colonography gp talk 2 sept 2008
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CT colonography(Virtual colonoscopy)
Dr Peng Hui LEEConsultant RadiologistMEHTwww.midessexray.com
Bowel Cancer
• 3rd most common cancer in UK• 2nd most common in women after breast• 3rd most common in men after lung and prostate• 2nd most common cause of cancer death in UK• 36 766 new diagnoses in 2005• 1 in 20 people in UK during lifetime
Detection
• Flex sig• Colonoscopy• Ba Enema• CT colonography• MR colonography (experimental)• Stool tests (FOB, FIT, eDNA)
Copyright ©Radiological Society of North America, 2006
Thompson, W. M. et al. Radiology 2006;239:139-148
Figure 5: Perceptual error: distraction due to diverticulosis
Copyright ©Radiological Society of North America, 2006
Thompson, W. M. et al. Radiology 2006;239:139-148
Figure 3b: Perceptual error: cancer visualized en face and contour defect
Copyright © 2007 by the American Roentgen Ray Society
Ko, E. Y. et al. Am. J. Roentgenol. 2007;188:785-791
AJR 1998 Jun;170(6)
Am. J. Roentgenol.172 (5); 1179 May 1999
Editor's Notebook: Bye-bye, bariumLF RogersNow don’t hang up your lead apron just yet. Admittedly, it’s a stretch to say we are now prepared to abandon barium. There will be ample opportunty for you to get barium in your shoes. But, hard as it may be to imagine, it seems quite possible that volumetric CT techniques, may eventually supplant our morning barium routine.Bye-bye, barium? Who would have thought?
….since April 2004, there has no longer been a viable indication to perform DCBE for examination of our patient population
http://www.nice.org.uk/guidance/IPG129
or just google: Nice colonography
Copyright © 2007 by the American Roentgen Ray Society
Pickhardt, P. J. Am. J. Roentgenol. 2003;181:1599-1606
OPTICAL COLONOSCOPY
Copyright © 2007 by the American Roentgen Ray Society
Pickhardt, P. J. Am. J. Roentgenol. 2003;181:1599-1606
VIRTUAL COLONOSCOPY
Basic Principles
• Cleanse• Distend• Image• Read
BOWEL PREP
got this at an auction in vegas EZ EM protocol colan insufflator I think its a virtual colanoscopy machine it retails at $11.000 dollars it works perfect do your reasearch and go ahead and bid NO RESERVE any questions you can call me at 702 281 7373
Copyright ©Radiological Society of North America, 2007
Mang, T. et al. Radiographics 2007;27:431-454
PRONE
Copyright ©Radiological Society of North America, 2007
Mang, T. et al. Radiographics 2007;27:431-454
SUPINE
Copyright ©Radiological Society of North America, 2006
Taylor, S. A. et al. Radiology 2006;239:759-767
2D
Copyright ©Radiological Society of North America, 2006
Taylor, S. A. et al. Radiology 2006;239:759-767
3D
Copyright ©Radiological Society of North America, 2007
Mang, T. et al. Radiographics 2007;27:431-454
Figure 14a. Polypoid stool simulating a filling defect in a 73-year-old woman
Copyright ©Radiological Society of North America, 2007
Mang, T. et al. Radiographics 2007;27:431-454
Figure 14b. Polypoid stool simulating a filling defect in a 73-year-old woman
CTC vs barium enema
• Comfort• Accuracy Sosna AJR 2008
• Extra-colonic findings Tolan AJR 2007
“Diminutive polyps”
• 6mm threshold • Low likelihood of malignancy• False positives• Costs
Copyright © 2007 by the American Roentgen Ray Society
Lefere, P. et al. Am. J. Roentgenol. 2005;184:1836-1842
TAGGING
Copyright © 2007 by the American Roentgen Ray Society
Lefere, P. et al. Am. J. Roentgenol. 2005;184:1836-1842
TAGGING
Copyright ©Radiological Society of North America, 2008
Park, S. H. et al. Radiology 2008;248:1018-1027
Figure 2e: Polyp and polypoid tagged stool pieces in 64-year-old man seen during 3D endoluminal fly-through CT colonography without and with selective discriminative color coding of tagged stool by using volume rendering with attenuation-dependent
color-enhancement technique
CAD
Copyright ©Radiological Society of North America, 2006
Taylor, S. A. et al. Radiology 2006;239:759-767
CAD
CAD
• 1st reader• 2nd reader• Concurrent reader
CAD
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 May
The following options are acceptable choices for colorectal cancer screening in average-risk adults beginning at age 50 years FSIG with insertion to 40 cm or to splenic flexure Every 5 yearsCSPY Every 10 yearsDCBE Every 5 yearsCTC Every 5 years
Copyright ©Radiological Society of North America, 2005
Zalis, M. E. et al. Radiology 2005;236:3-9
Figure 2. Suggested categorization system for CT colonography findings and follow-up recommendations
AGA Institute Position on CT ColonographyMay 2008 Guided by the principle that gastroenterologists should be able to use and manage any technology that can enable them to provide better patient care, the AGA continues to take a leadership role with technologies such as CT colonography. With the best interest of patients in mind, the AGA is monitoring this technology, creating training standards for performance of the study, and establishing coding and reimbursement codes for gastroenterologists who wish to perform the procedure.http://www.gastro.org/wmspage.cfm?parm1=5623
• Radiographers with training in CT colonographic evaluation achieved sensitivity and specificity in polyp detection comparable with that of radiologists. Radiographers can be considered reviewers in the evaluation of CT colonographic images. o Jensch et al AJR2007
Cost (-effectiveness)
• Ba Enema < CT colonography < Optical colonoscopy
• (Screening) o A number of studies assessing the cost-effectiveness of
CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. Mavranezouli et al Eur Rad 2008
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