Reducing Radiation Exposure for Children with Ventricular Shunts

Published on in CHOP News

4 arrows pointing to the center of a circle iconReduce Unnecessary Care

Why is this important?

Ventricular shunts are surgically placed tubes that drain spinal fluid from the brain to another part of the body to prevent fluid accumulation causing increased pressure on the brain. Children with congenital brain malformations, intracranial infections or brain tumors often benefit from having these devices placed. Malfunction of these shunts can result in life-threatening problems, and can be challenging to distinguish from routine childhood illness. Thus, many of these children require radiologic evaluation including brain CT scans and X-ray images to assure that the shunt is not malfunctioning. This increases the cumulative radiation exposure which increases the risk for cancer.

What we did

A team of Emergency Department and General Pediatric physicians, neuroradiologists and neurosurgeons at Children's Hospital of Philadelphia (CHOP) created a new clinical pathway to standardize the evaluation of these patients. This included a new brain CT protocol that minimizes radiation exposure along with delineating specific indications for when to obtain X-rays to evaluate for shunt position. The team then provided education, implemented the new practice and collected and reviewed outcomes of the patients treated using the new pathway.


ED Patient Total Radiation Exposure Millisievert (mSV) before and after Pathway Implementation

With the new imaging protocol, radiation exposure was decreased by 50 percent.

Percent of ED Patients that had Shunt X-rays before and After Pathway Implementation

Prior to the pathway, 62 percent of patients had X-rays done to evaluate the shunt. After the pathway was implemented, this rate was safely reduced to 5 percent.

Updated January, 2018

You Might Also Like

Reducing Albuterol Use in Children with Bronchiolitis

Bronchiolitis is often treated with albuterol, but this is an outdated practice. CHOP implemented an initiative to reduce its usage.

Broad-spectrum Antibiotics

CHOP works to avoid using broad-spectrum antibiotics for common childhood functions (ear, sinus, throat and lung infections).

Reducing Lumbar Punctures for Febrile Newborns

An initiative was implemented so that infants with fever who met low-risk criteria could be safely discharged home without a spinal tap.