Making computed tomography safer for patients with Crohn’s disease

Abstract

Background and aims: Computed tomography (CT), often more accessible than magnetic resonance imaging (MRI), remains widely used though radiation exposure is an obvious disadvantage. We previously showed that modern CT technology can achieve over 70% reduction in radiation-dose without loss of accuracy. Here, we compare low- versus conventional-dose CT in patients with known Crohn's disease to assess clinical confidence and accuracy of the low-dose procedure in the semi-acute setting.

Methods: A comparative study of low-dose CT with full iterative reconstruction (IR) versus conventional-dose CT was conducted in 50 consecutive outpatients with Crohn's disease. Clinicians were provided with the low-dose images and reports, whereas conventional-dose images were reviewed after 4 weeks.

Results: The clinical question was adequately addressed with low-dose IR imaging in all cases. Complications of Crohn's were detected in 37/50 (74%) with no disagreement between low- and conventional-dose imaging. The effective radiation dose reduction was 76.5% (low-dose mean 2.15 mSv versus conventional-dose CT 6.99 mSv).

Conclusion: Low-dose IR CT is safe and accurate for evaluating distribution and complications of known Crohn's disease in the outpatient setting. We propose that low-dose radiation imaging should be adopted as standard-of-care for the evaluation of Crohn's disease and an acceptable alternative to MR particularly in the acute setting. ClinicalTrials.gov: NCT03140306.

Keywords:

• Crohn’s disease
• radiation safety
• computed tomography
• patient outcomes
• quality care

Acknowledgments

The authors thank all investigators who have made significant contributions to this field including those whose work we are unable to cite due to space limitations, which we regret. The authors also thank all patients who provided consent to participate in this trial, as well as the staff at Cork University Hospital who facilitated the study.

Disclosure statement

Potential Conflicts of Interest: F. S. is a co-founder, shareholder in Atlantia Food Clinical Trials CRO and 4D Pharma Cork, Ltd.

Additional information

Funding

This work was supported by, in part, Science Foundation Ireland (AP C/SFI/12/RC/2273) in the form of a research centre, AP C Microbiome Ireland.