ACR Colon Cancer Committee white paper: status of CT colonography 2009

Area of Science:

• Radiology
• Gastroenterology
• Medical Imaging

Background:

• Computed Tomography Colonography (CTC) is an evolving imaging technique for colorectal cancer screening.
• Practice guidelines require regular updates to reflect advancements in technology and clinical validation.
• The American College of Radiology (ACR) provides essential guidelines for CTC implementation.

Purpose of the Study:

• To review the current status and rationale behind the updated ACR practice guidelines for CT colonography (CTC).
• To emphasize key technical aspects and implementation issues for CTC examinations.

Main Methods:

• Review of clinical validation trials in the US and Europe.
• Emphasis on low-dose protocols, insufflation, and bowel preparation.
• Discussion of training, lesion definition, reporting, quality metrics, reimbursement, and cost-effectiveness.

Main Results:

• Validation trials demonstrate CTC sensitivity > or = 90% for polyps >10 mm.
• Low-dose techniques (CTDIvol <= 12.5 mGy) are recommended for screening.
• Training includes interactive workstation use; target lesion defined as polyp >= 6 mm.
• Multiple third-party payers reimburse for screening CTC; cost-effectiveness is established.

Conclusions:

• CTC is a validated and cost-effective colorectal cancer screening method.
• Supported by reimbursement, CTC is transitioning into community practice.
• CTC serves as an important adjunctive examination for colorectal screening.