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Patient-Controlled Room Air Insufflation Versus Automated Carbon Dioxide Delivery for CT Colonography

Theodore J. Shinners1,2, Perry J. Pickhardt1,3, Andrew J. Taylor1, Debra A. Jones1 and Cara H. Olsen4

1 Department of Radiology, University of Wisconsin Medical School, Clinical Science Center, 600 Highland Ave., Madison, WI 53792.
2 Ministry Health-St. Mary's Hospital, Rhinelander, WI 54501.
3 Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD.
4 Biostatistics Consulting Center, Uniformed Services University of the Health Sciences, Bethesda, MD.


Figure 1
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  		Fig. 1 —Mean segmental distention scores on supine positioning with patient-controlled room air (RA) and automated carbon dioxide (CO2). Lower scores represent greater distention. Mean segmental distention was better for CO2 compared with RA in all segments, but differences were statistically significant only for sigmoid, descending, and transverse segments. Sigmoid segment on supine had worst mean distention score among all segments (supine or prone) for both RA and CO2.

 

Figure 2
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  		Fig. 2 —Mean segmental distention scores on prone positioning with patient-controlled room air (RA) and automated carbon dioxide (CO2). Lower scores represent greater distention. Mean segmental distention showed no clear preference between CO2 and RA on prone, with no statistically significant differences. Rectum on prone had best mean segmental distention score among all segments (supine or prone) for both RA and CO2.

 

Figure 3
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  		Fig. 3 —Histogram of segmental distention scores (supine and prone combined). Note that most colonic segments were deemed adequate for evaluation (distention score of 1 or 2). Lower scores represent greater distention.

 

Figure 4
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  		Fig. 4 —Mean patient discomfort scores during and after CT colonography examination. Significantly greater discomfort during active distention was reported by patients receiving automated carbon dioxide (CO2), whereas reverse trend was seen after examination, with greater discomfort reported with patient-controlled room air.

 

Figure 5
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  		Fig. 5A —Supine scout films in 52-year-old man undergoing CT colonography (CTC) screening. Patient volunteered to space out supine and prone scanning to allow distention with both carbon dioxide (CO2) and room air (RA), with additional scout films 15 min after each. Supine scout films using CO2 for distention immediately before supine CTC (A) and 15 min later (B) show significant resorption of colonic gas.

 

Figure 6
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  		Fig. 5B —Supine scout films in 52-year-old man undergoing CT colonography (CTC) screening. Patient volunteered to space out supine and prone scanning to allow distention with both carbon dioxide (CO2) and room air (RA), with additional scout films 15 min after each. Supine scout films using CO2 for distention immediately before supine CTC (A) and 15 min later (B) show significant resorption of colonic gas.

 

Figure 7
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  		Fig. 5C —Supine scout films in 52-year-old man undergoing CT colonography (CTC) screening. Patient volunteered to space out supine and prone scanning to allow distention with both carbon dioxide (CO2) and room air (RA), with additional scout films 15 min after each. Supine scout films using RA for distention immediately before prone CTC (A) and 15 min later (B) show significant retention of colonic gas. Patient noted no discomfort with CO2 at 15 min but intermediate discomfort with RA at 15 min.

 

Figure 8
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  		Fig. 5D —Supine scout films in 52-year-old man undergoing CT colonography (CTC) screening. Patient volunteered to space out supine and prone scanning to allow distention with both carbon dioxide (CO2) and room air (RA), with additional scout films 15 min after each. Supine scout films using RA for distention immediately before prone CTC (A) and 15 min later (B) show significant retention of colonic gas. Patient noted no discomfort with CO2 at 15 min but intermediate discomfort with RA at 15 min.

 

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