ESCA-Net: Knowledge-Guided Encoder-Shared Classification and Auxiliary Segmentation Network for Multi-Label Catheter Malposition Assessment in Chest Radiographs

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Malpositioned medical tubes and catheters are a persistent source of iatrogenic harm in critical care, yet the radiographic interpretation burden on intensive care units remains substantial. We present ESCA-Net, a knowledge-guided dual-task deep learning framework for simultaneous multi-label classification of endotracheal tubes (ETT), nasogastric tubes (NGT), central venous catheters (CVC), and Swan-Ganz catheters in portable chest radiographs (CXRs). The architecture couples an EfficientNet-Lite4 encoder with a UPerNet segmentation decoder and a spatial attention classification head, jointly optimised via focal loss and a hybrid segmentation loss to address extreme class imbalance. Clinical placement knowledge is encoded as structured pixel-level supervision, instantiating knowledge-guided multimodal fusion in which heterogeneous annotation modalities jointly constrain encoder representations toward clinically grounded features. The framework achieves a mean AUC-ROC of $0.9618 \pm 0.0016$ across five-fold cross-validation, with Swan-Ganz detection at AUC 0.9980 and ETT categories at mean AUC 0.9840. Auxiliary segmentation supervision yields targeted gains in CVC classification ($+1.45\%$ AUC) and CVC-Borderline ($+1.89\%$), demonstrating that approximate pixel-level anatomical knowledge provides effective spatial regularisation for borderline classification under severe class imbalance, without requiring formal knowledge graph construction at inference time.

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