Pediatric Inflammatory Bowel Disease and Imaging‐related Radiation: Are We Increasing the Likelihood of Malignancy?

Fuchs, Y.; Markowitz, James; Weinstein, Toba; Kohn, Nina; Choi-Rosen, Jeanne; Levine, Jeremiah

doi:10.1097/mpg.0b013e3181f57177

Cited by 42 publications

(21 citation statements)

References 22 publications

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“…Therefore, patients with IBD are frequently exposed to diagnostic radiation. Previous studies have shown that a substantial proportion of patients with IBD, especially patients with Crohn's disease (CD), were exposed to significantly harmful amounts of diagnostic radiation, mainly as a result of computed tomography (CT) examination [1][2][3][4][5][6][7]. Recently, we also demonstrated that 34.7 % of patients with CD were exposed to potentially harmful levels of ionizing radiation arising from diagnostic radiography, and abdominopelvic CT (APCT) accounted for 81.6 % of total effective radiation dose of all imaging studies [8].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Urgent Findings on Abdominopelvic CT in Patients with Crohn’s Disease Presenting to the Emergency Department

et al. 2014

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Section: Introductionmentioning

confidence: 99%

Predictors of Urgent Findings on Abdominopelvic CT in Patients with Crohn’s Disease Presenting to the Emergency Department

et al. 2014

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“…Most studies on radiation exposure of IBD patients have also found that CT contributed the majority of the total effective dose administered to IBD patients 10–13,24. Our recent study showed that intestinal complications such as intestinal fistulas, stricture, and abscesses were less frequent in intestinal BD than in CD and that small bowel involvement was uncommon in intestinal BD 25.…”

Section: Discussionmentioning

confidence: 89%

Radiation Exposure from Abdominal Imaging Studies in Patients with Intestinal Behçet Disease

Jung¹,

Park²,

Moon³

et al. 2014

Gut Liver

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Background/AimsRecently, several studies have revealed that diagnostic imaging can result in exposure to harmful levels of ionizing radiation in inflammatory bowel disease patients. However, the extent of radiation exposure in intestinal Behcet disease (BD) patients has not been documented. The aim of this study was to estimate the radiation exposure from abdominal imaging studies in intestinal BD patients.MethodsPatients with a diagnosis of intestinal BD established between January 1990 and March 2012 were investigated at a single tertiary academic medical center. The cumulative effective dose (CED) was calculated retrospectively from standard tables and by counting the number of abdominal imaging studies performed. High exposure was defined as CED >50 mSv.ResultsIn total, 270 patients were included in the study. The mean CED was 41.3 mSv, and 28.1% of patients were exposed to high levels of radiation. Computed tomography (CT) accounted for 81.7% of the total effective dose. In multivariate analyses, predictors of high radiation exposure were azathioprine/6-mercaptopurine use, surgery, and hospitalization.ConclusionsApproximately a quarter of intestinal BD patients were exposed to harmful levels of diagnostic radiation, mainly from CT examination. Clinicians should reduce the number of unnecessary CT examinations and consider low-dose CT profiles or alternative modalities such as magnetic resonance enterography.

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“…Approximately 5.8% of children and 7.1%13% of adults with IBD had an estimated CED > 50 mSv [5153] . Children and adults with CD, history of prior surgery, and prednisone use are more likely to have increased radiation exposure [51,52] . Adults with IBD are also at risk for increased radiation exposure within the first year after diagnosis [52] .…”

Section: Ionizing Radiationmentioning

confidence: 99%

“…A recent study demonstrated multiple CT scans in childhood with cumulative radia tion exposure of 50 mSv tripled the relative risk of leukemia and brain cancer [50] . Retrospective data among the pediatric IBD population suggests the average cumulative effective dose (CED) over an extended period of time was 20.5 mSv among children with CD and 11.7 mSv with UC [51] . Retrospective data among adults with IBD estimates CED was 20.1 mSv for patients with CD and 15.1 mSv with UC [52] .…”

Section: Ionizing Radiationmentioning

confidence: 99%

Role of imaging in the evaluation of inflammatory bowel disease: How much is too much?

Haas¹,

Rubesova²,

Bass³

2016

WJR

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Inflammatory bowel disease (IBD) is a lifelong condition with waxing and waning disease course that requires reassessment of disease status as well as screening for complications throughout a patient's lifetime. Laboratory testing, endoscopic assessment, and fecal biomarkers are often used in the initial diagnosis and ongoing monitoring of a patient with IBD. Imaging plays an integral role in the diagnosis and evaluation of IBD. Different imaging modalities can be used over the course of a patient's lifetime, from the initial screening and diagnosis of IBD, to determining the extent of intestinal involvement, monitoring for disease activity, and evaluating for complications of uncontrolled IBD. The various imaging modalities available to the provider each have a unique set of risks and benefits when considering cost, radiation exposure, need for anesthesia, and image quality. In this article we review the imaging techniques available for the evaluation of IBD including fluoroscopic small bowel follow-through, computed tomography enterography, magnetic resonance enterography, and transabdominal ultrasound with particular focus on the judicious use of imaging and the risks and benefits of each option. We also review the risks of ionizing radiation, strategies to reduce exposure to ionizing radiation, and current imaging guidelines among pediatric and adult patient with IBD. Core tip: Imaging plays a key role in the diagnosis and lifelong evaluation of a patient with inflammatory bowel disease (IBD). Several imaging modalities are available, each with a unique set of risks and benefits when considering cost, anesthesia risk in the pediatric population, ionizing radiation, image quality, and availability. In this article, we review the imaging techniques

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Pediatric Inflammatory Bowel Disease and Imaging‐related Radiation: Are We Increasing the Likelihood of Malignancy?

Cited by 42 publications

References 22 publications

Predictors of Urgent Findings on Abdominopelvic CT in Patients with Crohn’s Disease Presenting to the Emergency Department

Predictors of Urgent Findings on Abdominopelvic CT in Patients with Crohn’s Disease Presenting to the Emergency Department

Radiation Exposure from Abdominal Imaging Studies in Patients with Intestinal Behçet Disease

Role of imaging in the evaluation of inflammatory bowel disease: How much is too much?

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