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Esmaeilzadeh M, Bronzlik P, Solmaz H, Polemikos M, Heissler HE, Raab P, Lanfermann H, Krauss JK. Reducing radiation exposure and costs: CT body scout views with an enhanced protocol versus conventional radiography after shunt surgery. Clin Neurol Neurosurg 2024; 240:108281. [PMID: 38604085 DOI: 10.1016/j.clineuro.2024.108281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Ventriculoperitoneal shunt implantation has become standard treatment for cerebrospinal fluid diversion, besides endoscopic third ventriculostomy for certain indications. Postoperative X-ray radiography series of skull, chest and abdomen combined with cranial CT are obtained routinely in many institutions to document the shunt position and valve settings in adult patients. Measures to reduce postoperative radiation exposure are needed, however, there is only limited experience with such efforts. Here, we aim to compare routine postoperative cranial CT plus conventional radiography series (retrospective arm) with cranial CT and body scout views only (prospective arm) concerning both diagnostic quality and radiation exposure. PATIENTS AND METHODS After introduction of an enhanced CT imaging protocol, routine skull and abdomen radiography was no longer obtained after VP shunt surgery. The image studies of 25 patients with routine postoperative cranial CT and conventional radiography (retrospective arm of study) were then compared to 25 patients with postoperative cranial CT and CT body scout views (prospective arm of study). Patient demographics such as age, sex and primary diagnosis were collected. The image quality of conventional radiographic images and computed tomography scout views images were independently analyzed by one neurosurgeon and one neuroradiologist. RESULTS There were no differences in quality assessments according to three different factors determined by two independent investigators for both groups. There was a statistically significant difference, however, between the conventional radiography series group and the CT body scout view imaging group with regard to radiation exposure. The effective dose estimation calculation yielded a difference of 0.05 mSv (two-tailed t-test, p = 0.044) in favor of CT body scout view imaging. Furthermore, the new enhanced protocol resulted in a reduction of cost and the use of human resources. CONCLUSION CT body scout view imaging provides sufficient imaging quality to determine shunt positioning and valve settings. With regard to radiation exposure and costs, we suggest that conventional postoperative shunt series may be abandoned.
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Affiliation(s)
| | - Paul Bronzlik
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Hüseyin Solmaz
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Manolis Polemikos
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Heinrich Lanfermann
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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Abel F, Schubert T, Winklhofer S. Advanced Neuroimaging With Photon-Counting Detector CT. Invest Radiol 2023; 58:472-481. [PMID: 37158466 DOI: 10.1097/rli.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
ABSTRACT Photon-counting detector computed tomography (PCD-CT) is an emerging technology and promises the next step in CT evolution. Photon-counting detectors count the number of individual incoming photons and assess the energy level of each of them. These mechanisms differ substantially from conventional energy-integrating detectors. The new technique has several advantages, including lower radiation exposure, higher spatial resolution, reconstruction of images with less beam-hardening artifacts, and advanced opportunities for spectral imaging. Research PCD-CT systems have already demonstrated promising results, and recently, the first whole-body full field-of-view PCD-CT scanners became clinically available. Based on published studies of preclinical systems and the first experience with clinically approved scanners, the performance can be translated to valuable neuroimaging applications, including brain imaging, intracranial and extracranial CT angiographies, or head and neck imaging with detailed assessment of the temporal bone. In this review, we will provide an overview of the current status in neuroimaging with upcoming and potential clinical applications.
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Affiliation(s)
- Frederik Abel
- From the Department of Diagnostic and Interventional Radiology
| | - Tilman Schubert
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Afat S, Pjontek R, Nikoubashman O, Kunz WG, Brockmann MA, Ridwan H, Wiesmann M, Clusmann H, Othman AE, Hamou HA. Diagnostic Performance of Whole-Body Ultra-Low-Dose CT for Detection of Mechanical Ventriculoperitoneal Shunt Complications: A Retrospective Analysis. AJNR Am J Neuroradiol 2022; 43:1597-1602. [PMID: 36229165 PMCID: PMC9731254 DOI: 10.3174/ajnr.a7672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Radiographic shunt series are still the imaging technique of choice for radiologic evaluation of VP-shunt complications. Radiographic shunt series are associated with high radiation exposure and have a low diagnostic performance. Our aim was to investigate the diagnostic performance of whole-body ultra-low-dose CT for detecting mechanical ventriculoperitoneal shunt complications. MATERIALS AND METHODS This retrospective study included 186 patients (mean age, 54.8 years) who underwent whole-body ultra-low-dose CT (100 kV[peak]; reference, 10 mAs). Two radiologists reviewed the images for the presence of ventriculoperitoneal shunt complications, image quality, and diagnostic confidence. On a 5-point Likert scale, readers scored image quality and diagnostic confidence (1 = very low, 5 = very high). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Radiation dose estimation of whole-body ultra-low-dose CT was calculated and compared with the radiation dose of a radiographic shunt series. RESULTS 34 patients positive for VP-shunt complications were correctly identified on whole-body ultra-low-dose CT by both readers. No false-positive or -negative cases were recorded by any of the readers, yielding a sensitivity of 100% (95% CI, 87.3%-100%), a specificity of 100% (95% CI, 96.9%-100%), and perfect agreement (κ = 1). Positive and negative predictive values were high at 100%. Shunt-specific image quality and diagnostic confidence were very high (median score, 5; range, 5-5). Interobserver agreement was substantial for image quality (κ = 0.73) and diagnostic confidence (κ = 0.78). The mean radiation dose of whole-body ultra-low-dose CT was significantly lower than the radiation dose of a conventional radiographic shunt series (0.67 [SD, 0.4] mSv versus 1.57 [SD, 0.6] mSv; 95% CI, 0.79-1.0 mSv; P < .001). CONCLUSIONS Whole-body ultra-low-dose CT allows detection of ventriculoperitoneal shunt complications with excellent diagnostic accuracy and diagnostic confidence. With concomitant radiation dose reduction on contemporary CT scanners, whole-body ultra-low-dose CT should be considered an alternative to the radiographic shunt series.
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Affiliation(s)
- S Afat
- From the Department for Diagnostic and Interventional Radiology (S.A., A.E.O.), University Hospital Tuebingen, Tuebingen, Germany
| | - R Pjontek
- Department of Neurosurgery (R.P., H.C., H.A.H.)
| | - O Nikoubashman
- Diagnostic and Interventional Neuroradiology (O.N., H.R., M.W.), University Hospital RWTH Aachen, Aachen, Germany
| | - W G Kunz
- Department of Radiology (W.G.K.), University Hospital Ludwig-Maximilians-University, Munich, Germany
| | - M A Brockmann
- Department of Neuroradiology (M.A.B., A.E.O.), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - H Ridwan
- Diagnostic and Interventional Neuroradiology (O.N., H.R., M.W.), University Hospital RWTH Aachen, Aachen, Germany
| | - M Wiesmann
- Diagnostic and Interventional Neuroradiology (O.N., H.R., M.W.), University Hospital RWTH Aachen, Aachen, Germany
| | - H Clusmann
- Department of Neurosurgery (R.P., H.C., H.A.H.)
| | - A E Othman
- From the Department for Diagnostic and Interventional Radiology (S.A., A.E.O.), University Hospital Tuebingen, Tuebingen, Germany
- Department of Neuroradiology (M.A.B., A.E.O.), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - H A Hamou
- Department of Neurosurgery (R.P., H.C., H.A.H.)
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Ryan DJ, Kavanagh RG, Joyce S, O'Callaghan Maher M, Moore N, McMahon A, Hussey D, O'Sullivan MGJ, Wyse G, Fanning N, O'Connor OJ, Maher MM. Development and implementation of an ultralow-dose CT protocol for the assessment of cerebrospinal shunts in adult hydrocephalus. Eur Radiol Exp 2021; 5:26. [PMID: 34180040 PMCID: PMC8236421 DOI: 10.1186/s41747-021-00222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Cerebrospinal fluid shunts in the treatment of hydrocephalus, although associated with clinical benefit, have a high failure rate with repeat computed tomography (CT) imaging resulting in a substantial cumulative radiation dose. Therefore, we sought to develop a whole-body ultralow-dose (ULD) CT protocol for the investigation of shunt malfunction and compare it with the reference standard, plain radiographic shunt series (PRSS). Methods Following ethical approval, using an anthropomorphic phantom and a human cadaveric ventriculoperitoneal shunt model, a whole-body ULD-CT protocol incorporating two iterative reconstruction (IR) algorithms, pure IR and hybrid IR, including 60% filtered back projection and 40% IR was evaluated in 18 adult patients post new shunt implantation or where shunt malfunction was suspected. Effective dose (ED) and image quality were analysed. Results ULD-CT permitted a 36% radiation dose reduction (median ED 0.16 mSv, range 0.07–0.17, versus 0.25 mSv (0.06–1.69 mSv) for PRSS (p = 0.002). Shunt visualisation in the thoracoabdominal cavities was improved with ULD-CT with pure IR (p = 0.004 and p = 0.031, respectively) and, in contrast to PRSS, permitted visualisation of the entire shunt course (p < 0.001), the distal shunt entry point and location of the shunt tip in all cases. For shunt complications, ULD-CT had a perfect specificity. False positives (3/22, 13.6%) were observed with PRSS. Conclusions At a significantly reduced radiation dose, whole body ULD-CT with pure IR demonstrated diagnostic superiority over PRSS in the evaluation of cerebrospinal fluid shunt malfunction. Supplementary Information The online version contains supplementary material available at 10.1186/s41747-021-00222-4.
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Affiliation(s)
- David J Ryan
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland.
| | - Richard G Kavanagh
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Stella Joyce
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | | | - Niamh Moore
- Department of Radiography, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, T12 AK54, Ireland
| | - Aisling McMahon
- Department of Medical Physics, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Deirdre Hussey
- Department of Neurosurgery, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Michael G J O'Sullivan
- Department of Neurosurgery, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Gerald Wyse
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Noel Fanning
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland.,School of Medicine, University College Cork, Cork, Ireland
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