Radiation Exposure from Abdominal Imaging Studies in Patients with Intestinal Behçet Disease
0
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: Recently, several studies have revealedthat diagnostic imaging can result in exposure to harmfullevels of ionizing radiation in inflammatory bowel disease patients. However, the extent of radiation exposure in intestinalBehçet disease (BD) patients has not been documented. Theaim of this study was to estimate the radiation exposure fromabdominal imaging studies in intestinal BD patients. Methods:Patients with a diagnosis of intestinal BD establishedbetween January 1990 and March 2012 were investigatedat a single tertiary academic medical center. The cumulativeeffective dose (CED) was calculated retrospectively fromstandard tables and by counting the number of abdominalimaging studies performed. High exposure was defined asCED >50 mSv. Results: In total, 270 patients were includedin the study. The mean CED was 41.3 mSv, and 28.1% ofpatients were exposed to high levels of radiation. Computedtomography (CT) accounted for 81.7% of the total effectivedose. In multivariate analyses, predictors of high radiationexposure were azathioprine/6-mercaptopurine use, surgery,and hospitalization. Conclusions: Approximately a quarterof intestinal BD patients were exposed to harmful levels ofdiagnostic radiation, mainly from CT examination. Cliniciansshould reduce the number of unnecessary CT examinationsand consider low-dose CT profiles or alternative modalitiessuch as magnetic resonance enterography.
Abstract
Background/Aims: Recently, several studies have revealedthat diagnostic imaging can result in exposure to harmfullevels of ionizing radiation in inflammatory bowel disease patients. However, the extent of radiation exposure in intestinalBehçet disease (BD) patients has not been documented. Theaim of this study was to estimate the radiation exposure fromabdominal imaging studies in intestinal BD patients. Methods:Patients with a diagnosis of intestinal BD establishedbetween January 1990 and March 2012 were investigatedat a single tertiary academic medical center. The cumulativeeffective dose (CED) was calculated retrospectively fromstandard tables and by counting the number of abdominalimaging studies performed. High exposure was defined asCED >50 mSv. Results: In total, 270 patients were includedin the study. The mean CED was 41.3 mSv, and 28.1% ofpatients were exposed to high levels of radiation. Computedtomography (CT) accounted for 81.7% of the total effectivedose. In multivariate analyses, predictors of high radiationexposure were azathioprine/6-mercaptopurine use, surgery,and hospitalization. Conclusions: Approximately a quarterof intestinal BD patients were exposed to harmful levels ofdiagnostic radiation, mainly from CT examination. Cliniciansshould reduce the number of unnecessary CT examinationsand consider low-dose CT profiles or alternative modalitiessuch as magnetic resonance enterography.
참고문헌 (38)
- Wall BF, "What are the risks from medical X-rays and other low dose radiation?", Br J Radiol, 79, pp.285~294 (2006)
- Berrington de González A, "Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries", Lancet, 363, pp.345~351 (2004)
- Brenner DJ, "Cancer risks attributable to low doses of ionizing radiation: assessing what we really know", Proc Natl Acad Sci U S A, 100 (2003)
- Jess T, "Increased risk of intestinal cancer in Crohn’s disease: a meta-analysis of population-based cohort studies", Am J Gastroenterol, 100, pp.2724~2729 (2005)
- Loftus EV Jr, "Epidemiology and risk factors for colorectal dysplasia and cancer in ulcerative colitis", Gastroenterol Clin North Am, 35, pp.517~531 (2006)
- Persson PG, "Crohn’s disease and cancer: a population-based cohort study", Gastroenterology, 107, pp.1675~1679 (1994)
- Kandiel A, "Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine", Gut, 54, pp.1121~1125 (2005)
- Bickston SJ, "The relationship between infliximab treatment and lymphoma in Crohn’s disease", Gastroenterology, 117, pp.1433~1437 (1999)
- Newnham E, "Quantifying exposure to diagnostic medical radiation in patients with inflammatory bowel disease: are we contributing to malignancy?", Aliment Pharmacol Ther, 26, pp.1019~1024 (2007)
- Desmond AN, "Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation", Gut, 57, pp.1524~1529 (2008)
- Levi Z, "Factors associated with radiation exposure in patients with inflammatory bowel disease", Aliment Pharmacol Ther, 30, pp.1128~1136 (2009)
- Kroeker KI, "Patients with IBD are exposed to high levels of ionizing radiation through CT scan diagnostic imaging: a five-year study", J Clin Gastroenterol, 45, pp.34~39 (2011)
- Fuchs Y, "Pediatric inflammatory bowel disease and imaging-related radiation: are we increasing the likelihood of malignancy?", J Pediatr Gastroenterol Nutr, 52, pp.280~285 (2011)
- Sauer CG, "Medical radiation exposure in children with inflammatory bowel disease estimates high cumulative doses", Inflamm Bowel Dis, 17, pp.2326~2332 (2011)
- Cheon JH, "Development and validation of novel diagnostic criteria for intestinal Behcet’s disease in Korean patients with ileocolonic ulcers", Am J Gastroenterol, 104, pp.2492~2499 (2009)
- Ebert EC, "Gastrointestinal manifestations of Behcet’s disease", Dig Dis Sci, 54, pp.201~207 (2009)
- Sayek I, "Intestinal Behcet’s disease: surgical experience in seven cases", Hepatogastroenterology, 38, pp.81~83 (1991)
- Ketch LL, "Surgical implications of Behcet’s disease", Arch Surg, 115, pp.759~760 (1980)
- Moon CM, "Prediction of free bowel perforation in patients with intestinal Behcet’s disease using clinical and colonoscopic findings", Dig Dis Sci, 55, pp.2904~2911 (2010)
- Lee CR, "Colonoscopic findings in intestinal Behcet’s disease", Inflamm Bowel Dis, 7, pp.243~249 (2001)
- Cheon JH, "Development, validation, and responsiveness of a novel disease activity index for intestinal Behcet’s disease", Inflamm Bowel Dis, 17, pp.605~613 (2011)
- Hart D, "Radiation exposure of the UK population from medical and dental X-ray examinations" (2002), National Radiological Protection Board
- The 2007 Recommendations of the International Commission on Radiological Protection., "ICRP publication 103", Ann ICRP, 37, pp.1~332 (2007)
- Peloquin JM, "Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease", Am J Gastroenterol, 103, pp.2015~2022 (2008)
- Jung YS, "Long-term clinical outcomes of Crohn’s disease and intestinal Behcet’s disease", Inflamm Bowel Dis, 19, pp.99~105 (2013)
- Jung YS, "Quantifying exposure to diagnostic radiation and factors associated with exposure to high levels of radiation in Korean patients with inflammatory bowel disease", Inflamm Bowel Dis, 19, pp.1852~1857 (2013)
- Hall EJ, "Cancer risks from diagnostic radiology", Br J Radiol, 81, pp.362~378 (2008)
- Fletcher JG, "New concepts in intestinal imaging for inflammatory bowel diseases", Gastroenterology, 140, pp.1795~1806 (2011)
- Siddiki H, "Validation of a lower radiation computed tomography enterography imaging protocol to detect Crohn’s disease in the small bowel", Inflamm Bowel Dis, 17, pp.778~786 (2011)
- Allen BC, "Effect of altering automatic exposure control settings and quality reference mAs on radiation dose, image quality, and diagnostic efficacy in MDCT enterography of active inflammatory Crohn’s disease", AJR Am J Roentgenol, 195, pp.89~100 (2010)
- Kambadakone AR, "Low-dose CT examinations in Crohn’s disease: Impact on image quality, diagnostic performance, and radiation dose", AJR Am J Roentgenol, 195, pp.78~88 (2010)
- Horsthuis K, "Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies", Radiology, 247, pp.64~79 (2008)
- Fiorino G, "Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn’s disease", Inflamm Bowel Dis, 17, pp.1073~1080 (2011)
- Jung YS, "Prognostic factors and long-term clinical outcomes for surgical patients with intestinal Behcet’s disease", Inflamm Bowel Dis, 17, pp.1594~1602 (2011)
- Palmer L, "Diagnostic ionizing radiation exposure in a population-based sample of children with inflammatory bowel diseases", Am J Gastroenterol, 104, pp.2816~2823 (2009)
- Chatu S, "Meta-analysis: diagnostic medical radiation exposure in inflammatory bowel disease", Aliment Pharmacol Ther, 35, pp.529~539 (2012)
- Brenner D, "Estimated risks of radiation-induced fatal cancer from pediatric CT", AJR Am J Roentgenol, 176, pp.289~296 (2001)
- National Research Council (US) Committee to Assess Health Risks from Exposure to Low Level of Ionizing Radiation, "Health risks from exposure to low levels of ionizing radiation: BEIR VII, Phase 2" (2006), National Academies Press
