Strengthening the Argument for Rapid Brain MR Imaging: Estimation of Reduction in Lifetime Attributable Risk of Developing Fatal Cancer in Children with Shunted Hydrocephalus by Instituting a Rapid Brain MR Imaging Protocol in Lieu of Head CT

Abstract

BACKGROUND AND PURPOSE:Children with shunted hydrocephalus have been undergoing surveillance neuroimaging, generally in the form of head CT, for evaluation of ventricular size. As the life expectancy of these children has improved due to better shunt technology and medical care, risks related to the ionizing radiation incurred during multiple head CT examinations that they are expected to undergo throughout their lifetime have become a concern. The purpose of this study is to estimate the LAR of developing fatal cancer due to head CT for ventricular size assessment in children with shunted hydrocephalus and to assess the impact of instituting a rapid brain MR imaging protocol in reducing radiation exposure.

How to Reduce Head CT Orders in Children with Hydrocephalus Using the Lean Six Sigma Methodology: Experience at a Major Quaternary Care Academic Children's Center

“…Lowdose CT protocols have been used in some hospitals, including our own, following the principle of as low as reasonably achievable 16 ; however, children with hydrocephalus will have multiple neuroimaging studies throughout their lives, increasing their total lifetime radiation exposure and consequently having a greater lifetime risk of radiation-induced brain cancers. [5][6][7][8][9][10] Therefore, elimination of radiation-based imaging techniques whenever possible is critical to ensure the long-term health of this population. Highlighting this belief, Koral et al 7 recently found that there is an increased risk of developing fatal cancer if children with hydrocephalus undergo neuroimaging surveillance with head CTs.…”

“…[5][6][7][8][9][10] Therefore, elimination of radiation-based imaging techniques whenever possible is critical to ensure the long-term health of this population. Highlighting this belief, Koral et al 7 recently found that there is an increased risk of developing fatal cancer if children with hydrocephalus undergo neuroimaging surveillance with head CTs. These and similar results have repeatedly been reported in the lay press, and as a result, both providers and patients' families are routinely demanding that radiation-free protocols be used whenever possible.…”

“…Patients exposed to higher cumulative radiation doses have an increased risk of cancer (especially children), with the brain being the most sensitive to radiation-induced cancers on the basis of recent empiric studies. [5][6][7][8][9][10] Disease-specific imaging protocols and pathways to help mitigate unnecessary radiation exposure in high-risk/vulnerable populations have been discussed in various medical/scientific forums. Despite these considerations, radiation-free imaging modalities, such as brain MR imaging and head ultrasonography (US), are often underused due to logistic barriers and/or resource constraints such as lack of a 24/7 in-house MR imaging technologist, the longer examination times of MR imaging compared with CT, MR imaging often requiring sedation/anesthesia in the youngest patients, the higher unit cost of MR imaging, and so forth.…”

Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation

“…Koral et al estimate the annual frequency of surveillance neuroimaging in this patient population to be approximately 2 CTs per year throughout a lifetime. 8 An individual patient in our study underwent 25 brain imaging studies during the 4-year study period, and 21 of these 25 imaging studies were QB-MRI studies. With an estimate of 2-5 mSv administered per brain CT, this child was spared 42-105 mSv of effective radiation dose during our study period alone through the use of QB-MRI.…”

Retrospective Review of Rapid Pediatric Brain MR Imaging at an Academic Institution Including Practice Trends and Factors Affecting Scan Times

“…8 Recent developments in MR pulse sequences now allow for rapid evaluation of ventricular size in the pediatric population without the need for sedation. [9][10][11][12][13][14] Although various techniques have been used, heavily T2-weighted single-shot fast spin-echo and gradient recalled-echo imaging are the 2 most common pulse sequence methods used to interrogate ventricular size and shunt catheter tip location, respectively. 15 Starting in April 2009, our institution introduced a similar T2-weighted HASTE rapid-sequence MR imaging protocol.…”