Factors influencing cumulative radiation dose from percutaneous intra-abdominal abscess drainage in the setting of infla
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INTERVENTIONAL RADIOLOGY
Factors influencing cumulative radiation dose from percutaneous intra‑abdominal abscess drainage in the setting of inflammatory bowel disease Thomas J. An1 · Azadeh Tabari1 · Michael S. Gee1 · Colin J. McCarthy2 Received: 9 September 2020 / Revised: 6 November 2020 / Accepted: 11 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Patients with inflammatory bowel disease (IBD) are at risk for intra-abdominal abscesses requiring CT-guided drainage. These patients are at baseline risk of high cumulative radiation exposure from imaging, which may be exacerbated by CT-guided drainage. This study aimed to determine the radiation dose associated with percutaneous drainage in the setting of IBD and identify risk factors associated with high exposure. Methods An IRB-approved single-center retrospective study was performed to identify patients with IBD who underwent percutaneous abscess drainage over a 5-year period. An episode of drainage was defined from drain placement to removal, with all intervening procedures and diagnostic CT scans included in the cumulative radiation dose. Results The mean cumulative effective dose for a drainage episode was 47.50 mSv. The mean duration of a drainage episode was 68.7 days. Patients with a cumulative dose greater than 50 mSv required higher number of follow-up visits compared to patients with less than 50 mSv (6.9 vs. 3.5, p = 0.003*). Patients with higher cumulative dose were also more likely to require drain upsize (54% vs. 13%, p = 0.01*) or additional drain placement (63% vs 24%, p = 0.03*) compared to patients with lower dose. Conclusion Intra-abdominal abscess drainage may be associated with significant cumulative radiation exposure. Requirement of drain upsizing or additional drain placement were associated with higher cumulative radiation dose, which may be related to more severe underlying inflammatory bowel disease. Keywords Inflammatory bowel disease · Percutaneous drainage · Radiation dose
Introduction Patients with inflammatory bowel disease (IBD) such as Crohn’s disease (CD) and ulcerative colitis (UC) have a chronic, relapsing–remitting disease course. In particular, patients with CD are at risk for penetrating disease complications such as abscess, stricture, and fistula formation [1]. Repeated imaging studies are often required to evaluate the extent of intestinal involvement, monitor disease activity/ * Colin J. McCarthy [email protected] 1
Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1471, Houston, TX 77030, USA
2
treatment response, and diagnose extraluminal and extraintestinal disease complications [2, 3]. The utilization of computed tomography (CT) has increased dramatically over the past three decades, including in the IBD population, and carries potential risks associated with cumulative lifetime ionizing radiation exposure [4–6].
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