CT scan exposure in children with ventriculo-peritoneal shunts: single centre experience and review of the literature

Dobson, Gareth; Dalton, Arthur K; Nicholson, Claire; Jenkins, Alistair; Mitchell, Patrick; Cowie, Christopher J. A.

doi:10.1007/s00381-019-04345-3

Cited by 13 publications

(14 citation statements)

References 38 publications

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“… 38 Researchers have reported a greater incidence of malignancy in people who received ionizing radiation during childhood. 39 - 41 We define modified freehand (MF) as a group of methods to assist PS placement without the use of image-guidance (and non-ionizing) technologies. In this meta-analysis, MF showed a statistically significant higher accuracy compared to FH (OR 3.34 (95% CI, 2.33-4.79), P < .00 001).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis

Vega

Navarro

Gibson

et al. 2021

Global Spine Journal

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Study Design: Systematic review and meta-analysis. Objective: Various methods of pedicle screw (PS) placement in spinal fusion surgery existed, which can be grouped into conventional freehand (FH), modified freehand (MF), and image-guided methods (including fluoroscopy-based navigation (FL), computed tomography-based navigation (CT-nav), robot-assisted (RA), and ultrasound-guided (UG)). However, the literature showed mixed findings regarding their accuracy and complications. This review aimed to discover which method of PS placement has the highest accuracy and lowest complication rate in pediatric and adolescent spinal fusion surgery. Methods: A comprehensive search in MEDLINE (PubMed), EMBASE (OVID), CENTRAL, and Web of Science was conducted until May 2020 by 2 independent reviewers, followed by bias assessment with ROB 2 and ROBINS-I tools and quantification with meta-analysis. Overall evidence quality was determined with GRADE tool. Results: Four RCTs and 2 quasi-RCTs/CCTs comprising 3,830 PS placed in 291 patients (4-22 years old) were analyzed. The lowest accuracy was found in FH (78.35%) while the highest accuracy was found in MF (95.86%). MF was more accurate than FH (OR 3.34 (95% CI, 2.33-4.79), P < .00 001, I2 = 0%). Three-dimensional printed drill template (as part of MF) was more accurate than FH (OR 3.10 (95% CI, 1.98-4.86), P < .00 001, I2 = 14%). Overall, complications occurred in 5.84% of the patients with 0.34% revision rate. Complication events in MF was lower compared to FH (OR 0.47 (95% CI, 0.10-2.15), P = .33, I2 = 0%). Conclusions: Meta-analysis shows that MF is more accurate than FH in pediatric and adolescent requiring PS placement for spinal fusion surgery.

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Section: Discussionmentioning

confidence: 99%

Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis

Vega

Navarro

Gibson

et al. 2021

Global Spine Journal

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“…Similar concerns have been raised for children who undergo multiple head CTs for ventriculoperitoneal shunt placement, for instance, and a number of institutions have adjusted their protocols accordingly. 23,24 Furthermore, while the dose of radiation necessary to cause harm has not been clearly identified, there is evidence that cumulative radiation dose can theoretically increase the lifetime risk of cancer. 6,7,24 It is worthwhile, therefore, to strive for the lowest effective dose of radiation in children.…”

Section: Discussionmentioning

confidence: 99%

Variation in radiation dosing among pediatric trauma patients undergoing head computed tomography scan

LaQuaglia

Anderson

Goodhue

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:When head injured children undergo head computed tomography (CT), radiation dosing can vary considerably between institutions, potentially exposing children to excess radiation, increasing risk for malignancies later in life. We compared radiation delivery from head CTs at a level 1 pediatric trauma center (PTC) versus scans performed at referring adult general hospitals (AGHs).We hypothesized that children at our PTC receive a significantly lower radiation dose than children who underwent CTat AGHs for similar injury profiles. METHODS:We retrospectively reviewed the charts of all patients younger than 18 years who underwent CT for head injury at our PTC or at an AGH before transfer between January 1 and December 31, 2019. We analyzed demographic and clinical data. Our primary outcome was head CT radiation dose, as calculated by volumetric CT dose index (CTDI vol ) and dose-length product (DLP; the product of CTDI vol and scan length). We used unadjusted bivariate and multivariable linear regression (adjusting for age, weight, sex) to compare doses between Children's Hospital Los Angeles and AGHs. RESULTS:Of 429 scans reviewed, 193 were performed at our PTC, while 236 were performed at AGHs. Mean radiation dose administered was significantly lower at our PTC compared with AGHs (CTDI vol 20.3/DLP 408.7 vs. CTDI vol 30.6/DLP 533, p < 0.0001). This was true whether the AGH was a trauma center or not. After adjusting for covariates, findings were similar for both CTDI vol and DLP. Patients who underwent initial CT at an AGH and then underwent a second CT at our PTC received less radiation for the second CT (CTDI vol 25.6 vs. 36.5, p < 0.0001). CONCLUSIONS:Head-injured children consistently receive a lower radiation dose when undergoing initial head CT at a PTC compared with AGHs. This provides a basis for programs aimed at establishing protocols to deliver only as much radiation as necessary to children undergoing head CT.

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“…While it is commonly accepted that reducing the level of radiation exposure is reasonably achievable, radiation is still considerable in patients treated for hydrocephalus [ 5 , 6 ]. This partly relates to the relatively high incidences of shunt malfunction and surgical intervention and their effects on the longevity of the disease.…”

Section: Introductionmentioning

confidence: 99%

“…CT scans are frequently used for shunt-treated hydrocephalus. The level of radiation caused by CT scans has so far been described in three studies, of which only one included other imaging modalities [ 5 , 6 , 7 ]. Hydrocephalus can be accompanied by comorbidities that result in further radiation from imaging.…”

Section: Introductionmentioning

confidence: 99%

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Global Irradiation in Children Treated for Hydrocephalus and Its Change over Time—A Single Institutional Analysis

et al. 2022

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Radiation exposure early in life is associated with greater incidences of malignancy. Our goal was to quantify radiation exposure in shunt-treated hydrocephalus patients and study changes in the diagnostic modalities used. A single-center, retrospective analysis was performed, and 41 children treated for hydrocephalus using an adjustable ventriculoperitoneal shunt were identified. Diagnostics associated with hydrocephalus and other comorbidities were analyzed and radiation exposure was calculated. During 330.09 total shunt years, patients were exposed to a mean hydrocephalus-associated radiation dose of 3.93 mSv (range: 0–24.38 mSv), which amounted to a mean rate of 0.49 mSv per shunt year, respectively. Radiation exposure was greatest after shunt insertion in the first year of life. A continuous change from CT scans to MRIs could be seen over the study period, such that patients who underwent shunt insertion after 2017 were not exposed to additional hydrocephalus-associated radiation during their first year of life. Nevertheless, our patients, and a few individuals especially, seemed to be at higher risk for radiation sequelae. Our results suggest that CT scans should be substituted with MRIs, which decrease overall radiation exposure and can lead to zero additional radiation exposure during the first year of life after shunt insertion.

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CT scan exposure in children with ventriculo-peritoneal shunts: single centre experience and review of the literature

Cited by 13 publications

References 38 publications

Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis

Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis

Variation in radiation dosing among pediatric trauma patients undergoing head computed tomography scan

Global Irradiation in Children Treated for Hydrocephalus and Its Change over Time—A Single Institutional Analysis

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