Pediatric bowel disease patients see 53% jump in imaging use since 2001

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Pediatric inflammatory bowel disease (IBD) patients have undergone an increasing number of diagnostic exams over the past decade, though cumulative lifetime estimated effective radiation doses remain relatively low, according to a study published in the July issue of the American Journal of Roentgenology.

“Although the use of several ionizing imaging modalities has significantly decreased over this time period (including CT between 2006 and 2010), the use of abdominopelvic radiography, MRI, and EGD [esophagogastroduodenoscopy] has significantly increased,” wrote Jason G. Domina, MD, University of Michigan Health System, Ann Arbor, and colleagues.

IBDs include Crohn disease and ulcerative colitis and are typically chronic relapsing and remitting, explained the authors. Since those affected with such diseases require repeated diagnostic medical exams, their cumulative effective radiation dose is a concern, especially in children.

To better outline the trends in imaging pediatric IBD, Domina and colleagues looked at a cohort of patients from their institution for the 2001, 2006 and 2010 calendar years, identifying the number of abdominopelvic radiologic and endoscopic exams for each subject in a given year. Cumulative lifetime effective radiation dose was estimated for the 2010 cohort.

Results showed an increase in the average number of diagnostic exams obtained per patient from 1.29 in 2001 to 1.98 in 2010, a 53 percent jump. Abdominal radiography, MRI and EGD led the way, while the use of CT and ileocolonoscopy exhibited no significant increase in use. Contrast enema, small-bowel follow-through and upper gastrointestinal series all experienced a significant drop in use. Results were consistent between Crohn disease and ulcerative colitis populations.

Domina and colleagues explained that the increased utilization of MRI during the study period is due to the advent of MR enterography, which was developed specifically to assess the bowel.

The average cumulative lifetime estimated effective radiation dose for the 2010 cohort was 4.6 mSv. “This amount of radiation dose is less than that received from two years of background radiation exposure in the United States,” wrote the authors.

The 2010 cohort patient who had the greatest cumulative lifetime total number of exams was a 12-year-old girl with Crohn disease who underwent 95 diagnostic exams and greater than 80 mSv estimated effective dose, according to Domina and colleagues.

Compared with previous research, the current results suggest the pediatric IBD population is at least three times as likely to undergo CT in a given year compared with the general population, according to the authors. Even so, CT declined between 2006 and 2010, likely due to increased attention to ionizing radiation both among the public and among medical professionals.

Domina and colleagues concluded by suggesting “nonionizing diagnostic modalities, such as MRI, should be used whenever possible, and particular attention should be paid to accumulating lifetime radiation dose in pediatric IBD patients, given the chronic nature of Crohn disease and ulcerative colitis.”