developer Steve Roberts (now Hallmarq’s Operations Director) and programmer Graham Nayler (now Hallmarq’s chief software engineer) the code improved out of all recognition, and images of the fetlock and above became practical with EQ2.

Continuous improvements to the algorithms and the computing power available have made fetlock imaging routine, and images of the carpus and hock a practical proposition.

BUSINESS MODEL

The founders of Hallmarq were keen to avoid the financial challenge that would arise from having no regular income except through the developing and selling innovative new MR systems. They also recognised that the veterinary market would need a higher level of support than university physics departments. Equine scanners were therefore supplied using a novel financial model, with the systems being rented rather than sold, fees charged for each clinical case, and an "evergreen" fully inclusive maintenance contract. This ensured a regular income for the company while fitting well with the cash flow of the small businesses that were Hallmarq’s veterinary practice customers.

While this model was (and still is) attractive to vets, and allowed the company to establish a world-leading support team, the capital costs of new scanners eventually demanded substantial further equity investment. With the money came a change in management, and first James Otter and then Jos Belgrave have led the team on from the foundations that David Taylor and Nick Bolas laid. Nick remains a Director of the company.

Today Hallmarq has (updated 24.11.2016) over 90 veterinary MRI installations, in 23 countries worldwide, and over 70,000 horses have been scanned using standing MRI. The technique has changed not only the diagnosis of individual animals but also the entire veterinary approach to the once mysterious challenge of “navicular disease”.

COMPANION ANIMAL SCANNER

Starting in 2013, with an established financial and service model fitting closely to the needs of veterinarians, Hallmarq’s engineers applied their MRI expertise to the development of a small animal scanner. Diagnostic images of dogs and cats must resolve finer anatomical structures than are found in horses, so a high field MRI is needed.

Paying close attention also to keeping the ongoing costs low, and including innovations such as an integrated RF shield, V-shaped patient bed, and specially designed coils, Hallmarq has been able to create an economical specialty MRI system, making MRI accessible to more companion animals in the same way the company transformed its availability for horses.