Ulcerative Colitis Clinical Trial
The purpose of this study is to validate the use of a low-dose computed tomography (CT) protocol and facilitate reduced radiation doses in patients with inflammatory bowel disease (IBD). This is to be achieved using new computer software (Iterative Reconstruction and Automatic Tube Modulation) which will enable low-dose CT imaging at doses equivalent to that of an abdominal radiograph.
The increasing use of CT has prompted the development of new scanning protocols which reduce
radiation doses to patients and minimise the likelihood of radiation related morbidity. The
use of disease specific low-dose CT examinations is an emerging method of limiting radiation
doses.
Research conducted in Cork University Hospital(CUH) by the current authors has identified a
pressing need to reduce radiation doses in patients with IBD. A retrospective study of
radiation doses in patients with Crohn's disease demonstrated that increasing numbers of CT
exams are performed with average cumulative effective doses rising from 7.9 to 25mSv when the
first 5-years of the 15 year study period were compared with the final 5-years. Eight-five
percent of the dose during the final 5-year period was due to CT. Younger patients with more
severe disease requiring surgery or steroids were more likely to undergo an increased number
of exams. 15.5% of patients received cumulative effective doses of greater than 75mSv. This
quantity of radiation exposure is associated with a 7.3% increase in mortality from cancer.
In addition, patients with Crohn's disease are inherently predisposed to gastrointestinal and
hepatobiliary carcinoma and small bowel lymphoma.
As an alternative to CT, IBD patients are frequently imaging with conventional abdominal
radiography. The effective dose of a conventional abdominal radiograph (CAR) is approximately
10% that of a standard abdominal CT varying between 0.7 -0.1mSv. The current authors have
also investigated the value of CAR. We retrospectively examined over 500 CAR's performed over
a 16 year period in patients with IBD. Patients had an average of 3.5 CAR's performed but
there were positive findings in less than 30% of exams. Many of these findings were
non-specific requiring further investigation. For example separation of bowel loops on a
plain radiograph has a wide differential diagnosis including abscess formation, presence of a
phlegmonous mass, fibrofatty proliferation, bowel wall thickening and lymphadenopathy.
Patients with inflammatory bowel disease referred to CUH will undergo a modified abdominal CT
protocol. The radiation dose of a standard CT abdomen and pelvis will be divided into 2
quotients. Patients will have a low-dose CT scan requiring approximately 10% of the dose of a
standard abdominal CT. This equates to the radiation dose of a conventional abdominal
radiograph. Patients will be imaged with a second CT exam using 90% of the standard abdominal
CT dose ensuring a diagnostic study is acquired. Patients will be given oral and intravenous
contrast agents as for a standard CT. Patients will have a C-reactive protein measured on the
day of CT and will have their heights and weights also measured at the time of scanning.
Patients will have a plain film of abdomen performed prior to CT.
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