Meta‐analysis: diagnostic medical radiation exposure in inflammatory bowel disease

Chatu, Sukhdev; Subramanian, V; Pollok, Richard

doi:10.1111/j.1365-2036.2011.04975.x

Cited by 87 publications

(54 citation statements)

References 49 publications

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“…It reported a pooled estimate of 8.4% of IBD patients receiving high dose radiation exposure (CED > 50 mSv). More patients with CD (11.1%) were exposed to high cumulative radiation doses (CED > 50 mSv) than patients with UC (2%) [12] . Similar trends have been found in studies following this meta-analysis.…”

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%

“…Desmond et al [11] [18] , [17] , [12] , evaluated six studies including a total of 1704 IBD patients. It reported a pooled estimate of 8.4% of IBD patients receiving high dose radiation exposure (CED > 50 mSv).…”

Section: Ibd Patientsmentioning

confidence: 99%

See 2 more Smart Citations

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%

See 1 more Smart Citation

Diagnostic imaging and radiation exposure in inflammatory bowel disease

Zakeri¹,

Pollok²

2016

WJG

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“…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]. A meta-analysis of five studies involving 2,627 participants who provided data for risk factors indicated that IBD-related surgery and steroid use were predictors, with pooled adjusted odds ratio of 5.4 (95 % CI 2.6-11.2) and 2.4 (95 % CI 1.7-3.4), respectively [18]. A retrospective study of 648 adult CD patients presenting in two EDs in the USA found that the use of CT increased from 47 % in 2001 to 78 % in 2009 (p = 0.005) while the portion of urgent findings including perforation, obstruction, or abscess remained unchanged in that time period (30, 29 %) [19].…”

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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“…However, I would like to underscore the fact that these results possibly reflect a situation most common in our setting. When looking for risk factors associated with a higher exposure to ionizing radiation the need for corticoids as a marker for inflammatory activity and need for surgery stands out, which may be associated with to the presence of a higher number of complications and therefore more diagnostic testing both pre-and post-operatively (7).…”

mentioning

confidence: 99%

Ionizing radiation in Crohn's disease

Mendoza

2012

Rev. esp. enferm. dig.

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Meta‐analysis: diagnostic medical radiation exposure in inflammatory bowel disease

Cited by 87 publications

References 49 publications

Diagnostic imaging and radiation exposure in inflammatory bowel disease

Diagnostic imaging and radiation exposure in inflammatory bowel disease

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

Ionizing radiation in Crohn's disease

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