ACR Colon Cancer Committee White Paper: Status of CT Colonography 2009

McFarland, Elizabeth G.; Fletcher, Joel G.; Pickhardt, Perry; Dachman, Abraham; Yee, Judy; McCollough, Cynthia H.; Macari, Michael; Knechtges, Paul; Zalis, Michael; Barish, Matthew; Kim, David H.; Keysor, Kathryn J.; Johnson, C. Daniel

doi:10.1016/j.jacr.2009.09.007

« Previous Next »Journal of the American College of Radiology
Volume 6, Issue 11 , Pages 756-772.e4, November 2009

ACR Colon Cancer Committee White Paper: Status of CT Colonography 2009

Elizabeth G. McFarland, MD
- Center for Diagnostic Imaging, St Louis, Missouri
Joel G. Fletcher, MD
- Mayo Clinic, Rochester, Minnesota
- Corresponding author and reprint requests: Joel G. Fletcher, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
Perry Pickhardt, MD
- University of Wisconsin–Madison, Madison, Wisconsin
Abraham Dachman, MD
- University of Chicago Hospitals, Chicago, Illinois
Judy Yee, MD
- University of California, San Francisco, San Francisco, California
Cynthia H. McCollough, PhD
- Mayo Clinic, Rochester, Minnesota
Michael Macari, MD
- Langone Medical Center, New York University School of Medicine, New York, New York
Paul Knechtges, MD
- Medical College of Wisconsin, Milwaukee, Wisconsin
Michael Zalis, MD
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Matthew Barish, MD
- State University of New York, Stony Brook, New York
David H. Kim, MD
- University of Wisconsin–Madison, Madison, Wisconsin
Kathryn J. Keysor, BS
- American College of Radiology, Reston, Virginia
C. Daniel Johnson, MD
- Mayo Clinic, Scottsdale, Arizona

Purpose

To review the current status and rationale of the updated ACR practice guidelines for CT colonography (CTC).

Methods

Clinical validation trials in both the United States and Europe are reviewed. Key technical aspects of the CTC examination are emphasized, including low-dose protocols, proper insufflation, and bowel preparation. Important issues of implementation are discussed, including training and certification, definition of the target lesion, reporting of colonic and extracolonic findings, quality metrics, reimbursement, and cost-effectiveness.

Results

Successful validation trials in screening cohorts both in the United States with ACRIN^® and in Germany demonstrated sensitivity ≥90% for patients with polyps >10 mm. Proper technique is critical, including low-dose techniques in screening cohorts, with an upper limit of the CT dose index by volume of 12.5 mGy per examination. Training new readers includes the requirement of interactive workstation training with 2-D and 3-D image display techniques. The target lesion is defined as a polyp ≥6 mm, consistent with the American Cancer Society joint guidelines. Five quality metrics have been defined for CTC, with pilot data entered. Although the CMS national noncoverage decision in May 2009 was a disappointment, multiple third-party payers are reimbursing for screening CTC. Cost-effective modeling has shown CTC to be a dominant strategy, including in a Medicare cohort.

Conclusion

Supported by third-party payer reimbursement for screening, CTC will continue to further transition into community practice and can provide an important adjunctive examination for colorectal screening.

Key Words: CT colonography, CTDI_vol, 2-D and 3-D image display techniques, polyp