Colonography Gp Talk 2 Sept 2008

CT colonography(Virtual colonoscopy)

Dr Peng Hui LEEConsultant RadiologistMEHTwww.midessexray.com

Bowel Cancer

• 3rd most common cancer in UK• 2nd most common in women after breast• 3rd most common in men after lung and prostate• 2nd most common cause of cancer death in UK• 36 766 new diagnoses in 2005• 1 in 20 people in UK during lifetime

Detection

• Flex sig• Colonoscopy• Ba Enema• CT colonography• MR colonography (experimental)• Stool tests (FOB, FIT, eDNA)

Copyright ©Radiological Society of North America, 2006

Thompson, W. M. et al. Radiology 2006;239:139-148

Figure 5: Perceptual error: distraction due to diverticulosis


Thompson, W. M. et al. Radiology 2006;239:139-148

Figure 3b: Perceptual error: cancer visualized en face and contour defect

Copyright © 2007 by the American Roentgen Ray Society

Ko, E. Y. et al. Am. J. Roentgenol. 2007;188:785-791

AJR 1998 Jun;170(6)

Am. J. Roentgenol.172 (5); 1179 May 1999

Editor's Notebook: Bye-bye, bariumLF RogersNow don’t hang up your lead apron just yet. Admittedly, it’s a stretch to say we are now prepared to abandon barium. There will be ample opportunty for you to get barium in your shoes. But, hard as it may be to imagine, it seems quite possible that volumetric CT techniques, may eventually supplant our morning barium routine.Bye-bye, barium? Who would have thought?

….since April 2004, there has no longer been a viable indication to perform DCBE for examination of our patient population

http://www.nice.org.uk/guidance/IPG129

or just google: Nice colonography


Pickhardt, P. J. Am. J. Roentgenol. 2003;181:1599-1606

OPTICAL COLONOSCOPY


Pickhardt, P. J. Am. J. Roentgenol. 2003;181:1599-1606

VIRTUAL COLONOSCOPY

Basic Principles

• Cleanse• Distend• Image• Read

BOWEL PREP

got this at an auction in vegas EZ EM protocol colan insufflator I think its a virtual colanoscopy machine it retails at $11.000 dollars it works perfect do your reasearch and go ahead and bid NO RESERVE any questions you can call me at 702 281 7373


Mang, T. et al. Radiographics 2007;27:431-454

PRONE



SUPINE


Taylor, S. A. et al. Radiology 2006;239:759-767

2D



3D



Figure 14a. Polypoid stool simulating a filling defect in a 73-year-old woman



Figure 14b. Polypoid stool simulating a filling defect in a 73-year-old woman

CTC vs barium enema

• Comfort• Accuracy Sosna AJR 2008

• Extra-colonic findings Tolan AJR 2007

“Diminutive polyps”

• 6mm threshold • Low likelihood of malignancy• False positives• Costs


Lefere, P. et al. Am. J. Roentgenol. 2005;184:1836-1842

TAGGING


Lefere, P. et al. Am. J. Roentgenol. 2005;184:1836-1842

TAGGING


Park, S. H. et al. Radiology 2008;248:1018-1027

Figure 2e: Polyp and polypoid tagged stool pieces in 64-year-old man seen during 3D endoluminal fly-through CT colonography without and with selective discriminative color coding of tagged stool by using volume rendering with attenuation-dependent

color-enhancement technique

CAD



CAD

CAD

• 1st reader• 2nd reader• Concurrent reader

CAD

Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.

Gastroenterology. 2008 May

The following options are acceptable choices for colorectal cancer screening in average-risk adults beginning at age 50 years FSIG with insertion to 40 cm or to splenic flexure Every 5 yearsCSPY Every 10 yearsDCBE Every 5 yearsCTC Every 5 years


Zalis, M. E. et al. Radiology 2005;236:3-9

Figure 2. Suggested categorization system for CT colonography findings and follow-up recommendations

AGA Institute Position on CT ColonographyMay 2008 Guided by the principle that gastroenterologists should be able to use and manage any technology that can enable them to provide better patient care, the AGA continues to take a leadership role with technologies such as CT colonography. With the best interest of patients in mind, the AGA is monitoring this technology, creating training standards for performance of the study, and establishing coding and reimbursement codes for gastroenterologists who wish to perform the procedure.http://www.gastro.org/wmspage.cfm?parm1=5623

• Radiographers with training in CT colonographic evaluation achieved sensitivity and specificity in polyp detection comparable with that of radiologists. Radiographers can be considered reviewers in the evaluation of CT colonographic images. o Jensch et al AJR2007

Cost (-effectiveness)

• Ba Enema < CT colonography < Optical colonoscopy

• (Screening) o A number of studies assessing the cost-effectiveness of

CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. Mavranezouli et al Eur Rad 2008

Health & Medicine

Colonography Gp Talk 2 Sept 2008