Optimization of Codman® Hakim® adjustable valve radiography

Purpose Cerebrospinal fluid shunt valves is an important tool in hydrocephalus treatment. Adjustable valves, sensitive to MRI, are onerous. They need be controlled; in case of re-settings. The vendor give advices for the radiographic procedure; however, hospitals use variations. The purpose was to investigate the different variations. Method Eight images consisting combinations of protocol features, were subjectively and anonymous rated for image quality. The panel consisted of 60 professionals; 50 radiographers and 10 radiologists, from two hospitals doing neurosurgery services. Signal-to-noise ratio compared the level of desired signal to the level of background noise. Results 348 scores were distributed onto all eight images, revealing the image quality difference was within acceptance. Options as valve on the head side near to the detector versus far to; differing geometry, use of head bowl versus not use, air-gap versus grids, were favored by both professional groups and at both hospitals in a clear priority image, given 2.5 times scores over average (108/43). Noise, revealed being the strongest indicator for priority of the best image for shunt evaluation. Conclusions It is a potential to improve image optimization in shunt radiography.