Endotracheal Tube Position Assessment on Chest Radiographs Using Deep Learning.

To determine the efficacy of deep learning in assessing endotracheal tube (ETT) position on radiographs. In this retrospective study, 22 960 de-identified frontal chest radiographs from 11 153 patients (average age, 60.2 years ± 19.9 [standard deviation], 55.6% men) between 2010 and 2018 containing an ETT were placed into 12 categories, including bronchial insertion and distance from the carina at 1.0-cm intervals (0.0-0.9 cm, 1.0-1.9 cm, etc), and greater than 10 cm. Images were split into training (80%, 18 368 images), validation (10%, 2296 images), and internal test (10%, 2296 images), derived from the same institution as the training data. One hundred external test radiographs were also obtained from a different hospital. The Inception V3 deep neural network was used to predict ETT-carina distance. ETT-carina distances and intraclass correlation coefficients (ICCs) for the radiologists and artificial intelligence (AI) system were calculated on a subset of 100 random internal and 100 external test images. Sensitivity and specificity were calculated for low and high ETT position thresholds. On the internal and external test images, respectively, the ICCs of AI and radiologists were 0.84 (95% CI: 0.78, 0.92) and 0.89 (95% CI: 0.77, 0.94); the ICCs of the radiologists were 0.93 (95% CI: 0.90, 0.95) and 0.84 (95% CI: 0.71, 0.90). The AI model was 93.9% sensitive (95% CI: 90.0, 96.7) and 97.7% specific (95% CI: 96.9, 98.3) for detecting ETT-carina distance less than 1 cm. Deep learning predicted ETT-carina distance within 1 cm in most cases and showed excellent interrater agreement compared with radiologists. The model was sensitive and specific in detecting low ETT positions.© RSNA, 2020.

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2020 by the Radiological Society of North America, Inc.

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Disclosures of Conflicts of Interest: P.L. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author received honorarium from Infervision for lecture unrelated to this work. Other relationships: patent planned for AI assessment of support devices on radiography. A.F. disclosed no relevant relationships. R.G. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author is consultant for Bioclinica and Medtronic for clinical trial reads. Other relationships: disclosed no relevant relationships.