Fluoroscopic-Guided Peritoneal Catheter Insertion: Radiology Anthropometric Analysis for Determining Optimal Catheter Position
Bibliographic record
Abstract
Background: Placement of a functioning peritoneal catheter requires optimal catheter positioning. Traditionally the pubis symphysis has been used as a landmark for the true pelvis and referenced for catheter-tip positioning. This practice is based on physical-exam methods without the benefit of fluoroscopic imaging. Methods: Retrospective cohort of adult, peritoneal dialysis patients in London, Ontario, who underwent percutaneous peritoneal catheter insertion using fluoroscopy spanning Feb 1, 2013 - Aug 1, 2017. Pre-specified anthropometric measures: 1) distance between deep pelvic space (outlined by caudal border of pooled radiocontrast injected intra-procedure) and cranial border of pubis symphysis; 2) distance between catheter-tip and cranial border of pubis symphysis - were measured using Citrix software of stored images. Anthropometric measures were contrasted according to sex via t-tests (p<0.05) and multivariable regression analyses, assessing relationships of potential predictors (age, BMI, prior abdominal surgery). Results: 295 patients (69% male) underwent fluoroscopic catheter insertion during the study period. Average age was 60 ± 16 years (std. dev.), BMI 28 ± 5 kg/m2. 52% of patients had no prior surgical history, 30% had 1 prior abdominal surgery, 18% had ≥2 prior surgeries. Average distance between deep pelvic space and pubis symphysis was 2.9 ± 1.5 cm, with females having a larger distance (3.4 ± 1.7 cm) compared to males (2.8 ± 1.4 cm; P=0.001); Female sex being associated with a 0.6 ± 0.2 cm, (P=0.03) increase in distance between the pubis symphysis and deep pelvic space as compared to males, adjusted for age, BMI, and number of prior abdominal surgeries. Stratified by sex: age, BMI, number of prior abdominal surgeries was not associated with distance between the pubic symphysis and deep pelvic space. Catheter-tip to pubis symphysis distance was 3.8 ± 1.7 cm and similar across sexes. Conclusions: Fluoroscopic methods of outlining the deep pelvic space for peritoneal catheter positioning approximate traditional methods. Differences observed in the distance between the pubic symphysis and deep pelvic space according to sex may reflect the impact of anatomical differences and/or type of abdominal surgeries. However, catheter tip positioning remained unaffected.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".