# Photoacoustic Imaging for Image-Guided Gastric Tube Placement: Ex Vivo Characterization

## TL;DR

This paper introduces a new imaging system combining ultrasound and photoacoustic imaging to improve the safety and accuracy of gastric tube placement procedures.

## Contribution

A novel point-of-care imaging system using dual-wavelength photoacoustic imaging for safer gastrostomy tube placement is proposed and characterized.

## Key findings

- Photoacoustic imaging accurately differentiates organs at specific wavelengths in ex vivo tissue studies.
- The system detects low concentrations of Indocyanine Green dye on the colon wall, reducing toxicity risks.
- The proposed system offers safer and more precise gastrostomy tube placement compared to current methods.

## Abstract

Over 250,000 gastrostomy tubes (G-tubes) are placed annually in the United States. Percutaneous endoscopic gastrostomy (PEG) is the most widely used clinical method for placing G-tubes within the stomach. However, endoscope detectability is limited due to the scattering of light by tissues. Poor organ visibility and low sensitivity of the palpation techniques cause blind needle insertions, which cause colon/liver perforations, abdominal bleeding, and gastric resections. Additionally, imaging artifacts and the poor distinguishability between water-filled tissues make ultrasound (US) imaging-based techniques incompatible with G-tube placement. The risk of ionizing radiation exposure and the confinement of fluoroscopy to radiology suites limits its bedside utility in patients. Considering these limitations, we propose to design a safe, point-of-care integrated US and photoacoustic (PA) imaging system for accurate G-tube placement procedures, for a broad spectrum of patients, and to characterize the system’s effectiveness. Our proposed technology utilizes a clinically safe contrast agent and a dual-wavelength approach for precise procedures. Our ex vivo tissue studies indicated that PA imaging accurately differentiates the different organs at specific wavelengths. Our characterization studies revealed that PA imaging could detect lower concentrations of Indocyanine Green (ICG) dye coating the colon wall, minimizing the risk of ICG dye-related toxicity and providing safer G-tube placements.