Diagnostic Medical Radiation in Inflammatory Bowel Disease

Abstract

Diagnosis and management of inflammatory bowel disease (IBD) requires repeat diagnostic imaging for monitoring of disease activity. Recent evidence has suggested that patients with IBD are at increased risk of radiation exposure from repeat imaging. The aim of this article was to highlight risks associated with increasing radiation exposure and identify alternatives to minimize exposure. The increasing use of computed tomography (CT) in both Crohn's disease and ulcerative colitis has brought additional benefits to guiding management through non-invasive measures. However, the massive increase in use of CT scans poses a risk of exposing patients with IBD to high levels of diagnostic medical radiation. High levels of diagnostic medical radiation are associated with an increased risk of malignancy in several studies. Numerous studies have identified particular risk factors in IBD associated with high levels of diagnostic medical radiation which are also associated with a more severe disease course. Imaging techniques such as magnetic resonance enterography, ultrasound, small bowel follow through, and capsule endoscopy are alternatives to CT scans as they do not utilize radiation. Gastroenterologists managing patients with IBD, particularly Crohn's disease, should be aware of the increased risk of high cumulative doses of radiation exposure, particularly from CT scanning. Alternative forms of imaging should be carefully considered when evaluating patients, in particularly those with identifiable risk factors for an aggressive disease course.

Diagnostic Performance and Dose Comparison of Filtered Back Projection and Adaptive Iterative Dose Reduction Three-dimensional CT Enterography in Children and Young Adults

“…sequences could be performed. Patients with inflammatory bowel disease frequently require numerous diagnostic imaging examinations during their lifetime (3). In addition, because of the increased awareness of the potential risk of radiation exposure with repeated CT examinations, MR enterography gained particular importance in imaging children, whose cells are more susceptible to radiation injury (4)(5)(6).…”

Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application

“…CT and MRI are by far the most commonly employed imaging modalities for IBD disease assessment in many countries. CT imaging is associated with ionising radiation exposure and is an inappropriate modality for serial monitoring, especially in the young where risk of carcinogenesis is substantial 11. MRI is costly, time-consuming and access can be difficult 12.…”

CT and MR enterography in Crohn’s disease: current and future applications

“…The mean cumulative dose of diagnostic radiation received by patients in this study was 36.1 mSv with 15.5% of patients exceeding 75 mSV. Similar doses in nuclear industry workers have demonstrated an increased cancer-related mortality [49]. Of course, the medical benefit for any particular patient depends upon the relative benefit of imaging compared to risk, so simple assessments of cumulative dose do not convey medical benefit or harm in this group of patients at risk for complications from Crohn's and immunosuppression.…”