Radiation exposure in Crohn's disease patients
Keywords:
Crohn's disease; Ionizing radiation; Abdominal and Pelvic CT scanAbstract
Abstract:
Introudction: Crohn's disease (CD) is a lifelong condition. Multiple imaging investigations are often performed during follow-up. This could cause overexposure to radiation. The aim of our study was to determine mean radiation dose in patients with at least a 5-year course of CD and to determine possible risk factors associated with exposure to high doses of radiation.
Methods: We conducted a retrospective study including patients whose CD was diagnosed between 1998 and 2005. Epidemiologic features of patients, characteristics of the disease, types of imaging investigations that were performed during follow-up and cumulative radiation effective dose were determined. Risk factors associated with exposure to high doses of radiation were then determined.
Results: One hundred sixty seven patients were included. There were 92 males (55.1%) and 75 females (44.9%) with mean age at dianosis of 31.4±12.3years. Global radiation dose was 18.8±18.9 mSv. Twenty seven patients (16,2%) were exposed to more than 35 mSv and 4 patients (2.4%) had an exposure of more than 75 mSv. Use of Infliximab, age at disease onset ≤ 24 years old and number of flares ≥ 8 were independent risk factors of radiation exposure more than 35 mSv with adjusted Odds ratios (OR) : 2.5 [2.1- 5.3]; 1.6 [1.2- 4.7] and 3.2 [2.1- 7.8] respectively. Similarly, use of Infliximab and number of flares ≥ 8 were independent risk factors of radiation exposure more than 75 mSv with adjusted OR : 4.3 [2.8-9.5] and 7 [3.2-11.2] respectively.
Conclusion: Radiation risk seems to be increased with severe course of CD. Both referring physicians and radiologists have the responsibility to minimise radiation exposure. Entero-magnetic resonance imaging (Entero-MRI) may reduce this risk.
Downloads
References
Gatta G, Di Grezia G, Di Mizio V, Landolfi C, Mansi L, De Sio I, et al. Crohn's Disease Imaging: A Review. Gastroenterol Res Pract. 2012;2012:15.
Jacobi W. The concept of the effective dose--a proposal for the combination of organ doses. Radiat Environ Biophys. 1975;12(2):101-9.
Levi Z, Fraser E, Krongrad R, Hazazi R, benjaminov O, meyerovitch J, et al. Factors associated with radiation exposure in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2009;30(11-12):1128-36.
http://www.info-radiologie.ch/dose_rayon_radiologie.php.
Desmond AN, O'Regan K, Curran C, McWilliams S, Fitzgerald T, Maher MM, et al. Crohn's disease: factors associated with exposure to high levels of diagnostic radiation. Gut. 2008;57(11):1524-9.
Peloquin JM, Pardi DS, Sandborn WJ, Fletcher JG, McCollough CH, Schueler BA, et al. Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol. 2008;103(8):2015-22.
Magro F, Coelho R, Guimaraes LS, Silva M, Peixoto A, Lopes S, et al. Ionizing radiation exposure is still increasing in Crohn's disease: Who should be blamed? Scand J Gastroenterol. 2015;50(10):1214-25.
Kroeker KI, Lam S, Birchall I, Fedorak RN. Patients with IBD are exposed to high levels of ionizing radiation through CT scan diagnostic imaging: a five-year study. J Clin Gastroenterol. 2011;45(1):34-9.
Ching H-L, Pandey R, Chariah F, Lipman G, Train M, Mann S. PWE-199 Diagnostic Radiation Exposure in Patients with Crohn'S Disease Treated with Infliximab. Gut. 2013;62(Suppl 1):A211-A2.
Schreyer AG, Menzel C, Friedrich C, Poschenrieder F, Egger L, Dornia C, et al. Comparison of high-resolution ultrasound and MR-enterography in patients with inflammatory bowel disease. World J Gastroenterol. 2011;17(8):1018-25.
