Child's Nervous System

, Volume 24, Issue 4, pp 493–497 | Cite as

Cumulative diagnostic radiation exposure in children with ventriculoperitoneal shunts: a review

  • Matthew D. Smyth
  • Prithvi Narayan
  • R. Shane Tubbs
  • Jeffrey R. Leonard
  • T. S. Park
  • Marios Loukas
  • Paul A. Grabb
Case for Discussion

Abstract

Introduction

Children may be more vulnerable to diagnostic radiation exposure because of the increased dose–volume ratio and the increased lifetime risk per unit dose of radiation from early exposure. Moreover, recent radiological literature suggests that exposure to ionizing radiation from imaging studies may play a role in the later development of malignancies.

Materials and Methods

We review the literature and present two illustrative clinical examples of children (each child developed head and neck malignancies during their late teen years) with hydrocephalus requiring multiple cerebrospinal fluid (CSF) shunt revisions and diagnostic computerized tomography (CT) scans throughout their life.

Discussion

The literature reviewed suggests that children are more prone to diagnostic radiation exposure. Although it is not possible to prove that the multiple diagnostic studies result in malignancies, our review of the literature and illustrative cases describing malignancy risk and radiation exposure should give clinicians pause when considering requesting multiple diagnostic CT studies in children during the evaluation of possible CSF shunt dysfunction. Alternative tests such as “shunt MRI” protocols should be considered for patients and used whenever possible to minimize exposure to ionizing radiation.

Keywords

Pediatric Diagnostic Induced malignancy Hydrocephalus 

Notes

Acknowledgements

The authors express their sincere appreciation for the contributions to this manuscript from Drs. Arie Perry (Department of Pathology, Washington University) and Glenn Fletcher (Department of Physics, Washington University).

References

  1. 1.
    Ashley W, Leonard JR, Smyth MD, Ojemann JG, Park TS (2003) Rapid MRI in the evaluation of shunted hydrocephalus. AANS/CNS Joint Section on Pediatric Neurological Surgery, Salt Lake CityGoogle Scholar
  2. 2.
    Bance M, Guha A (2001) Radiation-induced malignant tumors after stereotactic radiosurgery. Otol Neurotol 22:124–125PubMedCrossRefGoogle Scholar
  3. 3.
    Berrington de Gonzalez A, Darby S (2004) Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 363:345–351PubMedGoogle Scholar
  4. 4.
    Boone JM, Geraghty EM, Seibert JA, Wootton-Gorges SL (2003) Dose reduction in pediatric CT: a rational approach. Radiology 228:352–360PubMedCrossRefGoogle Scholar
  5. 5.
    Brenner DJ, Elliston CD, Hall EJ, Berdon WE (2001) Estimates of the cancer risks from pediatric CT radiation are not merely theoretical: comment on “point/counterpoint: in x-ray computed tomography, technique factors should be selected appropriate to patient size. against the proposition. Med Phys 28:2387–2388PubMedCrossRefGoogle Scholar
  6. 6.
    Brenner D, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296PubMedGoogle Scholar
  7. 7.
    Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32:228–223discussion 242–244PubMedCrossRefGoogle Scholar
  8. 8.
    Chan CY, Wong YC, Chau LF, Yu SK, Lau PC (1999) Radiation dose reduction in paediatric cranial CT. Pediatr Radiol 29:770–775PubMedGoogle Scholar
  9. 9.
    Chang SM, Barker FG 2nd, Larson DA, Bollen AW, Prados MD (1995) Sarcomas subsequent to cranial irradiation. Neurosurgery 36:685–690PubMedCrossRefGoogle Scholar
  10. 10.
    Donnelly LF, Emery KH, Brody AS, Laor T, Gylys-Morin VM, Anton CG, Thomas SR, Frush DP (2001) Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large children's hospital. AJR Am J Roentgenol 176:303–306PubMedGoogle Scholar
  11. 11.
    Feigal DW Jr (2002) FDA public health notification: reducing radiation risk from computed tomography for pediatric and small adult patients. Int J Trauma Nurs 8:1–2PubMedCrossRefGoogle Scholar
  12. 12.
    Frush DP (2003) Responsible use of CT. Radiology 229:289–291PubMedCrossRefGoogle Scholar
  13. 13.
    Frush DP (2002) Introduction: the role of the pediatric radiologist in dose reduction. Pediatr Radiol 32:285–286PubMedCrossRefGoogle Scholar
  14. 14.
    Ganz JC (2002) Gamma knife radiosurgery and its possible relationship to malignancy: a review. J Neurosurg 97:644–652PubMedGoogle Scholar
  15. 15.
    Hall EJ (2002) Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol 32:700–706PubMedGoogle Scholar
  16. 16.
    Hanabusa K, Morikawa A, Murata T, Taki W (2001) Acoustic neuroma with malignant transformation. Case report. J Neurosurg 95:518–521PubMedGoogle Scholar
  17. 17.
    Hoshi M, Matsuura M, Hayakawa N, Ito C, Kamada N (1996) Estimation of radiation doses for atomic-bomb survivors in the Hiroshima University Registry. Health Phys 70:735–740PubMedCrossRefGoogle Scholar
  18. 18.
    Kaido T, Hoshida T, Uranishi R, Akita N, Kotani A, Nishi N, Sakaki T (2001) Radiosurgery-induced brain tumor. Case report. J Neurosurg 95:710–713PubMedCrossRefGoogle Scholar
  19. 19.
    Kamel IR, Hernandez RJ, Martin JE, Schlesinger AE, Niklason LT, Guire KE (1994) Radiation dose reduction in CT of the pediatric pelvis. Radiology 190:683–687PubMedGoogle Scholar
  20. 20.
    Khursheed A, Hillier MC, Shrimpton PC, Wall BF (2002) Influence of patient age on normalized effective doses calculated for CT examinations. Br J Radiol 75:819–830PubMedGoogle Scholar
  21. 21.
    Land CE (1995) Studies of cancer and radiation dose among atomic bomb survivors. The example of breast cancer. JAMA 274:402–407PubMedCrossRefGoogle Scholar
  22. 22.
    Linton OW, Mettler FA Jr (2003) National conference on dose reduction in CT, with an emphasis on pediatric patients. AJR Am J Roentgenol 181:321–329PubMedGoogle Scholar
  23. 23.
    Little MP, Charles MW (1997) The risk of non-melanoma skin cancer incidence in the Japanese atomic bomb survivors. Int J Radiat Biol 71:589–602PubMedCrossRefGoogle Scholar
  24. 24.
    Loeffler JS, Niemierko A, Chapman PH (2003) Second tumors after radiosurgery: tip of the iceberg or a bump in the road? Neurosurgery 52:1436–1440, discussion 1440–1442PubMedCrossRefGoogle Scholar
  25. 25.
    Lucaya J, Piqueras J, Garcia-Pena P, Enriquez G, Garcia-Macias M, Sotil J (2000) Low-dose high-resolution CT of the chest in children and young adults: dose, cooperation, artifact incidence, and image quality. AJR Am J Roentgenol 175:985–992PubMedGoogle Scholar
  26. 26.
    Mabuchi K, Soda M, Ron E, Tokunaga M, Ochikubo S, Sugimoto S, Ikeda T, Terasaki M, Preston DL, Thompson DE (1994) Cancer incidence in atomic bomb survivors. Part I: use of the tumor registries in Hiroshima and Nagasaki for incidence studies. Radiat Res 137:S1–S16PubMedCrossRefGoogle Scholar
  27. 27.
    Mannudeep K, Kalra M, Maher T, Toth L, Hamberg M, Blake J, Saini S (2004) Strategies for CT radiation dose optimization. Radiology 230:619–628CrossRefGoogle Scholar
  28. 28.
    Medow JE, Iskandar BJ (2002) “Quick brain” MRI versus CT scan for evaluating shunted hydrocephalus. AANS/CNS Joint Section on Pediatric Neurological Surgery, ScottsdaleGoogle Scholar
  29. 29.
    Morgan HT (2002) Dose reduction for CT pediatric imaging. Pediatr Radiol 32:724–728, discussion 751–754PubMedCrossRefGoogle Scholar
  30. 30.
    Paterson A, Frush DP, Donnelly LF (2001) Helical CT of the body: are settings adjusted for pediatric patients? AJR Am J Roentgenol 176:297–301PubMedGoogle Scholar
  31. 31.
    Pierce DA, Mendelsohn ML (1999) A model for radiation-related cancer suggested by atomic bomb survivor data. Radiat Res 152:642–654PubMedCrossRefGoogle Scholar
  32. 32.
    Preston DL, Ron E, Yonehara S, Kobuke T, Fujii H, Kishikawa M, Tokunaga M, Tokuoka S, Mabuchi K (2002) Tumors of the nervous system and pituitary gland associated with atomic bomb radiation exposure. J Natl Cancer Inst 94:1555–1563PubMedGoogle Scholar
  33. 33.
    Preston RJ (2004) Radiation biology: concepts for radiation protection. Heatlh Phys 87:3–14CrossRefGoogle Scholar
  34. 34.
    Robinson AE, Hill EP, Harpen MD (1986) Radiation dose reduction in pediatric CT. Pediatr Radiol 16:53–54PubMedCrossRefGoogle Scholar
  35. 35.
    Ron E, Preston DL, Kishikawa M, Kobuke T, Iseki M, Tokuoka S, Tokunaga M, Mabuchi K (1998) Skin tumor risk among atomic-bomb survivors in Japan. Cancer Causes Control 9:393–401PubMedCrossRefGoogle Scholar
  36. 36.
    Salvati M, Frati A, Russo N, Caroli E, Polli FM, Minniti G, Delfini R (2003) Radiation-induced gliomas: report of 10 cases and review of the literature. Surg Neurol 60:60–67 discussion 67PubMedCrossRefGoogle Scholar
  37. 37.
    Shamisa A, Bance M, Nag S, Tator C, Wong S, Noren G, Guha A (2001) Glioblastoma multiforme occurring in a patient treated with gamma knife surgery. Case report and review of the literature. J Neurosurg 94:816–821PubMedGoogle Scholar
  38. 38.
    Shin M, Ueki K, Kurita H, Kirino T (2002) Malignant transformation of a vestibular schwannoma after gamma knife radiosurgery. Lancet 360:309–310PubMedCrossRefGoogle Scholar
  39. 39.
    Yu JS, Yong WH, Wilson D, Black KL (2000) Glioblastoma induction after radiosurgery for meningioma. Lancet 356:1576–1577PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Matthew D. Smyth
    • 1
  • Prithvi Narayan
    • 1
  • R. Shane Tubbs
    • 2
  • Jeffrey R. Leonard
    • 1
  • T. S. Park
    • 1
  • Marios Loukas
    • 3
  • Paul A. Grabb
    • 4
  1. 1.Pediatric NeurosurgerySt. Louis Children’s Hospital, Washington UniversitySt. LouisUSA
  2. 2.Pediatric NeurosurgeryChildren’s HospitalBirminghamUSA
  3. 3.Department of Anatomical SciencesSt. George’s UniversitySt. GeorgeGrenada
  4. 4.Pediatric NeurosurgeryMemorial Hospital for ChildrenColorado SpringsUSA

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