CT Colonography. A Radiologist s View of the Colon from Outside-In. Donny Baek, MD

Transcription

1 CT Colonography A Radiologist s View of the Colon from Outside-In Donny Baek, MD

2 Computed Tomography (CT)

3

4 CT Image Reconstruction

5 CT Image Reconstruction

6 CT Image Reconstruction

7 Colorectal Cancer Annual Global Rates Cancer Epidemiol Biomarkers Prev 2015; 25(1); million new cases 700,000 deaths 3 rd most common in men 2 nd most common in women Highest rates: North America, Australia, Europe, and South Korea

8 Colorectal Cancer In the U.S. 140,000 new cases 50,000 deaths 3 rd most common cancer 2 nd leading cause of cancer deaths 10% of all new cancer cases Cancer Epidemiol Biomarkers Prev 2015; 25(1); 16-27

9 Screening American Cancer Society, U.S. Multi-Society Task Force on Colorectal Cancer, American College of Radiology Tests that primarily detect cancer FOBT or FIT annually Stool DNA tests (interval unknown) Tests that detect polyps and cancer Flexible sigmoidoscopy every 5 years Double contrast BE every 5 years CT colonography every 5 years Colonoscopy every 10 years

10 Screening American Cancer Society, U.S. Multi-Society Task Force on Colorectal Cancer, American College of Radiology Tests that primarily detect cancer FOBT or FIT annually Stool DNA tests (interval unknown) Tests that detect polyps and cancer Flexible sigmoidoscopy every 5 years Double contrast BE every 5 years CT colonography every 5 years Colonoscopy every 10 years

11 Screening American Cancer Society, U.S. Multi-Society Task Force on Colorectal Cancer, American College of Radiology Tests that primarily detect cancer FOBT or FIT annually Stool DNA tests (interval unknown) Tests that detect polyps and cancer Flexible sigmoidoscopy every 5 years Double contrast BE every 5 years CT colonography every 5 years Colonoscopy every 10 years

12 Screening American Cancer Society, U.S. Multi-Society Task Force on Colorectal Cancer, American College of Radiology Tests that primarily detect cancer FOBT or FIT annually Stool DNA tests (interval unknown) Tests that detect polyps and cancer Flexible sigmoidoscopy every 5 years Double contrast BE every 5 years CT colonography every 5 years Colonoscopy every 10 years

13 Screening American Cancer Society, U.S. Multi-Society Task Force on Colorectal Cancer, American College of Radiology Tests that primarily detect cancer FOBT or FIT annually Stool DNA tests (interval unknown) Tests that detect polyps and cancer Flexible sigmoidoscopy every 5 years Double contrast BE every 5 years CT colonography every 5 years Colonoscopy every 10 years

14 Screening American Cancer Society, U.S. Multi-Society Task Force on Colorectal Cancer, American College of Radiology Tests that primarily detect cancer FOBT or FIT annually Stool DNA tests (interval unknown) Tests that detect polyps and cancer Flexible sigmoidoscopy every 5 years Double contrast BE every 5 years CT colonography every 5 years Colonoscopy every 10 years

15 Screening American Cancer Society, U.S. Multi-Society Task Force on Colorectal Cancer, American College of Radiology Tests that primarily detect cancer FOBT or FIT annually Stool DNA tests (interval unknown) Tests that detect polyps and cancer Flexible sigmoidoscopy every 5 years Double contrast BE every 5 years CT colonography every 5 years Colonoscopy every 10 years

16 U.S. Preventive Services Task Force Evaluated 7 tests: Colonoscopy Flexible sigmoidoscopy CT colonography gfobt FIT Stool DNA Blood Septin biomarker The USPSTF concludes with high certainty that screening for colorectal cancer in averagerisk, asymptomatic adults aged 50 to 75 years is of substantial net benefit. Multiple screening strategies are available to choose from, with different levels of evidence to support their effectiveness, as well as unique advantages and limitations. there are no empirical data to suggest that any of the strategies provide a greater net benefit. Accordingly, the best screening test is the one that gets done, and the USPSTF concludes that maximizing the total proportion of the eligible population that receives screening will result in the greatest reduction in colorectal cancer deaths.

17 Screening FOBT Endoscopy Either yrs 8% 52% 55% >65 10% 61% 64% Total 9% 56% 59% Almost 40 million people remain unscreened! American Cancer Society. Colorectal Cancer Facts & Figures

18 Advantages of CT Colonography Less invasive Safer Very short procedural time No need for sedation Less costly Ease of access Extracolonic evaluation

19 Advantages of CT Colonography

20 Advantages of CT Colonography Overall Experience Which did you prefer 2.2% 5.0% 9.1% 13.8% 32.5% 60.4% 77.1% Poor Fair Good Excellent N = 1,417 No Pref Colonoscopy CT Colonography Screening CT Colonography: Multicenter Survey of Patient Experience, Preference, and Potential Impact on Adherence. AJR 2012 Jun; 198(6):

21 Radiation Dose Dose Range: <5 8 msv With Iterative Reconstruction: <3 msv Ave annual natural background dose: 3 msv Ave annual natural background dose in Denver: 12 msv

22 Radiation Dose Estimated colorectal cancer prevented from CT Colonography screening every 5 years: 3,380-5,190 / 100,000 patients Estimated radiation induced cancers from CT Colonography screening every 5 years: 150 / 100,000 patients Benefit : Risk Ratio = 24:1 to 35:1 Radiation-Related Cancer Risks From CT Colonography Screening: A Risk-Benefit Analysis. AJR 2011 Apr; 196(4):

23 How It s Done Bowel Prep ( Dry or Wet ) Check-In & change Rectal tube and colonic distension Scanning Discharge with instructions Image reconstruction Interpretation

24 Bowel Preparation

25 Polak Imaging

26 Check In

27 Changing

28 Scanning

29 Rectal Tube

30 Discharge

31 CT Image Interpretation

32 CT Image Interpretation

33 CT Image Interpretation

34 CT Image Interpretation

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36 Conclusion the best screening test is the one that gets done