Diagnosing shunt patency is crucial in the neurosurgical care of patients with shunted hydrocephalus. The shuntogram is a commonly used method to assess patency, yet its utility in accurately diagnosing shunt failure remains inconsistent. In this article, we examined studies on shuntograms performed in patients with fixed-pressure valves to clarify the techniques used and establish criteria for interpretation. We further reviewed conflicting evidence in the literature regarding the utility of shuntograms and outlined our institution’s protocol in the context of programmable valves. Studies included in this review detailed the following elements of shuntogram techniques: patient age, indication for shunt failure assessment, positioning, skin preparation, imaging protocol, contrast agents, patency testing, criteria for negative and positive results, troubleshooting shunt, and sensitivity and specificity of findings. Selection criteria included vague symptoms of shunt malfunction in the presence of non-diagnostic imaging. Patients were typically positioned supine or recumbent, with skin prepared using iodine-based products. Shunts were accessed using a 23 – 25-gauge needle, observing cerebrospinal fluid pressure and aspirate. The contrast agent most frequently used was ^99mTc-diethylene-triamine-pentaacetate, although the exact volume injected was inconsistently reported. Imaging protocols were not standardized, with delayed imaging intervals usually ranging from 9 to 20 min. Failure criteria for shuntograms varied significantly, with limited guidance on follow-up interventions or troubleshooting. Notably, there was no mention of shunt reprogramming during these studies. This review highlights the significant variability in shuntogram techniques and outcomes. We present our institution’s protocol and a case scenario demonstrating successful implementation. With proper techniques and protocolization, shuntograms hold the potential as a valuable resource for accurately diagnosing shunt patency.