BACKGROUND AND AIMS: Radiological imaging is crucial for diagnosing and monitoring patients with inflammatory bowel diseases (IBD). With increasing awareness of radiation risks, imaging doses should be "as low as reasonably achievable," with a risk level that one should try to stay underneath 75 mSv. However, real-world data on cumulative exposure are limited. We retrospectively analyzed the radiation exposure of patients with IBD in a Belgian tertiary referral center. METHODS: Radiation exposure examinations were reviewed using the electronic health records. Annual (AED) and cumulative effective dose (CED) were calculated. A sub-analysis of patients diagnosed after January 1, 2007 was performed, as detailed radiation doses were maintained prospectively from that date onwards. RESULTS: In total, 4333 IBD patients (2753 Crohn's disease [CD], 1512 ulcerative colitis [UC]) were included. The median (Interquartile range [IQR]) AED was 0.47 (0.02-1.67) mSv/year, and higher in CD than in UC (0.59 [0.05-1.79] vs 0.28 [0.01-1.44] mSv/year, P = .855). CED >/= 75 mSv was reached in 5.5% of patients after a median [IQR] of 24 [13-34] years of follow-up. Sub-analysis of 1754 patients diagnosed from 2007 showed a median (IQR) AED of 0.74 (0.02-2.76) mSv/year, again higher for CD than UC (1.16 [0.02-3.42] vs 0.29 [0.01-2.28] mSv/year, P = .189). Here, 3.3% reached a CED >/= 75 mSv after a median (IQR) of 9 [6-12] years of follow-up. The most common reasons for radiation exposure were comorbidities like malignancy. CONCLUSIONS: Up to 5.5% of IBD patients reached a CED >/= 75 mSv. While most imaging decisions were deemed appropriate, caution against excessive radiation remains crucial.