Radiation exposure in patients with inflammatory bowel disease

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Abstract Background and Aims Radiological imaging is crucial for diagnosing and monitoring patients with inflammatory bowel diseases (IBD). With increasing awareness of radiation risks, imaging doses should be ‘as low as reasonably achievable’, with a risk level that one should try to stay underneath 75 mSv. However, real-world data on cumulative exposure are limited. We retrospectively analyzed radiation exposure of patients with IBD in a Belgian tertiary referral center. Methods Radiation-exposure examinations were reviewed using the electronic health records. Annual (AED) and cumulative effective dose (CED) were calculated. A sub-analysis of patients diagnosed after January 1st, 2007, was performed, as detailed radiation doses were maintained prospectively from that date onwards. Results In total, 4333 IBD patients (2753 Crohn’s disease [CD], 1512 ulcerative colitis [UC]) were included. The median (Interquartile range [IQR]) AED was 0.47 (0.02-1.67) mSv/year, and higher in CD than in UC (0.59 [0.05-1.79] vs. 0.28 [0.01- 1.44] mSv/year, p=0.855). CED ≥75 mSv was reached in 5.5% of patients after a median [IQR] of 24 [13-34] years of follow-up. Sub-analysis of 1754 patients diagnosed from 2007 showed a median (IQR) AED of 0.74 (0.02- 2.76) mSv/yr, again higher for CD than UC (1.16 [0.02-3.42] vs. 0.29 [0.01-2.28] mSv/yr, p=0.189). Here, 3.3% reached a CED ≥75 mSv after a median (IQR) of 9 [6-12] years of follow-up. Most common reasons for radiation exposure were comorbidities like malignancy. Conclusion Up to 5.5% of IBD patients reached a CED ≥75mSv. While most imaging decisions were deemed appropriate, caution against excessive radiation remains crucial.