Global Irradiation in Children Treated for Hydrocephalus and Its Change over Time—A Single Institutional Analysis
Abstract
:1. Introduction
2. Materials and Methods
3. Results
- Overall, 41 patients were exposed to a total of 78 cCTs, of which 18 (23%) were performed during the first year of life, 38 (48%) between the ages of one and six and the remaining 14 (18%) after the age of six. Patients had a mean cCT rate of 1.9 per patient (0–12) and a mean cCT rate of 0.23 per shunt year. There was a mean shunt series rate of 0.92 (range: 0–4) and, for the lateral skull X-rays used to verify shunt settings, the mean rate was 2.37 (range: 0–13). Adding together the cCTs, shunt series X-rays and lateral skull X-rays, patients were exposed to a mean radiation exposure due to hydrocephalus of 3.93 mSv (range: 0–24.38), accounting for 0.49 mSv per shunt year. During the same study period, 272 MRIs were performed on these 41 patients due to hydrocephalus, leading to a mean MRI rate of 6.63 (range: 0–17). Table 1 summarizes these results.
- For patients operated on before 2017—and therefore with a CODMAN shunt system—radiation exposure due to hydrocephalus during the first year of life was calculated as having a mean of 1.68 mSv (range: 0–18.67), taking into consideration 18 cCTs, 8.7 shunt series X-rays and 3 lateral skull X-rays. Patients operated on after 2017—and therefore with a proGAV system—were not exposed to a single cCT, shunt series X-ray or lateral skull X-ray during the first year of life, meaning no additional radiation exposure due to shunt therapy.
- Radiation exposure, considering CT scans for all locations and for indications other than hydrocephalus during the same study period (seven pelvis CT scans (5 mSv), three abdomen CT scans (5 mSv), three PET-CT scans (21.6 mSv), two foot CT scans (1.5 mSv), four chest CT scans (8 mSv), one lower limb CT scan (3.5 mSv), four spine CT scans (6 mSv) and one petrosal bone CT scan (1.2 mSv)), added up to 178.5 mSv, which was 1.85 mSv per shunt year or 4.3 msV per patient (range: 0–80.8 mSv) [11,13,14,15].
- Global irradiation was 162.64 mSv, of which 158 mSv were caused by cCTs, 3.67 mSv by shunt series X-rays and 0.97 mSv by lateral skull X-rays. The causes for the global irradiation are visualized in Figure 2.
- For all patients, the dates of the MRIs and head CTs were listed in order to evaluate the possible change during the observation period. Figure 3 visualizes this change. Between 2000 and 2010, 4.57 CTs and 4.28 MRIs per patient were performed, in comparison to 1.84 CTs and 8.75 MRIs per patient between 2011 and 2021.
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Rate per Patient (Range) | Rate per Shunt Year | |
---|---|---|
cCT | 1.9 (0–12) | 0.23 |
Lateral skull X-ray | 2.37 (0–13) | 0.29 |
Shunt series | 0.92 (0–4) | 0.11 |
MRI head scan | 6.63 (0–17) | 0.82 |
mSv per patient (range) | mSv per shunt year | |
Hydrocephalus-associated radiation | 3.93 (0–24.38) | 0.49 |
Comorbidity-associated radiation | 4.3 (0–80.8) | 1.85 |
Study | Patients | Shunt Years | cCTs per Shunt Year | Shunt Series per Shunt Year | Skull X-rays per Shunt Year | Head MRIs per Shunt Year |
---|---|---|---|---|---|---|
Present study | 41 | 330 | 0.23 | 0.12 | 0.37 | 0.68 |
Antonucci et al. | 130 | 1300 | 0.9 | 0.3 | 0.1 | 0.1 |
White et al. | 62 | 989 | 0.97 | |||
Dobson et al. | 152 | 778 | 0.65 |
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Schabl, L.; Küppers, J.; Jhala, T.; Winicker, H.; Esslinger, P.; Lehner, M. Global Irradiation in Children Treated for Hydrocephalus and Its Change over Time—A Single Institutional Analysis. Children 2022, 9, 1062. https://doi.org/10.3390/children9071062
Schabl L, Küppers J, Jhala T, Winicker H, Esslinger P, Lehner M. Global Irradiation in Children Treated for Hydrocephalus and Its Change over Time—A Single Institutional Analysis. Children. 2022; 9(7):1062. https://doi.org/10.3390/children9071062
Chicago/Turabian StyleSchabl, Lukas, Julia Küppers, Tobias Jhala, Hermann Winicker, Peter Esslinger, and Markus Lehner. 2022. "Global Irradiation in Children Treated for Hydrocephalus and Its Change over Time—A Single Institutional Analysis" Children 9, no. 7: 1062. https://doi.org/10.3390/children9071062