P-100 Multiple Abdominal CT Scans May Result in Excess Radiation Exposure in Some Patients with Inflammatory Bowel Disease

Abstract Background Computed tomography (CT) imaging of the abdomen is often performed in the emergency department (ED) to exclude urgent pathology in patients with Inflammatory Bowel Disease (IBD). However, concerns over excessive radiation exposure from repeated use have led to expert consensus guidelines advising against CT imaging unless there is suspicion of complications (obstruction, perforation, abscess) or a non-IBD cause for symptoms. Aims Our study aimed to determine trends in abdominal CT utilization and findings among patients with IBD in the ED. Methods We performed a retrospective cohort study between 01/01/2009 and 31/12/2018 at a single academic center. We identified ED encounters for adults (age ≥17 years) with a pre-existing diagnosis of IBD from our institutional database and determined the proportion resulting in an abdominal CT scan within 72 hours of presentation. IBD subtypes were classified based on ICD-10 claims: K50.90* for Crohn’s disease (CD), K51.90* for Ulcerative colitis (UC) and IBD undifferentiated (IBDU) for patients with both claims. A time trend analysis was performed using a generalized linear model that assumed a Poisson distribution. CT scans were classified according to the dominant imaging finding. For this part we excluded studies performed within 1-month of surgery or those re-assessing a known abscess or malignancy. Results A total of 14783 encounters were identified. Among these encounters 3000 CT scans were performed: 2000 for patients with CD (21.9%), 652 for UC (16.5%) and 348 for IBDU (20.4%). The rates of CT utilization significantly increased by 2.7% (95% CI, 1.2–4.3; p=0.0004) in patients with CD, by 4.2% (95% CI, 1.7–6.7; p=0.0009) in patients with UC and by 6.3% in patients with IBDU (95% CI, 2.5–10.0; p=0.0011). Among the eligible CT scans performed for CD, the following dominant findings were reported: normal (25%), inflammation (23%), obstruction (23%), penetrating (18%) and unrelated to IBD (8.6%). In contrast, the following findings for patients with UC were reported: normal (20%), inflammation (39%), obstructive (19%), penetrating (8%) and unrelated to IBD (15%). Conclusions In this single center study, a steady increase in CT utilization in the ED was observed in patients with IBD. Interestingly, only a small proportion of the CT scans demonstrated urgent findings. Future studies are required to determine the factors that contribute to the ongoing increase in CT utilization in this patient population. Funding Agencies None

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Diagnostic Ionizing Radiation Exposure in a Population-Based Cohort of Patients with Inflammatory Bowel Disease

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2008.01920.x ◽

2008 ◽

Vol 103 (8) ◽

pp. 2015-2022 ◽

Cited By ~ 150

Author(s):

Joanna M. Peloquin ◽

Darrell S. Pardi ◽

William J. Sandborn ◽

Joel G. Fletcher ◽

Cynthia H. McCollough ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Ionizing Radiation ◽

Radiation Exposure ◽

Bowel Disease ◽

Population Based ◽

Inflammatory Bowel ◽

Ionizing Radiation Exposure

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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

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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.

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

Journal of Digestive Diseases ◽

10.1111/1751-2980.12213 ◽

2015 ◽

Vol 16 (2) ◽

pp. 83-89 ◽

Cited By ~ 19

Author(s):

Camila Estay ◽

Daniela Simian ◽

Jaime Lubascher ◽

Carolina Figueroa ◽

Andrés O'Brien ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Ionizing Radiation ◽

Radiation Exposure ◽

Bowel Disease ◽

Inflammatory Bowel ◽

Ionizing Radiation Exposure

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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.

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