Automated detection of enteric tubes misplaced in the respiratory tract on chest radiographs using deep learning with two centre validation

Abstract

To develop and test a model based on a convolutional neural network that can identify enteric tube position accurately on chest radiography. The chest radiographs of adult patients were classified by radiologists based on enteric tube position as either critically misplaced (within the respiratory tract) or not critically misplaced (misplaced within the oesophagus or safely positioned below the diaphragm). A deep-learning model based on the 121-layer DenseNet architecture was developed using a training and validation set of 4,693 chest radiographs. The model was evaluated on an external test data set from a separate institution that consisted of 1,514 consecutive radiographs with a real-world incidence of critically misplaced enteric tubes. The receiver operator characteristic area under the curve was 0.90 and 0.92 for the internal validation and external test data sets, respectively. For the external data set with a prevalence of 4.4% of critically misplaced enteric tubes, the model achieved high accuracy (92%), sensitivity (80%), and specificity (92%) for identifying a critically misplaced enteric tube. The negative predictive value (99%) was higher than the positive predictive value (32%). The present study describes the development and external testing of a model that accurately identifies an enteric tube misplaced within the respiratory tract. This model could help reduce the risk of the catastrophic consequences of feeding through a misplaced enteric tube.