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Purpose |
When patients are intubated, it is critical for successful ventilation that the tube tip is within the mid trachea. ET Tubes that are too low or too high can lead to serious complications such as under ventilation, cuff leak, or tracheal injury and therefore need to be repositioned and reimaged. |
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Tag(s) |
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Panel |
Thoracic |
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Define-AI ID |
20080024 |
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Originator |
Christopher P. Gange |
|
Panel Chair |
Carol C. Wu |
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Panel Reviewers |
John Newell, Raym Geis, Stephen Hobbs, Warren Gefter, Scott J. Adams, Carol C. Wu |
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License |
Creative Commons 4.0 |
| Status | Public Comment |
| RadElement Set | RDES179 |
Identifying a misplaced ET tube quickly would improve clinical management in the most critically ill patients by improving the odds of successful ventilation. It could also improve post-operative management as hypoxia from a misplaced tube can slow recovery. Unfortunately, at many hospitals there are a very large number of portable chest X-rays performed causing a delay between when the tube is placed and when misplacement is discovered.
An algorithm which could take a chest radiograph and quickly determine if a tube is misplaced could send an alert to the radiologist or flag the study on a worklist which should decrease the time until providers are notified and lead to more rapid correction.
A 30yo brought to the hospital after a drug overdose has to be intubated in the emergency department for airway protection. The endotracheal tube was placed too low and only the right lung is being ventilated. A few minutes after intubation, the ED providers are concerned about continued hypoxia. A chest radiograph is taken, and images are automatically analysed by an AI engine. The AI engine reports a potentially malpositioned tube and sends a notification flag to PACS prioritizing the chest radiograph for a radiologist's review, above several others that were taken near the same time. . The radiologist immediately interprets the radiograph, confirms that the ET tube is malpositioned, and communicates this critical finding to the referring clinical team, resulting in timely repositioning of the ET tube, and an improvement in clinical status of the patient."
All chest radiographs obtained from the modality are sent to PACS and the AI engine. The image is analyzed by the engine. The system first determines if an endotracheal tube is present. If present, the system will assess the tip location and the location of the carina. The difference in those coordinates will be returned, and checked against a preset criteria for appropriate position (usually 2-6 cm). If an abnormal position is found, an alert message is sent to PACS from the engine with the information about the current study, including the distance from the carina to the ET tube tip and a graphic overlay showing the suspected position of the tube tip and the carina.
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Procedure |
Chest XRAY |
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View(s) |
PA or AP views |
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Age |
18-100 |
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Sex at birth |
Male, Female |
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Comorbidities |
pleural air or fluid (including air/fluid levels), lung disease (e.g., Pneumonia, emphysema, bronchiectasis), recent trauma, recent surgery, altered mental status |
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Other lines and tubes |
Central venous catheters, pleural chest tubes, ECMO canulas, enteric tubes, pacer devices. |
DICOM Study
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Procedure |
Chest XRAY |
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Views |
AP,PA, Lat |
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Data Type |
DICOM |
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Modality |
XRAY |
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Body Region |
Chest |
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Anatomic Focus |
Lung |
ET Tube Detection
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RadElement ID |
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Definition |
Detect if an endotracheal tube is present |
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Data Type |
Categorical |
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Value Set |
|
|
Units |
N/A |
Location of ET Tube Tip
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RadElement ID |
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Definition |
Determine location of ET tube tip and define coordinates of location |
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Data Type |
Coordinates |
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Value Set |
N/A |
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Units |
N/A |
Location of the carina
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RadElement ID |
|
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Definition |
Determine the location of patient’s carina and define coordinates of location |
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Data Type |
Coordinates |
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Value Set |
N/A |
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Units |
N/A |
Position of ET Tube with respect to the carina
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RadElement ID |
|
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Definition |
Measure the distance between the coordinates for ET tube tip and carina |
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Data Type |
Numeric |
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Value Set |
N/A |
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Units |
cm |
ET Tube Position Appropriateness
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RadElement ID |
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Definition |
Determine position appropriateness based on the coordinates of the location of the ET tube tip, the carina, and a preset normal range |
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Data Type |
Categorical |
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Value Set |
|
|
Units |
N/A |