title: Evaluation of whole body Ultralow-Dose CT for the assessment of ventriculoperitoneal shunt complications: an experimental ex-vivo study in a swine model.
abstract: OBJECTIVE
  To evaluate the suitability of whole body Ultralow-dose CT (ULD-CT) as a diagnostic tool for the evaluation of ventriculoperitoneal shunt (VP-shunt) complications with special regards to radiation dose and image quality.
  
  
  METHODS
  Fourteen VP-shunts were implanted in 7 swine cadavers (weight: 55-70 kg). Twenty-two mechanical complications (extracranial and extraperitoneal malpositioning, breakages, disconnections) were induced in nine VP-shunts. Ten ULD-CT scans with different parameters (tube voltage: 80, 100, 120 kV; tube current: 20 or 50 mAs; Pitch (P): 1 or 1.5) were acquired; the combination of 120 kV and 50 mAs was omitted. Radiation dose estimation, blinded readings, and quantitative and qualitative assessment of the CT-data were performed.
  
  
  RESULTS
  Effective radiation doses varied between 0.44 ± 0.06 and 2.55 ± 0.35 mSv. ULD-CT protocols provided a mean sensitivity (i.e., correctly detected shunt complications) of 98.2 %. Unnoticed or incorrectly identified complications did not exceed one complication (4.5 %) in any ULD-CT protocol. Diagnostic confidence was sufficient for all ULD-CT protocols except for protocols with 80 kV and 20 mAs.
  
  
  CONCLUSIONS
  ULD-CT allows accurate detection of VP-shunt complications at radiation doses similar or lower than reported for a radiographic shunt series. At the tested radiation dose levels, ULD-CT thus provides an alternative to a radiographic shunt series.
  
  
  CONCLUSIONS
  • Ultralow-dose CT accurately detects Ventriculoperitoneal Shunt complications. • Radiation dosage is similar or lower than reported for a radiographic shunt series. • Ultralow-dose CT potentially shortens the diagnostic process when shunt complications are suspected.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany, ahmed.e.othman@googlemail.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Othman
authors.forename: Hussam A
authors.initials: HA
authors.lastname: Hamou
authors.forename: Rastislav
authors.initials: R
authors.lastname: Pjontek
authors.forename: Saif
authors.initials: S
authors.lastname: Afat
authors.forename: Hans
authors.initials: H
authors.lastname: Clusmann
authors.forename: Martin
authors.initials: M
authors.lastname: Wiesmann
authors.forename: Marc A
authors.initials: MA
authors.lastname: Brockmann
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D011829:Radiation Dosage; D059629:Signal-To-Noise Ratio; D034421:Sus scrofa; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D051598:Whole Body Imaging / Q000379:methods*