Thinking Outside The Scanner: Radiation Exposure From Diagnostic Imaging In Inflammatory Bowel Disease
Main Article Content
Abstract
Abdominal imaging is a vital tool in the diagnosis and management of inflammatory bowel disease (IBD). Patients with IBD, especially Crohn’s disease (CD) typically undergo multiple diagnostic imaging tests throughout their disease course. This can result in significant cumulative radiation exposure, which may increase the risk of radiation-induced cancers. In this review, we will explore the risks of radiation exposure from diagnostic imaging, the scope of the problem in IBD, risk factors for higher exposure, and alternative approaches to imaging and treatment of the underlying disease that can reduce an IBD patient’s exposure to radiation. Utilization of diagnostic imaging modalities and techniques that minimize radiation exposure and optimal disease management to reduce need for these tests should be considered best practices in the care of patients with IBD.
Article Details
How to Cite
PATIL, Seema A.; CROSS, Raymond K..
Thinking Outside The Scanner: Radiation Exposure From Diagnostic Imaging In Inflammatory Bowel Disease.
Medical Research Archives, [S.l.], v. 8, n. 6, june 2020.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2079>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v8i6.2079.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. “Inflammatory Bowel Disease Prevalence in the United States.” https://www.cdc.gov/ibd/data-statistics.htm. Accessed March 2, 2020.
2. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, Panaccione R, Ghosh S, Wu JCY, Chan FKL, Sung JJY, Kaplan GG. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 2018 Dec; 390: 2769-78.
3. Brenner DJ and Hall EJ. Computed tomography—an increasing source of radiation exposure. N Eng J Med 2007; 357: 2277-84.
4. National Research Council. 2006. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington, DC: The National Academies Press.
5. Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Preston DL, Preston RJ, Puskin JS, Ron E, Sachs RK, Samet JM, Setlow RB, Zaider M. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 2003; 100: 137611376.
6. “ACR Statement on FDA Radiation Reduction Program.” www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/FDA-Radiation-Reduction-Program. Accessed February 24, 2020.
7. Mettler FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 2008; 248: 254-63.
8. “Radiation Dose in X-ray and CT Exams.” https://www.radiologyinfo.org/en/info.cfm?pg=safety-xray. Accessed February 24, 2020.
9. Guite KM, Hinshaw LM, Ranallo FN, Lindstrom MJ, Lee FT. Ionizing radiation in abdominal computed tomography: unindicated multiphase scans are an important source of medically unnecessary exposure. J Am Coll Radiol 2011; 8: 756-61.
10. Peloquin JM, Pardi DS, Sandborn WJ, Fletcher JG, McCollough CH, Schueler BA, Kofler JA, Enders FTB, Achenbach SJ, Loftus EV. Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol 2008; 103: 2015-22.
11. Zakeri N, Pollok RCG. Diagnostic imaging and radiation exposure in inflammatory bowel disease. World J Gastroenterol 2016; 22: 2165-78.
12. Jess T, Gamborg M, Matzen P, Munkholm P, Sorensen TI. Increased risk of intestinal cancer in Crohn’s disease: a meta-analysis of population-based cohort studies. Am J Gastroenterol 2005; 100: 2724-9.
13. Chatu S, Subramanian V, Pollok CG. Meta-analysis: diagnostic medical radiation exposure in inflammatory bowel disease. Aliment Pharmacol Ther 2012; 35: 529-39.
14. Greenup A-J, Bressler B, Rosenfeld G. Medical imaging in small bowel Crohn’s disease—computed tomography enterography, magnetic resonance enterography, and ultrasound: “Which one is best for what?” Inflamm Bowel Dis 2016; 22: 1246-1261.
15. Rosenfeld G, Brown J, Vos PM, Leipsic J, Enns R, Bressler B. Prospective comparison of standard- versus low-radiation-dose CT enterography for the quantitative assessment of Crohn’s disease. Am J Roentgenol 2018; 2: W54-62.
16. Qiu Y, Mao R, Chen BL, Li XH, He Y, Zeng ZR, Li ZP, Chen MH. Systematic review with metaanalysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn’s disease. Aliment Pharmacol Ther 2014; 40: 134146.
17. Amitai MM, BenHorin S, Eliakim R, Kopylov U. Magnetic resonance enterography in Crohn’s disease: a guide to common imaging manifestations for the IBD physician. J Crohns Colitis 2013; 7: 603615.
18. Parente F, Greco S, Molteni M, Anderloni A, Sampietro GM, Danelli PG, Bianco R, Gallus S, Bianchi Porro G. Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn’s disease. A prospective comparison with conventional ultrasound, x ray studies, and ileocolonoscopy. Gut 2004; 53: 1652-7.
19. Chatu S, Pilcher J, Saxena SK, Fry DH, Pollok RC. Diagnostic accuracy of small intestine ultrasonography using an oral contrast agent in Crohn’s disease: comparative study from the UK. Clin Radiol 2012; 67: 553559.
20. Ripolles T, Rausell N, Paredes JM, Grau E, Martinez MJ, Vizuete J. Effectiveness of contrast-enhanced ultrasound for characterization of intestinal inflammation in Crohn’s disease: a comparison with surgical histopathology analysis. J Crohns Colitis 2013; 7: 120-8.
21. Kerner C, Carey K, Mills AM, Yang W, Synnestvedt MB, Hilton S, Weiner MG, Lewis JD. Use of abdominopelvic computed tomography in emergency departments and rates of urgent diagnoses in Crohn’s disease. Inflamm Bowel Dis 2013; 19: 1179-85.
22. Patil SA, Rustgi A, Quezada SM, Flasar MH, Vandermeer F, Cross RK. Anti-TNF therapy is associated with decreased imaging and radiation exposure in patients with Crohn’s disease. Inflamm Bowel Dis 2013; 19: 92-8.
23. Patil SA, Flasar MH, Lin J, Lingohr-Smith M, Skup M, Wang S, Chao J, Cross RK. Reduced imaging radiation exposure and costs associated with anti-tumor necrosis factor therapy in Crohn’s disease. Dig Dis Sci 2019; 64: 61-67.
2. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, Panaccione R, Ghosh S, Wu JCY, Chan FKL, Sung JJY, Kaplan GG. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 2018 Dec; 390: 2769-78.
3. Brenner DJ and Hall EJ. Computed tomography—an increasing source of radiation exposure. N Eng J Med 2007; 357: 2277-84.
4. National Research Council. 2006. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington, DC: The National Academies Press.
5. Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Preston DL, Preston RJ, Puskin JS, Ron E, Sachs RK, Samet JM, Setlow RB, Zaider M. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 2003; 100: 137611376.
6. “ACR Statement on FDA Radiation Reduction Program.” www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/FDA-Radiation-Reduction-Program. Accessed February 24, 2020.
7. Mettler FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 2008; 248: 254-63.
8. “Radiation Dose in X-ray and CT Exams.” https://www.radiologyinfo.org/en/info.cfm?pg=safety-xray. Accessed February 24, 2020.
9. Guite KM, Hinshaw LM, Ranallo FN, Lindstrom MJ, Lee FT. Ionizing radiation in abdominal computed tomography: unindicated multiphase scans are an important source of medically unnecessary exposure. J Am Coll Radiol 2011; 8: 756-61.
10. Peloquin JM, Pardi DS, Sandborn WJ, Fletcher JG, McCollough CH, Schueler BA, Kofler JA, Enders FTB, Achenbach SJ, Loftus EV. Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol 2008; 103: 2015-22.
11. Zakeri N, Pollok RCG. Diagnostic imaging and radiation exposure in inflammatory bowel disease. World J Gastroenterol 2016; 22: 2165-78.
12. Jess T, Gamborg M, Matzen P, Munkholm P, Sorensen TI. Increased risk of intestinal cancer in Crohn’s disease: a meta-analysis of population-based cohort studies. Am J Gastroenterol 2005; 100: 2724-9.
13. Chatu S, Subramanian V, Pollok CG. Meta-analysis: diagnostic medical radiation exposure in inflammatory bowel disease. Aliment Pharmacol Ther 2012; 35: 529-39.
14. Greenup A-J, Bressler B, Rosenfeld G. Medical imaging in small bowel Crohn’s disease—computed tomography enterography, magnetic resonance enterography, and ultrasound: “Which one is best for what?” Inflamm Bowel Dis 2016; 22: 1246-1261.
15. Rosenfeld G, Brown J, Vos PM, Leipsic J, Enns R, Bressler B. Prospective comparison of standard- versus low-radiation-dose CT enterography for the quantitative assessment of Crohn’s disease. Am J Roentgenol 2018; 2: W54-62.
16. Qiu Y, Mao R, Chen BL, Li XH, He Y, Zeng ZR, Li ZP, Chen MH. Systematic review with metaanalysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn’s disease. Aliment Pharmacol Ther 2014; 40: 134146.
17. Amitai MM, BenHorin S, Eliakim R, Kopylov U. Magnetic resonance enterography in Crohn’s disease: a guide to common imaging manifestations for the IBD physician. J Crohns Colitis 2013; 7: 603615.
18. Parente F, Greco S, Molteni M, Anderloni A, Sampietro GM, Danelli PG, Bianco R, Gallus S, Bianchi Porro G. Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn’s disease. A prospective comparison with conventional ultrasound, x ray studies, and ileocolonoscopy. Gut 2004; 53: 1652-7.
19. Chatu S, Pilcher J, Saxena SK, Fry DH, Pollok RC. Diagnostic accuracy of small intestine ultrasonography using an oral contrast agent in Crohn’s disease: comparative study from the UK. Clin Radiol 2012; 67: 553559.
20. Ripolles T, Rausell N, Paredes JM, Grau E, Martinez MJ, Vizuete J. Effectiveness of contrast-enhanced ultrasound for characterization of intestinal inflammation in Crohn’s disease: a comparison with surgical histopathology analysis. J Crohns Colitis 2013; 7: 120-8.
21. Kerner C, Carey K, Mills AM, Yang W, Synnestvedt MB, Hilton S, Weiner MG, Lewis JD. Use of abdominopelvic computed tomography in emergency departments and rates of urgent diagnoses in Crohn’s disease. Inflamm Bowel Dis 2013; 19: 1179-85.
22. Patil SA, Rustgi A, Quezada SM, Flasar MH, Vandermeer F, Cross RK. Anti-TNF therapy is associated with decreased imaging and radiation exposure in patients with Crohn’s disease. Inflamm Bowel Dis 2013; 19: 92-8.
23. Patil SA, Flasar MH, Lin J, Lingohr-Smith M, Skup M, Wang S, Chao J, Cross RK. Reduced imaging radiation exposure and costs associated with anti-tumor necrosis factor therapy in Crohn’s disease. Dig Dis Sci 2019; 64: 61-67.