title: The Burden of Ionizing Radiation Studies in Children with Ventricular Shunts.
abstract: To quantify the number of shunt-related imaging studies that patients with ventricular shunts undergo and to calculate the proportion of computed tomography (CT) scans associated with a surgical intervention.
  
  
  
  Retrospective longitudinal cohort analysis of patients up to age 22 years with a shunt placed January 2002 through December 2003 at a pediatric hospital. Primary outcome was the number of head CT scans, shunt series radiograph, skull radiographs, nuclear medicine, and brain magnetic resonance imaging studies for 10 years following shunt placement. Secondary outcome was surgical interventions performed within 7 days of a head CT. Descriptive statistics were used for analysis.
  
  
  
  Patients (n = 130) followed over 10 years comprised the study cohort. The most common reasons for shunt placement were congenital hydrocephalus (30%), obstructive hydrocephalus (19%), and atraumatic hemorrhage (18%), and 97% of shunts were ventriculoperitoneal. Patients underwent a median of 8.5 head CTs, 3.0 shunt series radiographs, 1.0 skull radiographs, 0 nuclear medicine studies, and 1.0 brain magnetic resonance imaging scans over the 10 years following shunt placement. The frequency of head CT scans was greatest in the first year after shunt placement (median 2.0 CTs). Of 1411 head CTs in the cohort, 237 resulted in surgical intervention within 7 days (17%, 95% CI 15%-19%).
  
  
  
  Children with ventricular shunts have been exposed to large numbers of imaging studies that deliver radiation and most do not result in a surgical procedure. This suggests a need to improve the process of evaluating for ventricular shunt malfunction and minimize radiation exposure.
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: Maria.antonucci@upmc.edu.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Antonucci
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Noel S
authors.initials: NS
authors.lastname: Zuckerbraun
authors.affiliation: Department of Neurological Surgery, Division of Pediatric Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Tyler-Kabara
authors.affiliation: Department of Radiology, Division of Pediatric Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Andre D
authors.initials: AD
authors.lastname: Furtado
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Murphy
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine and Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Marin
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003952:Diagnostic Imaging / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D000069079:Radiation Exposure / Q000517:prevention & control*; D011839:Radiation, Ionizing; D011877:Radionuclide Imaging / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
keywords: emergency medicine; pediatrics; radiation; ventricular shunts