• Liat Ben-Sira, Shelly I Shiran, Li-Tal Pratt, Ronit Precel, Dror Ovadia, Shlomi Constantini, and Jonathan Roth.
• Division of Pediatric Radiology, Department of Radiology, Dana Children's Hospital, Tel-Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
• World Neurosurg. 2018 Aug 1; 116: e273-e277.

IntroductionShunt series (SS) are a common diagnostic tool used to verify shunt integrity. SS include X-ray films of the skull, chest, and abdomen and often are performed either when a shunted patient presents with suspected shunt malfunction or as a screening test to identify shunt disconnections or dislodgment. EOS low-dose biplanar X-rays are associated with significantly reduced radiation doses compared with ordinary X-rays and are used for various indications. This is the first publication on the use of EOS as a SS technique.MethodsOver a period of 6 months, EOS were performed at our center for various orthopedic indications, mostly for scoliosis evaluation. Nine children (<20 years of age) had a ventriculoperitoneal shunt and served as the study group. We retrospectively reviewed shunt visibility and integrity in the EOS scans as well as regular SS or plain spinal X-rays.ResultsThree patients had bilateral shunts, and 8 had previous X-rays for comparison. In all patients, the shunt integrity was easily demonstrated on the EOS images. Two patients had an identified shunt disconnection confirmed on the EOS images. No shunt-related information was missed on the EOS compared with the other X-ray images.ConclusionsThese preliminary results suggest that EOS may be used as an alternative technology to demonstrate shunt integrity instead of regular X-ray SS. Favorable shunt visibility without the need for multiple radiation exposures and image processing (such as stitching) results in a significantly shorter examination time and significant less radiation.Copyright © 2018 Elsevier Inc. All rights reserved.

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