Placement of Enteric Tube

Purpose                                                                   

To assess the position of enteric tube placement. Enteric tubes refer to support devices placed for feeding patients who cannot swallow or for decompressing the GI tract.  The tip of these tubes needs to be in the correct location to function, and a misplaced tube that is used can injure the patient.  A frequent indication of chest and abdominal radiographs is to check position of the tube and an algorithm that could determine placement would automate this task.

Tag(s)

 

Panel

Abdominal Panel

Define-AI ID

20020012

Originator

Christopher P. Gange

Lead Christopher P. Gange

Panel Chair

Luther B. Adair

Panel Reviewers

Abdominal Panel

License

Status

RadElement Set

Creative Commons 4.0 

Public Comment

RDES176 

   

 
                               

Clinical Implementation


Value Proposition


Evaluation of tube placement on radiographs is a high volume, low priority job for radiologists.  An algorithm that could automate this process would improve workflow.  In addition, an abnormal result from this algorithm could be used as part of a system that elevates the priority of unread studies to lower the turnaround time for abnormal results that affect patient care.

Narrative(s)


A 65-year-old patient with abdominal pain is found on imaging to have a bowel obstruction and has an oral-gastric tube placed for decompression.  After the radiograph to check position is completed, it takes over 45 minutes for a radiologist to look at the images and find that the distal aspect of the tube is not within the stomach.  During this time, the patient could have an aspiration event, which could have been prevented if the misplaced tube was identified more quickly.

An 88-year-old patient with failure to thrive is to be started on tube feeds to improve nutrition.  A feeding tube placement is attempted but a chest radiograph shows that the tube is malpositioned with the tip located in the right lung.  It takes the clinical team 3 more attempts to correctly place this tube and begin refeeding the patient. 

Workflow Description


The images are obtained from modality and sent to PACS and the AI engine. The image is analyzed by the engine. The system first determines the coordinates of the tip’s location.  The system then determines whether the tube is positioned correctly based on the tip location. If an abnormal position is found, an alert message is sent to PACS from the engine with the information about the current study,  and graphic highlighting the enteric tube tip.


Considerations for Dataset Development



Procedure

X-Ray, Abdomen/Chest

View(s)

Chest: AP or PA, Abdominal: supine or upright

Age

0-100

Sex at birth

Male, Female

Comorbidities

lung disease (e.g., Pneumonia, emphysema, bronchiectasis, malignancy), cardiac disease, abdominal disease (bowel obstruction, ileus, malignancy) recent trauma, recent surgery

Other lines and tubes present

Central venous catheters, pleural chest tubes, ECMO cannulas, Endotracheal tubes, surgical drains, gastrostomy tubes, nephrostomy tubes pacer devices.

Post-surgical findings/devices

Spinal hardware, sternotomy wires, valve replacements, surgical clips, spinal stimulator leads, etc.

Technical Specifications


Inputs

DICOM Study

Procedure

X-Ray, Abdomen/Chest

Views

Chest: AP or PA, Abdominal: supine or upright

Data Type

DICOM

Modality

X-Ray

Body Region

Chest/Abdomen

Anatomic Focus




Primary Outputs


Tube Tip Location

RadElement ID

RDE1232

Definition

Identify the location of tube’s tip

Data Type

Coordinates

Value Set

N/A

Units


N/A


Tube Side-port Location

RadElement ID

RDE1231

Definition

Identify the location of tube’s side port

Data Type

Coordinates

Value Set

N/A

Units

N/A



Tube Placement

RadElement ID

RDE1230

Definition

Determine if the tube placement is correct

Data Type

Categorical

Value Set

  • Placed Correctly

  • Misplaced

  • Needs to be advanced

  • Undetermined

Units

N/A

Future Development Ideas


  • Ability to identify types of tubes.  

  • Ability to take an anatomic location as an input and output whether the location is correct.