Cumulative diagnostic radiation exposure in children with ventriculoperitoneal shunts

Excerpt

The article by Smyth and colleagues, although lacking in scientific rigor, serves as a reminder to us all that every intervention we make with our patients carries a certain amount of risk. There is no doubt that this risk/benefit ratio is what we become expert at assessing in our daily professional lives. It is the decision to study these children and to address their shunt malfunctions more rapidly that has allowed neurosurgeons to achieve a 1% per year mortality for shunted children. On the other hand, as the authors point out, routine CT scans and shunt series afford minimal information and do have a cumulative effect. For this reason, most pediatric neurosurgeons no longer perform routine annual studies on their shunt patients. Many centers now offer rapid sequence MRI imaging of the brain and ventricles as an alternative to a CT scan. One would hope that this article reaches the emergency room physicians and the pediatricians, as many times the cumulative studies are ordered and performed before the child even reaches neurosurgical attention. But the onus is also on the neurosurgeon, as patient advocate, to remind our associates that these studies do have cumulative effects and that there is a certain lifetime risk whenever they are ordered. Over time, we will develop improved shunt technology such that better, less risky forms of evaluation will become available. Until that time, we need the occasional reminder such as this article to remind us that X-rays are an invasive procedure. …