=====Low dose computed tomography=====
The implementation of a low-dose head CT protocol substantially reduced the amount of ionizing radiation exposure in a preselected population of pediatric neurosurgical patients. Image quality and diagnostic utility were not significantly compromised
((Morton RP, Reynolds RM, Ramakrishna R, Levitt MR, Hopper RA, Lee A, Browd SR. 
Low-dose head computed tomography in children: a single institutional experience 
in pediatric radiation risk reduction: clinical article. J Neurosurg Pediatr.
2013 Oct;12(4):406-10. doi: 10.3171/2013.7.PEDS12631. Epub 2013 Aug 23. PubMed
PMID: 23971634.
)).

In a cohort of patients in the neurosurgical [[intensive care unit]], dedicated ultra-low-dose CT for surveillance head CT imaging led to a significant dose reduction while maintaining adequate image quality
((Corcuera-Solano I, Doshi AH, Noor A, Tanenbaum LN. Repeated head CT in the
neurosurgical intensive care unit: feasibility of sinogram-affirmed iterative
reconstruction-based ultra-low-dose CT for surveillance. AJNR Am J Neuroradiol.
2014 Jul;35(7):1281-7. doi: 10.3174/ajnr.A3861. Epub 2014 Feb 20. PubMed PMID:
24557704.
)).

Although replacing a CT with magnetic resonance imaging is ideal to completely avoid ionizing radiation, this is not always practical or preferred. Therefore, it is important to have CT protocols in place that minimize radiation dose without sacrificing diagnostic quality
((Albert GW, Glasier CM. Strategies for Computed Tomography Radiation Dose
Reduction in Pediatric Neuroimaging. Neurosurgery. 2015 Aug;77(2):228-32;
discussion 232. doi: 10.1227/NEU.0000000000000764. PubMed PMID: 25856110.
)).
----
The evaluation of children with suspected [[ventriculoperitoneal shunt malfunction]] has evolved into a diagnostic dilemma. This patient population is vulnerable not only to the medical risks of [[hydrocephalus]] and surgical complications but also to silent but harmful effects of ionizing radiation secondary to imaging used to evaluate shunt efficacy and patency. The combination of increased medical awareness regarding ionizing radiation and public concern has generated desire to reduce the reliance on [[head computed tomography]] (CT) for the evaluation of VPS malfunction. Many centers have started to investigate the utility of [[low dose computed tomography]] and alternatives, such as fast [[magnetic resonance imaging]] for the investigation of VP shunt malfunction in order to keep radiation exposure as low as reasonably achievable.

A pilot study demonstrates that utilization of limited head CT scan in the evaluation of children with suspected VP shunt malfunction is a feasible strategy for the evaluation of the ventricular size
((Park DB, Hill JG, Thacker PG, Rumboldt Z, Huda W, Ashley B, Hulsey T, Russell 
WS. The Role of Limited Head Computed Tomography in the Evaluation of Pediatric
Ventriculoperitoneal Shunt Malfunction. Pediatr Emerg Care. 2016 Jun 14. [Epub
ahead of print] PubMed PMID: 27299297.
)).

In the study of Afat et al., low-dose computed tomography (LD-CT) provides excellent sensitivity and higher diagnostic confidence with lower radiation exposure compared with radiographic shunt series (SS)
((Afat S, Pjontek R, Hamou HA, Herz K, Nikoubashman O, Bamberg F, Brockmann MA, 
Nikolaou K, Clusmann H, Wiesmann M, Othman AE. Imaging of Ventriculoperitoneal
Shunt Complications: Comparison of Whole Body Low-Dose Computed Tomography and
Radiographic Shunt Series. J Comput Assist Tomogr. 2016 Aug 16. [Epub ahead of
print] PubMed PMID: 27529684.
)).