Image Technology to Verify the Placement of Nasogastric ......Nasogastric Feeding Tubes • Commonly accepted treatment • Makes passive feeding possible • Wrong placement can cause

Image Technology to Verify the

Placement of Nasogastric Feeding Tubes

to Improve Patient Care Outcomes

Presented

by

Tibor Zajki-Zechmeister

Table of Contents

• Introduction and Background

• Materials and Methods

• Results

• Further Optimization

• Discussion

• Sources

[1]

Nasogastric Feeding Tubes

• Commonly accepted

treatment

• Makes passive feeding

possible

• Wrong placement can cause damages

• Verification method needed

Fig. 1 A standardized feeding tube for passive

patient nutritioning

Current Verification Methods(1)

• Gold standard: X-Ray Imaging

• Alternative methods:

– Auscultation

– Electromagnetic verification

– pH-value test

– Test of aspirated material

Current Verification Methods (2)

• Alternative methods fail to have 100%

correct verifications

Fig. 2 Trials for current alternative verification methods [2]

Alternative Approach

• A basic endoscope is attached to feeding

tube

• Verification takes place

via imaging

• No radiation is needed Fig. 3 Endoscopes are commonly used in

medical environments [3]

Materials and Methods

• A working imaging system requires:

– Camera systems

– Additional components

– Data acquisition process

– Trials if the system is working properly

Components (1)

• Feeding tube

• Camera systems

• Lighting

[4]

Components (2)

• Signal transmission

• Power supply

• Image processing

[5]

[6]

Camera Systems (1)

• Considered camera systems:

Product Number: OV6922 CMOS

Resolution: 320x240 px

Size: 2mm x 2mm x 2mm

Extra tools required: Yes

Price: £ 2

Product Number: MT9V024IA7XTC CMOS

Resolution: 750x480 px

Size: 9mm x 9 mm x 5mm

Extra tools required: Yes

Price: £ 160

[7]

[8]

Camera Systems (2)

• Considered camera systems:

Product Number: IntroSpicio™ 120

Resolution: 220x224 px

Size: 1.2mm x 5mm

Extra tools required: No

Price: £ 3000

Product Number: OVM7692-RAAA CMOS

Resolution: 640x480 px

Size: 3mm x 3 mm x 3mm

Extra tools required: Yes

Price: £ 15

[9]

Data Acquisition (1)

• Images are processed within the following

steps:

– Image captured by camera

– Analog signal transmitted to evaluation board

– Microcontroller converts into digital signals

– Signal transmission to PC via USB-cable

– Output with proper software

Data Acquisition (2)

Fig. 4 Data acquisition process of the micro camera verification system: The images are taken by the cube camera

and afterwards sent to the evaluation board in which the digitalization takes place via the microcontroller. The data is

then sent via USB cable to a PC on which the images can be seen with the software that is provided

Results

• Combination of components is possible

• Data acquisition is

working

• Size is too large for

clinical trials Fig. 5 The prototype 1.0 has too large dimensions

for clinical trials although further improvements

can reduce the general size of the system

Range of Tests

• Tests for Image Quality:

• Fringe Test for Illumination:

Fig. 6 Output of the

cube camera system

and the processing

components: Left:

distant and near

objects imaged; Right:

The NG feeding tube is

imaged to test if near

objects are taken with

a certain sharpness

Fig 7. Image of a

labeled Graph with a

simple LED as the only

light source: Even with

a basic LED the

contrast is high

enough so recognize

the text

Live Demonstration

Further Optimization

• Size reduction via smaller PCBs

• Wireless signal transmission

• Wireless power supply

• Improved lighting

Discussion

• The verification method works in theory

and in practical trials

• Improvements have to be done for clinical

trials

• An efficient and cost effective alternative

has been found

Summary

• Project idea was to create a verification

method via imaging

• Components should be small and cheap

• Imaging output should make a fast

diagnosis of placement possible

Sources

• [1] Macmillan Cancer Support (2012, May) Nutritional support (artificial feeding) [Online]:

http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Eatingwell/Nutritionalsupport/N

utritionalsupport.aspx

• [2] Journal of Parenteral and Enteral Nutrition (2001, July) : A Controlled Comparison of Traditional

Feeding Tube Verification Methods to a Bedside, Electromagnetic Technique

• [3] Freie Universität Berlin (2012, May) Endoskopie [Online]: http://www.vetmed.fu-

berlin.de/einrichtungen/kliniken/we15/arbeitsgruppen/ziervoegel/arbeitsbereiche/endoskopie/index.html

• [4] Omnivision Technologies, Inc (2012, May) VGA CameraCubeChip [Online]:

http://www.ovt.com/products/category.php?id=21

• [5] Digi-Key Corporation (2012, May) Cable Mini USB [Online]: http://parts.digikey.com/1/parts-kws/mini-

usb-cable

• [6] Digi-Key Corporation (2012, May) OVM7692-ECJABA0A[Online]:

http://ca.digikey.com/1/5/omnivision-technologies-inc

• [7] 2001 Electronic Components (2012, May) OV6922 CMOS [Online]:

http://www.2k1.co.uk/products/productview.php?wid=28&pageno=2

• [8] Digi-Key Corporation (2012, May) MT9V024IA7XTC CMOS[Online]: http://parts.digikey.com/1/parts-

kws/cmos-camera-sensors

• [9] Medigus (2012, May) 1.2mm camera [Online ]:

http://www.medigus.com/camera_1_2mm/Camera.aspx

Acknowledgement

• WHOCC Charing Cross Campus

– Professor Azeem Majeed

– Elizabeth A. Dubois, MSc

• South Kensington Campus:

– Dr. Dylan Banks

Thank you for your attention