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Some IBD Patients Get Too Much Radiation

Summary and Comment |
August 26, 2013

Some IBD Patients Get Too Much Radiation

  1. Douglas K. Rex, MD

Among a cohort of patients with inflammatory bowel disease who presented to an emergency department, rates of CT scanning and cumulative radiation doses were relatively high.

  1. Douglas K. Rex, MD

Increasing attention is being paid to the amount of radiation exposure that some young patients with inflammatory bowel disease receive (IBD) from repeated computed tomography (CT) scans. To examine this issue, researchers identified 152 patients with Crohn disease (CD) and 130 patients with ulcerative colitis (UC) who visited an emergency department in a tertiary center over a 3-year period.

Abdominal CT scan was used in 49% of patients with CD and 19% with UC. CT findings often affected therapeutic decisions: for example, in patients with CD, imaging led to drainage or surgery for penetrating disease in 4% and to therapy for bowel obstruction in 19%. In both groups, CT led to intervention for a non-IBD finding in about 13%, hospitalization for severe disease in about 20%, and discharge in another 20%. In the period 6 months before to 6 months after the emergency department encounter, 31% of patients with CD had 2 or more CT scans, as did 24% of patients with UC. Among those who received CTs, the mean number of scans was 5 for CD and 4 for UC. CT accounted for 88% and 94% of total radiation doses in CD and UC patients, respectively; the mean cumulative dose over 80 months was 77 mSv and 67 mSv, respectively.

Comment

These data support the observation that a subset of the inflammatory bowel disease population is subjected to substantial amounts of radiation. In the linear, no-threshold model of radiation risk, a single abdominal pelvic CT scan performed at age 50 produces an estimated 0.14% lifetime risk for tumor formation (Gastroenterology 2005; 129:328). Many patients with IBD are younger than 50 and receive substantially greater doses. Those who do not acknowledge the linear, no-threshold model generally agree that doses above 100 mSv are of importance, a threshold clearly exceeded in some patients. I agree with others calling for a change to rely more on magnetic resonance and endoscopic imaging, especially for IBD patients who need repeat imaging.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Exact Sciences; Ferring Pharmaceuticals; Given Imaging; Olympus Speaker’s bureau Boston Scientific; Braintree; Ferring Pharmaceuticals Grant / research support Battelle; Braintree; Northwestern University; Olympus America Editorial boards Annals of Gastroenterology and Hepatology; Comparative Effectiveness Research; Expert Review of Gastroenterology and Hepatology; Gastroenterology; Gastroenterology and Hepatology News; Gastroenterology Report; Gastroenterology Research and Practice; Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; World Journal of Gastroenterology; World Journal of Gastrointestinal Oncology; World Journal of Gastrointestinal Pathophysiology; World Journal of Gastrointestinal Pharmacology and Therapeutics

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