Johnson CD, Chen MH, Toledano AY, Heiken JP, Dachman A, Kuo MD, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008;359(12):1207–17. doi:10.1056/NEJMoa0800996
Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al. 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;134(5):1570–95. doi:10.1053/j.gastro.2008.02.002.
•• Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, García FA, et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(23):2564–75. doi:10.1001/jama.2016.5989. This statement by the US Preventive Services Task Force strongly recommends colon cancer screening for adults starting at age 50. The USPSTF also recommends CT colonography as a safe and beneficial screening exam in reducing the prevalence and mortality of colon cancer in the population.
Lieberman D. Colorectal cancer screening: practice guidelines. Dig Dis. 2012;30(Suppl 2):34–8. doi:10.1159/000341891.
Johnson CD, Herman BA, Chen MH, Toledano AY, Heiken JP, Dachman AH, et al. The National CT Colonography Trial: assessment of accuracy in participants 65 years of age and older. Radiology. 2012;263(2):401–8. doi:10.1148/radiol.12102177.
•• Lin JS, Piper MA, Perdue LA, Rutter CM, Webber EM, O’Connor E, et al. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;315(23):2576–94. doi:10.1001/jama.2016.3332. This article reviews over 95 studies that have been conducted for CT screening information since the USPSTF published their original recommendation in 2008. The article reviews the test performance of CT colonography to optical colonoscopy and found that both exams provide equivalent results with CT colonography having little to no risk of serious adverse events. The article also evaluates the decreased radiation dose exposure in CT screening exams (approximately 1–5 mSv).
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Pooler BD, Baumel MJ, Cash BD, Moawad FJ, Riddle MS, Patrick AM, et al. Screening CT colonography: multicenter survey of patient experience, preference, and potential impact on adherence. AJR Am J Roentgenol. 2012;198(6):1361–6. doi:10.2214/AJR.11.7671.
McFarland EG, Fletcher JG, Pickhardt P, Dachman A, Yee J, McCollough CH, et al. ACR Colon Cancer Committee white paper: status of CT colonography 2009. J Am Coll Radiol. 2009;6(11):756–772 e4. doi:10.1016/j.jacr.2009.09.007.
Almond LM, Bowley DM, Karandikar SS, Roy-Choudhury SH. Role of CT colonography in symptomatic assessment, surveillance and screening. Int J Color Dis. 2011;26(8):959–66. doi:10.1007/s00384-011-1178-8.
ACR Colon Cancer Committee of the Comission on General Small and Rural Practice. Practice Parameter for the Performance of Computed Tomography (CT) Colonography in Adults (Resolution 2). In: The Process for Developing ACR Practice Parameters and Technical Standards. American College of Radiology Diagnostic Radiology: Computed Tomography (CT) Practice Parameters and Technical Standards. 2014. https://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/CT_Colonography.pdf. Accessed January 16 2017.
Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104(3):739–50. doi:10.1038/ajg.2009.104.
Pickhardt PJ, Kim DH, Pooler BD, Hinshaw JL, Barlow D, Jensen D, et al. Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history. Lancet Oncol. 2013;14(8):711–20. doi:10.1016/S1470-2045(13)70216-X.
Lieberman D, Moravec M, Holub J, Michaels L, Eisen G. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology. 2008;135(4):1100–5. doi:10.1053/j.gastro.2008.06.083.
Yoo TW, Park DI, Kim YH, Kim HS, Kim WH, Kim TI, et al. Clinical significance of small colorectal adenoma less than 10 mm: the KASID study. Hepato-Gastroenterology. 2007;54(74):418–21.
Butterly LF, Chase MP, Pohl H, Fiarman GS. Prevalence of clinically important histology in small adenomas. Clin Gastroenterol Hepatol. 2006;4(3):343–8. doi:10.1016/j.cgh.2005.12.021.
Zalis ME, Barish MA, Choi JR, Dachman AH, Fenlon HM, Ferrucci JT, et al. CT colonography reporting and data system: a consensus proposal. Radiology. 2005;236(1):3–9. doi:10.1148/radiol.2361041926.
Kim DH, Pickhardt PJ. Colorectal cancer: managing diminutive polyps-what is the optimal approach? Nat Rev Gastroenterol Hepatol. 2011;8(3):129–31. doi:10.1038/nrgastro.2011.19.
•• Pickhardt PJ, Pooler BD, Mbah I, Weiss JM, Kim DH. Colorectal findings at repeat CT colonography screening after initial CT colonography screening negative for polyps larger than 5 mm. Radiology, 2017. 282(1):139–48. doi:10.1148/radiol.2016160582. Pickhardt’s article supports the evidence based screening interval of 5–10 years for screening patients receiving a negative initial CTC screening exam. The article also supports the non-reporting management strategy for diminutive lesions since cancer rates are very low in these lesions.
Pooler BD, Kim DH, Lam VP, Burnside ES, Pickhardt PJ. CT Colonography Reporting and Data System (C-RADS): benchmark values from a clinical screening program. AJR Am J Roentgenol. 2014;202(6):1232–7. doi:10.2214/AJR.13.11272.
Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000;343(3):162–8. doi:10.1056/NEJM200007203430301.
•• Yee J, Chang KJ, Dachman AH, Kim DH, EG MF, Pickhardt PJ, et al. The added value of the CT colonography reporting and data system. J Am Coll Radiol. 2016;13(8):931–5. doi:10.1016/j.jacr.2016.04.031. Several experts in the field of CT colonography express their support of C-RADS as a first step towards a standardized reporting system for the assessment and management strategy of colonic and extracolonic findings with the potential to evolve. The acceptance of C-RADS and E-RADS has been adapted for the ACR’s CTC National Data Registry with the potential of broad acceptance.
Cash BD, Riddle MS, Bhattacharya I, Barlow D, Jensen D, del Pino NM, et al. CT colonography of a Medicare-aged population: outcomes observed in an analysis of more than 1400 patients. AJR Am J Roentgenol. 2012;199(1):W27–34. doi:10.2214/AJR.11.7729.
Regge D, Iussich G, Senore C, Correale L, Hassan C, Bert A, et al. Population screening for colorectal cancer by flexible sigmoidoscopy or CT colonography: study protocol for a multicenter randomized trial. Trials. 2014;15:97. doi:10.1186/1745-6215-15-97.
Goldstein NS. Clinical significance of (sessile) serrated adenomas: another piece of the puzzle. Am J Clin Pathol. 2005;123(3):329–30. doi:10.1309/8H7M-UH9E-T9U2-1R2E.
Kim DH, Matkowskyj KA, Lubner MG, Hinshaw JL, Munoz Del Rio A, Pooler BD, et al. Serrated polyps at CT colonography: prevalence and characteristics of the serrated polyp Spectrum. Radiology. 2016;280(2):455–63. doi:10.1148/radiol.2016151608.
• Coppola F, Regge D, Flor N, Papadopoulos D, Golfieri R. Flat lesions missed at conventional colonoscopy (CC) and visualized by CT colonography (CTC): a pictorial essay. Abdom Imaging. 2014;39(1):25–32. doi:10.1007/s00261-013-0052-2. This study evaluates the experience of false negative findings incurred with conventional colonoscopy that were simultaneously positively identified by CT colonography and confirmed with a second endoscopy. Coppola finds CT colonography is comparable to colonoscopy as a screening exam.
Sakamoto T, Mitsuzaki K, Utsunomiya D, Matsuda K, Yamamura S, Urata J, et al. Detection of flat colorectal polyps at screening CT colonography in comparison with conventional polypoid lesions. Acta Radiol. 2012;53(7):714–9. doi:10.1258/ar.2012.110685.
Pickhardt PJ, Lam VP, Weiss JM, Kennedy GD, Kim DH. Carpet lesions detected at CT colonography: clinical, imaging, and pathologic features. Radiology. 2014;270(2):435–43. doi:10.1148/radiol.13130812.
Park SH, Lee SS, Choi EK, Kim SY, Yang SK, Kim JH, et al. Flat colorectal neoplasms: definition, importance, and visualization on CT colonography. AJR Am J Roentgenol. 2007;188(4):953–9. doi:10.2214/AJR.06.0436.
• Utano K, Nagata K, Honda T, Mitsushima T, Yasuda T, Kato T, et al. Diagnostic performance and patient acceptance of reduced-laxative CT colonography for the detection of polypoid and non-polypoid neoplasms: a multicenter prospective trial. Radiology. 2017;282(2):399–407. doi:10.1148/radiol.2016160320. This study evaluates the comparable diagnostic accuracy in neoplasms larger than 6 mm and the increased patient acceptance rate for reduced-laxative CT colonography. Utano also discusses CT colonography as an efficient triage examination for patients with a positive FIT. Higher patient acceptance can lead to increased screening rates and detection of colonic neoplasms.
Iafrate F, Iussich G, Correale L, Hassan C, Regge D, Neri E, et al. Adverse events of computed tomography colonography: an Italian National Survey. Dig Liver Dis. 2013;45(8):645–50. doi:10.1016/j.dld.2013.02.020.
Borden ZS, Pickhardt PJ, Kim DH, Lubner MG, Agriantonis DJ, Hinshaw JL. Bowel preparation for CT colonography: blinded comparison of magnesium citrate and sodium phosphate for catharsis. Radiology. 2010;254(1):138–44. doi:10.1148/radiol.09090398.
Keedy AW, Yee J, Aslam R, Weinstein S, Landeras LA, Shah JN, et al. Reduced cathartic bowel preparation for CT colonography: prospective comparison of 2-L polyethylene glycol and magnesium citrate. Radiology. 2011;261(1):156–64. doi:10.1148/radiol.11110217.
Cai W, Kim SH, Lee JG, Yoshida H. Informatics in radiology dual-energy electronic cleansing for fecal-tagging CT colonography(1). Radiographics. 2013;33(3):891–912. doi:10.1148/rg.333125039.
Cai W, Yoshida H. Electronic cleansing in CT colonography: past, present, and future. In: Yoshida H, Cai W, editors. Virtual Colonoscopy and Abdominal Imaging. Computational Challenges and Clinical Opportunities: Second International Workshop, Held in Conjunction with MICCAI 2010, Beijing, China, September 20, 2010, Revised Selected Papers. Berlin, Heidelberg: Springer Berlin Heidelberg; 2011. p. 1–8.
Mahgerefteh S, Fraifeld S, Blachar A, Sosna J. CT colonography with decreased purgation: balancing preparation, performance, and patient acceptance. AJR Am J Roentgenol. 2009;193(6):1531–9. doi:10.2214/AJR.09.2342.
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Jensch S, Bipat S, Peringa J, de Vries AH, Heutinck A, Dekker E, et al. CT colonography with limited bowel preparation: prospective assessment of patient experience and preference in comparison to optical colonoscopy with cathartic bowel preparation. Eur Radiol. 2010;20(1):146–56. doi:10.1007/s00330-009-1517-0.
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. doi:10.2214/AJR.05.0416.
Burling D, Taylor SA, Halligan S, Gartner L, Paliwalla M, Peiris C, et al. Automated insufflation of carbon dioxide for MDCT colonography: distension and patient experience compared with manual insufflation. AJR Am J Roentgenol. 2006;186(1):96–103. doi:10.2214/AJR.04.1506.
Pendsé DA, Taylor SA. Complications of CT colonography: a review. Eur J Radiol. 2013;82(8):1159–65. doi:10.1016/j.ejrad.2012.04.011.
Stoop EM, de Haan MC, de Wijkerslooth TR, Bossuyt PM, van Ballegooijen M, Nio CY, et al. Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. Lancet Oncol. 2012;13(1):55–64. doi:10.1016/S1470-2045(11)70283-2.
Fletcher JG, Silva AC, Fidler JL, Cernigliaro JG, Manduca A, Limburg PJ, et al. Noncathartic CT colonography: image quality assessment and performance and in a screening cohort. AJR Am J Roentgenol. 2013;201(4):787–94. doi:10.2214/AJR.12.9225.
An S, Lee KH, Kim YH, Park SH, Kim HY, Kim SH, et al. Screening CT colonography in an asymptomatic average-risk Asian population: a 2-year experience in a single institution. AJR Am J Roentgenol. 2008;191(3):W100–6. doi:10.2214/AJR.07.3367.
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Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277–84. doi:10.1056/NEJMra072149.
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• Lambert L, Danes J, Jahoda J, Masek M, Lisy J, Ourednicek P. Submilisievert ultralow-dose CT colonography using iterative reconstruction technique: a feasibility study. Acta radiologica. 2015;56(5):517–25. This study demonstrates the potential for radiation doses in CT colonography to be less than 1 mSv in both prone and supine imaging acquisitions. Decreased risk and increased benefits for patient safety is essential in an efficient CT colonography screening program.
Chang KJ, Yee J. Dose reduction methods for CT colonography. Abdom Imaging. 2013;38(2):224–32. doi:10.1007/s00261-012-9968-1.
Berrington de González A, Kim KP, Knudsen AB, Lansdorp-Vogelaar I, Rutter CM, Smith-Bindman R, et al. Radiation-related cancer risks from CT colonography screening: a risk-benefit analysis. AJR Am J Roentgenol. 2011;196(4):816–23. doi:10.2214/AJR.10.4907.
Pickhardt PJ, Kim DH, Meiners RJ, Wyatt KS, Hanson ME, Barlow DS, et al. Colorectal and extracolonic cancers detected at screening CT colonography in 10,286 asymptomatic adults. Radiology. 2010;255(1):83–8. doi:10.1148/radiol.09090939.
•• Pooler BD, Kim DH, Pickhardt PJ. Potentially important extracolonic findings at screening CT colonography: incidence and outcomes data from a clinical screening program. AJR American journal of roentgenology. 2016;206(2):313–8. doi:10.2214/AJR.15.15193. Pooler writes in support of the E-RADS reporting system and the necessity of follow-up for category E4 findings that could prove to be clinically significant. Although uncommon, extracolonic findings increase the patient’s standard of care and can aid in the surveillance or treatment of once unknown findings.
•• Plumb AA, Boone D, Fitzke H, Helbren E, Mallett S, Zhu S, et al. Detection of extracolonic pathologic findings with CT colonography: a discrete choice experiment of perceived benefits versus harms. Radiology. 2014;273(1):144–52. doi:10.1148/radiol.14131678. This article demonstrates patient and provider tolerance for extracolonic findings in order to diagnose an occasional malignancy. Thus, strengthening the need for a standardized reporting system such as E-RADS.
von Wagner C, Ghanouni A, Halligan S, Smith S, Dadswell E, Lilford RJ, et al. Patient acceptability and psychologic consequences of CT colonography compared with those of colonoscopy: results from a multicenter randomized controlled trial of symptomatic patients. Radiology. 2012;263(3):723–31. doi:10.1148/radiol.12111523.
Zafar HM, Yang J, Harhay M, Lev-Toaff A, Armstrong K. Predictors of CT colonography utilization among asymptomatic medicare beneficiaries. J Gen Intern Med. 2013;28(9):1208–14. doi:10.1007/s11606-013-2414-4.
•• Pyenson B, Pickhardt PJ, Sawhney TG, Berrios M. Medicare cost of colorectal cancer screening: CT colonography vs. optical colonoscopy. Abdom Imaging. 2015;40(8):2966–76. doi:10.1007/s00261-015-0538-1. Pyenson evaluates the cost effectiveness of CT colonography screenings when compared to optical colonoscopy. Lower expenses for Medicare patients can increase screening rates for colon cancer.
Christie J, Itzkowitz S, Lihau-Nkanza I, Castillo A, Redd W, Jandorf L. A randomized controlled trial using patient navigation to increase colonoscopy screening among low-income minorities. J Natl Med Assoc. 2008;100(3):278–84.
Percac-Lima S, Grant RW, Green AR, Ashburner JM, Gamba G, Oo S, et al. A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial. J Gen Intern Med. 2009;24(2):211–7. doi:10.1007/s11606-008-0864-x.
Lasser KE, Murillo J, Lisboa S, Casimir AN, Valley-Shah L, Emmons KM, et al. Colorectal cancer screening among ethnically diverse, low-income patients: a randomized controlled trial. Arch Intern Med. 2011;171(10):906–12. doi:10.1001/archinternmed.2011.201.
Dietrich AJ, Tobin JN, Robinson CM, Cassells A, Greene MA, Dunn VH, et al. Telephone outreach to increase colon cancer screening in medicaid managed care organizations: a randomized controlled trial. Ann Fam Med. 2013;11(4):335–43. doi:10.1370/afm.1469.
• American Cancer Society. Medicare Coverage for Colorectal Cancer Testing. In: Medicare Coverage for Cancer Precention and Early Detection. American Cancer Society, Cancer Screening Guidelines. 2017. https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/medicare-coverage-for-cancer-prevention-and-early-detection.html. Accessed Jan 21 2017. The ACS provides coverage information for Medicare patients in different areas. Low financial costs beared by the patient can lead to increased colon cancer screening rates.
American College of Radiology. Private Payer Coverage. In: CT Colonography Resources American College of Radiology https://www.acr.org/Quality-Safety/Resources/CTC-Resources. Accessed Jan 21 2017.
U.S. Department of Health & Human Services. 15 Covered Preventive Services for Adults. In: Preventive Services Covered Under the Affordable Care Act. U.S. Department of Health & Human Services. 2010. https://www.hhs.gov/healthcare/facts-and-features/fact-sheets/preventive-services-covered-under-aca/#. Accessed Jan 21 2017.
• Centers for Medicare & Medicaid Services. Local Coverage Determination (LCD): Virtual Colonoscopy (CT Colonography) (L34055). Centers for Medicare & Medicaid Services. 2015. https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=34055&ver=4&Date=&DocID=L34055&bc=iAAAABAAAAAAAA%3d%3d&. Accessed Jan 21 2017. Medicare services continues to deny coverage for CTC studies unless an attempted optical colonoscopy or a patient safety issue prevents a successful colonoscopy screening. Allowing multiple options for patients to choose from can lead to increased rates and compliance with screening programs.