Optimizing Catheter Verification: An Understandable AI Model for Efficient Assessment of Central Venous Catheter Placement in Chest Radiography.

Abstract

Purpose: Accurate detection of central venous catheter (CVC) misplacement is crucial for patient safety and effective treatment. Existing artificial intelligence (AI) often grapple with the limitations of label inaccuracies and output interpretations that lack clinician-friendly comprehensibility. This study aims to introduce an approach that employs segmentation of support material and anatomy to enhance the precision and comprehensibility of CVC misplacement detection.

Materials and methods: The study utilized 2 datasets: the publicly accessible RANZCR CLiP dataset and a bespoke in-house dataset of 1006 annotated supine chest x-rays. Three deep learning models were trained: a classification network, a segmentation network, and a combination of both. These models were evaluated using receiver operating characteristic analysis, area under the curve, DICE similarity coefficient, and Hausdorff distance.

Results: The combined model demonstrated superior performance with an area under the curve of 0.99 for correctly positioned CVCs and 0.95 for misplacements. The model maintained high efficacy even with reduced training data from the local dataset. Sensitivity and specificity rates were high, and the model effectively managed the segmentation and classification tasks, even in images with multiple CVCs and other support materials.

Conclusions: This study illustrates the potential of AI-based models in accurately and reliably determining CVC placement in chest x-rays. The proposed method shows high accuracy and offers improved interpretability, important for clinical decision-making. The findings also highlight the importance of dataset quality and diversity in training AI models for medical image analysis.