title: Cumulative diagnostic radiation exposure in children with ventriculoperitoneal shunts: a review.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pediatric Neurosurgery, St. Louis Children's Hospital, Washington University, St. Louis, MO, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Smyth
authors.forename: Prithvi
authors.initials: P
authors.lastname: Narayan
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Leonard
authors.forename: T S
authors.initials: TS
authors.lastname: Park
authors.forename: Marios
authors.initials: M
authors.lastname: Loukas
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grabb
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D016609:Neoplasms, Second Primary / Q000209:etiology*; D010372:Pediatrics; D018788:Radioactive Hazard Release; D015898:Tomography Scanners, X-Ray Computed / Q000009:adverse effects*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*