NICU Radiograph

What it does

NICU Radiograph reads the combined chest and abdomen film of a newborn, the "babygram" taken after every umbilical line or tube placement and repeatedly in ventilated infants. It is a separate model from the adult chest film because the image (supine AP, chest and abdomen together, very small anatomy), the devices and the findings are different.

The run finds each endotracheal tube, umbilical venous catheter (UVC), umbilical arterial catheter (UAC), nasogastric or orogastric tube and PICC, locates its tip by vertebral level and flags a malposition. On the abdomen it looks for the signs of necrotising enterocolitis: pneumatosis intestinalis, portal venous gas, pneumoperitoneum and a fixed loop, and suggests the radiographic part of a modified Bell stage; clinical signs complete the staging.

Intended use

Decision support for the first reader of the film, often a neonatology resident at night, who must decide whether a freshly placed line can be used or needs to be repositioned. Line malposition is frequent and time-critical; the tip level and the target zone are shown on the image. NEC signs come with the modified Bell stage they suggest.

Who it is for

Neonatologists, neonatal nurse practitioners, paediatric residents, paediatric surgeons and paediatric radiologists. Developers can connect the run to a NICU imaging workflow so every line-check film gets a structured tip report.

Accepted input

• DICOM CR or DX neonatal radiographs: combined chest-abdomen film, or separate chest and abdominal films of the same infant.
• Supine AP is the expected projection.
• PNG or JPEG is read without calibration.

Requirements

Requirement	Why
Chest and upper abdomen in the field	UVC and UAC tips are judged against the vertebral bodies and the diaphragm
The whole abdomen for NEC	Pneumatosis, portal venous gas and fixed loops can be anywhere in the bowel
Patient age (days) or birth date	Selects the neonatal path; older children go to Chest X-ray
Low rotation	Rotation shifts the apparent tip level against the spine

The thymus shadow, skin folds and overlapping monitoring leads are the known mimics on neonatal films.

Optional context

Gestational age and the device just placed in clinical_context; a prior film in prior_files shows device moves and the evolution of bowel signs.

The result

A JSON result with a device list (type, tip coordinates, tip vertebral level, status) and a NEC section.

Section	Content
Lines and tubes	ETT, UVC, UAC, NG/OG tube and PICC: tip vertebral level, position against the target and a malposition flag
Necrotising enterocolitis	Pneumatosis intestinalis, portal venous gas, pneumoperitoneum, fixed loop, and the modified Bell stage these signs suggest
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Target positions

Device	Target used for the flag
UAC (high position)	Tip between T6 and T9
UVC	Tip at the junction of the inferior vena cava and the right atrium
ETT	Tip in the mid-trachea

Each device is reported as normal, borderline or abnormal, with its distance to the target landmark when the film is calibrated.

Standards

• DICOM: TID 1500 Measurement Report for tip levels; GSPS overlays marking each tip and its target; Encapsulated PDF.
• NEC: modified Bell staging, radiographic criteria; the full stage also needs the clinical signs.
• Terminology: RadLex device and anatomy terms, SNOMED CT for diagnoses.