Article

Quantifying exposure to diagnostic medical radiation in patients with inflammatory bowel disease: are we contributing to malignancy?

University of Vic, Vic, Catalonia, Spain
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.48). 10/2007; 26(7):1019-24. DOI: 10.1111/j.1365-2036.2007.03449.x
Source: PubMed

ABSTRACT While potential risks of diagnostic medical radiation are acknowledged, actual exposure of patients in routine clinical practice is poorly documented.
To quantify such exposure to vulnerable abdominal organs in patients with inflammatory bowel disease who are already at risk of intestinal cancer.
All incidences of exposure to diagnostic medical radiation were documented in a consecutive series of 100 patients with inflammatory bowel disease (62 Crohn's disease, 37 ulcerative colitis, 1 indeterminate colitis) attending a hospital-based clinic. Total effective dose (mSv) was calculated using published tables. Predictors of high or no irradiation were evaluated by multivariate logistic regression analysis.
Thirteen patients had no documented diagnostic irradiation. Twenty-three patients received an effective dose greater than 25 mSv. An at-risk effective dose >50 mSv was received by 11 patients. Dosage was higher in patients with Crohn's disease than ulcerative colitis (P = 0.02) and in patients undergoing surgery (P = 0.004). However, no predictive factors for high radiation dosage or for no exposure were identified.
At-risk irradiation from diagnostic medical radiation is common in patients with inflammatory bowel disease, and might potentially contribute to the elevated risk of intra-abdominal and other cancers. The level of irradiation should be considered in clinical decisions regarding abdominal imaging.

Full-text

Available from: Eliza Hawkes, Apr 07, 2015
0 Followers
 · 
68 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and AimsIncidence of inflammatory bowel disease (IBD), including Ulcerative Colitis (UC) and Crohn′s disease (CD), is increasing. Imaging techniques are accurate and reliable in diagnosing IBD. The main disadvantage of CT compared with MRI is radiation exposure and the potential risk factor for cancer, especially since IBD patients are already at increased risk of malignancies. High cumulative effective dose (CED) presents in 7–11% of IBD patients. Our aim was to quantify and characterize effective radiation exposure of IBD patients.Methodsretrospective study, from a cohort of IBD patients enrolled in a registry of Clínica las Condes between years 2011-2013. High cumulative radiation exposure was defined as CED > 50 mSv.ResultsA total of 325 IBD patients were enrolled in our registry, including 243 (74.7%) with UC and 82 (25.3%) with CD. High CED was significantly higher in patients with CD compared with UC (19.5% vs 2.4%). Higher exposure to radiation was associated with longer duration of disease, ileal involvement, stricturing behavior, treatments with steroids and biological agents, and CD-related hospitalization or surgery. Abdominopelvic CT and Enteroclysis CT accounted for 93.6% of total CED.ConclusionsA high percentage of IBD patients is exposed to high CED. Radiation-free cross-sectional exams, such as MRI, should be used, especially in young patients, those who have undergone prior surgery and those with severe IBD.
    Journal of Digestive Diseases 11/2014; 16(2). DOI:10.1111/1751-2980.12213 · 1.92 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Crohn's disease (CD) patients undergo many radiological studies employing ionizing radiation for diagnosis and management purposes. Our aim was to assess the total radiation exposure of our patients over the years, to estimate the risk factors for exposure to high doses, and to correlate radiation exposure to immunosuppression. The cumulative effective dose of radiation (CEDR) was calculated multiplying the number of imaging studies by the effective dose of each examination. A total of 451 patients with CD (226 female) were followed during 11.0 years (interquartile range [IQR]: 6.0-16.0), with 52.1% of the patients being classified with penetrating (B3) and 38.6% being steroid-dependent. About 16% were exposed to high-radiation dose levels (CEDR >50 mSv) and 4% were exposed to CEDR >100 mSv. The mean CEDR between age 26 and 35 years was 12.539 mSv and a significant dose of radiation (over 50 mSv) was achieved at a median age of 40 (IQR: 29.0-47.0). Abdominal-pelvic computed tomography scan was the examination that contributed the most for CEDR. Patients with B3 phenotype, previous surgery, azathioprine, and anti-tumor necrosis factor (TNF)-α therapy were exposed earlier on the course of the disease to CEDR >50 mSv (p < 0.001). The value of CEDR in the patients under immunosuppression mainly increased in the first year of immunosuppression. Penetrating phenotype, abdominal surgery, steroid resistance or steroid dependence, and treatment with anti-TNF-α and azathioprine were predictive factors for high CEDR. It was also demonstrated that immunosuppression and anti-TNF-α treatment were followed by a sustained increment of radiation exposure and that a significant dose of radiation was achieved <40 years of age.
    Scandinavian Journal of Gastroenterology 04/2015; DOI:10.3109/00365521.2015.1037344 · 2.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with Crohn's disease (CD) are often exposed to ionizing diagnostic radiation with inherent risks from protracted exposure. Meanwhile, bolder definitions of disease control have changed treatment paradigms, with earlier introduction of biological therapy in many. Our aim was to compare the effective radiation dose a year before and 1 and 3 years after initiating anti-tumor necrosis factor (anti-TNF) or corticosteroid therapy.
    European Journal of Gastroenterology & Hepatology 10/2014; DOI:10.1097/MEG.0000000000000222 · 2.15 Impact Factor