{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:38:48Z","timestamp":1792809528316,"version":"4.5.0"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>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\u2013$366 and $1300\u2013$1547, respectively). The radiation dose was also lower for EOS images, with an effective dose of 0.086\u20130.140 mSv compared to approximately 1.6 mSv for a similar field of view with conventional radiography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2020.8.peds20428","type":"journal-article","created":{"date-parts":[[2021,1,8]],"date-time":"2021-01-08T02:19:10Z","timestamp":1610072350000},"page":"375-381","source":"Crossref","is-referenced-by-count":5,"title":["Image quality of EOS low-dose radiography in comparison with conventional radiography for assessment of ventriculoperitoneal shunt integrity"],"prefix":"10.3171","volume":"27","author":[{"given":"Karen","family":"Monuszko","sequence":"first","affiliation":[{"name":"Duke University School of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Malinzak","sequence":"additional","affiliation":[{"name":"Departments of Radiology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lexie Zidanyue","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Niedzwiecki","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie R.","family":"Muh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Westchester Medical Center, Valhalla, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista","family":"Gingrich","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Duke University Medical Center;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Lark","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Duke University Medical Center;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric M.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Curr Probl Diagn Radiol","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1067\/j.cpradiol.2017.07.006","article-title":"Common and uncommon causes of ventriculoperitoneal shunt malfunction diagnosed on plain radiographs","volume":"47","author":"Bates P","year":"2018","unstructured":"Bates P, \nRajderkar D\n. \nCommon and uncommon causes of ventriculoperitoneal shunt malfunction diagnosed on plain radiographs. Curr Probl Diagn Radiol. \n2018;\n47(\n5):\n317\u2013\n323.\n10.1067\/j.cpradiol.2017.07.00628830622"},{"issue":"2","key":"b2","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1097\/00006123-199808000-00068","article-title":"Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus","volume":"43","author":"Drake JM","year":"1998","unstructured":"Drake JM, \nKestle JR, \nMilner R, \n\n \nRandomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery. \n1998;\n43(\n2):\n294\u2013\n305.\n969608210.1097\/00006123-199808000-00068"},{"issue":"1","key":"b3","series-title":"J Taibah Univ Med Sci","first-page":"45","article-title":"Is shunt series X-ray necessary before revision of obstructed ventriculoperitoneal shunt?","volume":"9","author":"Elgamal EA","year":"2014","unstructured":"Elgamal EA, \nMurshid WR, \nElwatidy SMF, \nJamjoom ZB\n. \nIs shunt series X-ray necessary before revision of obstructed ventriculoperitoneal shunt? J Taibah Univ Med Sci. \n2014;\n9(\n1):\n45\u2013\n49."},{"issue":"5","key":"b4","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1159\/000055960","article-title":"Long-term follow-up data from the Shunt Design Trial","volume":"33","author":"Kestle J","year":"2000","unstructured":"Kestle J, \nDrake J, \nMilner R, \n\n \nLong-term follow-up data from the Shunt Design Trial. 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Childs Nerv Syst. \n2008;\n24(\n4):\n493\u2013\n497.\n1818093510.1007\/s00381-007-0560-x"},{"issue":"12","key":"b6","series-title":"Pediatr Radiol","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1007\/s00247-007-0625-8","article-title":"Radiation doses to children with shunt-treated hydrocephalus","volume":"37","author":"Holmedal LJ","year":"2007","unstructured":"Holmedal LJ, \nFriberg EG, \nB\u00f8rretzen I, \n\n \nRadiation doses to children with shunt-treated hydrocephalus. Pediatr Radiol. \n2007;\n37(\n12):\n1209\u2013\n1215.\n10.1007\/s00247-007-0625-817926028"},{"issue":"3","key":"b7","series-title":"Joint Bone Spine","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1016\/j.jbspin.2012.09.018","article-title":"Musculoskeletal imaging in progress: the EOS imaging system","volume":"80","author":"Wybier M","year":"2013","unstructured":"Wybier M, \nBossard P\n. \nMusculoskeletal imaging in progress: the EOS imaging system. 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