02 December 2025
Misplaced nasogastric tubes (NGTs) remain a significant patient safety concern, with pulmonary misplacement classified as a “Never Event” by NHS England. Although chest radiographs (CXRs) are widely used to confirm NGT position when pH aspirate testing is inconclusive, interpretation errors continue to occur across healthcare systems.
A new study published in Radiography (doi.org/10.1016/j.radi.2024.10.022) has, for the first time, examined how diagnostic radiographers without formal CXR reporting qualifications perform in this safety-critical task. Conducted using the RAIQC clinical simulation platform, the study recruited 68 radiographers from international conferences in Europe and the UK, each of whom reviewed 15 chest radiographs featuring NGTs placed in the stomach, oesophagus, or lung.
Across more than 1,000 individual image assessments, radiographers achieved correct tip localisation and safe-to-feed decisions in 76% of cases. However, the study also highlighted key risks: in 6% of cases, tubes in unsafe positions were mistakenly judged to be safe, with errors most frequently arising when the tube tip lay in the oesophagus.
The findings highlight the need for structured training before radiographer-led NGT evaluation services can be safely implemented at scale. The authors emphasise that training should specifically address the difficulties of identifying poorly visualised tube tips, making effective use of image manipulation tools, and consistently applying the National Patient Safety Agency’s four criteria for confirming safe NGT placement.
This work provides important baseline evidence to guide the development of training for radiographers, supporting NHS England’s wider strategy to reduce NGT-related “Never Events” and improve patient safety.
A comprehensive training resource that also addresses this has been developed by RAIQC in collaboration with the Royal College of Radiologists (RCR), the British Society of Gastrointestinal and Abdominal Radiology (BSGAR), the Society of Radiographers (SOR), and the British Association for Parenteral and Enteral Nutrition (BAPEN).
It is free to use and is available here: https://www.raiqc.com/packages/nasogastric-tube-position-on-chest-x-ray
This resource is designed to help healthcare professionals improve their skills in accurately identifying nasogastric tube placement, which is critical for ensuring patient safety and avoiding never events.
The full article is available in Radiography: https://doi.org/10.1016/j.radi.2024.10.02
RAIQC is a web-based platform that simulates day-to-day practice, allowing healthcare professionals, students and educators to review and report on diagnostic quality medical images in a secure online environment. Using over 6000 real-world clinical cases, RAIQC offers structured reporting study lists for training and assessment for individuals and healthcare providers across a range of imaging modalities and disease areas. The platform also provides hosting for clinical research and AI validation studies that require review of medical imaging.
For more information visit www.raiqc.com or email info@raiqc.com.
RAIQC Ltd is registered in England and Wales with company number 09863569 and its registered address at 1 & 3 Kings Meadow, Osney Mead, Oxford, OX2 0DP.