Clinical and Economic Evaluation of a Real-Time Chest X-Ray Computer-Aided Detection System for Misplaced Endotracheal and Nasogastric Tubes and Pneumothorax in Emergency and Critical Care Settings: Protocol for a Cluster Randomized Controlled Trial
BackgroundAdvancements in artificial intelligence (AI) have driven substantial breakthroughs in computer-aided detection (CAD) for chest x-ray (CXR) imaging. The National Taiwan University Hospital research team previously developed an AI-based emergency CXR system (Capstone...
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JMIR Publications
2025-08-01
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| Series: | JMIR Research Protocols |
| Online Access: | https://www.researchprotocols.org/2025/1/e72928 |
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| author | Chu-Lin Tsai Teresa Cheng-Chieh Chu Chih-Hung Wang Wei-Tien Chang Min-Shan Tsai Shih-Chi Ku Yen-Hung Lin Hao-Chih Tai Shuenn-Wen Kuo Kuo-Chuan Wang Anne Chao Sung-Chun Tang Wei-Lun Liu Ming-Han Tsai Ting-Ann Wang Shu-Lin Chuang Yi-Chia Lee Lu-Cheng Kuo Chiuan-Jung Chen Jia-Horng Kao Weichung Wang Chien-Hua Huang |
| author_facet | Chu-Lin Tsai Teresa Cheng-Chieh Chu Chih-Hung Wang Wei-Tien Chang Min-Shan Tsai Shih-Chi Ku Yen-Hung Lin Hao-Chih Tai Shuenn-Wen Kuo Kuo-Chuan Wang Anne Chao Sung-Chun Tang Wei-Lun Liu Ming-Han Tsai Ting-Ann Wang Shu-Lin Chuang Yi-Chia Lee Lu-Cheng Kuo Chiuan-Jung Chen Jia-Horng Kao Weichung Wang Chien-Hua Huang |
| author_sort | Chu-Lin Tsai |
| collection | DOAJ |
| description |
BackgroundAdvancements in artificial intelligence (AI) have driven substantial breakthroughs in computer-aided detection (CAD) for chest x-ray (CXR) imaging. The National Taiwan University Hospital research team previously developed an AI-based emergency CXR system (Capstone project), which led to the creation of a CXR module. This CXR module has an established model supported by extensive research and is ready for application in clinical trials without requiring additional model training. This study will use 3 submodules of the system: detection of misplaced endotracheal tubes, detection of misplaced nasogastric tubes, and identification of pneumothorax.
ObjectiveThis study aims to apply a real-time CXR CAD system in emergency and critical care settings to evaluate its clinical and economic benefits without requiring additional CXR examinations or altering standard care and procedures. The study will evaluate the impact of CAD system on mortality reduction, postintubation complications, hospital stay duration, workload, and interpretation time, as wells as conduct a cost-effectiveness comparison with standard care.
MethodsThis study adopts a pilot trial and cluster randomized controlled trial design, with random assignment conducted at the ward level. In the intervention group, units are granted access to AI diagnostic results, while the control group continues standard care practices. Consent will be obtained from attending physicians, residents, and advanced practice nurses in each participating ward. Once consent is secured, these health care providers in the intervention group will be authorized to use the CAD system. Intervention units will have access to AI-generated interpretations, whereas control units will maintain routine medical procedures without access to the AI diagnostic outputs.
ResultsThe study was funded in September 2024. Data collection is expected to last from January 2026 to December 2027.
ConclusionsThis study anticipates that the real-time CXR CAD system will automate the identification and detection of misplaced endotracheal and nasogastric tubes on CXRs, as well as assist clinicians in diagnosing pneumothorax. By reducing the workload of physicians, the system is expected to shorten the time required to detect tube misplacement and pneumothorax, decrease patient mortality and hospital stays, and ultimately lower health care costs.
International Registered Report Identifier (IRRID)PRR1-10.2196/72928 |
| format | Article |
| id | doaj-art-80c184ee321a4dbf96fa6c76d6241707 |
| institution | Kabale University |
| issn | 1929-0748 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | JMIR Publications |
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| series | JMIR Research Protocols |
| spelling | doaj-art-80c184ee321a4dbf96fa6c76d62417072025-08-20T19:01:13ZengJMIR PublicationsJMIR Research Protocols1929-07482025-08-0114e7292810.2196/72928Clinical and Economic Evaluation of a Real-Time Chest X-Ray Computer-Aided Detection System for Misplaced Endotracheal and Nasogastric Tubes and Pneumothorax in Emergency and Critical Care Settings: Protocol for a Cluster Randomized Controlled TrialChu-Lin Tsaihttps://orcid.org/0000-0003-4639-1513Teresa Cheng-Chieh Chuhttps://orcid.org/0000-0002-8682-5825Chih-Hung Wanghttps://orcid.org/0000-0003-0802-7825Wei-Tien Changhttps://orcid.org/0000-0002-1880-7932Min-Shan Tsaihttps://orcid.org/0000-0002-2862-7572Shih-Chi Kuhttps://orcid.org/0000-0002-4123-0967Yen-Hung Linhttps://orcid.org/0000-0001-8153-1441Hao-Chih Taihttps://orcid.org/0000-0001-8155-3077Shuenn-Wen Kuohttps://orcid.org/0000-0001-5026-5582Kuo-Chuan Wanghttps://orcid.org/0000-0002-4083-4689Anne Chaohttps://orcid.org/0000-0002-7170-3817Sung-Chun Tanghttps://orcid.org/0000-0003-3731-5973Wei-Lun Liuhttps://orcid.org/0000-0001-8593-8492Ming-Han Tsaihttps://orcid.org/0009-0008-6956-3641Ting-Ann Wanghttps://orcid.org/0000-0001-6261-8541Shu-Lin Chuanghttps://orcid.org/0000-0003-1039-080XYi-Chia Leehttps://orcid.org/0000-0002-8160-1216Lu-Cheng Kuohttps://orcid.org/0000-0003-4247-5197Chiuan-Jung Chenhttps://orcid.org/0009-0000-5418-6507Jia-Horng Kaohttps://orcid.org/0000-0002-2442-7952Weichung Wanghttps://orcid.org/0000-0002-6154-7750Chien-Hua Huanghttps://orcid.org/0000-0003-2981-4537 BackgroundAdvancements in artificial intelligence (AI) have driven substantial breakthroughs in computer-aided detection (CAD) for chest x-ray (CXR) imaging. The National Taiwan University Hospital research team previously developed an AI-based emergency CXR system (Capstone project), which led to the creation of a CXR module. This CXR module has an established model supported by extensive research and is ready for application in clinical trials without requiring additional model training. This study will use 3 submodules of the system: detection of misplaced endotracheal tubes, detection of misplaced nasogastric tubes, and identification of pneumothorax. ObjectiveThis study aims to apply a real-time CXR CAD system in emergency and critical care settings to evaluate its clinical and economic benefits without requiring additional CXR examinations or altering standard care and procedures. The study will evaluate the impact of CAD system on mortality reduction, postintubation complications, hospital stay duration, workload, and interpretation time, as wells as conduct a cost-effectiveness comparison with standard care. MethodsThis study adopts a pilot trial and cluster randomized controlled trial design, with random assignment conducted at the ward level. In the intervention group, units are granted access to AI diagnostic results, while the control group continues standard care practices. Consent will be obtained from attending physicians, residents, and advanced practice nurses in each participating ward. Once consent is secured, these health care providers in the intervention group will be authorized to use the CAD system. Intervention units will have access to AI-generated interpretations, whereas control units will maintain routine medical procedures without access to the AI diagnostic outputs. ResultsThe study was funded in September 2024. Data collection is expected to last from January 2026 to December 2027. ConclusionsThis study anticipates that the real-time CXR CAD system will automate the identification and detection of misplaced endotracheal and nasogastric tubes on CXRs, as well as assist clinicians in diagnosing pneumothorax. By reducing the workload of physicians, the system is expected to shorten the time required to detect tube misplacement and pneumothorax, decrease patient mortality and hospital stays, and ultimately lower health care costs. International Registered Report Identifier (IRRID)PRR1-10.2196/72928https://www.researchprotocols.org/2025/1/e72928 |
| spellingShingle | Chu-Lin Tsai Teresa Cheng-Chieh Chu Chih-Hung Wang Wei-Tien Chang Min-Shan Tsai Shih-Chi Ku Yen-Hung Lin Hao-Chih Tai Shuenn-Wen Kuo Kuo-Chuan Wang Anne Chao Sung-Chun Tang Wei-Lun Liu Ming-Han Tsai Ting-Ann Wang Shu-Lin Chuang Yi-Chia Lee Lu-Cheng Kuo Chiuan-Jung Chen Jia-Horng Kao Weichung Wang Chien-Hua Huang Clinical and Economic Evaluation of a Real-Time Chest X-Ray Computer-Aided Detection System for Misplaced Endotracheal and Nasogastric Tubes and Pneumothorax in Emergency and Critical Care Settings: Protocol for a Cluster Randomized Controlled Trial JMIR Research Protocols |
| title | Clinical and Economic Evaluation of a Real-Time Chest X-Ray Computer-Aided Detection System for Misplaced Endotracheal and Nasogastric Tubes and Pneumothorax in Emergency and Critical Care Settings: Protocol for a Cluster Randomized Controlled Trial |
| title_full | Clinical and Economic Evaluation of a Real-Time Chest X-Ray Computer-Aided Detection System for Misplaced Endotracheal and Nasogastric Tubes and Pneumothorax in Emergency and Critical Care Settings: Protocol for a Cluster Randomized Controlled Trial |
| title_fullStr | Clinical and Economic Evaluation of a Real-Time Chest X-Ray Computer-Aided Detection System for Misplaced Endotracheal and Nasogastric Tubes and Pneumothorax in Emergency and Critical Care Settings: Protocol for a Cluster Randomized Controlled Trial |
| title_full_unstemmed | Clinical and Economic Evaluation of a Real-Time Chest X-Ray Computer-Aided Detection System for Misplaced Endotracheal and Nasogastric Tubes and Pneumothorax in Emergency and Critical Care Settings: Protocol for a Cluster Randomized Controlled Trial |
| title_short | Clinical and Economic Evaluation of a Real-Time Chest X-Ray Computer-Aided Detection System for Misplaced Endotracheal and Nasogastric Tubes and Pneumothorax in Emergency and Critical Care Settings: Protocol for a Cluster Randomized Controlled Trial |
| title_sort | clinical and economic evaluation of a real time chest x ray computer aided detection system for misplaced endotracheal and nasogastric tubes and pneumothorax in emergency and critical care settings protocol for a cluster randomized controlled trial |
| url | https://www.researchprotocols.org/2025/1/e72928 |
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