"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",
Ronald M. Summers, Jeffrey A. Swift, Andrew J. Dwyer, J. Richard Choi, and Perry J. Pickhardt, Am. J. Roentgenol., Nov 2009; 193: 1296 - 1304
"Comparison of Optical Colonoscopy and CT Colonography for Polyp Detection",
Dachman, A.H., Am. J. Roentgenol., 2009; 193:1289-1290
"Comparison of Polyp Size and Volume at CT Colonography: Implications for
Follow-Up CT Colonography",
Emily Bethea, Ogonna K. Nwawka, and Abraham H. Dachman, Am. J. Roentgenol., Dec 2009; 193: 1561
– 1567
"Clinical Management of Small (6- to 9-mm) Polyps Detected at Screening CT Colonography: A Cost-Effectiveness Analysis",
Perry J. Pickhardt, Cesare Hassan, Andrea Laghi, Angelo Zullo, David H. Kim, Franco Iafrate, and Sergio
Morini, Am. J. Roentgenol., Nov 2008; 191: 1509 - 1516.
"Performance of a previously Validated CT Colonography Computer-Aided
Detection System in a New Patient Population",
Ronald M. Summers, Laurie R. Handwerker, Perry J. Pickhardt, Robert L. Van Uitert, Keshav K. Deshpande, Srinath Yeshwant, Jianhua Yao, and Marek Franaszek Am. J. Roentgenol., Ju 2008; 191:
168-174
"Replacing Barium Enema with CT Colonography in Patients Older Than 70
Years: The Importance of Detecting Extracolonic Abnormalities",
Damian J. M. Tolan, Euan M. Armstrong, and Anthony H. Chapman, Am. J. Roentgenol., Nov 2007; 189:
1104 - 1111
" Primary 2D Versus Primary 3D Polyp Detection at Screening CT Colonography",
Perry J. Pickhardt, Andrew D. Lee, Andrew J. Taylor, Steven J. Michel, Thomas C. Winter, Anthony Shadid, Ryan J. Meiners, Peter J. Chase, J. Louis Hinshaw, John G. Williams, Tyler M. Prout, S. Hamid Husain, David H. Kim, 189, December 2007
"Translucency Rendering in 3D Endoluminal CT Colonography: A Useful Tool for
Increasing Polyp Specificity and Decreasing Interpretation Time",
P. J. Pickhardt August 2004 AJR:183(2),429 - 436
"Three-Dimensional Endoluminal CT Colonography (Virtual Colonoscopy): Comparison on Three Commercially Available Systems",
P. J. Pickhardt December 4, 2003 AJR: 181, 1599-1606
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"
Perry J. Pickhardt, September 2003:181, 799-805
"Performance of a Previously Validated CT Colonography Computer-Aided
Detection System in a New Patient Population",
Ronald M. Summers, Laurie R. Handwerker, Perry J. Pickhardt, Robert L. Van Uitert, Keshav K. Deshpande, Srinath Yeshwant, Jianhua Yao, and Marek Franaszek Am. J. Roentgenol., Jul 2008; 191: 168 - 174.
“National CT Colonography Trial (ACRIN 6664): Comparison of
Three Full-Laxative Bowel Preparations in More Than 2500
Average-Risk Patients”
Amy K. Hara, Mark D. Kuo, Meridith Blevins, Mei-Hsiu Chen, Judy Yee, Abraham Dachman, Christine O. Menias, Betina Siewert, Jugesh I. Cheema, Richard G. Obregon, Jeff L. Fidler1, Peter Zimmerman1, Karen M. Horton, Kevin Coakley, Revathy B. Iyer, Robert A. Halvorsen Jr., Giovanna Casola, and C. Daniel Johnson, May 2011 196(5): 1076–1082. doi:10.2214/AJR.10.4334.
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”
Ju Hee Lee, Seong Ho Park, Seung Soo Lee, Ah Young Kim, Jin Cheon Kim, Chang Sik Yu, and Hyun Kwon Ha, October 2011 197:W653-W657; doi:10.2214/AJR.10.6225
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”
Amy Berrington de González1, Kwang Pyo Kim2, Amy B. Knudsen3, Iris Lansdorp-Vogelaar4,
Carolyn M. Rutter5, Rebecca Smith-Bindman6, Judy Yee7, Karen M. Kuntz8, Marjolein van Ballegooijen4,
Ann G. Zauber9 and Christine D. Berg10, April 2011, Vol. 196:4, pp 816-823
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.
Annals of Internal Medicine
Is Computed Tomographic Colonography Being Held to a Higher Standard?,
Samita Garg, MD, and Dennis J. Ahnen, MD
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",
Perry J. Pickhardt, MD; Pamela A. Nugent, MD; Pauline A. Mysliweic, MD, MPH; J. Richard Choi, ScD, MD; and William R. Schnindler, DO, September 7, 2004 | Volume 141 Issue 5| Pages 352-359
Archives of Internal Medicine
Computed Tomographic Colonography to Screen for Colorectal Cancer, Extracolonic Cancer, and Aortic Aneurysm Model Simulation With Cost- effectiveness Analysis
Cesare Hassan, MD; Perry Pickhardt, MD; Andrea Laghi, MD; Daniel Kim, MD; Angelo Zullo, MD; Franco
Iafrate, MD; Lorenzo Di Giulio, MD; Sergio Morini, MD Arch Intern Med. 2008;168(7):696-705
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.
AuntMinnie.com
“Acceptance grows for VC among patients, referring physicians”
Eric Barnes, November 3, 2011
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”
David Barnes, October 26, 2011
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”
Eric Barnes, May 17, 2011
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”
Eric Barnes, October 27, 2011
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”
Eric Barnes, June 6, 2011
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”
Erik L. Ridley, February 15, 2011
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",
Erik L. Ridley, 3/5/2008
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
Cancer
"Age and Illness Increase Colonoscopy Risks"
Gregory S. Cooper, MD, Tzuyung Doug Kou, PH, MA, CANCER, Volume 112, Issue 2, Pages 293-299, Published Online
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.
Cancer Consultants.com
"Underuse of colorectal cancer screening in a cohort of medicare beneficiaries"
Reference: Warren JL, Klabunde CN, Mariotto AB et al. Adverse events after outpatient colonoscopy in the Medicare population. Annals of Internal Medicine. 2009;150:849-857.
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”
Pickhardt PJ, Hassan C, Laghi A, Kim DH, 1/16/2011 10:11 AM
The authors concluded that CTC was a highly cost-effective screening strategy.
Diagnostic Imaging
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
Gastroenterology
“AGA Standards for Gastroenterologists for Performing and Interpreting Computed Tomography Colonography: 2011 Update”
Brooks D. Cash, Don C. Rockey, Joel V. Brill, December 2011
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",
Don C. Rockey, Matthew Barish, Joel V. Brill, Brooks D. Cash, Joel G. Fletcher, Prateer Sharma, Sachin Wani, Maurits J. Wiersema, Laura E. Peterson, and Jennifer Conte, 2007;133:1005–10242-158
"Surface Visualization at 3D Endoluminal CT Colonography: Degree of Coverage and Implications for Polyp Detection",
Perry J. Pickhardt, MD; Andrew J. Taylor, and Deepak V. Gopal, 2006 | 130: 1582-1587
"Computed Tomographic Virtual Colonoscopy Computer-Aided-Polyp-Detection in Screening",
Ronald M. Summers, Jianhua Yao, Perry J. Pickhardt, Marek Franaszek, Ingmar Bitter, Daniel Brickman, Vamsi Krisna, and J. Richard Choi, 2005 | 129: 1832-1844
"Position of the American Gastroenterological Association (AGA) Institute on Computed Tomographic Colonography",
2006 | 131: 1627-1628
Gastrointestinal Endoscopy
“CT Colonography: Perforation Rates an Potential Radiation Risks”
Berrington de Gonzalez A, DPhila, *, Kwang Pyo Kim, PhDb, Judy Yee, MDc Gastrointest Endosc Clin N Am. 2010 Apr;20(2):279-291 April 2010
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”
Mark E. Benson, Jeff Pier, Sally Kraft, David H. Kim, Perry J. Pickhardt, Deepak V. Gopal, Mark Reichelderfer, Kevin Dasher, Patrick Pfau, Volume 71, Issue 5 , Page AB129, April 2010
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?”
Caroline Helwick, SEPTEMBER 2011 | VOLUME: 38:9
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)",
Beth Walsh, 9/01/07
"Wait and "C",
Renee DiIulio, August 2007
"Third-Party Payor-Reimbursed Study Validates Virtual Colonoscopy",
Cat Vasko, 12/04/2006
Health Imaging.com
"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”
Tamaki Ichikawa • Shuichi Kawada • Satoru Hirata - Shu Ikeda • Yuuki Sato • Yutaka Imai, July 2011, Vol. 29:6, pp. 386-393) Jpn J Radiol (2011) 29:386–393 DOI 10.1007/s11604-011-0569-7
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
“Adoption of CT Colonography by US Hospitals”
Megan McHugh, PhD, Awo Osei-Anto, MPP, Carrie N. Klabunde, PhD, Barbara A. Galen, MSN, CRNP, CNMT, March 2011, Volume 8, Issue 3, Pages 169-174
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"
by Pickhardt, Perry J. MD; Schumacher, Clark MD; Kim, David H. MD, Journal of Computer Assisted
Tomography: July/August 2009 - Volume 33 - Issue 4 - pp 631-635 doi: 0.1097/RCT.0b013e31819778ea
The Journal of Urology
"Prevalence of Urolithiasis in Asymptomatic Adults: Objective Determination
Using Low Dose Noncontrast Computerized Tomography",
Cody J. Boyce, Perry J. Pickhardt, Edward M. Lawrence, David H. Kim, and Richard J. Bruce
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.
Kay Granger
"CMS Made the Wrong Decision", 05/12/2009
The Lancet Oncology
“Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial”
Esther M Stoop*, Margriet C de Haan*, Thomas R de Wijkerslooth, Patrick M Bossuyt, Marjolein van Ballegooijen,
C Yung Nio, Marc J van de Vijver,Katharina Biermann, Maarten Thomeer, Monique E van Leerdam, Paul Fockens, Jaap Stoker, Ernst J Kuipers, Evelien Dekker, Published Online: November 15, 2011
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”
Perry J. Pickhardt, M.D., Published Online: November 15, 2011
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.
Nature Reviews Clinical Oncology
"Screening: CT colonography: time for clinical implementation", Perry J. Pickhardt, MD, April 2009
Perry J. Pickhardt, MD, April 2009
Radiology
Colorectal and Extracolonic Cancers Detected at Screening CT Colonography in
10 286 Asymptomatic Adults,
Authors: 1. Perry J. Pickhardt, MD, 2. David H. Kim, MD, 3. Ryan J. Meiners, MD, 4. Kimberly S. W yatt, MD, 5. Meghan E. Hanson, MD, 6. Duncan S. Barlow, MD, 7. Priscilla A. Cullen, RN, 8. Rahim A. Remtulla, MD and 9. Brooks D. Cash, MD
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
Screening Population,
David H. Kim, MD, Perry J. Pickhardt, MD, Meghan E. Hanson, MD and J. Louis Hinshaw, MD
Purpose: To evaluate computed tomographic (CT) colonography performance and program outcome measures in an older cohort (65–79 years) of an established large-scale colorectal cancer screening program.
"Unsuspected Extracolonic Findings at Screening CT Colonography: Clinical and
Economic Impact",
Perry J. Pickhardt, MD, Meghan E. Hanson, MD, David J. Vanness, PhD, Justin Y. Lo, MS, David H. Kim, MD, Andrew J. Taylor, MD, Thomas C. W inter, MD, and J. Louis Hinshaw, MD, Radiology 2008;249:151-159
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",
Perry J. Pickhardt, MD, Andrew J. Taylor, MD, David H. Kim, MD, Mark Reicheldferfer, MD, Deepak V. Gopal, MD, and Patrick R. Pfau, MD, 2006. 0:2412052007
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",
Perry J. Pickhardt, MD, Andrew D. Lee, MD, Elizabeth G. McFarland, MD, Andrew J. Taylor, MD, 2005; 236:872-878
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",
Perry J. Pickhardt, MD,Andrew J. Taylor, MD, Gary L. Johnson, MD, Lawrence A. Fleming, MD, Debra A. Jones, MD, Patrick R. Pfau, MD, Mark Reichelderfer, MD, 2005; 235:17-20
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",
Perry J. Pickhardt, MD, 2006; 239: 313-316
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
are employed.
Radiology Today
"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",
By Rhonda L. Rundle, The Wall Street Journal, 10/28/2008
"Why We'll Never Cure Cancer",
Peter B. Bach, The Wall Street Journal, 10/27/07
"CT Colonography vs. Colonoscopy",
Allan S. Brett, M.D., Journal Watch, November 1, 2007, Vol 27 No. 21
