Radiation doses to children with shunt-treated hydrocephalus

Holmedal, Lise Jofrid; Friberg, Eva Godske; Børretzen, Ingelin; Olerud, Hilde Marie; Lægreid, Liv; Rosendahl, Karen

doi:10.1007/s00247-007-0625-8

Cited by 30 publications

(11 citation statements)

References 22 publications

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“…4,5 Given the substantial morbidity and mortality associated with shunt malfunctions, current practice relies heavily on emergent neuroimaging, most commonly cranial CT. [6][7][8][9][10] Repeated CT scans expose children to a cumulative dose of ionizing radiation that has been associated with a significant increase in lifetime malignancy risk. [11][12][13] Thus, children with ventricular shunts are among the most vulnerable populations to the long-term deleterious effects of ionizing radiation exposure.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Rapid Cranial MRI to CT for Ventricular Shunt Malfunction

Boyle¹,

Paldino

Kimia³

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Rapid cranial MRI is a radiation-free method to assess children with possible ventricular shunt malfunction. However, the test performance of rapid cranial MRI has never been compared with that of cranial CT, the current reference standard. WHAT THIS STUDY ADDS:The accuracy of rapid cranial MRI was not inferior to that of CT for diagnosing ventricular shunt malfunction. Rapid cranial MRI is an important radiation-sparing diagnostic alternative for children presenting emergently with possible ventricular shunt malfunction. abstract OBJECTIVES: To compare the accuracy of rapid cranial magnetic resonance imaging (MRI) with that of computed tomography (CT) for diagnosing ventricular shunt malfunction. METHODS:We performed a single-center, retrospective cohort study of children #21 years of age who underwent either rapid cranial MRI or cranial CT in the emergency department (ED) for evaluation of possible ventricular shunt malfunction. Each neuroimaging study was classified as "normal" (unchanged or decreased ventricle size) or "abnormal" (increased ventricle size). We classified a patient as having a ventricular shunt malfunction if operative revision for relief of mechanical causes of altered shunt flow was needed within 72 hours of initial ED evaluation. Our primary analysis tested noninferiority of the accuracy of rapid cranial MRI to CT for diagnosing shunt malfunction (noninferiority margin 10%). RESULTS:We included 698 ED visits for 286 unique patients, with a median age at visit of 10.0 years (interquartile range 5.9-15.5 years). Patients underwent CT in 336 (48%) or rapid cranial MRI in 362 (52%) of ED visits for evaluation of possible shunt malfunction. Patients had operative revision for ventricular shunt malfunction in 140 ED visits (20%). The accuracy of rapid cranial MRI was not inferior to that of CT scan for diagnosing ventricular shunt malfunction (81.8% MRI vs 82.4% CT; risk difference 2.0%; 95% confidence interval, -4.2% to 8.2%).CONCLUSIONS: Rapid cranial MRI was not inferior to CT for diagnosing ventricular shunt malfunction and offers the advantage of sparing a child ionizing radiation exposure. Pediatrics 2014;134:e47-e54

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Section: Resultsmentioning

confidence: 99%

Comparison of Rapid Cranial MRI to CT for Ventricular Shunt Malfunction

Boyle¹,

Paldino

Kimia³

et al. 2014

Pediatrics

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“…Robbins29 found that for three selected malignancies the cumulative effective dose ranged from 109 to 152 mSv. Holmedal et al 30 investigated the estimated cumulative effective dose of CT scans in children with shunted hydrocephalus, and calculated a total effective dose ranging from 2.3 to 63.8 mSv. Brunetti et al 31 investigated diagnostic radiation exposure in paediatric trauma patients ranging from 0 to 73.5 mSv (mean 12.8 mSv).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic radiation exposure in children with spinal dysraphism: an estimation of the cumulative effective dose in a cohort of 135 children from The Netherlands

Aalst

Jeukens

Vles

et al. 2013

Archives of Disease in Childhood

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“…This potential risk has led to the common practice of ordering a cranial CT scan for most children with VP shunt presenting to the ED following a minor head trauma [ 109 ]. However, it must be taken into account that children with ventricular shunt are exposed to repeated CT scans for their underlying condition and additional CT scans following a head trauma contribute to the cumulative risk of repeated radiation exposures [ 110 ].…”

Section: Diagnosis Of Clinically Important Traumatic Brain Injurymentioning

confidence: 99%

Italian guidelines on the assessment and management of pediatric head injury in the emergency department

et al. 2018

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ObjectiveWe aim to formulate evidence-based recommendations to assist physicians decision-making in the assessment and management of children younger than 16 years presenting to the emergency department (ED) following a blunt head trauma with no suspicion of non-accidental injury.MethodsThese guidelines were commissioned by the Italian Society of Pediatric Emergency Medicine and include a systematic review and analysis of the literature published since 2005. Physicians with expertise and experience in the fields of pediatrics, pediatric emergency medicine, pediatric intensive care, neurosurgery and neuroradiology, as well as an experienced pediatric nurse and a parent representative were the components of the guidelines working group.Areas of direct interest included 1) initial assessment and stabilization in the ED, 2) diagnosis of clinically important traumatic brain injury in the ED, 3) management and disposition in the ED. The guidelines do not provide specific guidance on the identification and management of possible associated cervical spine injuries. Other exclusions are noted in the full text.ConclusionsRecommendations to guide physicians practice when assessing children presenting to the ED following blunt head trauma are reported in both summary and extensive format in the guideline document.

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Radiation doses to children with shunt-treated hydrocephalus

Abstract: None of the children was exposed to doses known to cause deterministic effects. However, since the threshold for radiation-induced damage is not known with certainty, alternative modalities such as US and MRI should be used whenever possible.

Cited by 30 publications

References 22 publications

Comparison of Rapid Cranial MRI to CT for Ventricular Shunt Malfunction

Comparison of Rapid Cranial MRI to CT for Ventricular Shunt Malfunction

Diagnostic radiation exposure in children with spinal dysraphism: an estimation of the cumulative effective dose in a cohort of 135 children from The Netherlands

Italian guidelines on the assessment and management of pediatric head injury in the emergency department

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