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Development and clinical feasibility of a reduced-dose radiograph in children for feeding tube placement

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Abstract

Background

Temporary feeding tubes are commonly used but may lead to complications if malpositioned. Radiographs are the gold standard for assessing tube position, but clinician concern over radiation risks may curtail their use.

Objective

We describe development and use of a reduced dose feeding tube radiograph (RDFTR) targeted for evaluation of feeding tube position.

Materials and methods

Age-based abdominal radiograph was adapted to use the lowest mAs setting of 0.32 mAs with field of view between carina and iliac crests. The protocol was tested in DIGI-13 line-pair plates and anthropomorphic phantoms. Retrospective review of initial clinical use compared dose area product (DAP) for RDFTR and routine abdomen, chest, or infant chest and abdomen. Review of RDFTR reports assessed tube visibility, malpositioning, and incidental critical findings.

Results

Testing through a line-pair phantom showed loss of spatial resolution from 2.2 line pairs to 0.6 line pairs but preserved visibility of feeding tube tip in RDFTR protocol. DAP comparisons across 23,789 exams showed RDFTR reduced median DAP 72–93% compared to abdomen, 55–78% compared to chest, and 76–79% compared to infant chest and abdomen (p<0.001). Review of 3286 reports showed tube was visible in 3256 (99.1%), malpositioned in airway 8 times (0.2%) and in the esophagus 74 times (2.3%). The tip was not visualized in 30 (0.9%). Pneumothorax or pneumoperitoneum was noted seven times (0.2%) but was expected or spurious in five of these cases.

Conclusion

RDFTR significantly reduces radiation dose in children with temporary feeding tubes while maintaining visibility of tube tip.

Graphical Abstract

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Data availability

Data generated or analyzed during the study are available from the corresponding author by request.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Summer L. Kaplan, Mohammad Jalloul, Erfan Akbari, Ammie M. White, Colleen Flowers & Xiaowei Zhu

  2. Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, USA

    Summer L. Kaplan, Ammie M. White & Vijay Srinivasan

  3. Thomas Jefferson University, 4201 Henry Ave, Philadelphia, PA, USA

    Gabriella Shumyatsky

  4. Division of Critical Care Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA

    Vijay Srinivasan & Sharon Y. Irving

  5. University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, USA

    Sharon Y. Irving

Authors
  1. Summer L. Kaplan
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Contributions

S.L.K. conceptualized and oversaw the study. S.L.K. and A.W. interpreted the images. M.J. drafted the initial manuscript and performed data analysis. E.A. and X.Z. contributed to the study design and data analysis. G.S. participated in data collection. C.F. oversaw the use of the exam by radiology technologists. V.S. oversaw clinical use of the exam in the pediatric critical care setting. S.Y. contributed to the study concept, design, and manuscript writing. All authors participated in drafting the manuscript and gave approval for the final format.

Corresponding author

Correspondence to Summer L. Kaplan.

Ethics declarations

Ethics approval

This work was performed as quality improvement and therefore was not subject to overview from the institutional review board.

Consent to participate

Patient consent was not required; the project adhered to all applicable regulations and ethical considerations, ensuring the protection of patient confidentiality and privacy. HIPPA compliant methods were employed for data management.

Conflicts of interest

None

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Kaplan, S.L., Jalloul, M., Akbari, E. et al. Development and clinical feasibility of a reduced-dose radiograph in children for feeding tube placement. Pediatr Radiol 54, 218–227 (2024). https://doi.org/10.1007/s00247-023-05829-w

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  • DOI: https://doi.org/10.1007/s00247-023-05829-w

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