Article

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

ABSTRACT

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.

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    Full-text · Article · Oct 2000 · American Journal of Roentgenology
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    Full-text · Article · Mar 2001 · American Journal of Roentgenology
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    ABSTRACT: The purpose of our study was to determine how parents' understanding of and willingness to allow their children to undergo CT change after receiving information regarding radiation dose and risk. One hundred parents of children undergoing nonemergent CT studies at a tertiary-care children's hospital were surveyed before and after reading an informational handout describing radiation risk. Parental knowledge of whether CT uses radiation or increases lifetime risk of cancer was assessed, as was willingness to permit their child to undergo both a CT examination that their child's doctor recommended and one for which their doctor thought observation might be equally effective. Of the 100 parents who were surveyed, 66% believed CT uses radiation before reading the handout, versus 99% afterward (p < 0.01). Before reading the handout, 13% believed CT increases the lifetime risk of cancer, versus 86% afterward (p < 0.01). After reading the handout, parents became less willing to have their child undergo CT given a hypothetic situation in which their doctor believed that either CT or observation would be equally effective (p < 0.01), but their willingness to have their child undergo CT recommended by their doctor did not significantly change. After reading the handout, 62% of parents reported no change in level of concern. No parent refused or requested to defer CT after reading the handout. A brief informational handout can improve parental understanding of the potential increased risk of cancer related to pediatric CT without causing parents to refuse studies recommended by the referring physician.
    Preview · Article · Sep 2007 · American Journal of Roentgenology
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