Child's Nervous System

, Volume 29, Issue 7, pp 1177–1181 | Cite as

The open fontanelle: a window to less radiation

  • Tafadzwa MandiwanzaEmail author
  • Colm Saidlear
  • John Caird
  • Darach Crimmins
Original Paper



Over the years, there has been increasing awareness of the radiation doses from medical investigation and treatment modalities and the long-term effect of this radiation. In no other patient population is this more of an issue than in the paediatric population who are more radiosensitive and have a longer life span in which to express any negative effects of radiation. In children under the age of one, the anterior fontanelle is an acoustic window to intracranial structures allowing for the use of cranial ultrasound (CRUSS) instead of CT.


To determine the pattern of CT and Cranial ultrasound used in patients aged one or younger with shunt treated hydrocephalus.


A retrospective review of patients who had a shunt inserted before the age of one and their imaging. Effective radiation doses were calculated for those who had CT scans.


One hundred thirty-five patients were included with 227 CTs and 124 CRUSS conducted. In the follow-up period after shunt insertion, 92 patients had CTs while 14 were followed with CRUSS and 51 patients required a shunt revision before the age of one. The average effective radiation dose per scan was 2.76 mSv.


Children with an open fontanelle and shunt can be followed reliably with CRUSS in order to reduce their exposure to radiation.


Anterior fontanelle Cranial ultrasound Hydrocephalus Effective radiation dose 


  1. 1.
    Antes S, Kiefer M, Schmitt M, Lechtenfeld M, Geipel M, Eymann R (2012) Frontal and temporal horn ratio: a valid and reliable index to determine ventricular size in paediatric hydrocephalus patients? Acta Neurochirurgica Suppliment 114:227–230CrossRefGoogle Scholar
  2. 2.
    Bernier M, Rehel J, Brisse H, Wu-Zhou X, Caer-Lorho S, Jacob S, Chateil J, Aubert B, Laurier D (2012) Radiation exposure from CT in early childhood: a French large-scale multicentre study. Br J Radiol 85(1009):53–60PubMedCrossRefGoogle Scholar
  3. 3.
    Berrington de Gonzalez A, Darby S (2004) Risks of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 363(9406):345–351PubMedCrossRefGoogle Scholar
  4. 4.
    Bithell J, Stewart A (1975) Pre-natal radiation and childhood malignancy: a review of British data from the Oxford Survey. Br J Cancer 31(3):271–287PubMedCrossRefGoogle Scholar
  5. 5.
    Brady Z, Cain T, Johnston P (2011) Paediatric CT imaging trends in Australia. Journal of Medical Imaging and Radiation Oncology 55:132–142PubMedCrossRefGoogle Scholar
  6. 6.
    Brenner D (2002) Estimating cancer risks from paediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32:228–231PubMedCrossRefGoogle Scholar
  7. 7.
    Brenner D, Doll R, Goodhead D, Hall E, Land C, Little J, Lubin J, Preston D, Preston R, Puskin J, Ron E, Sachs R, Samet J, Setlow R, Zaider M (2003) Cancer risks attributable to low dose of ionising radiation: assessing what we really know. Proc Natl Acad Sci U S A 100(24):13761–13766PubMedCrossRefGoogle Scholar
  8. 8.
    Brenner D, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from paediatric CT. Am J Roentgenol 176(2):289–296CrossRefGoogle Scholar
  9. 9.
    Deak P, Smal Y, Kalender W (2010) Multisection CT Protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 257:158–166PubMedCrossRefGoogle Scholar
  10. 10.
    Dincer A, Ozek M (2011) Radiologic evaluation of paediatric hydrocephalus. Childs Nervous System 27:1543–1562CrossRefGoogle Scholar
  11. 11.
    Environment ECD-Gft (2007) Radiation Protection 118- Referral Guidelines for imaging, .19 and 111Google Scholar
  12. 12.
    Hall E, Brenner D (2008) Cancer risks from diagnostic radiology. Br J Radiol 81(965):362–378. doi: 10.1259/bjr/01948454 PubMedCrossRefGoogle Scholar
  13. 13.
    Holmedal L, Friberg E, Borretzen I, Olerud H, Laegreid L, Rosendahl K (2007) Radiation doses to children with shunt-treated hydrocephalus. Pediatr Radiol 37(12):1209–1215PubMedCrossRefGoogle Scholar
  14. 14.
    Hounsfield G (1973) Computerized transverse axial scanning (tomography): Part 1. Description of system British Journal of Radiology 46:1016–1022CrossRefGoogle Scholar
  15. 15.
    Hsu C, Lee K, Jeng M, Chang K, Yang C, Tsao P, Lee Y, Chen S, Soong W, Tang R (2012) Cranial ultrasonoraphic findings in healthy full-term neonates: a retrospective review. Journal of the Chinese Medical Association 75(8):389–395PubMedCrossRefGoogle Scholar
  16. 16.
    Kielser J, Ricer R (2003) The abnormal fontanel. Am Fam Physician 67(12):2547–2552Google Scholar
  17. 17.
    Lowe L, Bailey Z (2011) State-of-the-art cranial sonography: part 1, modern techniques and image interpretation. Am J Roentgenol 196(5):1028–1033CrossRefGoogle Scholar
  18. 18.
    Pearce M (2011) Patterns in paediatric CT use: an international and epidemiological perspective. Journal of Medical Imaging and Radiation Oncology 55:107–109PubMedCrossRefGoogle Scholar
  19. 19.
    Pearce M, Salotti J, Little M, McHugh K, Lee C, Kim K, Howe N, Ronckers C, Rajaraman P, Craft A, Parker L, Berrington de Gonzalez A (2012) Radiation exposure from ct scns in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505PubMedCrossRefGoogle Scholar
  20. 20.
    Preston D, Ron E, Tokuoka S, Funamoto S, Nishi N, Soda M, Mabuchi K, Kodama K (2007) Solid cancer incidence in atomic bomb survivors: 1958–1998. Radiat Res 168(1):1–64PubMedCrossRefGoogle Scholar
  21. 21.
    Protection ICoR (2007) The 2007 Recommendations of the International Commission on Radiological Protection: ICRP Publication 103. Annals of the International Commission on Radiation Protection 37(2–4):1–332Google Scholar
  22. 22.
    VII B (2006) Health risks from exposure to low levels of ionizing radiation: BEIR VII- Phase 2 committee to assess health risks from exposure to low levels of ionizing radiation, National Research Council, The national academies pressWashington:1–424Google Scholar
  23. 23.
    Wakhlu A, Ansari N (2004) The prediction of postoperative hydrocephalus in patients with spina bifida. Childs Nervous System 20:104–106CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Tafadzwa Mandiwanza
    • 1
    Email author
  • Colm Saidlear
    • 2
  • John Caird
    • 1
  • Darach Crimmins
    • 1
  1. 1.Department of Paediatric NeurosurgeryChildren’s University HospitalDublin 1Republic of Ireland
  2. 2.Department of RadiologyChildren’s University HospitalDublin 1Republic of Ireland

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