Introduction In 2012 we audited Crohn’s patients’ exposure to radiation in the first year of diagnosis at the Leicester Royal Infirmary (LRI) and compared this to patients diagnosed prior to the introduction of small bowel ultrasound scanning (and more widespread use of MRI) in our department. We had hoped to find that over that time (10 years) exposure to radiation had fallen, but unfortunately the data actually showed a 47% increase in exposure over that time.
With this in mind we decided to repeat the audit in Kettering General Hospital, a DGH without small bowel US or easy access to MRI scanning.
Method Using a key word search of clinic letters we identified 79 patients diagnosed with Crohn’s disease between 1999 and 2014, and looked at their exposure to ionising radiation in their first year of diagnosis (6 months prior to 6 months post diagnosis).
ResultsInterestingly we once again identified a rise in average exposure to radiation, this time by 54%. Comparing this to the 47% increase we identified at the LRI we are convinced that this is a real phenomenon. In the LRI we found that much of the rise was attributable to Computerised Tomography (CT) scanning, with a huge surge in its use – data that we have replicated in this audit in a DGH, where we have demonstrated a 3-fold increase.
The notable difference is that the use of newer modalities (US and MRI) in this DGH has not changed greatly over time in comparison to the teaching hospital where we observed a huge surge in the use of these. We believe that this is the reason for the relatively slower rise in the overall exposure to radiation in the teaching hospital (around 7%).
Conclusion We have now looked at Crohn’s patients’ exposure to radiation over 15 years in two different settings and the results are clear- there is a huge increase in the exposure of such patients to potentially harmful ionising radiation, and we think this data could be replicated throughout the country.
Most of the increase is clearly attributable to CT scanning, and we think this may be due to its increased availability and lower cost. We also believe increasingly defensive practice by clinicians may be playing a role, and this might be evidenced by the fact that we found a doubling of the number of plain abdominal films performed in both hospitals.
Although our results are cause for concern we believe that with recognition of the problem practice can be changed to try and protect these patients. We also hope that the development of new modalities such as low-dose computerised tomography will impact this risk positively.
Disclosure of interest None Declared.
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