The Royal Veterinary College (RVC) has published the first standardised research-based radiographic guidelines to support the accurate checking of feeding tube placement in dogs and cats.

Although feeding tubes are widely used in practice, there has previously been no agreed radiographic criteria to confirm correct positioning, creating uncertainty and increasing the risk of serious complications such as aspiration pneumonia and pneumothorax.

The new guidelines address this gap by providing an evidence-based framework for interpreting lateral neck and thoracic radiographs.

Led by Andrea Vila Cabaleiro, Small Animal Diagnostic Imaging Resident at the RVC, the research team collected 256 lateral neck and chest radiographs of dogs and cats with nasoesophageal or nasogastric feeding tubes in place.

The images were sourced from ten private and academic institutions, including the RVC’s Queen Mother Hospital for Animals.

Expert veterinary radiologists then verified whether the tubes were correctly placed in the oesophagus or incorrectly in the trachea.

From this dataset, the researchers developed a three-point radiographic checklist to confirm correct tube placement:

1. whether the tube passes dorsal to the cricoid cartilage lamina
2. whether any part of the tube course is visible outside the trachea (i.e. not completely superimposed)
3. whether the tube passes dorsal to the dorsal wall of the carina

To assess the clinical value of the guidelines, six veterinarians with varying levels of experience reviewed the same radiographs on two occasions, first using their usual judgement and then, after a minimum seven-day interval, using the new guidelines.

Diagnostic accuracy improved from 82% to 96%, while uncertainty fell from 14% to 2%.

Agreement between clinicians also improved from moderate to almost perfect.

The guidelines performed consistently across dogs and cats, a wide range of patient sizes and multiple clinical settings.

The authors concluded that this structured, evidence-based approach improves both accuracy and confidence without requiring additional equipment, making it suitable for use in general practice, referral hospitals and emergency and critical care environments.

An accompanying step-by-step infographic has been produced to support uptake of the guidelines in day-to-day clinical practice: https://www.rvc.ac.uk/Media/Default/VetCompass/260105%20RVC%20Infographic%20-%20Radiographic%20guidelines%20on%20feeding%20tube%20placment.pdf 

Reference

1. Vila Cabaleiro, A., O'Neill, D.G., Cordella, A., Vilaplana Grosso, F.R., Gioele Rizzo, S., Matson, H.L., Porcarelli, F., Bosher, J.C., Matkar, V.S., Duggan, R.G., Diana, A., Stock, E., Pearce, H. and Fitzgerald, E. (2026) 'Introduction and Validation of Radiographic Guidelines for Identification of Nasoesophageal and Nasogastric Tube Position in Dogs and Cats', Veterinary Radiology & Ultrasound, 67(1), e70138, available: http://dx.doi.org/https://doi.org/10.1111/vru.70138 

PS: Whilst you're here, take a moment to see our latest job opportunities for vets.