New x-ray technique for checking tube placement cuts radiation dose 80%
Radiologists have developed an abdominal x-ray protocol for checking placement of feeding tubes. Testing the technique on more than 220 patients, they showed it yields images of high quality while reducing radiation dose by 80% and can be easily generalized to similar imaging indications.
The work was conducted at the University of Chicago and is described in a study published April 30 in Academic Radiology.
Lead author Wesley Klejch, MD, senior author Abraham Dachman, MD, and colleagues based their new protocol’s image-acquisition parameters on the “thickness” of the patient. They calculated this by accounting for differences in body mass index, ventilator status and distances from the x-ray signal source to both the patient and the detector.
After developing the protocol in a phantom-based study phase, Klejch and co-authors built a baseline dataset on 226 standard abdominal x-rays, then ran their thickness-based protocol on 229 patients who comprised the experimental group (93 considered small, 117 medium, 16 large and three extra-large).
The two cohorts had no statistically significant differences in sex or BMI, although the experimental group had 83 patients on ventilators vs. 58 in the baseline cohort.
The team randomized the images and had seven experienced radiologists grade them for diagnostic quality using a standardized scale. The expert readers recorded no significant difference in diagnostic quality between the two cohorts, and technologists trained in the new protocol complied with its guidelines at a 96.5% clip.
What’s more, the dedicated thickness-based protocol brought a reduction in effective dose of 80% (p-value < 0.01).
“While the scope of the current work focuses on enteric tube confirmation, the protocol development processes outlined here may be expanded to other diagnostic tasks with relative ease,” the authors comment in their discussion. “This work demonstrates both the importance and feasibility of allowing the imaging task to define the image quality needs and optimal protocol techniques.”
Klejch et al. acknowledge limitations in their study design. These include its use of a single site—one that treats a high volume of patients on ventilators—and one whose depth of available imaging expertise may not be readily replicable outside of similarly resourced settings.
They write:
The radiologists interpreting images at our institution are subspecialty trained and demonstrated a high tolerance for reading noisy images. In addition, these physicians read high volumes of radiographs for confirmation of enteric tube placement, and their daily experiences created an increased level of comfort when reading dose optimized radiographs. Differences in physician training, and daily experience, may impact the translational aspects of this work outside of our own institution.”
More coverage of enteric tube placement:
Radiologists grab growing share of enteric tube-placement market, Medicare data reveal
3 steps radiologists can take to keep healthcare-associated infections out of their practice
Reference:
Wesley Klejch, Emily Marshall, Kayla Blunt, Tiffany Kinsey, Ingrid Reiser, Zheng Feng Lu, Melvy Mathew, Pritesh Patel, Paul Chang, David Paushter, Carla Harmath, Abraham Dachman, “A Clinically Optimal Protocol for the Imaging of Enteric Tubes: On the Basis of Radiologist Interpreted Diagnostic Utility and Radiation Dose Reduction.” Academic Radiology, April 30, 2022. DOI: https://doi.org/10.1016/j.acra.2022.03.014
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.