"CT Colonography: Coming of Age", C. Daniel Johnson, Am. J. Roentgenol., Nov 2009; 193: 1239 – 1242
"Normalized Distance Along the Colon Centerline: A Method for Correlating Polyp
Location on CT Colonography and Optical Colonoscopy",
"Comparison of Optical Colonoscopy and CT Colonography for Polyp Detection",
"Comparison of Polyp Size and Volume at CT Colonography: Implications for
Follow-Up CT Colonography",
"Clinical Management of Small (6- to 9-mm) Polyps Detected at Screening CT Colonography: A Cost-Effectiveness Analysis",
"Performance of a previously Validated CT Colonography Computer-Aided
Detection System in a New Patient Population",
"Replacing Barium Enema with CT Colonography in Patients Older Than 70
Years: The Importance of Detecting Extracolonic Abnormalities",
" Primary 2D Versus Primary 3D Polyp Detection at Screening CT Colonography",
"Translucency Rendering in 3D Endoluminal CT Colonography: A Useful Tool for
Increasing Polyp Specificity and Decreasing Interpretation Time",
"Three-Dimensional Endoluminal CT Colonography (Virtual Colonoscopy): Comparison on Three Commercially Available Systems",
Among Viatronix,GE and Vital Images products, V3D-Colon was heavily favored by participating
physicians, ranking consistently higher in all categories (92%), including polyp conspicuity, 3D
effect, likeness to OC and navigational features.
"Electronic Cleansing and Stool Tagging in CT Colonography: Advantages and
Pitfalls with Primary Three Dimensional Evaluation"
"Performance of a Previously Validated CT Colonography Computer-Aided
Detection System in a New Patient Population",
“National CT Colonography Trial (ACRIN 6664): Comparison of
Three Full-Laxative Bowel Preparations in More Than 2500
Polyp detection was comparable for all three preparations, although phosphosoda had significantly higher patient compliance and the least residual stool.
“CT Colonography in Patients Who Have Undergone Sigmoid Colostomy: A Feasibility Sudy”
CT colonographic examination through a sigmoid stoma was technically feasible with currently available instruments, but further improvements in technique are needed.
“Radiation-Related Cancer Risks From CT Colonography Screening: A Risk-Benefit Analysis”
Concerns have been raised about recommending CTC as a routine screening tool because of potential harms including the radiation risks. Based on these models, the benefits from CTC screening every 5 years from the age of 50 to 80 years clearly outweigh the radiation risks.
Screening CT Colonography: Multicenter Survey of Patient Experience, Preference, and Potential Impact on Adherence
Respondents reported a very high satisfaction level with CTC, and
those who had experienced both modalities indicated a preference for CTC over optical colonoscopy. These results suggest that CTC has the potential to increase adherence to CRC screening guidelines if widely available.
CT Colonography of a Medicare-Aged Population: Outcomes Observed in an Analysis of More
Than 1400 Patients
The frequency of referral to colonoscopy based on a polyp size threshold of 6 mm was 14.5%. Colorectal neoplasia was found in 9.3% of patients, with advanced neoplasia in 3.3%. Potentially important extracolonic findings were observed in 2.9% of patients. The low rates of referral to colonoscopy, prevalence of advanced neoplasia, and prevalence of extracolonic findings make CTC a viable option for Medicare-aged patients.
Annals of Internal Medicine
Diagnostic Accuracy of Laxative-Free Computed Tomographic Colonography for Detection of Adenomatous Polyps in Asymptomatic Adults
Computed tomographic colonography was accurate in detecting adenomas 10 mm or larger but less so for smaller lesions. Patient experience was better with laxative-free CTC. These results suggest a possible role for laxative-free CTC as an alternate screening method.
Is Computed Tomographic Colonography Being Held to a Higher Standard?,
Recent guidelines for colorectal cancer screening have reached different conclusions on whether computed tomographic colonography (CTC) is an acceptable screening option, and the Centers for Medicare & Medicaid Services recently decided not to cover CTC screening. The rationale against recommending or covering CTC screening includes concerns about radiation exposure, false negative rates for small polyps, the discovery of extracolonic findings, variability in performance, a lack of targeted studies, a higher adenoma rate in the Medicare-eligible age group, and an absence of evidence that covering CTC would increase overall screening rates. Similar concerns can be raised for other recommended and covered colon cancer screening tests, but it seems that CTC is being held to a new and higher standard.
"Location of Adenomas Missed by Optical Colonoscopy",
Archives of Internal Medicine
Adherence to Colorectal Cancer Screening:
A Randomized Clinical Trial of Competing Strategies
Arch Intern Med. 2012;172(7):575-582. doi:10.1001/archinternmed.2012.332
The common practice of universally recommending colonoscopy may reduce adherence to CRC screening, especially among racial/ethnic minorities. Significant variation in overall and strategy-specific adherence exists between racial/ethnic groups; however, this may be a proxy for health beliefs and/or language. These results suggest that patient preferences should be considered when making CRC screening recommendations.
Computed Tomographic Colonography to Screen for Colorectal Cancer, Extracolonic Cancer, and Aortic Aneurysm Model Simulation With Cost- effectiveness Analysis
When detection of extracolonic findings such as AAA and extracolonic cancer are considered in addition to colorectal neoplasia in our model simulation, CT colonography is a dominant screening strategy (i.e., more clinically effective and more cost-effective) over both colonoscopy and colonoscopy with 1-time ultrasonography.
AJR: Virtual colonoscopy's time has come
Virtual colonoscopy researchers have served up all the evidence the U.S. government asked for, and as a result they've concluded the time is now for approval of the technique to screen for colorectal cancer, according to an article published in the July American Journal of Roentgenology.
Repeat VC after 5 years shows few advanced lesions
Individuals who were negative in their first round of virtual colonoscopy screening tend to stay that way at repeat screening five years later. The results are a positive sign that VC is a good way to detect significant lesions before they can advance to malignancies.
Virtual colonoscopy delivers in laparoscopy planning
Italian researchers have found that virtual colonoscopy outperforms conventional colonoscopy for planning laparoscopic surgery in patients with colorectal cancer or complicated diverticular disease. They presented their results at the recent European Congress of Radiology (ECR).
“Acceptance grows for VC among patients, referring physicians”
A large survey of patients who underwent virtual colonoscopy at three U.S. centers found high acceptance of the noninvasive exam, as well as a reluctance to undergo conventional colonoscopy among nearly one-third of screeningpatients, according to results presented at the 2011 International Symposium on Virtual Colonoscopy in Cambridge, MA.
“Virtual Colonoscopy Advocates Press on for Reimbursement”
Virtual colonoscopy screening advocates were upbeat about their quest for reimbursement of the exam at this week’s 2011 International Symposium on Virtual Colonoscopy. Which is not to say that getting paid to perform virtual colonoscopy has been an easy struggle, or a particularly quick one.
“Virtual colonoscopy boosts screening compliance”
Offering virtual colonoscopy as an option for colorectal cancer screening
significantly boosted patient compliance in programs operated by U.S. naval medical centers, according to a study presented at last week's Digestive Disease Week (DDW) meeting in Chicago.
“Technology brings new opportunities in VC screening”
Technology is affecting virtual colonoscopy in ways that will improve the patient experience and increase the technique’s detection accuracy, according to presentations at the 2011 International Symposium on Virtual Colonoscopy.
Reviewing a few of the dozens of recent technology and research advancements presented at the symposium, Dr. Ronald Summers, PhD, director of radiology research at the U.S. National Institutes of Health (NIH), touched on innovations in virtual colonoscopy that could change practice patterns and differentiate VC from other colons screening tests.
“Some VC patients won't consider other screening exams”
Nearly all individuals screened with virtual colonoscopy are satisfied enough to say that they prefer the exam for future colorectal cancer screening, according to a study presented at last month's Digestive Disease Week meeting in Chicago.
“CAD helps expert radiologists detect difficult polyps on VC”
Computer-aided detection (CAD) software can boost the performance of even expert radiologists in finding challenging polyps on virtual colonoscopy studies, say researchers from the University of Chicago.
"VC should target rare growths rather than all polyps" - By Marty Graham April 13, 2011
"Study boosts screening by adding colon exams to mammo visits " - By Kate Madden Yee AuntMinnie.com staff writer October 15, 2010
"Study: VC improves colon screening rates " - By AuntMinnie.com staff writers October 21, 2010
"Higher colonoscopy complication rates found in seniors " - By Eric Barnes AuntMinnie.com staff writer October 19, 2010
"Lack of sleep linked to risky colon polyps" - By Reuters Health October 18, 2010
"Adenoma recurrence more likely among the overweight " - By Eric Barnes AuntMinnie.com staff writer October 18, 2010
"Surveillance VC is promising for follow-up after colon surgery" - By Eric Barnes AuntMinnie.com staff writer October 12, 2010
"Missed cancers common after colonoscopy" - By Reuters Health October 7, 2010
"Requiring prone and supine CAD marks boosts VC results" - By Eric Barnes AuntMinnie.com staff writer July 14, 2010
"Screening VC sorts out incidental kidney lesions" - By Eric Barnes AuntMinnie.com staff writer June 15, 2010
"5-year C-RADS analysis shows stable VC screening results" - 05/06/2010
In what is likely the largest screening population ever classified by virtual colonoscopy's standardized reporting system, C-RADS, researchers found stable results over five years in the single-center program, along with a large majority of patients who were able to avoid invasive colonoscopy.
"Massive VC study yields trove of extracolonic cancers" - 03/23/2010
A study of more than 10,000 asymptomatic screening subjects found that more than one in 200 had unsuspected and typically large but mostly early-stage cancers detected outside the colon at virtual colonoscopy (also known as CT colonography or CTC).
"Obama gets virtual colonoscopy, keeps presidential powers (Viatronix V3D-Colon software used for performing VC)"
As part of his first annual comprehensive physical exam as chief executive, U.S. President Barack Obama underwent a virtual colonoscopy exam (also known as CT colonography or CTC) that found him free of colorectal polyps or cancer, chief White House physician and Navy Captain Dr. Jeffrey Kuhlman told reporters yesterday.
"VC obviates need for colonoscopy even in symptomatic patients" By Eric Barnes, AuntMinnie.com staff writer February 24, 2010
Even among individuals with symptoms suggesting a higher risk of colorectal polyps and cancer, virtual colonoscopy screening is enough to prevent most of them from having to undergo invasive colonoscopy. Researchers from Venlo, Netherlands, said that referrals to optical colonoscopy after VC (also known as CT colonography or CTC) remained low even among the oldest symptomatic patients in the group's recent study.
"VC screening maintains performance in Medicare population" by Eric Barnes, AuntMinnie.com, November 9, 2009
"Meta-analysis reveals paucity of advanced neoplasia in small polyps" by Eric Barnes, AuntMinnie.com, November 2, 2009
"VC CAD nabs undetected polyps in jumbo screening study" ,Eric Barnes, 10/29/09
"VC's high positive predictive value important for colonoscopy follow-up ", Eric Barnes, 4/30/09
"VC CAD plus 3D improves sensitivity for novice readers", Eric Barnes, 4/21/09
"VC/AAA Screening combo cost-effective in older adults", Eric Barnes, 3/26/09
"Model finds small polyp surveillance safe, cost-effective", Eric Barnes, 11/4/2008
"Wider 3D viewing angle may aid polyp detection", Eric Barnes, 9/9/2008
"ACR, others exhort CMS to cover virtual colonoscopy", By Aunt Minnie.com Staff Writers, 6/19/2008
"VC's extracolonic findings lend an edge in cost-effectiveness", Eric Barnes, 4/15/2008
"American Cancer Society recognizes virtual colonoscopy screening benefit",
The ACS says "Provided that advanced, proven techniques are employed in the clinical setting, CTC is included in the guidelines as an option for colorectal cancer screening and prevention in average-risk adults aged 50 years and older"
"Disparate VC results suggest 2D/3D debate isn't over", Eric Barnes, 12/11/2007
"Primary 3D VC equivalent to colonoscopy", Eric Barnes, 9/12/2007
"Significant Extracolonic Cancer Found in VC Screening Patients", Eric Barnes, 6/12/2007
"Translucency rendering aids prepless 3D VC", Eric Barnes, 5/14/2007
"Screening model calls VC most cost-effective colon exam", Eric Barnes, 4/24/2007
"VC CAD delivers accuracy on unfamiliar datasets", Eric Barnes, 2/5/2007
"Low Incidence of Serious Extracolonic Findings Seen in VC Screening Population", Eric Barnes, 12/18/2006
"New Data Reveal Higher Efficacy for Primary VC Screening", Eric Barnes, 10/18/2006
"VC Finds Early Niche in Screening", Eric Barnes, 9/27/2006
"VC Finds Risky Polyps, Might Reduce Polypectomies", Eric Barnes, 6/8/2006
"Age and Illness Increase Colonoscopy Risks"
In a population-based cohort of Medicare beneficiaries, despite insurance reimbursement, there is significant underuse of colorectal testing. Given the ability of screening tests to reduce cancer incidence and mortality, continued efforts to promote screening are clearly warranted.
"Underuse of colorectal cancer screening in a cohort of medicare beneficiaries"
This study suggests that the overall risk of colonoscopy complications among Medicare beneficiaries is low. Nevertheless, risk increases with age and with certain chronic health problems. These observations suggest that some elderly or debilitated patients might have fewer complications from a CT colonography when the risks of perforation and bleeding are nonexistent.
Centre for Reviews and Dissemination
“CT colonography to screen for colorectal cancer and aortic aneurysm in
the Medicare population: cost-effectiveness analysis”
The authors concluded that CTC was a highly cost-effective screening strategy.
Two sites show how to make CTC clinically routine - Diagnostic Imaging,
Each has taken a distinct approach to making CT colonography part of the clinical routine, Pickhardt reaching out to third-party payers and Puckett reaching ... Greg Freiherr, April 6, 2010
"Extracolonic Findings from CT Colonography Can Uncover Serious Disease", James Brice, 05/21/2009
"CT Colonography bests conventional screening in cost-effectiveness test", Pia Pyne Miller, 4/23/2007
"GI Docs Find Value in Virtual Colonoscopy", C.P. Kaiser, 5/31/2006
“AGA Standards for Gastroenterologists for Performing and Interpreting Computed Tomography Colonography: 2011 Update”
As the technology surrounding CT colonography evolves, it is important that gastroenterologists not only understand the multiple issues surrounding CT colonography, but also that those who wish to perform it be able to interpret it accurately.
"Standards for Gastroenterologists for Performing and Interpreting Diagnostic Computed Tomographic Colonography",
"Surface Visualization at 3D Endoluminal CT Colonography: Degree of Coverage and Implications for Polyp Detection",
"Computed Tomographic Virtual Colonoscopy Computer-Aided-Polyp-Detection in Screening",
"Position of the American Gastroenterological Association (AGA) Institute on Computed Tomographic Colonography",
“CT Colonography: Perforation Rates an Potential Radiation Risks”
Although several organizations have raised concerns about the safety of CTC, the current evidence suggests that the risks are likely to be small. The data on colonic perforation suggest that the rate is low (0.005%-0.03%), especially compared with colonoscopy (0.06%-0.19%). Also, because no sedation is required the cardiopulmonary risks are avoided. Current CTC technique uses low-dose parameters. The 2009 American College of Radiology practice guidelines specifically recommend the use of low-dose technique for screening CTC. Studies have been performed showing that with the use of multidetector CT scanners the ability to detect polyps of size 6 mm and larger is maintained with low-dose techniques. New dose-modulation techniques that are now available may be used to help reduce radiation dose further.
“Impact of a CT Colonography Colorectal Cancer Screening
Program on Optical Colonoscopy: 5 Year Data”
Since the initiation of third party covered CTC screening at our institution, the overall number of total CRC screening exams (CTC + OC) has greatly increased. 2) Furthermore, the initiation of a CTC screening program did not lead to a reduction in the number of OC exams performed, conversely, a significant increase in the number of screening and total OC exams completed was observed. 3) Five years after the initiation of a CTC CRC screening program, OC remains the predominant screening modality for colorectal cancer.
General Surgery News
“Disruption of Screening Colonoscopy Looming on the Horizon. Can Focus on Better Quality Colonoscopy Prevent This?”
In his lecture, Dr. Rex said that colonoscopy dominates colorectal cancer (CRC) screening in the United States and has had a “huge impact” on the practice of gastroenterology, but many wonder whether it will someday be supplanted by a newer, perhaps even better approach.
Health Imaging & IT
"Virtual Colonoscopy Going for the Gold (Standard)",
"Wait and "C",
"Third-Party Payor-Reimbursed Study Validates Virtual Colonoscopy",
"Low-dose protocol doesn’t affect 3D CTC" by Editorial Staff, Healthimaging.com
Japan Radiological Society
“Initial experience with computed tomographic colonography applied for noncolorectal cancerous conditions”
The indications for CTC were varied for patients with noncolorectal cancerous conditions. CTC was not necessarily required for the diagnosis of noncolorectal cancers. Unlike colonoscopy or CT without preparation, CTC was able prove the existence of both colonic and extracolonic findings, so it may reduce the number of colonoscopies performed after CTC. It may also be used in weakened patients with malignancy who were unable to undergo colonoscopy.
Journal of the American College of Radiology
Clinical Use of CT Colonography for Colorectal Cancer Screening in Military Training Facilities and Potential Impact on HEDIS Measures
CTC is actively being used for CRC screening across military treatment facilities. The inclusion of CTC as a HEDIS-compliant CRC screening test has the potential to significantly increase health care system compliance for National Committee for Quality Assurance CRC screening measures.
“Adoption of CT Colonography by US Hospitals”
Growth of CT colonographic services at US hospitals occurred even in the absence of Medicare coverage or agreement among national guideline-setting organizations regarding CTC's use in screening. Almost one-third of hospitals that offer CTC do not offer optical colonoscopy and may not be prepared to provide adequate follow-up for patients with failed CTC.
Journal of Computer Assisted Tomography
"Polyp Detection at 3-Dimensional Endoluminal Computed Tomography Colonography: Sensitivity of One-Way Fly-Through at 120 Degrees Field-of-View Angle"
Journal of General Internal Medicine
"Predictors of CT Colonography Utilization Among Asymptomatic Medicare Beneficiaries"
1Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; 2Department of Internal Medicine, Hospital of the
University of Pennsylvania, Philadelphia, PA, USA.
During the 2 years preceding CMS denial for screening, CTC was targeted to asymptomatic patients with relatively appropriate clinical indications
for CTC/not receiving OC. However, CTC utilization was lower among certain demographic groups, including minority patients. These findings raise the possibility that future coverage of screening CTC might exacerbate
disparities in colorectal cancer screening while increasing overall screening rates.
The Journal of Urology
"Prevalence of Urolithiasis in Asymptomatic Adults: Objective Determination
Using Low Dose Noncontrast Computerized Tomography",
A clinical study of more than 5,000 asymptomatic individuals is shedding new light on the prevalence and sequelae of stone disease in adults screened with virtual colonoscopy. Researchers found evidence of calculi in nearly 9% of the study population, results that tweak assumptions about groups thought to be at higher risk of stone disease.
Urolithiasis is an expensive and time-consuming condition for healthcare providers to treat, accounting for more than 2 million office visits and nearly
200,000 hospital admissions each year, with estimated costs of more than $2
billion annually in the U.S., noted study authors Dr. Cody Boyce, Dr. Perry Pickhardt, Dr. Edward Lawrence, Dr. David Kim, and Dr. Richard Bruce from the University of Wisconsin School of Medicine and Public Health in Madison. Studies also suggest that the incidence of symptomatic stone disease is increasing, they wrote.
"CMS Made the Wrong Decision", 05/12/2009
The Lancet Oncology
Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history
Volumetric growth assessment of small colorectal polyps could be a useful biomarker for determination of clinical importance. Advanced adenomas show more rapid growth than non-advanced adenomas, whereas most other small polyps remain stable or regress. Our findings might allow for less invasive
“Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial”
Participation in colorectal cancer screening with CT colonography was significantly better than with colonoscopy, but colonoscopy identified significantly more advanced neoplasia per 100 participants than did CT colonography. The diagnostic yield for advanced neoplasia per 100 invitees was similar for both strategies, indicating that both techniques can be used for population-based screening for colorectal cancer. Other factors such as cost effectiveness and perceived burden should be taken into account when deciding which technique is preferable.
“Strong Evidence in Support of CT Colonography Screening”
The bottom line is quite simple—too many people are dying of a readily preventable disease. The issue with screening for colorectal cancer is not related to test efficacy per se, but rather to the willingness of patient participation (and study availability). By offering the additional option of CT colonography for screening, overall patient outcomes will be positively affected by the equivalent (or greater) yield for advanced neoplasia coupled with a decrease in complications and costs.
National Cancer Institute - Life Lines
"Colorectal Cancer Screening: for African Americans, It's about Prevention, Not
Nature Reviews Clinical Oncology
"Screening: CT colonography: time for clinical implementation", Perry J. Pickhardt, MD, April 2009
Colorectal and Extracolonic Cancers Detected at Screening CT Colonography in
10 286 Asymptomatic Adults,
The overall detection rate of unsuspected cancer is approximately one per 200 asymptomatic adults undergoing routine screening CT colonography, including about one invasive CRC per 500 cases and one extracolonic cancer per 300 cases. Detection and treatment at an early presymptomatic stage may have contributed to the favorable outcome.
CT Colonography: Performance and Program Outcome Measures in an Older
"Unsuspected Extracolonic Findings at Screening CT Colonography: Clinical and
Detection of relevant unsuspected extracolonic disease at CT colonographic screening is not rare, accounting for a relatively large percentage of cases in which additional workup was recommended. Judicious handling of potential extracolonic findings is warranted to balance the cost of additional workup against the potential for early detection of important disease, because many findings will prove to be of no clinical consequence.
"Screening for Colorectal Neoplasia with CT Colonography: Initial Experience from the 1st Year of Coverage by Third-Party Payers",
As a primary colorectal screening tool, CT colonography covered by third-party payers has an
acceptably low endoscopic referral rate and a high concordance of positive findings at optical colonoscopy.
"Linear Polyp Measurement at CT Colonography: In Vitro and in Vivo Comparison of Two-Dimensional and Three-dimensional Displays",
Linear polyp measurement on 3D endoluminal views was significantly more accurate than
measurement on 2D transverse, coronal, or sagittal views, both in vitro and in vivo, for the CT colonography system evaluated. Use of the optimized 2D view substantially reduced 2D measurement error and may be valuable when used in conjunction with 3D measurement.
"Building a CT Colonography Program: Necessary Ingredients for
Reimbursement and Clinical Success",
The challenges facing widespread implementation of CT colonography programs for primary
screening are substantial but certainly not insurmountable.
"Incidence of Colonic Perforation at CT Colonography: Review of Existing Data and Implications for Screening of Asymptomatic Adults",
The actual risk of colonic perforation at CT colonography is exceedingly low and may likely approach zero in asymptomatic patients who are undergoing screening when specific techniques
The National CT Colonography Trial: Assessment of Accuracy in Participants 65 Years of Age and Older
For most measures of diagnostic performance and in most subsets, the difference between senior-aged participants and those younger than 65 years was not statistically significant.
"Virtual Colonoscopy — On Its Way to Being a Real Screening Tool?" by Beth W. Orenstein, Radiology Today, Vol. 9 No. 23 P. 22
The Wall Street Journal / Journal Watch
"CT Scans Gain Favor as Option for Colonoscopy",
"Why We'll Never Cure Cancer",
"CT Colonography vs. Colonoscopy",