Virtual Colonography. Virtual Colonoscopy. Colon Cancer 2007: 145,290 new cases

Size: px

Start display at page:

Download "Virtual Colonography. Virtual Colonoscopy. Colon Cancer 2007: 145,290 new cases"

Allen Hampton
5 years ago
Views:

11 Virtual Colonography CT IVP What No One Wants To See Virtual Colonoscopy Colon Cancer 2007: 145,290 new cases Est.

The screening population has a high prevalence of detectable preclinical phase 3.

The screening test has high accuracy for detecting the detectable preclinical phase 5.

1 11 Virtual Colonography CT IVP What No One Wants To See Virtual Colonoscopy Colon Cancer 2007: 145,290 new cases Est. 73,470 deaths Screening Test Criteria 1. The Disease has serious consequences 2. The screening population has a high prevalence of detectable preclinical phase 3. The screening test detects little pseudo-disease disease 4. The screening test has high accuracy for detecting the detectable preclinical phase 5. The screening test detects disease before the critical point 6. The screening test causes little morbidity 7. The screening test is affordable and available 8. Treatment exists 9. Treatment is more effective when applied before symptoms begin 10.Treatment is not too risky or toxic Is VC an option for screening? Slide courtesy of Steve Studerman 1

Published Sensitivity Pickhard, PJ et al NJME 12-4-03 DOD study : 1233 patients 10mm polyps 93.

2 Published Sensitivity Pickhard, PJ et al NJME DOD study : 1233 patients 10mm polyps 93.8% Controversial Data* Cotton et al JAMA cases sensitivity 55%* specificity 96% Rockey et al Lancet cases sensitivity 59%* specificity 96% *Significant number of readers had no training in VC *High risk patient population ACRIN 6664 Study 2007 Funded by NIH 2531 patients in 15 centers (academic and private) 90% sensitivity for polyps 1 cm and larger Approx. 8% referral rate for Optical Colonoscopy All readers had significant training in reading VC 2008 A consensus guideline released jointly by The ACR, ACS, and the US Multi-Society Task Force on Colorectal Cancer (Am. College of Gastroenterology, Am. Gastroenterological Assoc. & Am. Society for Gastrointestinal Endoscopy) CT Colonography is included as one of the screening options in average risk adults age 50 and older. The recommendation is once every 5 years. The Politics and Payment of the procedure ICD Code 2

(keeps radiation dose low) Scan Supine and prone (Decubs +/-) Colonic distension by electronic CO2 (monitored at ~ 24psi,approximately 4lt.

3 Patient Preparation 24 hours low fiber diet Lo So Prep tm with Tegatol for stool tagging Magnesium citrate 18.o0 grams Potassium citrate 3% Citric acid 65% Bisacodyl tablets & Bisacodyl Suppository NPO morning of exam (may take medications) Examination Parameters Multi slice CT scanner 16 Low ma technique (keeps radiation dose low) Scan Supine and prone (Decubs +/-) Colonic distension by electronic CO2 (monitored at ~ 24psi,approximately 4lt.) Average time on table minutes Screening Indications Failed Optical Colonoscopy Routine Scheduling Currently performed at the Rancho Bernardo site only Schedule routinely Medical Conditions Contraindicating OC Patient Preference Off line work station 2-D and 3-D mode Fly through examination Extra colonic findings Interpretation The Report C-0 Inadequate Exam / awaiting comparison study C-1 Normal Examination: Continue Routine screening C-2 Intermediate Polyp: Surveillance or Colonscopy recommended (6-9mm polyp <3 in number) C-3 Polyp, Possible Advanced Adenoma: F/U Colonscopy recommended (>3 polyps 6-9mm or Polyp 10mm in size) C-4 Colonic Mass, likely Malignant 3

4 Examples from VC Normal Ileocecal Valve Ileocecal valves and Polyps Ileocecal Valve Polyps Polyps 2-D & 3-D Polyp 4

5 Extra Colonic Findings The Future Pericardial effusion Coronary A. Ca++ AAA / iliac artery aneurism Nephrolithiasis Cholelithiasis Lung nodule probably CA Pelvic masses (including 2 patients with unknown ovarian CA) Hiatal Hernia Prep-less VC using electronic stool subtraction? CAD Radiologist Contacts Walter B. Goff II, D.O., FACR Ugne Skripkus, MD Murray Warmath, MD Richard Abello, MD Douglas Bates, MD CT IVP Scan Sequences Abdomen-Pelvis Non-contrast A/P Nephrogenic Phase A/P Delayed (6 minutes) Axial, Coronal, and Sagital images Indications Hematuria (If a stone is suspected may only need the non-contrast Renal Stone Study) An indeterminist mass or cyst by Ultrasound or incidentally seen at MRI Post operative or traumatic renal, ureteral, or bladder injury 5

6 Renal Mass Bladder Mass 6

Current trends in virtual colonoscopy

Current trends in virtual colonoscopy Zarina I Lockhat, FFRad(D)SA Department of Radiology, Pretoria Academic Hospital and Irma van de Werke, FRCR Department of Radiology, Kalafong Hospital and André du