Identify a Shunt Valve by X-ray

First-look sorting

Gallery

CERTAS Plus Integra (Codman) · Current

• Elongated valve; bright rectangular magnets on a central rotating construct.
• Setting = the overlay sector holding the magnet that has the tantalum ball beside it; a right-hand-side (RHS) marker orients the film.
• Read with the Integra X-ray overlay tool aligned to the valve centerline and connectors.

X-ray: Vach M, Weiss D, Ivan VL, et al. Clin Neuroradiol 2025;35:347–354, Fig. 2 — CC BY 4.0; cropped.

Hakim Programmable (CHPV) Integra (Codman) · Current

• Small ring (cam) with an adjacent white dot — the radiopaque marker on the cam.
• Read the marker position against the fixed right-hand-side marker; settings 70, 120 and 170 sit on the central cross.
• Inverted valve: the white marker appears on the LEFT. Program 210 − desired (190/200 not reachable) after first setting 200.

X-ray: Vach M, Weiss D, Ivan VL, et al. Clin Neuroradiol 2025;35:347–354, Fig. 2 — CC BY 4.0; cropped.

Strata II (with Delta chamber) Medtronic (PS Medical) · Legacy (widely implanted)

• Bright, slightly irregular dense magnet inside a faint (mostly non-metallic) valve body.
• Performance level can be confirmed by X-ray, though Medtronic designed the hand tools to verify without one.

X-ray: Rhomberg T, Trivik-Barrientos F, Hakim A, Raabe A, Murek M. Acta Neurochir 2024;166:69, Fig. 1B — CC BY 4.0; tiles cropped and joined.

Strata NSC (no siphon control) Medtronic (PS Medical) · Legacy (widely implanted)

• Dense magnet inside a faint valve body — radiographically similar to Strata II (the source dataset grouped them as 'Strata II – NSC').

X-ray: Giancardo L, Arevalo O, Tenreiro A, Riascos R, Bonfante E. Sci Rep 2018;8:16052, Fig. 2 — CC BY 4.0; tiles cropped and joined.

Polaris (SPV) Sophysa · Current

• Two square magnets in a round, mostly radiolucent body; arrow-shaped connectors show flow direction.
• Titanium studs on the right side mark the 5 rotor positions; radiopaque range dots left of the inlet: 0 = 10–140, 1 = 30–200, 2 = 50–300, 3 = 80–400.

X-ray: Giancardo L, Arevalo O, Tenreiro A, Riascos R, Bonfante E. Sci Rep 2018;8:16052, Fig. 2 — CC BY 4.0; tiles cropped and joined.

Sophy Mini SM8 Sophysa · Current

• Two square magnets inside a faint round outline; arrow-shaped connectors.
• Radiopaque dots read the 8 positions directly; range dots left of the inlet (0–3) identify the range.

X-ray: Vach M, Weiss D, Ivan VL, et al. Clin Neuroradiol 2025;35:347–354, Fig. 2 — CC BY 4.0; cropped.

proGAV 2.0 Miethke · Current

• Round titanium valve; four rotor magnets show as white dots in opposite pairs.
• Two black burr holes mark the rotor's rear; the gap between the two front magnets (triangle apex) points to the setting.
• A side recess marks orientation so the scale is not read mirror-image; the gravitational unit carries a coded pressure marking.

X-ray: Vach M, Weiss D, Ivan VL, et al. Clin Neuroradiol 2025;35:347–354, Fig. 2 — CC BY 4.0; cropped.

proGAV (1st generation) Miethke · Legacy (superseded by proGAV 2.0)

• Round titanium valve with a central rotor; the rotor position is read against the scale (0–20 cmH2O).

X-ray: Rhomberg T, Trivik-Barrientos F, Hakim A, Raabe A, Murek M. Acta Neurochir 2024;166:69, Fig. 1B — CC BY 4.0; tiles cropped and joined.

Hakim Precision (fixed) Integra (Codman) · Current

• Small metallic ball-in-cone housing; no adjustable cam or rotor.

X-ray: Rhomberg T, Trivik-Barrientos F, Hakim A, Raabe A, Murek M. Acta Neurochir 2024;166:69, Fig. 1B — CC BY 4.0; tiles cropped and joined.

Delta valve Medtronic (PS Medical) · Current

• Valve body is essentially radiolucent — look for the radiopaque arrow/dot code: PL 0.5 = bar + arrow, 1.0 = single arrow, 1.5 = dot + arrow, 2.0 = double arrow.

X-ray: Rhomberg T, Trivik-Barrientos F, Hakim A, Raabe A, Murek M. Acta Neurochir 2024;166:69, Fig. 1B — CC BY 4.0; tiles cropped and joined.

Integra DP Integra · Legacy (many SKUs no longer in US distribution)

• Two small metallic in-line housings (the paired ball-in-cone mechanisms).

X-ray: Rhomberg T, Trivik-Barrientos F, Hakim A, Raabe A, Murek M. Acta Neurochir 2024;166:69, Fig. 1B — CC BY 4.0; tiles cropped and joined.

Spitz-Holter Holter (later Integra) · Historic

• Cylindrical in-line valve with metal end segments, often just below a burr-hole reservoir ring.

X-ray: Rhomberg T, et al. Acta Neurochir 2024;166:69, Fig. 1B row (j) — CC BY 4.0; cropped. The source caption labels row (j) "Codman Certas Plus", duplicating row (a); the study's 10 classes include the Integra Spitz-Holter, which this cylindrical in-line valve matches.

Valves without an openly licensed radiograph (yet)

These valves are described from the manufacturer's radiographic guidance; the link opens the manufacturer's own X-ray illustration.

Film technique

• Shoot perpendicular to the valve, with the non-implanted side of the head on the plate; position the film relative to the valve, not the patient's anatomy (Integra Hakim guide).
• Check orientation markers before reading a dial — a mirror-image read gives the wrong setting (Hakim right-hand-side marker; Miethke valve-marking recess; Sophysa range dots left of the inlet).
• Get a baseline film after implantation. After every MRI, confirm the setting of MRI-sensitive valves — Codman HAKIM (X-ray or programmer), Strata / Strata NSC (Medtronic tools or X-ray) and Sophy SM8 (adjustment kit or X-ray).
• Compare with the patient's own baseline films — an unknown outside valve should be identified before anyone tries to adjust it.