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Preparation of CTC Patient: Diet, Bowel Preparation, the Role of Tagging, and Methods of Colonic Insufflation

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CT Colonography for Radiographers

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Abstract

Cathartic bowel preparation and tagging agents are pivotal in CT colonography (CTC). For a successful study, it is important that a clean bowel is well distended, and that residual fluid is tagged. Although perforation is rare, it is important to use a sterile disposable small gauge rectal catheter and an automated pressure-controlled insufflator to prevent risk of perforation. Patients must be informed of their responsibilities before and during the study. Patients should be told that it is essential that they adhere to a liquid diet and take the bowel preparation medication at the correct times. CTC images are presented of poor bowel preparation and tagging of residual fluid.

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References

  1. Pickhardt PJ. Imaging and screening for colorectal cancer with CT colonography. Radiol Clin N Am. 2017;55:1183–96.

    Article  PubMed  Google Scholar 

  2. Yee J, Weinstein S, Morgan T, Alore P, Aslam R. Advances in CT colonography for colorectal screening and diagnosis. J Cancer. 2013;4(3):200–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Pickhardt PJ. Screening CT colonography: how I do it. AJR Am J Roentgenol. 2007;189(2):290–8.

    Article  PubMed  Google Scholar 

  4. Bortz JH. CT colonography: an approach for a successful examination. S Afr J Radiol. 2014;18(1):607. https://doi.org/10.4102/sajr.v18i1.607.

    Article  Google Scholar 

  5. Kim B, Park SH, Hong GS, et al. Iohexol versus diatrizoate for fecal/fluid tagging during CT colonography performed with cathartic preparation: comparison of examination quality. Eur Radiol. 2015;25(6):1561–9. https://doi.org/10.1007/s00330-014-3568-0.

    Article  PubMed  Google Scholar 

  6. Pickhardt PJ. Colonic preparation for computed tomographic colonography: understanding the relative advantages and disadvantages of a noncathartic approach. Mayo Clin Proc. 2007;82(6):659–61.

    Article  PubMed  Google Scholar 

  7. Johnson CD, Manduca A, Fletcher JG, MacCarty RL, et al. Noncathartic CT colonography with stool tagging: performance with and without electronic stool subtraction. AJR Am J Roentgenol. 2008;190:361–6.

    Article  PubMed  Google Scholar 

  8. Liedenbaum MH, Denters MJ, de Vries AH, van Ravesteijn VF, et al. Low-fiber diet in limited bowel preparation for CT colonography: influence on image quality and patient acceptance. AJR Am J Roentgenol. 2010;195:W31–7.

    Article  PubMed  Google Scholar 

  9. Johnson B, Hindshaw JL, Robbins JB, Pickhardt PJ. Objective and subjective intrapatient comparison of iohexol versus diatrizoate for bowel preparation at CT colonography. AJR Am J Roentgenol. 2016;206(2):1202–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. McNamara MM, Lockhart ME, Fineberg NS, Berland LL. Oral contrast media for body CT: comparison of diatrizoate sodium and iohexol for patient acceptance and bowel opacification. AJR Am J Roentgenol. 2010;195:1137–41.

    Article  PubMed  Google Scholar 

  11. Pollentine A, Ngan-Soo E, McCoubrie P. Acceptability of oral iodinated contrast media: a head-to-head comparison of four media. Br J Radiol. 2013;86:20120636. https://doi.org/10.1259/bjr.20120636.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Moreno CC, Yee Y, Ahmed FS, Barish MA, Brewington C, Dachman AH, Gollup MJ, Kim DH, McFarland E, Pickhardt PJ, Reddy S, Zalis M, Chang KJ. CT colonography’s role in the Covid-19 pandemic: a safe (r), socially distanced total colon examination. Abdom Radiol. 2021;46(2):486–90. https://doi.org/10.1007/s00261-020-02674-5.

    Article  Google Scholar 

  13. Pickhardt PJ, Kim DH. CT colonography: principles and practice of virtual colonoscopy. Philadelphia: Saunders; 2009.

    Google Scholar 

  14. Summers R. The elephant in the room: bowel preparation for CT colonography. Acad Radiol. 2009;16(7):777–9. https://doi.org/10.1016/j.acra.2009.04.001.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hara AK, Kuo MD, Blevins M, Chen M, et al. National CT colonography trial (ACRIN 6664): comparison of three full-laxative bowel preparations in more than 2500 average-risk patients. AJR Am J Roentgenol. 2011;196(5):1076–82. https://doi.org/10.2214/AJR.10.4334.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Harewood GO, Wiersema MJ, Melton LJ 3rd. A prospective controlled assessment of factors influencing acceptance of screening colonoscopy. Am J Gastroenerol. 2002;97(12):3186–94.

    Article  Google Scholar 

  17. Beebe TJ, Johnson CD, Stoner SM, Anderson KJ, Limburg PJ. Assessing attitudes towards laxative preparation in colorectal cancer screening and effects on future testing: potential receptivity to computed tomographic colonoscopy. Mayo Clin Proc. 2007;82(6):666–71.

    Article  PubMed  Google Scholar 

  18. Bortz JH, Munro L. Does the everyday lifestyle diet of patients for screening CT colonography impact on their bowel cleaning and perceptions of a 1-day liquid diet? S Afr Radiogr. 2018;56(2):11–7.

    Google Scholar 

  19. Kim DH, Pickhardt PJ, Hinshaw JL, et al. Prospective blinded trial comparing 45-mL and 90-mL dose of oral sodium phosphate for bowel preparation before computed tomographic colonography. J Comput Assit Tomogr. 2007;31(1):53–8.

    Article  CAS  Google Scholar 

  20. Markowitz GS, Stoke MB, Radhakrishnan J, D'Agati VD. Acute phosphate nephropathy following oral sodium phosphate bowel purgative: an under recognised cause of chronic renal failure. J Am Soc Nephrol. 2005;16(11):3389–96.

    Article  CAS  PubMed  Google Scholar 

  21. Borden ZS, Pickhardt PJ, Kim DH, et al. Bowel preparation for CT colonography: blinded comparison of magnesium citrate and sodium phosphate for catharsis. Radiology. 2010;254(1):138–44.

    Article  PubMed  Google Scholar 

  22. Bannas P, Bakke J, Munoz de Rio A, Pickhardt PJ. Intra-individual comparison of magnesium citrate and sodium phosphate for bowel preparation at CT colonography: automate volumetric analysis of residual fluid for quality assessment. Clin Radiol. 2014;69:1171–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Macari M, Lovelle M, Pedrosa I, et al. Effect of different bowel preparation on residual fluid at CT colonography. Radiology. 2001;218(1):274–7.

    Article  CAS  PubMed  Google Scholar 

  24. OSS: Suprep Bowel Prep Kit, Braintree Laboratories, Braintree, MA.

    Google Scholar 

  25. Di Palma JA, Rodriguez R, McGowan J, et al. A randomised clinical study evaluating the safety and efficacy of a new, reduced-volume, oral sulphate colon-cleansing preparation for colonoscopy. Am J Gastroenterol. 2009;104(9):2275–84.

    Article  PubMed  Google Scholar 

  26. Bannas P, Bakke J, Patrick JL, Pickhardt JP. Automated volumetric analysis for comparison of oral sulphate solution (SUPREP) with established cathartic agents at CT colonography. Abdom Imaging. 2015;40(1):11–8. https://doi.org/10.1007/s00261-014-0186-x.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kim DH, Hinshaw JL, Lubner MG, Munoz del Rio A, Pooler BD, Pickhardt PJ. Contrast coating for the surface of flat polyps at CT colonography: a marker for detection. Eur Radiol. 2014;24(4):940–6. https://doi.org/10.1007/s00330-014-3095-z.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Grist TM, Canon CL, Fishman EK, Kohi MP, Mossa-Basha M. Short-, mid-, and long-term strategies to manage the shortage of iohexol. Radiology. 2022;304(2):289–93. https://doi.org/10.1148/radiol.221183.

    Article  PubMed  Google Scholar 

  29. Vi-Jon, LLC expands voluntary nationwide recall of all flavors and lots within expiry of magnesium citrate saline laxative oral solution due to microbial contamination. 2022. https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/vi-jon-llc-expands-voluntary-nationwide-recall-all-flavors-and-lots-within-expiry-magnesium-citrate. Accessed 30 Sept 2022.

  30. Gastrografin®. Oral solution. Sodium amidotrizoate 100 mg/mL, meglumine amidotrizoate 660 mg/mL. Gastrografin Australian Approved Product Information from 2009.

    Google Scholar 

  31. Miller SH. Anaphylactoid reaction after administration of diatrizoate meglumine and diatrizoate sodium solution. AJR Am J Roentgenol. 1997;168:959–61.

    Article  CAS  PubMed  Google Scholar 

  32. Pickhardt PJ. CT colonography: does it satisfy the criteria for colorectal screening test? Expert Rev Gastroenterol Hepatol. 2014;8(3):211–3.

    Article  CAS  PubMed  Google Scholar 

  33. Zalis ME, Blake MA, Cai W, et al. Diagnostic accuracy of laxative-free computed tomographic colonography for detection of adenomatous polyps in asymptomatic adults: a prospective evaluation. Ann Intern Med. 2012;156:692–702.

    Article  PubMed  Google Scholar 

  34. RANZCR. Requirements for the practice of computed tomography colonography (CTC). Sydney: The Royal Australian and New Zealand College of Radiologists; 2013. p. 6.

    Google Scholar 

  35. Singh R, Neo EN, Nordeen N, Shanmuganathan G, et al. Carbon dioxide insufflation during colonoscopy in deeply sedated patients. World J Gastroenterol. 2012;18(25):3250–3. https://doi.org/10.3748/wjg.v18.i25.3250.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. ASGE Technology Committee. Methods of luminal distention for colonoscopy. Gastrointest Endosc. 2013;77(4):519–25. https://doi.org/10.1016/j.gie.2012.09.025.

    Article  Google Scholar 

  37. Burling D, Taylor SA, Halligan S, Gartner L, et al. Automated insufflation of carbon dioxide for MDCT colonography: distension and patient experience compared with manual insufflation. AJR Am J Roentgenol. 2006;186:96–103. https://doi.org/10.2214/ajr.04.1506.

    Article  PubMed  Google Scholar 

  38. Shinners TJ, Pickhardt PJ, Taylor AJ, Jones DA, Olsen CH. Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography. AJR Am J Roentgenol. 2006;186(6):1491–6. https://doi.org/10.2214/ajr.05.0416.

    Article  PubMed  Google Scholar 

  39. Burling D, Taylor SA, Halligan S. How to get the colon distended? In: Lefere P, Grypspeerdt S, editors. Virtual colonoscopy. Berlin: Springer; 2006. p. 51–60.

    Chapter  Google Scholar 

  40. Sosna J, Bar-Ziv J, Libson E, Eligulashvili M, Blachar A. CT colonography: positioning order and intracolonic pressure. AJR Am J Roentgenol. 2008;191:W175–80. https://doi.org/10.2214/ajr.07.3303.

    Article  Google Scholar 

  41. Williams R. CO2 hand bulb colon distention used with CT colonography. New York: E-Z-E-M Inc.; 2002.

    Google Scholar 

  42. Kim SY, Park SH, Choi EK, et al. Automated carbon dioxide insufflation for CT colonography: effectiveness of colonic distention in cancer patients with severe luminal narrowing. AJR Am J Roentgenol. 2008;190(3):698–706. https://doi.org/10.2214/AJR.07.2156.

    Article  PubMed  Google Scholar 

  43. Pickhardt PJ. Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults. Radiology. 2006;239(2):313–6.

    Article  PubMed  Google Scholar 

  44. Farley DR, Greenlee SM, Dirk R, et al. Double-blind, prospective, randomised study of warmed, humidified carbon dioxide insufflation vs standard carbon dioxide for patients undergoing laparoscopic cholecystectomy. Arch Surg. 2004;139(7):739–44. https://doi.org/10.1001/archsurg.139.7.739.

    Article  PubMed  Google Scholar 

  45. Glew PA, Campher MJJ, Pearson K, Schofield JC, Davey AK. The effect of warm humidified CO2 on the dissipation of residual gas following laparoscopy in piglets. J Am Assoc Gynecol Laparosc. 2004;11(2):204–10.

    Article  PubMed  Google Scholar 

  46. Sosna J, Blacher A, Amitai M, et al. Colonic perforation at CT colonography: assessment of risk in a multicenter large cohort. Radiology. 2006;239(2):457–63.

    Article  PubMed  Google Scholar 

  47. Culp CE, Carlson HC. Is there a safe interval between diagnostic invasive procedures and the barium study of the colorectum? Gastrointest Radiol. 1984;9:69–72.

    Article  CAS  PubMed  Google Scholar 

  48. Dachman AH. Advice for optimising colonic distention and minimising risk of perforation during CT colonography. Radiology. 2006;239:317–21.

    Article  PubMed  Google Scholar 

  49. The joint guidance for CTC standards of practice of the British Society of Gastrointestinal and Abdominal Radiology (BSGAR) and The Royal College of Radiology. 2021. https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr201-standards-of-practice-for-computed-tomography-colonography-ctc.pdf. Accessed 29 Sept 2022.

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Acknowledgements

Vimap Technologies provided the cross-section illustration of their of CO2 warming mechanism in the VMX 1020 A, and the close-up view of the Vimap gauge insufflator.

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Authors and Affiliations

  1. LSG Imaging, Los Angeles, CA, USA

    Joel H. Bortz

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  1. Joel H. Bortz
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Editors and Affiliations

  1. Los Angeles, CA, USA

    Joel H. Bortz

  2. Buckinghamshire New University, High Wycombe, UK

    Aarthi Ramlaul

  3. Morningside Durban, South Africa

    Leonie Munro

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Bortz, J.H. (2023). Preparation of CTC Patient: Diet, Bowel Preparation, the Role of Tagging, and Methods of Colonic Insufflation. In: Bortz, J.H., Ramlaul, A., Munro, L. (eds) CT Colonography for Radiographers. Springer, Cham. https://doi.org/10.1007/978-3-031-30866-6_9

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  • DOI: https://doi.org/10.1007/978-3-031-30866-6_9

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  • Online ISBN: 978-3-031-30866-6

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