Ionizing radiation exposure in patients with inflammatory bowel disease: Are we overexposing our patients?

Estay, Camila; Simian, Daniela; Lubascher, Jaime; Figueroa, Carolina; O'Brien, Andrés; Quera, Rodrigo

doi:10.1111/1751-2980.12213

Cited by 38 publications

(25 citation statements)

References 28 publications

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“…Similar trends have been found in studies following this meta-analysis. A 2015 retrospective review of 325 IBD patients in Chile, reported 19.5% of patients with CD and 2.4% of patients with UC, to be exposed to CED > 50 mSv [13] . A recent United Kingdom retrospective study of 415 patients with IBD referred from primary care, reported a median total CED of 7.2 mSv in CD patients and 2.8 mSv in UC patients, with 8% of IBD patients overall exposed to CED > 50 mSv.…”

Section: Ibd Patientsmentioning

confidence: 99%

“…Risk factors for high radiation exposure in IBD patients have been widely studied [11][12][13][14][15]17] . In a cohort of 354 adult and paediatric patients with CD, Desmond et al [11] identified that patients diagnosed under the age of 17, patients with upper gastrointestinal (GI) disease, penetrating disease, multiple surgeries, or those that required intravenous steroids or infliximab, were at greater risk of receiving high cumulative radiation exposure.…”

Section: Factors Associated With Increased Radiation Exposure In Ibd mentioning

confidence: 99%

“…Although the perforation rate is low, at around 0.04%, CTC is generally avoided in the acute phase of IBD [30] . Unfortunately while CT performs very well as an imaging modality there is an emerging recognition that it is responsible for the majority of the total radiation dose to which IBD patients are exposed [11][12][13]15] . Indeed in a recent study from Chile, abdominal-pelvic CT and CT enteroclysis accounted for 93.6% of the total CED exposure [13] .…”

Section: Ulcerative Colitismentioning

confidence: 99%

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Diagnostic imaging and radiation exposure in inflammatory bowel disease

Zakeri¹,

Pollok²

2016

WJG

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Section: Ibd Patientsmentioning

confidence: 99%

Section: Factors Associated With Increased Radiation Exposure In Ibd mentioning

confidence: 99%

Section: Ulcerative Colitismentioning

confidence: 99%

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Diagnostic imaging and radiation exposure in inflammatory bowel disease

Zakeri¹,

Pollok²

2016

WJG

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“…However, CT can result in a high amount of cumulative radiation 4. As children can be expected to have a longer life expectancy than older individuals, their potential risk for developing cancer due to radiation exposure from diagnostic imaging is also higher 5, 6.…”

Section: Introductionmentioning

confidence: 99%

Relationship between the radiation doses at nonenhanced CT studies using different tube voltages and automatic tube current modulation during anthropomorphic phantoms of young children

Masuda

Funama

Kiguchi

et al. 2017

J Applied Clin Med Phys

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To compare the radiation dose and image noise of nonenhanced CT scans performed at 80, 100, and 120 kVp with tube current modulation (TCM) we used anthropomorphic phantoms of newborn, 1‐year‐old, and 5‐year‐old children. The noise index was set at 12. The image noise in the center of the phantoms at the level of the chest and abdomen was measured within a circumscribed region of interest. We measured the doses in individual tissues or organs with radio‐photoluminescence glass dosimeters for each phantom. Various tissues or organs were assigned and the radiation dose was calculated based on the international commission on radiological protection definition. With TCM the respective radiation dose at tube voltages of 80, 100, and 120 was 29.71, 31.60, and 33.79 mGy for the newborn, 32.00, 36.79, and 39.48 mGy for the 1‐year‐old, and 32.78, 38.11, and 40.85 mGy for the 5‐year‐old phantom. There were no significant differences in the radiation dose among the tube voltages and phantoms (P > 0.05). Our comparison of the radiation dose using anthropomorphic phantoms of young children showed that the radiation dose of nonenhanced CT performed at different tube voltages with TCM was not significantly different.

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“…A retrospective experience on 325 IBD patients from a clinic in Santiago, Chile, reported that CD, longer duration of disease, ileal involvement, stricturing behavior, steroid or biologic agents, and CDrelated hospitalizations and surgery were risk factors. A full 19.5 % of their CD patients were exposed to high levels of radiation, defined as CED [50 mSv [16]. In contrast, a smaller retrospective study of 99 CD patients indicated that initiation of an anti-TNF agent decreased radiation exposure in the subsequent year from a CED from 28.1 to 15.0 mSV, unlike steroid treatment, which did not reduce radiation exposure in the subsequent year [17].…”

mentioning

confidence: 99%

Predicting the Need for Imaging in IBD: Radiating Only Badness?

Shah

2015

Dig Dis Sci

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Multiple imaging tests are needed to diagnose, evaluate symptoms of, and manage Crohn's disease (CD) patients, with particular regard to excluding complications such as obstruction, perforation, and abscess [1]. Imaging modalities used in evaluating CD include conventional radiography, fluoroscopy, computed tomography (CT), ultrasound (US), and magnetic resonance imaging (MRI) [1]. CT use has increased extensively in general but especially for those with CD, raising concerns about the effects of radiation exposure and subsequent risk of cancer [2]. The estimated lifetime attributable risk of malignancy from a single abdominal-pelvic CT scan is *0.7 % [3]. The radiation exposure from a single CT scan can vary greatly based on scanner type, protocol settings, and patient size, with newer protocols that reduce radiation exposure increasingly utilized [4,5]. CT, especially CT enterography (CTE), is considered the ''gold-standard'' imaging examination for patients with symptomatic CD. CT provides critical information to treating physicians regarding the presence or absence of disease, disease activity, severity of disease, and complications of penetrating disease such as abscess. Supporting this, a recent study reported that CT performed in the emergency department (ED) changed the management of 81 % of patients with CD with urgent findings in 48 % (35 % penetrating or obstructive disease, 13 % non-IBD urgent findings) [6]. One-third of the patients in this study had a cumulative effective dose (CED) of [75 millisieverts (mSv). Thus, CT remains a ''doubleedged sword'' given its associated radiation exposure, particularly for younger patients. Multiple retrospective studies have reported radiation exposures in CD patients to be higher than that of the general population [7,8]. The use of CT in patients with inflammatory bowel disease (IBD) has increased noticeably in the last decade with an 840 % increase from 2003 to 2007 reported at one institution [9]. A retrospective cohort study of 415 patients over 20 years found that usage of CTs increased by 310 % and that 1 in 13 patients was exposed to potentially harmful levels of ionizing radiation defined as CED [50 mSv. A history of IBD-related surgery was a risk factor for high exposure [10]. CD patients are commonly diagnosed in their 20s and 30s with *20 % diagnosed during childhood [11]. Furthermore, there is an increased risk of radiation-induced malignancies in patients exposed at a younger age given the elevated biologic activity of their tissues and the longer available ''lag-time'' for the development of malignancy [12]. A recent study by Brenner and Hall [13] suggests that it is not until patients reach 35 years of age that the risks of ionizing radiation decrease substantially.Since many of the CT scans in CD patients are performed acutely in the ED, it is important to evaluate whether there are predictors of positive or negative factors that would maximize benefit and minimize risk of imaging in this setting. Previous studies of CT use in IBD have identified ...

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Ionizing radiation exposure in patients with inflammatory bowel disease: Are we overexposing our patients?

Abstract: A high percentage of IBD patients are exposed to high CED. Radiation-free cross-sectional examinations, such as MRI, should be used, especially in young patients, those who have undergone prior surgery and those with severe IBD.

Cited by 38 publications

References 28 publications

Diagnostic imaging and radiation exposure in inflammatory bowel disease

Diagnostic imaging and radiation exposure in inflammatory bowel disease

Relationship between the radiation doses at nonenhanced CT studies using different tube voltages and automatic tube current modulation during anthropomorphic phantoms of young children

Predicting the Need for Imaging in IBD: Radiating Only Badness?

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