Abstract
Assess the efficacy of deep convolutional neural networks (DCNNs) in detection of critical enteric feeding tube malpositions on radiographs. 5475 de-identified HIPAA compliant frontal view chest and abdominal radiographs were obtained, consisting of 174 x-rays of bronchial insertions and 5301 non-critical radiographs, including normal course, normal chest, and normal abdominal x-rays. The ground-truth classification for enteric feeding tube placement was performed by two board-certified radiologists. Untrained and pretrained deep convolutional neural network models for Inception V3, ResNet50, and DenseNet 121 were each employed. The radiographs were fed into each deep convolutional neural network, which included untrained and pretrained models. The Tensorflow framework was used for Inception V3, ResNet50, and DenseNet. Images were split into training (4745), validation (630), and test (100). Both real-time and preprocessing image augmentation strategies were performed. Receiver operating characteristic (ROC) and area under the curve (AUC) on the test data were used to assess the models. Statistical differences among the AUCs were obtained. p < 0.05 was considered statistically significant. The pretrained Inception V3, which had an AUC of 0.87 (95 CI; 0.80–0.94), performed statistically significantly better (p < .001) than the untrained Inception V3, with an AUC of 0.60 (95 CI; 0.52–0.68). The pretrained Inception V3 also had the highest AUC overall, as compared with ResNet50 and DenseNet121, with AUC values ranging from 0.82 to 0.85. Each pretrained network outperformed its untrained counterpart. (p < 0.05). Deep learning demonstrates promise in differentiating critical vs. non-critical placement with an AUC of 0.87. Pretrained networks outperformed untrained ones in all cases. DCNNs may allow for more rapid identification and communication of critical feeding tube malpositions.
Highlights
Assess the efficacy of deep convolutional neural networks (DCNNs) in detection of critical enteric feeding tube malpositions on radiographs. 5475 de-identified HIPAA compliant frontal view chest and abdominal radiographs were obtained, consisting of 174 x-rays of bronchial insertions and 5301 non-critical radiographs, including normal course, normal chest, and normal abdominal x-rays
Nasogastric or nasoenteric feeding tubes preserve the integrity of the intestinal microvilli and decrease the risk of bacterial transfection and thrombotic events associated with parenteral nutrition [1]
Nasoenteric feeding tube placement is commonly confirmed by radiography after insertion and before the commencement of tube feeding
Summary
Assess the efficacy of deep convolutional neural networks (DCNNs) in detection of critical enteric feeding tube malpositions on radiographs. 5475 de-identified HIPAA compliant frontal view chest and abdominal radiographs were obtained, consisting of 174 x-rays of bronchial insertions and 5301 non-critical radiographs, including normal course, normal chest, and normal abdominal x-rays. Assess the efficacy of deep convolutional neural networks (DCNNs) in detection of critical enteric feeding tube malpositions on radiographs. Untrained and pretrained deep convolutional neural network models for Inception V3, ResNet, and DenseNet 121 were each employed. The radiographs were fed into each deep convolutional neural network, which included untrained and pretrained models. Recent significant advances in artificial intelligence using deep learning to classify images using multi-layered neural networks make an automated solution for nasoenteric feeding tube placement detection possible [6,7,8]. The primary goal of this study is to assess the efficacy of deep convolutional neural networks in the classification of nasoenteric feeding tube position on radiography, and to distinguish between a critical bronchial insertion and a non-critical placement. Because there were far more images of non-critical than critical placements, oversampling was performed for critical placements
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