Replacing Computed Tomography with "Rapid" Magnetic Resonance Imaging for Ventricular Shunt Imaging

Area of Science:

• Pediatric Neurology
• Radiology
• Quality Improvement

Background:

• Children with ventricular shunts require frequent neuroimaging, leading to significant radiation exposure.
• Evaluating shunt malfunctions necessitates timely and accurate diagnostic imaging.

Purpose of the Study:

• To reduce radiation exposure in pediatric patients with ventricular shunts by decreasing computed tomography (CT) use.
• To increase the utilization of rapid magnetic resonance imaging (rMRI-shunt) for evaluating shunt malfunctions.

Main Methods:

• A single-center quality improvement study was conducted in a pediatric emergency department.
• A multidisciplinary guideline was implemented, prioritizing rMRI-shunt over CT for shunt evaluation.
• Data on neuroimaging rates, CT use, rMRI-shunt use, and emergency department (ED) length of stay were collected pre- and post-intervention.

Main Results:

• CT use decreased from 90.1% to 34.8%, while rMRI-shunt use increased from 9.9% to 65.2%.
• Neuroimaging rates remained similar (80.7% vs. 81.5%), with no significant changes in revisits or follow-up imaging.
• Mean time to neuroimaging and ED length of stay increased, but these increases were not statistically significant.

Conclusions:

• Implementation of a standardized guideline effectively reduced CT use and increased rMRI-shunt use in a pediatric ED.
• The findings suggest a successful strategy for minimizing radiation exposure in children with ventricular shunts.
• Clinicians must consider the trade-offs between reduced radiation and increased imaging time when utilizing rMRI-shunt.