Final Read

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I was recruited to help train CT technologists at Fort Defiance Indian Hospital and Tuba City Regional Health Care Corp., two rural hospitals in Arizona, to perform remote CT colonography (CTC) for colorectal carcinoma screening.

Potential referring physicians were concerned about CTC's accuracy compared with optical colonoscopy, but not enough endoscopists were available to perform optical colonoscopies. Additionally, there were barriers in this population to alternative screening methods like fecal occult blood testing, which required individuals to capture their own samples and mail them to laboratories. Such obstacles included a lack of modern plumbing, access to postal service, and an aversion to certain body parts.

“So far, we have performed CTCs on about 700 patients with optical colonoscopy follow-up on all positive cases.” — Arnold C. Friedman, M.D., FACR

I started by training CT technologists from each institution how to do CTC by performing the examination on a volunteer. I instructed the technologists, key potential referring physicians, and endoscopists about scheduling appointments, prepping patients, and transmitting images to the reading workstation in Tucson. So far, we have performed CTCs on about 700 patients with optical colonoscopy follow-up on all positive cases. Our published CTC efficacy results are in line with nonremote programs. My goal is to remain in contact with the referring physicians, ensure that appropriate examinations are ordered, and encourage patients to choose CTC surveillance to keep their follow-up appointments.

These rural populations can serve as a template for many other places with limited access to optical colonoscopy. While the debate continues about which is more effective, there is little doubt that screening with CTC is better than fecal occult blood screening only or no screening at all.

final read headshotArnold C. Friedman, M.D., FACR
Department of Radiology
University of Arizona, Tucson, Ariz.

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