Low-dose CT Using Iterative Reconstruction in Patients With Inflammatory Bowel Disease

NCT ID: NCT01244386

Last Updated: 2010-11-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

250 participants

Study Classification

OBSERVATIONAL

Study Start Date

2010-06-30

Study Completion Date

2011-12-31

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Inflammatory Bowel Disease Crohn's Disease Ulcerative Colitis

Keywords

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Computed tomography Iterative reconstruction Automatic tube current modulation Crohn's disease Inflammatory bowel disease Radiation dose optimization C reactive protein

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Inflammatory bowel disease

Patients with inflammatory bowel disease requiring CT for clinical purposes will be studied.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Adult patients requiring a CT abdomen for clinical purposes will be included

Exclusion Criteria

* Pediatric patients
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University College Cork

OTHER

Sponsor Role lead

Responsible Party

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University College Cork

Principal Investigators

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Michael M Maher, MD

Role: PRINCIPAL_INVESTIGATOR

University College Cork

Owen J O'Connor, MD

Role: STUDY_DIRECTOR

University College Cork

Fergus Shanahan, MD

Role: STUDY_DIRECTOR

University College Cork

Locations

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Cork University Hospital

Cork, Co Cork, Ireland

Site Status RECRUITING

Countries

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Ireland

Central Contacts

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Michael M Maher, MD

Role: CONTACT

Phone: +353 86 1731929

Email: [email protected]

Owen J O'Connor, MD

Role: CONTACT

Phone: USA 617 676 7627

Email: [email protected]

Facility Contacts

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Michael M Maher, MD

Role: primary

References

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Desmond AN, O'Regan K, Curran C, McWilliams S, Fitzgerald T, Maher MM, Shanahan F. Crohn's disease: factors associated with exposure to high levels of diagnostic radiation. Gut. 2008 Nov;57(11):1524-9. doi: 10.1136/gut.2008.151415. Epub 2008 Apr 28.

Reference Type BACKGROUND
PMID: 18443021 (View on PubMed)

Kalra MK, Rizzo S, Maher MM, Halpern EF, Toth TL, Shepard JA, Aquino SL. Chest CT performed with z-axis modulation: scanning protocol and radiation dose. Radiology. 2005 Oct;237(1):303-8. doi: 10.1148/radiol.2371041227.

Reference Type BACKGROUND
PMID: 16183938 (View on PubMed)

Kalra MK, Wittram C, Maher MM, Sharma A, Avinash GB, Karau K, Toth TL, Halpern E, Saini S, Shepard JA. Can noise reduction filters improve low-radiation-dose chest CT images? Pilot study. Radiology. 2003 Jul;228(1):257-64. doi: 10.1148/radiol.2281020606. Epub 2003 May 15.

Reference Type BACKGROUND
PMID: 12750460 (View on PubMed)

Kalra MK, Maher MM, Rizzo S, Kanarek D, Shepard JA. Radiation exposure from chest CT: issues and strategies. J Korean Med Sci. 2004 Apr;19(2):159-66. doi: 10.3346/jkms.2004.19.2.159.

Reference Type BACKGROUND
PMID: 15082885 (View on PubMed)

O'Connor OJ, Vandeleur M, McGarrigle AM, Moore N, McWilliams SR, McSweeney SE, O'Neill M, Ni Chroinin M, Maher MM. Development of low-dose protocols for thin-section CT assessment of cystic fibrosis in pediatric patients. Radiology. 2010 Dec;257(3):820-9. doi: 10.1148/radiol.10100278. Epub 2010 Sep 27.

Reference Type BACKGROUND
PMID: 20876388 (View on PubMed)

Other Identifiers

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10-CT-Crohn's

Identifier Type: -

Identifier Source: org_study_id