P198. Ionizing radiation exposure in patients with inflammatory bowel disease: Are we overexposing our patients?

Abstract Background Abdominal imaging is important in managing inflammatory bowel disease (IBD). We characterized utilization of imaging and exposure to ionizing radiation. Methods We enumerated abdominal diagnostic imaging in a population-based cohort of IBD patients between 1994 and 2016. Trends in utilization of abdominal computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound were characterized. Cumulative doses of ionizing radiation were compared between IBD patients and non-IBD controls and between Crohn’s disease (CD) and ulcerative colitis (UC) patients. Regression models were constructed to assess predictors of high ionizing radiation exposure. Results There were 72,933 incident cases of IBD. During the first 5 years of diagnosis, IBD patients were exposed to nearly 6-fold higher exposure to cumulative ionizing radiation attributable to abdominal imaging compared with non-IBD controls (18.6 mSv vs 2.9 mSv). Cumulative ionizing radiation exposure was higher in CD than UC (26.0 mSv vs 12.0 mSv; P < 0.001). Crohn’s disease patients were more than twice as likely as UC patients to exceed 50 mSv (15.6% vs 6.2%; P < 0.001) and 100 mSV (5.0% vs 2.1%; P < 0.001). There was geographic variation in ionizing radiation exposure, and individuals of lower income were more likely to have high exposure. Utilization of abdominal MRI has increased substantially, peaking between 2007 and 2012 and increasing annually at 34%, which coincided with an annual 2% decline in the use of abdominal CT. Conclusions Crohn’s disease patients are at highest risk for high exposure to ionizing radiation, with a subgroup receiving potentially harmful levels. Increasing utilization and access to abdominal MRI may alleviate exposure.

Download Full-text

Minimization of Radiation Exposure due to Computed Tomography in Inflammatory Bowel Disease

ISRN Gastroenterology ◽

10.5402/2012/790279 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Patrick D. Mc Laughlin ◽

Owen J. O’Connor ◽

Siobhán B. O’Neill ◽

Fergus Shanahan ◽

Michael M. Maher

Keyword(s):

Computed Tomography ◽

Inflammatory Bowel Disease ◽

Ionizing Radiation ◽

Radiation Exposure ◽

Bowel Disease ◽

Media Coverage ◽

Ionising Radiation ◽

Imaging Modalities ◽

Potential Health ◽

Inflammatory Bowel

Patient awareness and concern regarding the potential health risks from ionizing radiation have peaked recently (Coakley et al., 2011) following widespread press and media coverage of the projected cancer risks from the increasing use of computed tomography (CT) (Berrington et al., 2007). The typical young and educated patient with inflammatory bowel disease (IBD) may in particular be conscious of his/her exposure to ionising radiation as a result of diagnostic imaging. Cumulative effective doses (CEDs) in patients with IBD have been reported as being high and are rising, primarily due to the more widespread and repeated use of CT (Desmond et al., 2008). Radiologists, technologists, and referring physicians have a responsibility to firstly counsel their patients accurately regarding the actual risks of ionizing radiation exposure; secondly to limit the use of those imaging modalities which involve ionising radiation to clinical situations where they are likely to change management; thirdly to ensure that a diagnostic quality imaging examination is acquired with lowest possible radiation exposure. In this paper, we synopsize available evidence related to radiation exposure and risk and we report advances in low-dose CT technology and examine the role for alternative imaging modalities such as ultrasonography or magnetic resonance imaging which avoid radiation exposure.

Download Full-text

Factors associated with radiation exposure in patients with inflammatory bowel disease

Alimentary Pharmacology & Therapeutics ◽

10.1111/j.1365-2036.2009.04205.x ◽

2010 ◽

Vol 31 (4) ◽

pp. 534-535 ◽

Cited By ~ 1

Author(s):

E. Newnham ◽

R. Gearry ◽

P. Gibson

Keyword(s):

Inflammatory Bowel Disease ◽

Radiation Exposure ◽

Bowel Disease ◽

Factors Associated ◽

Inflammatory Bowel

Download Full-text

Diagnostic Radiation Exposure in Patients with Inflammatory Bowel Disease

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/2030735 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Catherine Langevin ◽

Lysanne Normandeau ◽

Mickael Bouin

Keyword(s):

Inflammatory Bowel Disease ◽

Radiation Exposure ◽

Bowel Disease ◽

Indeterminate Colitis ◽

Number Of Patients ◽

Inflammatory Bowel ◽

The Mean ◽

Effects Of Radiation ◽

And Control

Background. Because of the chronic and relapsing nature of inflammatory bowel disease (IBD), which often requires characterization with CT scan, IBD patients might be exposed to a large amount of radiation. As a cumulative effective dose (CED) ≥ 100 mSv is considered significant for stochastic risks of cancer, it is important to monitor and control the radiation exposure of the IBD patients. In the present work, we aimed to quantify the mean CED in IBD patients to assess any harmful effects of radiation. Methods. This study includes 200 IBD patients, identified retrospectively, from the outpatient clinics of the Centre Hospitalier de l’Université de Montréal between January 1, 2010, and February 15, 2017, from the gastroenterologists’ patients lists. The number and type of each radiology test performed were listed for each patient during the study period and the CED was calculated using our institution’s dose index when available and standardized tables. Results. Among the 200 IBD patients, 157 patients had Crohn’s disease (CD), 41 had ulcerative colitis (UC), and 2 had indeterminate colitis. The mean CED for IBD patients was 23.1 ± 45.2 mSv during a mean follow-up duration of 4.3 years. CED was higher among patients with CD than with UC (27.5 ± 49.5 versus 6.8 ± 14.8 mSv; p<0.01). Six patients were exposed to a high CED (>100 mSv) and all had CD. Conclusion. While potentially harmful levels of radiation exposure are of concern in only a small number of patients, strategies to limit such exposure are encouraged when clinically appropriate.

Download Full-text

Minimization of radiation exposure due to computed tomography in inflammatory bowel disease

Clinics and Research in Hepatology and Gastroenterology ◽

10.1016/j.clinre.2010.11.007 ◽

2011 ◽

Vol 35 (2) ◽

pp. 105-110 ◽

Cited By ~ 8

Author(s):

S.B. O’Neill ◽

O.J. O’Connor ◽

S.R. McWilliams ◽

F. Shanahan ◽

M.M. Maher

Keyword(s):

Computed Tomography ◽

Inflammatory Bowel Disease ◽

Radiation Exposure ◽

Bowel Disease ◽

Inflammatory Bowel

Download Full-text

Medical radiation exposure in children with inflammatory bowel disease estimates high cumulative doses

Inflammatory Bowel Diseases ◽

10.1002/ibd.21626 ◽

2011 ◽

Vol 17 (11) ◽

pp. 2326-2332 ◽

Cited By ~ 66

Author(s):

Cary G. Sauer ◽

Subra Kugathasan ◽

Diego R. Martin ◽

Kimberly E. Applegate

Keyword(s):

Inflammatory Bowel Disease ◽

Radiation Exposure ◽

Bowel Disease ◽

Medical Radiation ◽

Inflammatory Bowel ◽

Medical Radiation Exposure

Download Full-text

Utilization of Diagnostic Imaging and Ionizing Radiation Exposure—Has the Tide Already Turned?

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz220 ◽

2019 ◽

Vol 26 (6) ◽

pp. 907-908

Author(s):

Sebastian Zundler

Keyword(s):

Ionizing Radiation ◽

Diagnostic Imaging ◽

Radiation Exposure ◽

Case Control Study ◽

Management Of Complications ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Ionizing Radiation Exposure ◽

Control Study

Abstract Inflammatory bowel diseases require repetitive abdominal imaging for diagnosis, follow-up, or management of complications. This editorial comments on the large incident-based case–control study on utilization of diagnostic imaging and ionizing radiation exposure by Nguyen and colleagues published in this issue.

Download Full-text