Image quality of EOS low-dose radiography in comparison with conventional radiography for assessment of ventriculoperitoneal shunt integrity

View More View Less
  • 1 Duke University School of Medicine;
  • 2 Departments of Radiology,
  • 4 Neurosurgery, and
  • 6 Orthopedic Surgery, Duke University Medical Center;
  • 3 Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina; and
  • 5 Department of Neurosurgery, Westchester Medical Center, Valhalla, New York
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Patients with shunted hydrocephalus often accumulate high levels of radiation over their lifetimes during evaluation of hardware integrity. Current practice involves the use of a series of conventional radiographs for this purpose. Newer low-dose EOS radiography is currently used to evaluate scoliosis but has not been explored to evaluate shunt integrity on a large scale. The goal of this study was to compare the quality of imaging using EOS low-dose radiography to conventional radiography to evaluate shunt tubing.

METHODS

A retrospective chart review was performed on 57 patients who previously had both conventional radiographs and low-dose EOS images of their cerebral shunt tubing from 2000 to 2018. Patient demographics (age, sex, type of shunt tubing, primary diagnosis) were collected. Conventional radiographic images and low-dose EOS images were independently analyzed by a neurosurgeon and neuroradiologist in three categories: image quality, delineation of shunt, and distinction of shunt compared to adjacent anatomy.

RESULTS

All patients had shunted hydrocephalus due to spina bifida and Chiari type II malformation. Ratings of EOS and conventional radiographic images by both raters did not differ significantly in terms of image quality (rater 1, p = 0.499; rater 2, p = 0.578) or delineation of shunt (p = 0.107 and p = 0.256). Conventional radiographic images received significantly higher ratings than EOS on the ability to distinguish the shunt versus adjacent anatomy by rater 1 (p = 0.039), but not by rater 2 (p = 0.149). The overall score of the three categories combined was not significantly different between EOS and conventional radiography (rater 1, p = 0.818; rater 2, p = 0.186). In terms of cost, an EOS image was less costly than a conventional radiography shunt series ($236–$366 and $1300–$1547, respectively). The radiation dose was also lower for EOS images, with an effective dose of 0.086–0.140 mSv compared to approximately 1.6 mSv for a similar field of view with conventional radiography.

CONCLUSIONS

The image quality of low-dose EOS radiography does not significantly differ from conventional radiography for the evaluation of cerebral shunts. In addition, EOS affords a much lower radiation dose and a lower cost.

ABBREVIATIONS AP = anterior-posterior; CI = confidence interval; VNS = vagus nerve stimulator.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Eric M. Thompson: Duke University Medical Center, Durham, NC. eric.thompson@duke.edu.

INCLUDE WHEN CITING Published online January 8, 2021; DOI: 10.3171/2020.8.PEDS20428.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Bates P, Rajderkar D. Common and uncommon causes of ventriculoperitoneal shunt malfunction diagnosed on plain radiographs. Curr Probl Diagn Radiol. 2018;47(5):317323.

    • Search Google Scholar
    • Export Citation
  • 2

    Drake JM, Kestle JR, Milner R, Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery. 1998;43(2):294305.

    • Search Google Scholar
    • Export Citation
  • 3

    Elgamal EA, Murshid WR, Elwatidy SMF, Jamjoom ZB. Is shunt series X-ray necessary before revision of obstructed ventriculoperitoneal shunt? J Taibah Univ Med Sci. 2014;9(1):4549.

    • Search Google Scholar
    • Export Citation
  • 4

    Kestle J, Drake J, Milner R, Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg. 2000;33(5):230236.

  • 5

    Smyth MD, Narayan P, Tubbs RS, Cumulative diagnostic radiation exposure in children with ventriculoperitoneal shunts: a review. Childs Nerv Syst. 2008;24(4):493497.

    • Search Google Scholar
    • Export Citation
  • 6

    Holmedal LJ, Friberg EG, Børretzen I, Radiation doses to children with shunt-treated hydrocephalus. Pediatr Radiol. 2007;37(12):12091215.

    • Search Google Scholar
    • Export Citation
  • 7

    Wybier M, Bossard P. Musculoskeletal imaging in progress: the EOS imaging system. Joint Bone Spine. 2013;80(3):238243.

  • 8

    Harris PA, Taylor R, Thielke R, Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377381.

    • Search Google Scholar
    • Export Citation
  • 9

    Fathi A-R, Mariani L, Szucs Farkas Z, Evaluation of the new Statscan radiography device for ventriculoperitoneal shunt assessment. AJR Am J Roentgenol. 2011;196(3):W285W289.

    • Search Google Scholar
    • Export Citation
  • 10

    Law M, Ma W-K, Chan E, Evaluation of cumulative effective dose and cancer risk from repetitive full spine imaging using EOS system: impact to adolescent patients of different populations. Eur J Radiol. 2017;96:15.

    • Search Google Scholar
    • Export Citation
  • 11

    Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248(1):254263.

    • Search Google Scholar
    • Export Citation
  • 12

    Ben-Sira L, Shiran SI, Pratt LT, Use of EOS low-dose biplanar X-ray for shunt series in children with hydrocephalus: a preliminary study. World Neurosurg. 2018;116:e273e277.

    • Search Google Scholar
    • Export Citation
  • 13

    Hey HWD, Chan CX, Wong YM, The effectiveness of full-body EOS compared with conventional chest X-ray in preoperative evaluation of the chest for patients undergoing spine operations: a preliminary study. Spine (Phila Pa 1976). 2018;43(21):15021511.

    • Search Google Scholar
    • Export Citation
  • 14

    Powell J, Gibly RF, Faulk LW, Can EOS imaging substitute for conventional radiography in measurement of acetabular morphology in the young dysplastic hip? J Pediatr Orthop. 2020;40(6):294299.

    • Search Google Scholar
    • Export Citation
  • 15

    Hirsch C, Ilharreborde B, Mazda K. Flexibility analysis in adolescent idiopathic scoliosis on side-bending images using the EOS imaging system. Orthop Traumatol Surg Res. 2016;102(4):495500.

    • Search Google Scholar
    • Export Citation
  • 16

    Alrehily F, Hogg P, Twiste M, Scoliosis imaging: an analysis of radiation risk in the CT scan projection radiograph and a comparison with projection radiography and EOS. Radiography (Lond). 2019;25(3):e68e74.

    • Search Google Scholar
    • Export Citation
  • 17

    Pedersen PH, Petersen AG, Østgaard SE, EOS micro-dose protocol: first full-spine radiation dose measurements in anthropomorphic phantoms and comparisons with EOS standard-dose and conventional digital radiology. Spine (Phila Pa 1976). 2018;43(22):E1313E1321.

    • Search Google Scholar
    • Export Citation
  • 18

    Huda W. Effective doses to adult and pediatric patients. Pediatr Radiol. 2002;32(4):272279.

  • 19

    McKenna C, Wade R, Faria R, EOS 2D/3D X-ray imaging system: a systematic review and economic evaluation. Health Technol Assess. 2012;16(14):1188.

    • Search Google Scholar
    • Export Citation
  • 20

    Andriole KP. Productivity and cost assessment of computed radiography, digital radiography, and screen-film for outpatient chest examinations. J Digit Imaging. 2002;15(3):161169.

    • Search Google Scholar
    • Export Citation
  • 21

    Hull NC, Binkovitz LA, Schueler BA, Upright biplanar slot scanning in pediatric orthopedics: applications, advantages, and artifacts. AJR Am J Roentgenol. 2015;205(1):W124W132.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 109 109 109
Full Text Views 64 64 64
PDF Downloads 40 40 40
EPUB Downloads 0 0 0