Accuracy of interpretation of nasogastric tube position on chest radiographs by diagnostic radiographers: A multi-case, multi-reader study

Journal article

Creeden, A., McFadden, S., Ather, S. and Woznitza, N. 2025. Accuracy of interpretation of nasogastric tube position on chest radiographs by diagnostic radiographers: A multi-case, multi-reader study. Radiography. 31 (1), pp. 83-88. https://doi.org/10.1016/j.radi.2024.10.022
AuthorsCreeden, A., McFadden, S., Ather, S. and Woznitza, N.
Abstract

Introduction
Feeding via a misplaced nasogastric tube (NGT) is a common but preventable cause of patient harm. The aim of this study was to determine the accuracy of diagnostic radiographers’ assessment of NGT position on chest radiographs (CXRs) and safe-to-feed decisions.

Methods
A multi-case, multi-reader study was conducted using an online image interpretation platform. A test bank consisting of 15 CXRs with an NGT in-situ was created. Diagnostic radiographers without formal qualifications in CXR interpretation were recruited via two international conferences. Participants placed an electronic marker on each CXR to identify the location of the tip of the NGT and indicated whether or not they believed that the tube was safely positioned.

Results
68 participants were recruited. Each participant reviewed 15 CXRs, providing 1020 unique image assessments. 76 % (n = 778/1020) image assessments were completely correct (both the position of the tip of the NGT was accurately located and an appropriate safe-to-use decision made). In 5 % (n = 56/1020) of cases the NGT was safely positioned and the location of the tip was correctly identified by the participant but the tube was erroneously determined to be unsafe for feeding. In a further 6 % (n = 59/1020) of cases the participant correctly located the tip of an NGT in an unsafe position but indicated that the tube was safe to use. Participants failed to correctly identify the tip of the NGT in the remaining 12 % (n = 127/1020) of cases.

Conclusion
Consistent with previous studies involving other staff groups, diagnostic radiographers without formal qualification in CXR interpretation can assess NGT positioning on radiographs with moderate accuracy but require further training, including strategies for the identification of poorly-visualised tube tips, to achieve the 100 % accuracy necessary for this safety-critical task.

Implications for practice
A bespoke training programme which includes teaching on image quality, tube tip identification and assessment of tube positioning using the National Patient Safety Agency (NPSA) four criteria, should be delivered prior to implementation of a radiographer-led NGT CXR evaluation service.

KeywordsNasogastric tube; Radiograph; Chest x-ray; Radiographer; Reader performance; Accuracy
Year2025
JournalRadiography
Journal citation31 (1), pp. 83-88
PublisherElsevier
ISSN1078-8174
1532-2831
Digital Object Identifier (DOI)https://doi.org/10.1016/j.radi.2024.10.022
Official URLhttps://www.sciencedirect.com/science/article/pii/S1078817424003201
Publication dates
Online14 Nov 2024
Publication process dates
Accepted23 Oct 2024
Deposited11 Dec 2024
Publisher's version
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Open
Output statusPublished
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The radiography workforce: current challenges and changing needs
Beardmore, C., Woznitza, N., Goodman, S. and Society & College of Radiographers 2016. The radiography workforce: current challenges and changing needs. College of Radiographers.
Chest reporting by radiographers: Findings of an accredited postgraduate programme.
Piper, K., Cox, S., Paterson, A., Thomas, A., Thomas, N., Jeyagopal, N. and Woznitza, N. 2014. Chest reporting by radiographers: Findings of an accredited postgraduate programme. Radiography. 20 (2), pp. 94-99. https://doi.org/10.1016/j.radi.2014.01.003
Adult chest radiograph reporting by radiographers: Preliminary data from an in-house audit programme
Woznitza, N., Piper, K., Burke, S., Patel, K., Amin, S., Grayson, K. and Bothamley, G. 2014. Adult chest radiograph reporting by radiographers: Preliminary data from an in-house audit programme. Radiography. 20 (3), pp. 223-229. https://doi.org/10.1016/j.radi.2014.03.002
Optimizing patient care in radiology through team-working: A case study
Woznitza, N., Piper, K., Rowe, S. and West, C. 2014. Optimizing patient care in radiology through team-working: A case study. Radiography. 20 (3), pp. 258-263. https://doi.org/10.1016/j.radi.2014.02.007
Chest x-ray agreement: comparative analysis between consultant radiologists, reporting radiographers and expert chest radiologists
Woznitza, N., Piper, K., Burke, S., Ellis, S. and Bothamley, G. 2015. Chest x-ray agreement: comparative analysis between consultant radiologists, reporting radiographers and expert chest radiologists.
Conceptualisation of the characteristics of advanced practitioners in the medical radiation profession
Smith, Tony, Harris, J., Woznitza, N., Marese, S. and Sale, C. 2015. Conceptualisation of the characteristics of advanced practitioners in the medical radiation profession. Journal of Medical Radiation Sciences. 62 (3), pp. 204-211. https://doi.org/10.1002/jmrs.115
e-Learning for Healthcare – Image Interpretation Project
Woznitza, N., e-Learning for Healthcare and College of Radiographers 2012. e-Learning for Healthcare – Image Interpretation Project. e-Learning for Healthcare.
An unusual cause of respiratory distress
Woznitza, N., Datsopolous, S., Shukla, R. and Aladangady, N. 2012. An unusual cause of respiratory distress. Archives of Disease in Childhood. 97, pp. A12-A13. https://doi.org/10.1136/archdischild-2012-301885.30
Chest X-Ray interpretation: agreement between consultant radiologists and a reporting radiographer in clinical practice in the United Kingdom
Woznitza, N., Piper, K., Burke, S., Patel, K., Amin, S. and Grayson, K. 2013. Chest X-Ray interpretation: agreement between consultant radiologists and a reporting radiographer in clinical practice in the United Kingdom.
Radiographer clinical reporting
Woznitza, N. 2014. Radiographer clinical reporting.
Commentary: radiographer reporting
Woznitza, N. 2014. Commentary: radiographer reporting. Journal of Medical Radiation Sciences. 61 (2), pp. 66-68. https://doi.org/10.1002/jmrs.51
Do you see what I see? Clinical review of discordant chest x-ray consultant radiologist and radiographer interpretations
Woznitza, N., Piper, K., Bothamley, G. and Burke, S. 2014. Do you see what I see? Clinical review of discordant chest x-ray consultant radiologist and radiographer interpretations.
Optimizing patient care in radiology through team-working: audit data
Woznitza, N. 2014. Optimizing patient care in radiology through team-working: audit data.
Optimizing neonatal X-ray quality: results of an audit
Woznitza, N., Hayes, N., Malshava, N. and McGuinness, D. 2014. Optimizing neonatal X-ray quality: results of an audit.
Agreement in neonatal x-ray interpretation: a comparison between consultant paediatric radiologists and a reporting radiographer
Woznitza, N., Piper, K., Aladangady, N., Iliadis, K., Prakash, R. and Santos, R. 2014. Agreement in neonatal x-ray interpretation: a comparison between consultant paediatric radiologists and a reporting radiographer.
Advanced radiographic practice in adult chest imaging
Woznitza, N. 2014. Advanced radiographic practice in adult chest imaging.
Can reporting radiographers produce clinically relevant reports?
Woznitza, N. and Piper, K. 2011. Can reporting radiographers produce clinically relevant reports?