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Crohn's disease: factors associated with exposure to high levels of diagnostic radiation
  1. Alan N Desmond (aldesmond{at}hotmail.com)
  1. Alimentary Pharmabiotic Centre, Department of Medicine, National University of Ireland, Cork., Republic of Ireland
    1. Kevin O'Regan (oregankevin{at}yahoo.co.uk)
    1. Department of Radiology, Cork University Hospital, National University of Ireland, Cork., Republic of Ireland
      1. Carmel Curran (cnichurrain{at}yahoo.co.uk)
      1. Alimentary Pharmabiotic Centre, Department of Medicine, National University of Ireland, Cork., Republic of Ireland
        1. Sebastian McWilliams (sebastian.mcwilliams{at}gmail.com)
        1. Alimentary Pharmabiotic Centre, Department of Medicine, National University of Ireland, Cork., Republic of Ireland
          1. Tony Fitzgerald (fitz.tony{at}gmail.com)
          1. Department of Epidemiology, National University of Ireland, Cork., Republic of Ireland
            1. Michael M Maher (m.maher{at}ucc.ie)
            1. Department of Radiology, Cork University Hospital, National University of Ireland, Cork., Republic of Ireland
              1. Fergus Shanahan (f.shanahan{at}ucc.ie)
              1. Alimentary Pharmabiotic Centre, Department of Medicine, National University of Ireland, Cork., Republic of Ireland

                Abstract

                Aims: Exposure to diagnostic radiation may be associated with increased risk of malignancy. The aims of this study were: (a) to examine patterns of use of imaging in Crohn's disease; (b) to quantify the cumulative effective dose (CED) of diagnostic radiation received by patients; and (c) to identify patients at greatest risk of exposure to high levels of diagnostic radiation.

                Methods: 409 patients with Crohn's disease were identified at a tertiary centre. CED was calculated retrospectively from imaging performed between July 1992 and June 2007. High exposure was defined as CED>75 milli-Sieverts (mSv), an exposure level which has been reported to increase cancer mortality by 7.3%. Complete data were available for 399 patients. 45 were excluded (20 attended outside study period, 25 primarily managed at other centres).

                Results: Use of computed tomography increased significantly and accounted for 77.2% of diagnostic radiation. Mean CED was 36.1mSv and exceeded 75mSv in 15.5% of patients. Factors associated with high cumulative exposure were: age<17 years at diagnosis (HR 2.1, CI 1.1-4.1), upper gastrointestinal tract disease (OR 2.4, CI 1.2-4.9), penetrating disease (OR 2.0, CI 1.0-3.9) and requirement for intravenous steroids (OR 3.7, CI 2.0-6.6); infliximab (OR 2.3, CI 1.2-4.4); or multiple (>1) surgeries (OR 2.7, CI 1.4-5.4).

                Conclusions: Identifiable subsets of patients with Crohn's disease are at risk of exposure to significant amounts of diagnostic radiation. Given the background risk of neoplasia and exposure to potentially synergistic agents such as purine analogues and other immune-modulators, specialist centres should develop low-radiation imaging protocols.

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