Magnetic Resonance Guided Nasojejunal Feeding Tube Placement for Neonates
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University of Cincinnati / OhioLINK
2015
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ndltd-OhioLink-oai-etd.ohiolink.edu-ucin14392816382021-08-03T06:32:47Z Magnetic Resonance Guided Nasojejunal Feeding Tube Placement for Neonates Daniels, Barret R. Radiology MR Tracking Enteral Feeding MRI Interventional MRI Neonatal Feeding Tube <p>Premature birth (< 37 weeks of gestational age) is a leading contributor to neonatal morbidity and mortality worldwide. A major challenge in managing neonatal health is to provide adequate and appropriate nutrition such that growth and development are supported in a manner as close to in utero as possible. However, it is difficult to establish postnatal nutritional delivery in premature infants due to their inability to ingest nutrients. Enteral feeding is the gold standard for such patients, but their small size and fragility present significant challenges in nasogastric and particularly nasojejunal (NJ) feeding tube placement. Inadvertent feeding tube placement in the respiratory tract is common and can lead to pneumothorax.</p><p>There are several methods to ensure correct placement of NJ tubes, but fluoroscopic guidance is the only real-time visualization methodology used clinically. Fluoroscopic placements are limited by the lack of soft tissue contrast and the exposure of the neonate to ionizing radiation. Frequently, NJ feeding tubes are displaced due to coughing, vomiting, and/or baby movement resulting in repeated tube placements and a significant cumulative X-ray dose.</p><p>Magnetic resonance (MR) has the significant advantage of not requiring exposure of the neonate to ionizing radiation, allowing for repeated procedures and imaging when required. Additionally, MR imaging is superior to fluoroscopy in anatomical resolution and soft-tissue visualization. This dissertation investigates the hypothesis that magnetic resonance can be used to guide nasojejunal feeding tube placements in neonates providing improved device visualization over fluoroscopic methods without ionizing radiation if certain challenges are overcome. These challenges include: 1) the size mismatch between an adult-sized MR scanner and the neonate, 2) inaccuracies in active MR tracking caused by non-ideal conditions, 3) radiofrequency heating of conducting wires used to connect MR tracking coils to the MRI system, and 4) design of NJ tubes which can be reliably placed under MR-guidance.</p><p>This research addressed the aforementioned challenges in an attempt to make a neonatal MR-guided NJ feeding tube placement a reality. First, two novel small-footprint neonatal MRI scanners were designed and built. These scanners allowed for the first time the ability to perform MR-guided interventions on neonates. Second, the accuracy and precision of MR device tracking was improved with two novel methods: centroid pixel and micro-transmit tracking. These methods are important when an interventional device encounters non-ideal conditions within the body. Third, several innovative methods to reduce radiofrequency (RF) heating of the conducting wires used to connect MR tracking coils to the MRI system were designed and evaluated experimentally. Fourth, a novel MR-guidable feeding tube and guidewire with integrated MR tracking coils were designed, built, and evaluated. Lastly, the feasibility of a MR-guided neonatal NJ feeding tube placement was assessed experimentally with an animal model.</p><p>The research performed in this dissertation demonstrated the feasibility and benefits offered by an MR-guided approach to NJ feeding tube placement. The ability to acquire high-quality MR images of soft tissue without ionizing radiation coupled with accurate three-dimensional device tracking promises to have a powerful and sustained impact on future neonatal interventions.</p> 2015-09-01 English text University of Cincinnati / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=ucin1439281638 http://rave.ohiolink.edu/etdc/view?acc_num=ucin1439281638 unrestricted This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws. |
| collection |
NDLTD |
| language |
English |
| sources |
NDLTD |
| topic |
Radiology MR Tracking Enteral Feeding MRI Interventional MRI Neonatal Feeding Tube |
| spellingShingle |
Radiology MR Tracking Enteral Feeding MRI Interventional MRI Neonatal Feeding Tube Daniels, Barret R. Magnetic Resonance Guided Nasojejunal Feeding Tube Placement for Neonates |
| author |
Daniels, Barret R. |
| author_facet |
Daniels, Barret R. |
| author_sort |
Daniels, Barret R. |
| title |
Magnetic Resonance Guided Nasojejunal Feeding Tube Placement for Neonates |
| title_short |
Magnetic Resonance Guided Nasojejunal Feeding Tube Placement for Neonates |
| title_full |
Magnetic Resonance Guided Nasojejunal Feeding Tube Placement for Neonates |
| title_fullStr |
Magnetic Resonance Guided Nasojejunal Feeding Tube Placement for Neonates |
| title_full_unstemmed |
Magnetic Resonance Guided Nasojejunal Feeding Tube Placement for Neonates |
| title_sort |
magnetic resonance guided nasojejunal feeding tube placement for neonates |
| publisher |
University of Cincinnati / OhioLINK |
| publishDate |
2015 |
| url |
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1439281638 |
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AT danielsbarretr magneticresonanceguidednasojejunalfeedingtubeplacementforneonates |
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