Xiaoqin Jennifer Wang MD, Presenter: Nothing to Disclose

Jie Zhang PhD, Abstract Co-Author: Nothing to Disclose

Jessica Cornett, Abstract Co-Author: Nothing to Disclose

Edward Joel Escott MD, Abstract Co-Author: Royalties, Thieme Medical Publishers, Inc Researcher, Athersys, Inc Grant, Athersys, Inc

Computed tomography (CT) is the most common imaging modality employed for shunt evaluation in pediatric hydrocephalus, yet it increases cancer risk due to ionizing radiation exposure. Rapid Magnetic Resonance Imaging (rMRI) was introduced as an alternative approach. This study is to evaluate utilization of rMRI and its effect on the reduction of CT use and lifetime cancer risk.

We retrospectively reviewed the CT and rMRI exams performed for pediatric hydrocephalus shunt evaluation from 2010 to 2012. CT and rMRI utilization and acceptance by various requesting clinical services were evaluated. For patients undergoing CT and rMRI, average age-specific effective dose was calculated and lifetime cancer risk was estimated using the Biological Effects of Ionizing Radiation (BEIR) VII. Comparison was made to utilization trends, radiation dose and cancer risk before and after (April 2011) the institution of the rMRI protocol.

Prior to April 2011, there were approximately 144 annual CT head scans for shunt evaluation, which produces an average age-specific dose of 2.59 mSv per patient per procedure with potential lifetime cancer risk of 1 in 3861. The annual CT head scans were significantly reduced by 42.3%, one year after the introduction of rMRI, and the radiation dose was decreased by 0.84 mSv per patient per procedure. The averaged lifetime cancer risk decreased to 1 in 5714. Approximately 47.2%, 39.6% and 11.8% CT scans were ordered by the Neurosurgery, Emergency Department and Pediatric Department, respectively, before the implementation of rMRI. Significant reduction of CT usage is observed in these three requesting services after initiation of rMRI.

Our utilization trends demonstrate that rMRI is a viable alternative to CT scans for shunt evaluation in pediatric hydrocephalus patients. The use of rMRI reduces the imaging radiation related cancer risk and is readily adopted by the primary referral services.

rMRI is a viable alternative to head CT scan for pediatric hydrocephalus shunt evaluation. rMRI was accepted by the referring clinicians, and resulted in decreased patient lifetime cancer risk.

Wang, X, Zhang, J, Cornett, J, Escott, E, Rapid Brain Magnetic Resonance Imaging as an Alternative to Computed Tomography for Pediatric Hydrocephalus Shunt Evaluation: Modality Utilization and Cancer Risk Reduction.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12028067.html