Utilization Pattern of Computed Tomographic Colonography in the United States: Analysis of the U.S. National Health Interview Survey.

CT colonography for colorectal cancer screening has been proved to be effective and cost-saving. CT colonography uses minimally invasive evaluation of colorectum and has better patient acceptance, which appears to be a promising screening modality to improve low colorectal cancer screening rate. This study investigated the utilization patterns of CT colonography and factors associated with its use among U.S. adult population. This retrospective cross-sectional study analyzed the National Health Interview Survey 2015 and 2018. U.S. adults ages 45 or older without a history of colorectal cancer were included. Survey design-adjusted Wald F tests were used to compare the utilization of CT colonography during the study period. Multivariable logistic regression was used to identify the predictors of CT colonography among individual socioeconomic and health-related characteristics. The study sample included 34,768 individuals representing 129,430,319 U.S. adult population ages 45 or older. The overall utilization of CT colonography increased from 0.79% in 2015 to 1.33% in 2018 (P < 0.001). 54.5% study participants reported being up-to-date on recommended colorectal cancer screening; of those, 1.8% used CT colonography. Compared with individuals ages 65+, those ages 45-49 years were 2.08 times (OR, 2.08, 95% confidence interval, 1.01-4.35) more likely to use CT colonography. Socioeconomically disadvantaged characteristics (e.g., racial/ethnic minority, low income, publicly funded insurance) were associated with a greater likelihood of CT colonography. This study demonstrated an increasing trend in utilization of CT colonography for colorectal cancer screening in U.S. adults. Younger individuals, racial/ethnic minorities, or those with lower income appear to have a higher CT colonography utilization. PREVENTION RELEVANCE: Although computed tomographic (CT) colonography has been proved to be cost-effective and have better patient acceptance, its overall utilization for colorectal cancer (CRC) screening is low (<1.4%) among US adults aged 45+ in 2018. More efforts are needed to implement strategies to increase CT colonography for effective CRC prevention.

Nationwide, Longitudinal Trends in CT Colonography Utilization: Cross-Sectional Survey Results From the 2010 and 2015 National Health Interview Survey.

PURPOSE: Colon cancer screening reduces deaths from colorectal cancer. Screening rates have plateaued; however, studies have found that giving patients a choice between different screening tests improves adherence. CT colonography is a minimally invasive screening test with high sensitivity for colonic polyps (>1 cm). With increasing insurance coverage of CT colonography nationwide, there are limited estimates of CT colonography utilization over time. Our purpose was to estimate CT colonography utilization over time using nationally representative cross-sectional survey data. METHODS: We utilized 2010 and 2015 National Health Interview Survey cross-sectional data. Participants between ages 50 and 75 without colorectal cancer history were included. Accounting for complex survey design elements, logistic regression analyses evaluated changes in CT colonography utilization over time, adjusted for potential confounders, and stratified by insurance and age. RESULTS: Overall, 21,686 respondents were included (8,965 in 2010, 12,721 in 2015). Reported CT colonography utilization decreased from 1.2% to 0.9% (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.86-0.98). Stratified analyses revealed no changes in utilization in patients with private insurance (P = .35) and in patients younger than 65 (P = .07). Overall awareness of CT colonography decreased from 20.5% to 15.9% (OR 0.93, 95% CI 0.91-0.95). Reported optical colonoscopy utilization increased from 57.9% to 63.6% (OR 1.03, 95% CI 1.02-1.05). CONCLUSION: Despite increasing self-reported utilization of optical colonoscopy from 2010 to 2015, survey results suggest that CT colonography awareness (∼16%) and utilization (∼1%) remain low. Improved public awareness and coverage expansion to Medicare-aged populations will promote improved CT colonography utilization and overall colorectal cancer screening rates.

Progress of colorectal cancer screening in United States: Past achievements and future challenges.

The United States has seen progress with colorectal cancer with both falling incidence and mortality rates. Factoring into this decline, the significance of early detection and removal of precancerous lesions through screening must be underscored. With the advancement of screening modalities, attention has been directed towards optimizing the quality of screening and detecting adenomas. Colorectal cancer screening has been a major agenda item for national gastroenterology societies, culminating in a major victory with passage of the Balanced Budget Act that allowed for Medicare coverage of colorectal cancer screening. Colonoscopy as the primary screening modality was solidified in the 1990s after landmark studies demonstrated its superiority over modalities for detecting precancerous polyps. Despite progress, colorectal cancer screening disparities between race and gender continue to exist. Legislative efforts are on-going and include the SCREEN Act and Dent Act that aim to further improve access to screening. The National Colorectal Cancer Roundtable has launched colorectal cancer screening initiatives targeting at risk populations. Today, the current goal of these initiatives is to reach colorectal screening rate of 80% of eligible patients by 2018. With these initiatives, efforts to narrow the gaps in screening disparities and lower overall mortality have been prioritized and continued by the medical community. This review article details colorectal cancer screening progress to date and highlights major studies and initiatives that have solidified its success in the United States.

Advanced diagnostic endoscopy in the lower gastrointestinal tract: A review of JGES core sessions.

At each of the 89th to the 92nd congresses of the Japan Gastroenterological Endoscopy Society, a series of featured discussion sessions concerning advanced diagnostic endoscopy in the lower gastrointestinal tract were presented. In total, 45 lectures were presented in this subject area. It was shown that, in recent years, several convenient and less invasive colonoscopic modalities have been developed. This review article summarizes these core sessions and the efficacy of the techniques discussed.

CT Colonography: an update on current and future indications.

Computed tomographic colonography (CTC) is a minimally invasive, patient-friendly, safe and robust colonic imaging modality. The technique is standardized and consolidated evidence from the literature shows that the diagnostic performances for the detection of colorectal cancer and large polyps are similar to colonoscopy (CS) and largely superior to alternative radiological exams, like barium enema. A clear understanding of the exact role of CTC will be beneficial to maximize the benefits and minimize the potential sources of frustration or disappointment for both referring clinicians and patients. Incomplete, failed, or unfeasible CS; investigation of elderly, and frail patients and assessment of diverticular disease are major indications supported by evidence-based data and agreed by the endoscopists. The use of CTC for symptomatic patients, colorectal cancer screening and colonic surveillance is still under debate and, thus, recommended only if CS is unfeasible or refused by patients.

Recent developments in colorectal imaging.

PURPOSE OF REVIEW: The aim of this review is to provide an update on important recent advances in radiologic colorectal imaging, with emphasis on detection, staging, and surveillance of colorectal neoplasia. RECENT FINDINGS: Colorectal imaging advances with magnetic resonance (MR), computed tomography colonography (CTC), and positron emission tomography (PET) over the past year or so have been substantial. Progress in MRI for rectal cancer was most notable in terms of assessment of response to neoadjuvant therapy. Continued maturation and clinical validation of CTC was observed for the evaluation of advanced neoplasia, among other areas. Multimodality approaches to colorectal imaging that incorporate functional PET data have also made impressive strides forward. SUMMARY: Recent advances in cross-sectional and functional radiologic imaging of the colorectum will positively impact the clinical capabilities for noninvasive evaluation of colorectal neoplasia.

History, evolution, and current status of radiologic imaging tests for colorectal cancer screening.

Colorectal cancer screening is thought to be an effective tool with which to reduce the mortality from colorectal cancer through early detection and removal of colonic adenomas and early colon cancers. In this article, we review the history, evolution, and current status of imaging tests of the colon-including single-contrast barium enema, double-contrast barium enema, computed tomographic (CT) colonography, and magnetic resonance (MR) colonography-for colorectal cancer screening. Despite its documented value in the detection of colonic polyps, the double-contrast barium enema has largely disappeared as a screening test because it is widely perceived as a labor-intensive, time-consuming, and technically demanding procedure. In the past decade, the barium enema has been supplanted by CT colonography as the major imaging test in colorectal cancer screening in the United States, with MR colonography emerging as another viable option in Europe. Although MR colonography does not require ionizing radiation, the radiation dose for CT colonography has decreased substantially, and regular screening with this technique has a high benefit-to-risk ratio. In recent years, CT colonography has been validated as an effective tool for use in colorectal cancer screening that is increasingly being disseminated.

Pseudoobstrucción intestinal en la distrofia miotónica de Steinert: descripción clínico-radiológica de dos casos / Intestinal pseudo-obstruction in Steinert myotonic dystrophy: a clinical-radiological description of 2 cases

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Current status on performance of CT colonography and clinical indications.

CT colonography (CTC) is a robust and reliable imaging test of the colon. Accuracy for the detection of colorectal cancer (CRC) is as high as conventional colonoscopy (CC). Identification of polyp is size dependent, with large lesions (≥10mm) accurately detected and small lesions (6-9mm) identified with moderate to good sensitivity. Recent studies show good sensitivity for the identification of nonpolypoid (flat) lesions as well. Current CTC indications include the evaluation of patients who had undergone a previous incomplete CC or those who are unfit for CC (elderly and frail individuals, patients with underlying severe clinical conditions, or with contraindication to sedation). CTC can also be efficiently used in the assessment of diverticular disease (excluding patients with acute diverticulitis, where the exam should be postponed), before laparoscopic surgery for CRC (to have an accurate localization of the lesion), in the evaluation of colonic involvement in the case of deep pelvic endometriosis (replacing barium enema). CTC is also a safe procedure in patients with colostomy. For CRC screening, CTC should be considered an opportunistic screening test (not available for population, or mass screening) to be offered to asymptomatic average-risk individuals, of both genders, starting at age 50. The use in individuals with positive family history should be discussed with the patient first. Absolute contraindication is to propose CTC for surveillance of genetic syndromes and chronic inflammatory bowel diseases (in particular, ulcerative colitis). The use of CTC in the follow-up after surgery for CRC is achieving interesting evidences despite the fact that literature data are still relatively weak in terms of numerosity of the studied populations. In patients who underwent previous polypectomy CTC cannot be recommended as first test because debate is still open. It is desirable that in the future CTC would be the first-line and only diagnostic test for colonic diseases, leaving to CC only a therapeutic role.

Effective radiation dose in CT colonography: is there a downward trend?

RATIONALE AND OBJECTIVES: Radiation dose is an important drawback of computed tomography (CT) colonography, especially for its use as a screening tool for colorectal cancer. It is therefore important to know the present radiation dose. Our objective is to assess the effective radiation doses used for CT colonography and its trend over time. MATERIALS AND METHODS: Institutions performing CT colonography research were asked to provide their CT colonography protocols. Median effective doses were calculated and compared with a 2007 inventory. Separate analyses were performed for protocols using intravenous contrast medium and for academic versus nonacademic institutions. Differences in effective dose were tested for significance, using Wilcoxon rank-sum or Wilcoxon signed-rank test. RESULTS: Sixty-two of 109 (57%) institutions responded, providing protocols for 58 institutions. Median effective dose for daily practice protocols was 7.6 mSv (4.3 mSv and 2.0 mSv for supine and prone, respectively) and for screening 4.4 mSv (2.6 mSv and 2.0 mSv, respectively; P = .01). For daily practice with and without contrast medium, the median effective doses were 10.5 mSv and 4.0 mSv (P < .001), respectively. Academic and nonacademic institutions used similar doses (all comparisons P > .05). For institutions also participating in the 2007 inventory, effective dose for both daily practice and screening protocols were similar (P > .05). CONCLUSION: In 2011 the median effective radiation dose for daily practice protocols was 7.6 mSv and for screening 4.4 mSv. Median effective doses have not decreased as compared to 2007. Academic and nonacademic institutions use similar radiation dose.

[CT colonography as routine method]. / CT-Kolonographie in der täglichen Praxis.

CLINICAL/METHODICAL ISSUE: Colorectal cancer is a major public health challenge in Austria and Germany. As the participation in dedicated colonoscopy screening programs is rather low, the question of alternative methods is raised again and computed tomography (CT) colonography seems to be a gentle alternative with a very high patient acceptance. STANDARD RADIOLOGICAL METHODS: In recent years CT colonography (CTC) has been established besides conventional colonoscopy as a radiological method for the investigation of the entire colon. From axial two-dimensional images three-dimensional images can be generated, allowing a virtual flight through the colon which is why this technique is also known as virtual colonoscopy. METHODICAL INNOVATIONS: The technique of CTC has been improved continuously during recent years. On the one hand the steady decrease in the layer thickness (currently ≤ 1 mm) has improved the resolution of volume data sets and on the other hand there has been significant progress in postprocessing. PERFORMANCE: Numerous studies have recently shown that the significance of CTC in the detection of advanced adenomas is similar to conventional colonoscopy. ACHIEVEMENTS: Meanwhile CT colonography is now a routine investigation method established in both symptomatic and asymptomatic patients (screening). PRACTICAL RECOMMENDATIONS: Study data now clearly show that CTC, as an alternative to conventional colonoscopy, is a powerful method for investigation of colorectal cancer. To achieve good results adequate preparation including fecal tagging, standardized technical procedures during the investigation and expertise in both 2D and 3D reading are essential.

[Screening for colorectal cancer. Current evidence and novel developments]. / Screening auf kolorektale Neoplasien. Aktuelle Evidenz und neue Entwicklungen.

CLINICAL ISSUE: Colorectal cancer is one of the leading causes of cancer-related morbidity and mortality. Screening has been demonstrated to reduce both the incidence and mortality of colorectal cancer. In addition to the large group with a normal risk level, two further risk groups need to be distinguished: increased family risk and hereditary colorectal cancer syndromes. STANDARD METHODS FOR SCREENING: The highest evidence for all screening tests has been demonstrated for guaiac-based fecal occult blood testing. Colonoscopy is a diagnostic and therapeutic tool and it serves as the reference standard for other tests in clinical studies. INNOVATIONS: Fecal immunochemical tests have a higher sensitivity than guaiac-based tests. Several novel techniques are under development and could be adopted by screening programs in the future. Next to colonoscopy, computed tomography (CT) colonography and colon capsule endoscopy have the highest sensitivity for colorectal neoplasia. Molecular tests which are based on the detection of genetic and epigenetic changes of DNA released by the tumor into feces or blood have a high potential and could potentially replace occult blood tests in the future. PRACTICAL RECOMMENDATIONS: Colonoscopy is the primary instrument for screening for colorectal neoplasia. Fecal occult blood testing should only be performed if colonoscopy is denied and CT colonography has not yet been approved for screening in Germany.

Colonoscopia hoy: ¿real o virtual? / Colonoscopy today: real or virtual?

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