Diagnostic imaging and radiation exposure in inflammatory bowel disease

Table 2 Quantification of the cumulative effective dose of diagnostic radiation received by IBD patients, and factors associated with high cumulative radiation exposure (cumulative effective dose > 50 mSv); adapted from Chatu et al[12] with permission

Study	Number of patients (n)	Country	Design	Patient population	Outcome CED≥50 mSv	Mean/Median CED (mSv)	Factors associated with high radiation exposure
Newnham et al[59], 2007	100 (62 CD, 37 UC, 1 indeterminate colitis)	Australia	Retrospective study, single tertiary centre, patients recruited consecutively from clinic	Adult (16-84 yr)	11/100 (11%) 9 CD, 2 UC	Median CED 10 mSv	Assessed: age, gender, disease, disease duration, previous surgery, immunomodulator use, referral source Significant: none
Desmond et al[11], 2008	354 CD	Ireland	Retrospective study, single tertiary centre, patients recruited from IBD database July 1992-June 2007	Adult and paediatric (8.6-78.3 yr)	CED ≥ 75 mSv in 55/354 patients (15.5%)	Mean CED 36.1 mSv	Assessed: age, gender, smoking, FH, disease distribution, disease behaviour, medication, surgical history Significant: age < 17 at diagnosis, upper GI tract disease, penetrating disease, requirement for IV steroids, infliximab use, multiple surgeries
Peloquin et al[18], 2008	215 (103 CD, 112 UC)	United States	Retrospective study, population based inception cohort diagnosed between 1991 to 2001 from Olmsted County	Adult and paediatric (1.2-91.4 yr)	N/A	Median CED CD: 26.6 mSv UC: 10.5 mSv	N/A
Levi et al[60], 2009	324 (199 CD, 125 UC)	Israel	Retrospective study, single tertiary centre, patients diagnosed Jan 1999-Dec 2006, recruited from IBD database	Adult and paediatric ≤ 17 yr (18) > 18 yr (306)	23/324 (7.1%)	Mean CED CD: 21.1mSv UC: 15.1mSv	Assessed: age, surgery, diagnosis, medical therapy, disease duration, gender Significant: CD, surgery, prednisolone use, disease duration, first year of disease, age
Palmer et al[61], 2009	1593 (965 CD, 628 UC)	United States	Retrospective study, population based cohort recruited from insurance claims database Jan 2003-December 2004	Paediatric (2-18 yr)	N/A (34% CD, 23% UC exposed to moderate radiation - at least 1 CT or 3 fluoroscopic procedures)	N/A	Assessed: age, gender, region, hospitalisation, surgery, ED encounter, medication Significant: hospitalisation, inpatient GI surgery, ED encounter, use of steroids
Kroeker et al[62], 2011	553 (371 CD, 182 UC)	Canada	Retrospective study, single tertiary centre, patients diagnosed 2003-2008, recruited from IBD database	Adult and paediatric (15-84 yr)	28/553 (5%) 27 CD, 1 UC	Mean CED CD: 14.3 mSv UC: 5.9 mSv	Assessed: age at diagnosis, gender, disease distribution, previous surgery Significant: previous surgery
Fuchs et al[63], 2011	257 (171 CD, 86 UC)	United States	Retrospective study single tertiary centre, patients reviewed Jan-May 2008	Paediatric (< 18 yr)	15/257 (5.8%) 14 CD, 1UC	Mean CED CD: 20.5 mSv UC: 11.7 mSv	Assessed in CD cohort: gender, disease behaviour, previous surgery, disease duration, elevated platelet count at diagnosis Significant: previous surgery, elevated platelet count at diagnosis
Sauer et al[64], 2011	117 (86 CD, 31 UC)	United States	Retrospective study, single tertiary centre, patients diagnosed 2002-2008	Paediatric (2-18 yr)	6/117 (5%) 6 CD	Median CED CD: 15.6 mSv UC: 7.2 mSv	N/A
Huang et al[65], 2011	105 (61 CD, 32 UC, 12 indeterminate colitis)	United States	Single tertiary paediatric centre, patients identified from medical records	Paediatric cohort (11 mo-18 yr)	6/105 (6%)	Mean CED 15 mSv	Assessed: surgery, disease type, disease location, racioethnic background, anti TNF agents, use of immunomodulators, hospital admissions, age at diagnosis Significant: CD, small bowel involvement, black ethnicity, number of hospital admissions, previous surgery, anti TNF alpha use
Butcher et al[17], 2012	280	United Kingdom	Retrospective study, single tertiary centre, consecutive patients attending IBD clinic	Adult cohort	6.3% CD	Mean CED 10.17 mSv Median CED 4.12 mSv	Significant: smoking status, disease duration, previous surgery
Jung et al[15], 2013	2199 (777 CD, 1422 UC)	South Korea	Retrospective study, multicentre conducted at 13 university hospitals in South Korea, patients diagnosed July 1987-Jan 2012 included	Adult cohort (Mean age: CD 29.2 yr; UC 42.2 yr)	34.7% CD, 8.4% UC	Mean CED CD: 53.6 mSv UC: 16.4 mSv	Assessed: gender, age at diagnosis, disease duration, disease extent, surgery, hospitalisation, 5-ASA use, steroids, immunomodulator use Significant: For CD - longer disease duration, ileocolonic disease, upper GI tract involvement, surgery, hospitalisation, steroids For UC - surgery, hospitalisation, infliximab use
Chatu et al[14], 2013	415 (217 CD, 198 UC)	United Kingdom	Retrospective study, single tertiary centre, patients consecutively recruited from clinic Jan 2011- June 2011	Adult cohort (Mean age: CD 30.8 yr; UC 36.9 yr)	32/415 (8%) 29 CD, 3 UC	Median CED CD: 7.2 mSv UC: 2.8 mSv	Assessed: gender, age at diagnosis, disease type, steroid use within 3 mo diagnosis, use of immunomodulators or biologics, extraintestinal features, IBD related surgery Significant: males, IBD related surgery
Estay et al[13], 2015	325 (82 CD, 243 UC)	Chile	Retrospective study, patients recruited from IBD Registry 2011-2013	Adult cohort (16-86 yr)	22/325 (6.8%): CD 16 (19.5%); UC 6 (2.5%)	Mean CED 11.97 mSv CD: 29.9 mSv UC: 5.92 mSv	Assessed in CD cohort only: age at diagnosis, disease duration, disease location, disease behaviour, perianal disease, surgery, hospitalisation, medications Significant: longer disease duration, ileal involvement, stricturing disease, treatment with steroids and biological agents, CD related hospitalisation or surgery

UC: Ulcerative colitis; CD: Crohn’s disease; IBD: Inflammatory bowel disease; CED: Cumulative effective dose; mSv: Millisieverts of radiation; ED: Emergency department; FH: Family history.