Crohn's disease: factors associated with exposure to high levels of diagnostic radiation
Crohn's disease: factors associated with exposure to high levels of diagnostic radiation
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DOI：
10.1136/gut.2008.151415
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发表时间：
2008-11-01
期刊：
影响因子：
24.5
通讯作者：
Shanahan, F.
中科院分区：
文献类型：
--
作者：
Desmond, A. N.;O'Regan, K.;Shanahan, F.
目的：暴露于诊断辐射可能与恶性肿瘤的风险增加有关。本研究的目的是（1）检查模式的使用成像在克罗恩病;（2）量化的累积有效剂量（CED）的诊断辐射患者收到的;和（3）确定患者在最大的风险暴露于高水平的诊断radiations.Methods：409例克罗恩病患者被确定在三级中心。根据1992年7月至2007年6月期间进行的成像回顾性计算CED。高暴露定义为CED>75 mSv，据报告，这一暴露水平使癌症死亡率增加7.3%。399例患者的完整数据可用。45人被排除在外（20参加研究期间外，25人主要在其他中心管理）。结果：使用计算机断层扫描显着增加，占诊断辐射的77.2%。平均CED为36.1 mSv，15.5%的患者超过75 mSv。与高累积暴露相关的因素有：年龄1）手术（OR 2.7，CI 1.4至5.4）。结论：可识别的克罗恩病患者亚群有暴露于大量诊断辐射的风险。考虑到肿瘤形成的背景风险和暴露于潜在的协同剂，如嘌呤类似物和其他免疫调节剂，专科中心应制定低辐射成像方案。
Aims: Exposure to diagnostic radiation may be associated with increased risk of malignancy. The aims of this study were to (1) examine patterns of use of imaging in Crohn's disease; (2) quantify the cumulative effective dose (CED) of diagnostic radiation received by patients; and (3) 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 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 the study period, 25 were primarily managed at other centres).Results: Use of computed tomography increased significantly and accounted for 77.2% of diagnostic radiation. Mean CED was 36.1 mSv and exceeded 75 mSv in 15.5% of patients. Factors associated with high cumulative exposure were: age 1) surgeries (OR 2.7, CI 1.4 to 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.