A Clinically Optimal Protocol for the Imaging of Enteric Tubes: On the Basis of Radiologist Interpreted Diagnostic Utility and Radiation Dose Reduction

Acad Radiol. 2022 Dec;29(12):e279-e288. doi: 10.1016/j.acra.2022.03.014. Epub 2022 Apr 30.


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.

Results: 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).

Conclusion: 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.

Keywords: Enteric tube; Plain film radiography; Radiation dose; Radiology and Radiation dose reduction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Drug Tapering*
  • Humans
  • Radiation Dosage
  • Radiography
  • Radiography, Abdominal*
  • Radiologists