Gullo Giuseppe, Rotzinger David Christian, Frossard Pierre, Colin Anaïs, Saliou Guillaume, Qanadli Salah Dine
Department of Diagnostic and Interventional Radiology, University Hospital, 1011 Lausanne, Switzerland.
Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), 1015 Lausanne, Switzerland.
Br J Radiol. 2025 Feb 1;98(1166):237-245. doi: 10.1093/bjr/tqae218.
The cavo-atrial junction (CAJ) is the most appropriate central venous catheters CVC tip location to reduce complications. Among chest X-ray (CXR) landmarks for tips assessment, only the pericardial reflection lies in the same plane as the vascular structures. We aimed to evaluate the observer variability to determine tip positioning on CXR, using CT as a gold standard.
We retrospectively analyzed 107 CT scans of patients with port catheters (January-December 2021). The tip to CAJ distance (DCAJ) was measured on both projectional (PJ) and cross-sectional (CS) CT images by 2 × 2 observers (within and between evaluations). Observational statistics included paired t-tests, repeatability coefficients (RC), and intraclass correlation coefficients (ICC), with data visualized using Bland-Altman plots.
All ICC were >0.9, indicating excellent reliability. The mean difference between observers comparing CS and PJ was 0.13 ± 0.80 cm (P = .10) with outer 95% confidence limits of 1.92 cm and -2.17 cm and an RC of 1.79 cm.
CXR provides a reliable method for CVC tip localization, though assessment variability is ±2 cm.
CXR assessment of CVC tips shows both intra- and inter-individual variability, due to challenges in identifying the CAJ and catheter tip . While considering the 3 cm anatomical zone around the CAJ acceptable, operators should be aware of the 2 cm variability resulting from CXR assessment. To account for this variability and avoid the risk of positioning the tip beyond 3 cm from the CAJ, operators should reduce the CXR-based acceptable zone to 1 cm around the CAJ, impacting approximately 30% of procedures.
腔房交界处（CAJ）是最适合中心静脉导管（CVC）尖端放置的位置，以减少并发症。在用于评估尖端位置的胸部X线（CXR）标志中，只有心包反折与血管结构位于同一平面。我们旨在以CT作为金标准，评估观察者在确定CXR上尖端位置时的变异性。
我们回顾性分析了2021年1月至12月期间107例带端口导管患者的CT扫描图像。由2×2名观察者（评估内和评估间）在投影（PJ）和横断面（CS）CT图像上测量尖端至CAJ的距离（DCAJ）。观察性统计包括配对t检验、重复性系数（RC）和组内相关系数（ICC），数据使用Bland-Altman图进行可视化。
所有ICC均>0.9，表明可靠性极佳。比较CS和PJ时观察者之间的平均差异为0.13±0.80 cm（P = 0.10），95%的外部置信限为1.92 cm和 -2.17 cm，RC为1.79 cm。
CXR为CVC尖端定位提供了一种可靠的方法，尽管评估变异性为±2 cm。
由于在识别CAJ和导管尖端方面存在挑战，CXR对CVC尖端的评估显示出个体内和个体间的变异性。虽然认为CAJ周围3 cm的解剖区域是可接受的，但操作人员应意识到CXR评估导致的2 cm变异性。为了考虑到这种变异性并避免将尖端放置在距CAJ超过3 cm处的风险，操作人员应将基于CXR的可接受区域缩小至CAJ周围1 cm，这将影响约30%的操作。
