title: A Non-invasive Real-time Localization System for Enhanced Efficacy in Nasogastric Intubation.
abstract: Nasogastric (NG) intubation is one of the most commonly performed clinical procedures. Real-time localization and tracking of the NG tube passage at the larynx region into the esophagus is crucial for safety, but is lacking in current practice. In this paper, we present the design, analysis and evaluation of a non-invasive real-time localization system using passive magnetic tracking techniques to improve efficacy of the clinical NG intubation process. By embedding a small permanent magnet at the insertion tip of the NG tube, a wearable system containing embedded sensors around the neck can determine the absolute position of the NG tube inside the body in real-time to assist in insertion. In order to validate the feasibility of the proposed system in detecting erroneous tube placement, typical reference intubation trajectories are first analyzed using anatomically correct models and localization accuracy of the system are evaluated using a precise robotic platform. It is found that the root-mean-squared tracking accuracy is within 5.3 mm for both the esophagus and trachea intubation pathways. Experiments were also designed and performed to demonstrate that the system is capable of tracking the NG tube accurately in biological environments even in presence of stationary ferromagnetic objects (such as clinical instruments). With minimal physical modification to the NG tube and clinical process, this system allows accurate and efficient localization and confirmation of correct NG tube placement without supplemental radiographic methods which is considered the current clinical standard.
authors.affiliation: Engineering Product Development Pillar, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372, Singapore.
authors.forename: Zhenglong
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Engineering Product Development Pillar, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372, Singapore. foongshaohui@sutd.edu.sg.
authors.forename: Shaohui
authors.identifier: http://orcid.org/0000-0002-9724-6159
authors.initials: S
authors.lastname: Foong
authors.affiliation: Engineering Product Development Pillar, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372, Singapore.
authors.forename: Luc
authors.initials: L
authors.lastname: Maréchal
authors.affiliation: Engineering Product Development Pillar, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372, Singapore.
authors.forename: U-Xuan
authors.initials: UX
authors.lastname: Tan
authors.affiliation: Engineering Product Development Pillar, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372, Singapore.
authors.forename: Tee Hui
authors.initials: TH
authors.lastname: Teo
authors.affiliation: Division of General Surgery (Upper Gastrointestinal Surgery), University Surgical Cluster, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
authors.forename: Asim
authors.initials: A
authors.lastname: Shabbir
mesh_terms: D003199:Computer Systems; D004867:Equipment Design; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation* / Q000379:methods; D060328:Magnetic Phenomena; D015203:Reproducibility of Results; D012371:Robotics
keywords: Healthcare safety; Magnetic localization; Nasogastric intubation; Wearable device