Feasibility of remote CT colonography at two rural native American medical centers

Arnold C. Friedman, David Downing, Joachim Chino, Elizabeth A Krupinski, Caroline Kilian, Michael P Lance

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

OBJECTIVE. Fort Defiance Indian Hospital and Tuba City Regional Health Care Center are two rural hospitals with limited availability of optical colonoscopy (OC) and other methods of colorectal cancer screening. Our goals were to determine whether adequate examinations could be obtained with remote supervision after brief onsite instruction and to share lessons learned in our experience with a remote CT colonography (CTC) screening program. MATERIALS AND METHODS. After brief onsite instruction, including performing a CTC examination on a volunteer to train the CT technologists, both sites began performing CTC using standard bowel preparation, fecal tagging, automatic insufflation, and low-dose technique. Studies were transferred to the University of Arizona Hospital for image quality assessment of stool, residual fluid, distention, and interpretation, with reports returned via the teleradiology information system. Clinical follow-up was performed on those patients referred for polypectomy or biopsy. RESULTS. Three hundred twenty-one subjects underwent CTC, including 280 individuals referred for screening examinations (87%). Ninety-two percent of subjects (295/321) had acceptable amounts of residual stool, 91% (293/321) had acceptable levels of fluid, and 92% (294/321) had acceptable distention. Fourteen percent (44/321) of CTC patients had polyps 6 mm or larger in size, with a positive predictive value of 41% for those who subsequently underwent colonoscopy-polypectomy (11/27). CONCLUSIONS. CTC can be introduced to rural underserved communities, performed locally, and interpreted remotely with satisfactory performance, thereby increasing colorectal cancer screening capacity. Important aspects of implementation should include technologist training, referring physician education, careful attention to image transmission, and clearly defined methods of communication with patients and referring providers.

Original languageEnglish (US)
Pages (from-to)1110-1117
Number of pages8
JournalAmerican Journal of Roentgenology
Volume195
Issue number5
DOIs
StatePublished - Nov 2010

Fingerprint

Computed Tomographic Colonography
North American Indians
Colonoscopy
Early Detection of Cancer
Colorectal Neoplasms
Teleradiology
Rural Hospitals
Insufflation
Urban Hospitals
Rural Population
Polyps
Information Systems
Volunteers
Communication
Delivery of Health Care
Physicians
Biopsy
Education

Keywords

  • Colorectal cancer
  • CT colonography
  • Rural medicine
  • Teleradiology
  • Virtual colonoscopy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Feasibility of remote CT colonography at two rural native American medical centers. / Friedman, Arnold C.; Downing, David; Chino, Joachim; Krupinski, Elizabeth A; Kilian, Caroline; Lance, Michael P.

In: American Journal of Roentgenology, Vol. 195, No. 5, 11.2010, p. 1110-1117.

Research output: Contribution to journalArticle

Friedman, Arnold C. ; Downing, David ; Chino, Joachim ; Krupinski, Elizabeth A ; Kilian, Caroline ; Lance, Michael P. / Feasibility of remote CT colonography at two rural native American medical centers. In: American Journal of Roentgenology. 2010 ; Vol. 195, No. 5. pp. 1110-1117.
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abstract = "OBJECTIVE. Fort Defiance Indian Hospital and Tuba City Regional Health Care Center are two rural hospitals with limited availability of optical colonoscopy (OC) and other methods of colorectal cancer screening. Our goals were to determine whether adequate examinations could be obtained with remote supervision after brief onsite instruction and to share lessons learned in our experience with a remote CT colonography (CTC) screening program. MATERIALS AND METHODS. After brief onsite instruction, including performing a CTC examination on a volunteer to train the CT technologists, both sites began performing CTC using standard bowel preparation, fecal tagging, automatic insufflation, and low-dose technique. Studies were transferred to the University of Arizona Hospital for image quality assessment of stool, residual fluid, distention, and interpretation, with reports returned via the teleradiology information system. Clinical follow-up was performed on those patients referred for polypectomy or biopsy. RESULTS. Three hundred twenty-one subjects underwent CTC, including 280 individuals referred for screening examinations (87{\%}). Ninety-two percent of subjects (295/321) had acceptable amounts of residual stool, 91{\%} (293/321) had acceptable levels of fluid, and 92{\%} (294/321) had acceptable distention. Fourteen percent (44/321) of CTC patients had polyps 6 mm or larger in size, with a positive predictive value of 41{\%} for those who subsequently underwent colonoscopy-polypectomy (11/27). CONCLUSIONS. CTC can be introduced to rural underserved communities, performed locally, and interpreted remotely with satisfactory performance, thereby increasing colorectal cancer screening capacity. Important aspects of implementation should include technologist training, referring physician education, careful attention to image transmission, and clearly defined methods of communication with patients and referring providers.",
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