Inflammatory Bowel DiseaseNCT01244386
Low-dose CT Using Iterative Reconstruction in Patients With Inflammatory Bowel Disease
An observational study of Inflammatory Bowel Disease and Crohn's Disease, run by University College Cork at 1 site in Ireland.
Trial summary
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). Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Inflammatory Bowel Disease, Crohn's Disease, Ulcerative Colitis
- How many people
- 250 participants
- Where
- 1 siteIreland
- Study dates
- Jun 2010to Dec 2011
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Patients under the care of the hospital gastrointestinal services including in-patients and outpatients.
Who may be able to join
- Adult patients requiring a CT abdomen for clinical purposes will be included
Who cannot join
- Pediatric patients
Trial locations and contacts
1 site in 1 country.
Ireland1 site, 1 recruiting
- Recruiting
Cork University Hospital
Cork, Co Cork
Michael M Maher, MD, + 353 86 1731929, m.maher@ucc.ie
About this study
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.
Read the detailed description
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.
- Keywords
- Computed tomography, Iterative reconstruction, Automatic tube current modulation, Crohn's disease, Inflammatory bowel disease, Radiation dose optimization, C reactive protein
- Medical subject headings
- Inflammatory Bowel Diseases, Crohn Disease, Colitis, Ulcerative
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Inflammatory bowel disease | Patients with inflammatory bowel disease requiring CT for clinical purposes will be studied. |
What is being measured
The primary outcome is the main question the study is designed to answer.
The adequacy of low dose CT in patients with Inflammatory bowel disease compared with standard dose CT
Radiation dose of a standard CT abdomen and pelvis will be divided into 2 quotients. A low-dose CT scan acquired using automatic tube current modulation (ATM) requiring 10% the dose of a standard abdominal CT and equating to that of a conventional abdominal radiograph. High noise index will be used ensuring reduced mAs. Increased image noise will be overcome by the IR filter. A second CT using 90% of the standard abdominal CT dose will ensure a diagnostic study is acquired.
Measured: At the time of CT
Secondary outcomes (1)
The correlation of C-reactive protein assay with CT disease severity in inflammatory bowel disease.
The severity of inflammatory bowel disease will also be quantified based on the CT appearances. The disease severity as measured by CT will be correlated with C-reactive protein measured on the day of imaging.
Measured: CRP sample on same day as CT
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Nov 2010 (estimated)
- Study startJun 2010
- Primary completionDec 2011 (estimated)
- Study completionDec 2011 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Inflammatory Bowel DiseaseStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 250 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University College Cork
- Sponsor type
- University, hospital or other
- Investigators
- Michael M Maher, MD, Principal investigator, University College CorkOwen J O'Connor, MD, Study director, University College CorkFergus Shanahan, MD, Study director, University College Cork
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01244386
- Sponsor's protocol ID
- 10-CT-Crohn's
- Status last verified
- Nov 2010
- First submitted
- 18 Nov 2010
- Last updated
- 19 Nov 2010
- Results posted
- No
- Data monitoring committee
- No
Publications
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.
PubMed 18443021Kalra 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.
PubMed 16183938Kalra 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.
PubMed 12750460Kalra 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.
PubMed 15082885O'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.
PubMed 20876388
Study at a glance
From the registry record, last updated by the sponsor on 19 Nov 2010. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Low-dose CT Using Iterative Reconstruction in Patients With Inflammatory Bowel Disease
- ClinicalTrials.gov ID
- NCT01244386
- Acronym / sponsor ID
- 10-CT-Crohn's
- Keywords
- Computed tomography, Iterative reconstruction, Automatic tube current modulation, Crohn's disease, Inflammatory bowel disease, Radiation dose optimization, C reactive protein
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 250 participants (estimated)
- Lead sponsor
- University College CorkUniversity, hospital or other
- Study start
- Jun 2010
- Primary completion
- Dec 2011 (estimated)
- Study completion
- Dec 2011 (estimated)
- First posted
- 19 Nov 2010 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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
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.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Inflammatory bowel disease | – | –Patients with inflammatory bowel disease requiring CT for clinical purposes will be studied. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients under the care of the hospital gastrointestinal services including in-patients and outpatients.
Key inclusion criteria (1 listed)
- Adult patients requiring a CT abdomen for clinical purposes will be included
Key exclusion criteria (1 listed)
- Pediatric patients
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
The adequacy of low dose CT in patients with Inflammatory bowel disease compared with standard dose CT
Time frame: At the time of CT
Radiation dose of a standard CT abdomen and pelvis will be divided into 2 quotients. A low-dose CT scan acquired using automatic tube current modulation (ATM) requiring 10% the dose of a standard abdominal CT and equating to that of a conventional abdominal radiograph. High noise index will be used ensuring reduced mAs. Increased image noise will be overcome by the IR filter. A second CT using 90% of the standard abdominal CT dose will ensure a diagnostic study is acquired.
1 secondary outcome
The correlation of C-reactive protein assay with CT disease severity in inflammatory bowel disease.
Time frame: CRP sample on same day as CT
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 19 Nov 2010.
- Background: PubMed 18443021Desmond 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.
- Background: PubMed 16183938Kalra 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.
- Background: PubMed 12750460Kalra 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.
- Background: PubMed 15082885Kalra 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.
- Background: PubMed 20876388O'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.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Michael M Maher, MD principal investigator
University College Cork
Owen J O'Connor, MD study director
University College Cork
Fergus Shanahan, MD study director
University College Cork
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Inflammatory Bowel Disease and Crohn's Disease, run by University College Cork at 1 site in Ireland.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 19 Nov 2010. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Ireland. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Michael M Maher, MD (+353 86 1731929, m.maher@ucc.ie), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The adequacy of low dose CT in patients with Inflammatory bowel disease compared with standard dose CT (time frame: At the time of CT). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01244386, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Nov 2010.