Respiratory and pulmonary illnesses such as respiratory distress syndrome and transient tachypnoea of the newborn are leading causes of death among newborns. These morbidities result in lung collapse and reduction in the lung gas volume. While these conditions can be treated using surfactant administration and supplemental oxygen, continuous feedback on the health of the lung during these procedures can be helpful in improving their efficiency and avoiding later complications. Optical techniques like GASMAS (Gas in scattering media absorption spectroscopy) have shown considerable promise in this regard. The technique is non-invasive and non-ionizing and causes no short term or long term discomfort to the infant. It also allows for real time continuous monitoring of the oxygen content which is critical in a clinical setting. In this work, we discuss the results from a pilot clinical study performed at the INFANT Research Centre, Cork. A GASMAS device was used to measure the oxygen concentration of the lung in this healthy cohort of 100 healthy neonatal infants between 1 to 5 days of age. Lung oxygen concentration was measured at multiple locations and across multiple visits for each infant. The huge dataset allows us to understand the influence of different parameters such as the weight of the infant, chest circumference, location etc, on the instrument performance and recovered oxygen concentration. This information and understanding will set the stage for the next phase of the study which is aimed at a similar cohort of term and pre-term infants with respiratory morbidities.
Gas in scattering media absorption spectroscopy shortly called GASMAS, is a tunable diode laser spectroscopic technique developed for the measurement of gas present in turbid media. The technique relies on the sharp and specific absorption lines of gases which enables sensitive measurements of gas concentrations in the presence of a scattering solid medium with much broader absorption features. The Biophotonics laboratory at Tyndall National Institute (Biophotonics@Tyndall) is currently exploring the clinical translation of GASMAS technology into the respiratory healthcare of neonates. In this study, we use computational tools to assess the potential gain in gas absorption signal. One of the challenges in the development of the GASMAS technique is to obtain a sufficiently good signal in the measurements, as the light attenuation is high in tissue and the lungs are interior organs. To have an estimation of the capabilities and limitations in this specific application of gas spectroscopy, we model the transmission of near infrared (NIR) light in tissue when a 760 nm source and a set of 68 detectors are placed in different locations over the thorax. We segmented the main organs of the thorax from anonymized DICOM images of a neonate. This is followed by the creation of 3D computational models to solve light propagation with the diffusion equation, and the modelling of light propagation through the thorax of an infant including optical properties of lung, heart, arteries, bone, muscle, trachea, fat and skin. Finally, we calculate a map of the optimal light source – detector configurations to obtain the highest signal from oxygen gas imprint in the lungs. The use of computational tools such as NIRFAST Slicer 2.0 for investigation and further understanding of the advantages and limitations of the technology is fundamental.
Such simulations enable the recreation of different clinical scenarios and identification of the minimum requirements necessary to further improve the application and develop a bedside clinical device that can potentially be used for continuous monitoring of lung function and control of ventilator settings. The potential capability of measuring non-invasively oxygen, water vapour and carbon dioxide in the lungs, would reduce the need for intubation and extracorporeal membrane oxygenation, as well as lower the incidences of chronic lung disease.
Pulmonary X-ray imaging together with pulse oximetry are harmful and invasive techniques used to monitor and diagnose the clinical course of lung dysfunction in preterm born infants which most of the cases suffer Respiratory Distress Syndrome (RDS) [1]. Biophotonics@Tyndall is exploring Gas in Scattering Media Absorption Spectroscopy (GASMAS) [2] as a novel non-invasive technique to measure continuously absolute lung oxygen volume and concentration. This could assist and improve the assessment of lung function in neonates [3].
In this paper, we present results of bench-top measurements carried out in the preclinical phase of GASMAS studies. We start with a detailed explanation of the manufacturing process of multi-structure thorax phantoms with realistic geometry based on organ segmentation from anonymized DICOM images of neonates. After segmentation, the organs are 3D printed and used to create negative rubber molds. The tissue optical properties of heart, bone and muscle are assigned by mixing the silicone matrix with different concentrations of absorbers and scatters, the lung is kept as a gas content cavity and the thorax phantom is build up by placing all organs inside out immersed in the muscle structure.
The phantoms are used for quality control and validation of the system performance [4]. Oxygen gas absorption imprints are measured for different light source-detector remittance configurations and the results are used to define the potential and limitations of the GASMAS technology in the development of a bed-side clinical device.
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