Rationale and Comments

Computed tomography (CT) scans have been used for diagnostic imaging for more than 40 years, but it should not be assumed that a head CT is always needed in an evaluation for shunt failure. Because CT is the usual mode of imaging for children with hydrocephalus, these patients have a much higher cumulative radiation exposure than the average population. Children have an increased risk of cancer with exposure to higher cumulative radiation doses. CT scans should be performed only when warranted to reduce exposure to radiation and decrease the risk for radiation-induced cancer. Consider using head ultrasonography when there is an open fontanel or a rapid sequence magnetic resonance imaging (MRI) scan to reduce the amount of ionizing radiation exposure to pediatric patients with a ventricular shunt. A rapid sequence MRI is less expensive than a formal MRI and comparable in cost to a CT scan. Sedation is not needed because the rapid sequence MRI is quick, which further reduces the costs and medical risks of sedation. A CT scan can be used for emergencies and if the child has implanted metal or a device that is not compatible with an MRI.

Sponsoring Organizations

• American Association of Neuroscience Nurses, Society of Pediatric Nurses, & American Pediatric Surgical Nurses Association, Inc.

Sources

• Expert consensus

Disciplines

• Neurologic
• Pediatric

References

• Tekes A, Jackson EM, Ogborn J, et al. How to reduce head CT orders in children with hydrocephalus using the lean six sigma methodology: experience at a major quaternary care academic children's center. AJNR Am J Neuroradiol. 2016;37(6):990-996.
• Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289-296.
• Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology. Br J Radiol. 2008;81(965):362-378.
• Miglioretti DL, Johnson E, Williams A, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 2013;167(8):700-707.
• Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499-505.
• Ashley WW Jr, McKinstry RC, Leonard JR, et al. Use of rapid-sequence magnetic resonance imaging for evaluation of hydrocephalus in children. J Neurosurg. 2005;103(2 Suppl):124-130.
• O'Neill BR, Pruthi S, Bains H, et al. Rapid sequence magnetic resonance imaging in the assessment of children with hydrocephalus. World Neurosurg. 2013;80(6):e307-e312.