One step back, two steps forward

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Lisa Fratt, Editor

Colon CAD [compute-aided detection] studies continue to demonstrate the power of the technology. Consider the September issue of Radiology, in which two separate group of researchers highlight giant strides forward.

Edward M. Lawrence, BS, of University of Wisconsin in Madison, and colleagues reported excellent performance of stand-alone CAD in a large screening population. Such data are essential to transitioning to a general screening model. A second study in the same edition complemented Lawrence’s findings. Meanwhile, Abraham H. Dachman, MD, of University of Chicago, and his colleagues demonstrated that colon CAD improved reader performance, especially with regards to sensitivity.

However, the ultimate fate of colon CAD is tied to that of CT colonography (CTC), and the status of CT colonography screening (CTC) remains in flux. Decision-making bodies, like the U.S. Preventive Services Task Force (USPSTF), continue to hem and haw. In August, USPSTF insisted that further research is required prior to a conclusive recommendation regarding CTC. This uncertainty creates a clinical and economic drag on CTC and colon CAD.

The clinical community is responding. The CT Colonography Coalition is urging the Task Force to reconsider its decision. The facts support the coalition. Consider:

  • In 2008, the American College of Radiology Imaging Network (ACRIN) found that CTC and standard colonoscopy deliver comparable detection of cancer and precancerous polyps; and
  • When institutions providing CTC have surveyed patients, nearly 40 percent reported they would not have undergone screening without the CTC option; and
  • Regular screening increases the odds of finding colon cancer at its earliest, most curable stage and also allows physicians to remove pre-cancerous polyps.

Our hope at Health Imaging & IT and Health Imaging News is that the current stalemate represents a temporary stumbling block. CTC merits reimbursement, and colon CAD is valuable adjunct to the technology.

I would value your comments on the topic.

Lisa Fratt, Editor