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Therefore, we sought to develop a whole-body ultralow-dose (ULD) CT protocol for the investigation of shunt malfunction and compare it with the reference standard, plain radiographic shunt series (PRSS).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Following ethical approval, using an anthropomorphic phantom and a human cadaveric ventriculoperitoneal shunt model, a whole-body ULD-CT protocol incorporating two iterative reconstruction (IR) algorithms, pure IR and hybrid IR, including 60% filtered back projection and 40% IR was evaluated in 18 adult patients post new shunt implantation or where shunt malfunction was suspected. Effective dose (ED) and image quality were analysed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>ULD-CT permitted a 36% radiation dose reduction (median ED 0.16 mSv, range 0.07\u20130.17, <jats:italic>versus<\/jats:italic> 0.25 mSv (0.06\u20131.69 mSv) for PRSS (<jats:italic>p<\/jats:italic> = 0.002). Shunt visualisation in the thoracoabdominal cavities was improved with ULD-CT with pure IR (<jats:italic>p<\/jats:italic> = 0.004 and <jats:italic>p<\/jats:italic> = 0.031, respectively) and, in contrast to PRSS, permitted visualisation of the entire shunt course (<jats:italic>p<\/jats:italic> &lt; 0.001), the distal shunt entry point and location of the shunt tip in all cases. For shunt complications, ULD-CT had a perfect specificity. False positives (3\/22, 13.6%) were observed with PRSS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>At a significantly reduced radiation dose, whole body ULD-CT with pure IR demonstrated diagnostic superiority over PRSS in the evaluation of cerebrospinal fluid shunt malfunction.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s41747-021-00222-4","type":"journal-article","created":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T00:02:18Z","timestamp":1624838538000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Development and implementation of an ultralow-dose CT protocol for the assessment of cerebrospinal shunts in adult hydrocephalus"],"prefix":"10.1186","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8906-2379","authenticated-orcid":false,"given":"David J.","family":"Ryan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard G.","family":"Kavanagh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stella","family":"Joyce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mika","family":"O\u2019Callaghan Maher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niamh","family":"Moore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aisling","family":"McMahon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deirdre","family":"Hussey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael G. J.","family":"O\u2019Sullivan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald","family":"Wyse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noel","family":"Fanning","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Owen J.","family":"O\u2019Connor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael M.","family":"Maher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,6,28]]},"reference":[{"key":"222_CR1","doi-asserted-by":"publisher","first-page":"i17","DOI":"10.1136\/jnnp.73.suppl_1.i17","volume":"73","author":"IK Pople","year":"2002","unstructured":"Pople IK (2002) Hydrocephalus and shunts: what the neurologist should know. 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Written informed consent was obtained from all patients in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"MMM was a co-investigator on Science Foundation Ireland grant (SFI\/12\/RC\/2273) which funded a research centre, the APC Microbiome Institute based at University College Cork, Ireland. Investigation of Utility of Model-Based Iterative Reconstruction in optimising CT scanning in patients with Inflammatory Bowel Disease was a funded theme of this research grant. MMM has not received any personal renumeration from GE Healthcare or other companies.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"26"}}