Are radiology residents safe to report feeding nasogastric (NG) tubes on chest X-rays?

The task of issuing reports on whether nasogastric (NG) tubes are safe for enteral nutrition on chest X-ray (CXR) often falls to radiology residents. The aims of this study are to evaluate whether radiology residents are formally trained and their performance in interpreting NG tube position on CXR.

Radiology residents were invited to participate in an online study evaluating NG tube position on CXR. The CXR images comprised 20 NG tubes, 14 of which were correctly sited, while 4 were in the distal oesophagus and 2 in the lung.

Twenty-eight (of 185, 15%) radiology residents responded-despite incentives to participate and directed by Training Program Directors/Heads of School. Of those, only 10 (35.7%) correctly identified all NG tube positions on CXR. The most common error was reporting a correctly sited NG tube as mal-positioned for enteral nutrition. Global error rate was 8.9%. Radiology residents who correctly interpreted all 20 NG tube CXRs were significantly more confident in their abilities on a 5-point Likert scale than those who got at least 1 NG tube CXR wrong [4.4 (0.52) versus 3.8 (0.79), P = .02].

This study suggests that radiology residents may not be adequately trained to interpret the position of NG tubes on CXRs. Early and compulsory training in this important skill should be instituted urgently.

There is a critical gap in radiology training. Radiology residents may not be adequately prepared to safely interpret NG tube position on chest X-rays. New DHSC memorandum of understanding mandates competency-based education across all training programs.