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Changing Trends in Brain Imaging Technique for Pediatric Patients with Ventriculoperitoneal Shunts
Margaret J Trost1, Nathan Robison, Dean Coffey
1Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
Magnetic resonance imaging (MRI) is increasingly used for evaluating children with ventriculoperitoneal shunts (VPS), offering a radiation-free alternative to computed tomography (CT). Increased MRI use is associated with older patients but not higher costs.
Area of Science:
- Pediatric neurosurgery
- Medical imaging
- Radiation oncology
Background:
- Children with ventriculoperitoneal shunts (VPS) face malignancy risks from repeated brain computed tomography (CT) scans.
- Magnetic resonance imaging (MRI) offers a radiation-free alternative for evaluating VPS malfunction.
Purpose of the Study:
- To assess the adoption rate of radiation-avoiding MRI techniques in hospitals evaluating pediatric VPS patients.
- To identify factors influencing MRI utilization compared to CT scans.
Main Methods:
- Secondary analysis of the Pediatric Health Information System (PHIS) database (2007-2015).
- Inclusion of children with VPS receiving noncontrast neuroimaging.
- Comparison of MRI incidence over time and demographic characteristics between high-use and minimal-use MRI hospitals.
Main Results:
- MRI use increased by 18.1% between 2007 and 2015.
- Hospitals were categorized into high-use (n=12) and minimal-use (n=19) MRI groups.
- High-MRI-use hospitals had older patients (mean age 8.1 vs. 7.5 years; p=0.03) but no significant difference in cost or length of stay.
Conclusions:
- MRI is increasingly adopted for evaluating pediatric VPS patients.
- Higher MRI utilization is linked to older patient demographics.
- Quality improvement initiatives may help overcome barriers to wider MRI adoption.
Background:
Children with ventriculoperitoneal shunts (VPS) undergoing brain computed tomography (CT) for shunt malfunction evaluation are at risk for later malignancy due to radiation exposure. We aimed to determine if and how hospitals have adopted radiation-avoiding magnetic resonance imaging (MRI) techniques.
Methods:
We performed a secondary analysis of the Pediatric Health Information System (PHIS) database. Children with VPS presenting to acute wards at 31 PHIS hospitals between January 1, 2007 and January 2, 2015 and receiving noncontrast neuroimaging on day of service 0/1 were included. Outcome measures were (1) incidence of MRI over time and (2) comparison of demographic characteristics between hospitals with MRI representing higher versus lower proportions (>15% or <15%) of total brain imaging.
Results:
MRIs increased by 18.1% from 2007 to 2015. Hospitals were assigned to high-use (n = 12) or minimal-use (n = 19) MRI groups based on year 2014/2015 MRI percentages. The only identified difference was an older mean age in the high-use group (8.1 vs. 7.5 years; p = 0.03).
Conclusions:
MRI is increasingly used to evaluate patients with VPS. Hospitals with more MRI use had older patients and no increase in cost or length of stay. Initiating local quality improvement projects may help identify barriers to MRI uptake and increase use.
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