Teleradiology brings CT colonography to rural areas

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BOSTON--CT colonography (CTC) is feasible in rural health centers with the help of teleradiology, according to a presentation Tuesday at the 2009 annual meeting of the American Roentgen Ray Society (ARRS).

Fort Defiance Indian Hospital in Fort Defiance, Ariz., and Tuba City Indian Medical Center in Tuba City, Ariz., are two rural hospitals with limited availability of screening optical colonoscopy. Remote CTC was performed on 86 patients at the two remote medical centers (343 and 337 miles from the University of Arizona in Tucson). Technologists at the facilities performed CTC on the patients and the data obtained was then sent to a local teleradiology server, where it was uploaded to a CTC workstation and interpreted by an off-site radiologist.

"Out of the 86 patients who had CTC examinations, we obtained 77 technically satisfactory examinations," said the study's lead author Arnold Friedman, MD.

"In many remote health centers there are not enough personnel and resources to use optical colonoscopy as a colorectal cancer screening test. Most centers have CT machines modern enough to do these exams but do not have the resources to perform optical colonoscopy screening. This is an excellent model for rural centers," said Friedman.

The researchers graded the studies for quality on a five-point scale (five being excellent, one being poor) by one author evaluating residual stool, residual fluid and degree of distention:

  • Residual stool assessment: 43 patients 5/5, 20 patients 4/5, 18 patients 3/5, one patient 2/5, three patients 1/5 (one of which did not take prep), one patient failed (could not retain gas);
  • Residual fluid assessment: 37 patients 5/5, 27 patients 4/5, 16 patients 3/5, two patients 2/5, three patients 1/5, one patient failed; and
  • Distention assessment: 36 patients 5/5, 11 patients 4/5, 13 patients 3/5, 17 patients 2/5, eight patients 1/5, one patient failed.

Based on their findings, CTC can be introduced with minimal effort to rural underserved communities, adequately performed locally and then interpreted remotely by an expert.

"Availability of CTC permits access to a robust method of colorectal screening for these rural patients. Using an existing teleradiology network is the most cost efficient way to get the datasets for interpretation," he said.