Cumulative diagnostic radiation exposure in children with ventriculoperitoneal shunts: A review

Pediatric Neurosurgery, St. Louis Children's Hospital, Washington University, St. Louis, MO, USA.
Child s Nervous System (Impact Factor: 1.11). 05/2008; 24(4):493-7. DOI: 10.1007/s00381-007-0560-x
Source: PubMed


Children may be more vulnerable to diagnostic radiation exposure because of the increased dose-volume ratio and the increased lifetime risk per unit dose of radiation from early exposure. Moreover, recent radiological literature suggests that exposure to ionizing radiation from imaging studies may play a role in the later development of malignancies.
We review the literature and present two illustrative clinical examples of children (each child developed head and neck malignancies during their late teen years) with hydrocephalus requiring multiple cerebrospinal fluid (CSF) shunt revisions and diagnostic computerized tomography (CT) scans throughout their life.
The literature reviewed suggests that children are more prone to diagnostic radiation exposure. Although it is not possible to prove that the multiple diagnostic studies result in malignancies, our review of the literature and illustrative cases describing malignancy risk and radiation exposure should give clinicians pause when considering requesting multiple diagnostic CT studies in children during the evaluation of possible CSF shunt dysfunction. Alternative tests such as "shunt MRI" protocols should be considered for patients and used whenever possible to minimize exposure to ionizing radiation.

10 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The hydrocephalic patient is at risk throughout life of developing complications that may be severe or even fatal. The neurological, developmental, social and occupational outcome is affected by the sequelae of the initial disease and the consequences of intracranial hypertension, but also by imaginary obstacles. Unless proved otherwise, the patient with a shunt must be considered shunt-dependent; shunt independence is rare and must be proved following a rigorous protocol. The hydrocephalic patient should therefore be followed regularly and for life in neurosurgery to screen for and prevent complications as much as possible. Follow-up also allows patient education and coordination by the neurosurgeon and other specialists such as the neurologist and the physical therapist. Organizing the follow-up of the hydrocephalic patient into adulthood is the responsibility of the neurosurgeon in charge; the modalities of this follow-up will vary depending on local conditions. The patient should be educated on the need for this follow-up and prepared for this transition long before it occurs.
    Neurochirurgie 10/2008; 54(5):587-596. DOI:10.1016/j.neuchi.2008.07.002 · 0.41 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: ObjectiveThe published guidelines for radiographic examination of lower extremity injuries are known as the ‘Ottawa rules’. These rules, initially published in 1992, were established to decrease the amount of unnecessary radiographs. False negatives when following the Ottawa rules are low and have reduced the number of unnecessary x-rays. In clinical settings, the rules and their associated algorithms are important as an aid for determining course of care. This paper documents two cases where adaptation of the Ottawa rules suggested the need for upper extremity radiography. Subsequent x-rays revealed the presence of a fracture in both cases.Clinical featuresThe first case was an 8-year-old girl who was struck on the arm while playing. She experienced pain but refused to let anyone examine her arm. The second case was a 24-year-old male who fell 5 days earlier and landed on his right hand. The application of the adapted Ottawa rules suggested the potential for fracture, which was subsequently confirmed by radiographs.Intervention and outcomeRadiographs confirmed the fracture and both patients were referred for orthopedic consultation and treatment.ConclusionThese two cases, where the clinical decision making for a wrist injury was guided by an adaptation of the Ottawa ankle rules, highlight the lack of guidelines for upper extremity x-rays following injury and suggest that the Ottawa rules could form the basis for such guidelines. Further studies are required to demonstrate their reliability and validity for everyday clinical use.
    Clinical Chiropractic 06/2009; DOI:10.1016/j.clch.2009.08.003
  • Journal of Neurosurgery Pediatrics 10/2010; 6(4):316-7; discussion 317. DOI:10.3171/2010.6.PEDS10229 · 1.48 Impact Factor
Show more