Rationale and Objectives
The purpose of this study was to develop and evaluate a patient thickness-based protocol specifically for the confirmation of enteric tube placements in bedside abdominal radiographs. Protocol techniques were set to maintain image quality while minimizing patient dose.
Materials and Methods
A total of 226 pre-intervention radiographs were obtained to serve as a baseline cohort for comparison. After the implementation of a thickness-based protocol, a total of 229 radiographs were obtained as part of an intervention cohort. Radiographs were randomized and graded for diagnostic quality by seven expert radiologists based on a standardized conspicuity scale (grades: 0 non-diagnostic to 3+). Basic patient demographics, body mass index, ventilatory status, and enteric tube type were recorded and subgroup analyses were performed. Effective dose was estimated for both cohorts.
The dedicated thickness-based protocol resulted in a significant reduction in effective dose of 80% (p-value < 0.01). There was no significant difference in diagnostic quality between the two cohorts with 209 (92.5%) diagnostic radiographs in the baseline and 221 (96.5%) diagnostic radiographs in the thickness-based protocol (p-value 0.06).
A protocol optimized for the confirmation of enteric tube placements was developed. This protocol results in lower patient effective dose, without sacrificing diagnostic accuracy. The technique chart is provided for reference. The protocol development process outlined in this work could be readily generalized to other imaging clinical tasks.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Academic Radiology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Evidenced-based radiology? A single-institution review of imaging referral appropriateness including monetary and dose estimates for inappropriate scans.Ir J Med Sci. 2019; 188: 1385-1389
- A team-based protocol and electromagnetic technology eliminate feeding tube placement complications.Ann Surg. 2011; 253: 287-302
- Pulmonary Complications of 9931 Narrow-Bore Nasoenteric Tubes During Blind Placement.Journal of Parenteral and Enteral Nutrition. 2011; 35: 625-629
- American Gastroenterological Association technical review on tube feeding for enteral nutrition.Gastroenterology. 1995; 108: 1282-1301
- Perforation of abdominal esophagus following nasogastric feeding tube intubation: a case report.Int J Surg Case Rep. 2018; 45: 67-71
- The current state of CT dose management across radiology: well intentioned but not universally well executed.AJR Am J Roentgenol. 2018; 211: 405-408
- A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes.Heart Lung. 2019; 48: 226-235
- Naso-enteric tube placement: a review of methods to confirm tip location, global applicability and requirements.World J Surg. 2015; 39: 2243-2252
- Consequences of modern anthropometric dimensions for radiographic techniques and patient radiation exposures.Med Phys. 2008; 35: 3616-3625
- An exposure indicator for digital radiography: AAPM Task Group 116 (Executive Summary).Med Phys. 2009; 36: 2898-2914
- The standardized exposure index for digital radiography: an opportunity for optimization of radiation dose to the pediatric population.Pediatr Radiol. 2011; 41: 573-581
- exposure creep in computed radiography: a longitudinal study.Academic Radiology. 2012; 19: 458-462
- Dose reduction and image quality improvement of chest radiography by using bone-suppression technique and low tube voltage: a phantom study.Eur Radiol. 2020; 30: 571-580
- Radiation dose reduction in plain radiography of the full-length lower extremity and full spine.Br J Radiol. 2017; 9020170483
- Evaluation of radiation dose and image quality following changes to tube potential (kVp) in conventional paediatric chest radiography.Biomed Imaging Interv J. 2006; 2: e35
- Portable abdomen radiography: moving to thickness-based protocols.Pediatr Radiol. 2018; 48: 210-215
- Calculation of effective dose.Med Phys. 2000; 27: 828-837
Rosenstein M Handbook of selected tissue doses for projections common in diagnostic radiology. Food and Drug Administration; 1988.
- The 2007 Recommendations of the International Commission on Radiological Protection.Elsevier, 2007
Published online: April 30, 2022
Accepted: March 17, 2022
Received in revised form: March 7, 2022
Received: September 29, 2021
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.