title: Benefits of brain magnetic resonance imaging over computed tomography in children requiring emergency evaluation of ventriculoperitoneal shunt malfunction: reducing lifetime attributable risk of cancer.
abstract: OBJECTIVE
  The rapid growth of computed tomography (CT) has resulted in increased concerns of ionizing radiation exposure and its subsequent risk of cancer development. We evaluated the impact of a new protocol using rapid sequence magnetic resonance imaging (rsMRI) instead of CT in children presenting with possible ventriculoperitoneal shunt (VPS) malfunction to promote patient safety.
  
  
  METHODS
  This is a retrospective case series of pediatric patients who received a neuroimaging study for emergency evaluation of possible VPS malfunction at New York University's Tisch Hospital Emergency Department between January 2010 and July 2011. Radiology Charge Master was queried to identify the patient database. The trend in the use of rsMRI and CT was calculated for 3 patient age groups and compared across 3 chronological intervals. The effective dose of ionizing radiation per CT scan was calculated using the CT dose index and dose-length product for each patient.
  
  
  RESULTS
  Total of 365 patients with the mean age of 8.87 years received either rsMRI or CT study during the study period. One hundred forty-four of these patients required the imaging studies because of VPS malfunction. Overall, 62% of all VPS malfunction cases used rsMRI instead of CT. The ratio of the number of patients receiving rsMRI divided by CT studies has progressively increased from 1.4:1 to 2.1:1 over 3 chronologic periods.
  
  
  CONCLUSIONS
  Children with VPS are subject to multiple neuroimaging studies throughout their lifetime. Rapid sequence MRI is an effective alternative to CT while providing no ionizing radiation exposure or risk of developing radiation-induced cancer.
authors.affiliation: From the Department of Pediatric Emergency Medicine, New York University Langone Medical Center, New York, NY.
authors.forename: In
authors.initials: I
authors.lastname: Kim
authors.forename: Susan B
authors.initials: SB
authors.lastname: Torrey
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Milla
authors.forename: Marisa C
authors.initials: MC
authors.lastname: Torch
authors.forename: Michael G
authors.initials: MG
authors.lastname: Tunik
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Foltin
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology*; D009518:New York / Q000453:epidemiology; D011829:Radiation Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000379:methods*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*