放射诊断技师对胸片上鼻胃管位置判读的准确性：多病例、多阅片人员研究。

IF 2.5 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography Pub Date : 2024-11-14 DOI:10.1016/j.radi.2024.10.022

A. Creeden , S. McFadden , C. Rainey , S. Campbell , S. Ather , A. Hajilou , R. Bond , P. McAllister , N. Woznitza

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引用次数: 0

摘要

导言：通过位置错误的鼻胃管 (NGT) 喂食是造成患者伤害的常见原因，但却可以预防。本研究旨在确定放射诊断技师对胸片（CXR）上鼻胃管位置的评估准确性以及安全喂食决策：方法：使用在线图像解读平台进行了一项多病例、多阅片师研究。建立了一个包含 15 张带有原位 NGT 的 CXR 的测试库。通过两次国际会议招募了未获得正规 CXR 解读资格的放射诊断技师。参与者在每张 CXR 图像上放置一个电子标记，以确定 NGT 尖端的位置，并指出他们是否认为 NGT 管已安全就位：结果：共招募了 68 名参与者。每位参与者查看了 15 张 CXR，提供了 1020 次独特的图像评估。76%（n = 778/1020）的图像评估完全正确（既准确定位了 NGT 尖端的位置，又做出了适当的安全使用决定）。在 5%（n = 56/1020）的病例中，NGT 被安全定位，参与者也正确识别了管尖的位置，但却错误地判定该管不适合喂食。在另外 6% 的案例中（n = 59/1020），受试者正确找到了 NGT 管尖端的不安全位置，但表示该管可以安全使用。在其余 12% 的案例中（n = 127/1020），参与者未能正确识别 NGT 的尖端：结论：与之前涉及其他员工群体的研究一致，没有获得正规气管造影判读资格的放射诊断技师可以在X光片上评估NGT位置，准确率中等，但需要进一步的培训，包括识别视野不佳的管尖的策略，才能达到这项安全关键任务所需的100%准确率：在实施由放射技师主导的 NGT CXR 评估服务之前，应提供定制的培训计划，其中包括图像质量、管尖识别以及使用国家患者安全局 (NPSA) 的四项标准评估管道定位等方面的教学内容。

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

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.

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来源期刊

Radiography RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

4.70

自引率

34.60%

发文量

169

审稿时长

63 days

期刊介绍： Radiography is an International, English language, peer-reviewed journal of diagnostic imaging and radiation therapy. Radiography is the official professional journal of the College of Radiographers and is published quarterly. Radiography aims to publish the highest quality material, both clinical and scientific, on all aspects of diagnostic imaging and radiation therapy and oncology.