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

Abstract

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 U.S. 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 target lesion, reporting of colonic and extracolonic findings, quality metrics, reimbursement, and cost-effectiveness.

Results: Successful validation trials in screening cohorts both in the U.S. with ACRIN® and in Germany demonstrated sensitivity of 90% or greater for patients with polyps 10 mm or greater. Proper technique is critical, including low-dose techniques in screening cohorts with upper limits in CTDI_vol of 12.5 mGy per exam. Training of 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 or greater, 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.

Keywords: CT colonography • CTDI_vol • 2-D and 3-D image display techniques • polyp

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