Double-contrast barium enema study with computed radiography: assessment in detection of colorectal polyps

Is minimal preparation computed tomography comparable with barium enema in elderly patients with colonic symptoms?

The barium enema (BE) examination in the elderly is often an unsatisfactory investigation. Recent papers have proposed computed tomography (CT) as an alternative method of investigation. They have used a variety of preparation techniques prior to the CT study such as bowel preparation, rectal air insufflation, tap water enemas and intravenous contrast medium. We wished to devise a minimal preparation, minimal supervision technique that could realistically replace the standard BE. One hundred and eighteen elderly patients admitted with symptoms referable to the large bowel had an unenhanced CT following oral contrast medium commenced the previous evening, followed at an interval by a BE performed to a standard technique. Both techniques congruently gave negative reports in 66 (68.8%) individuals. Ten tumours were confidently diagnosed on CT. One annular tumour of the sigmoid colon and one case of colitis were diagnosed on BE only and the severity of a diverticular stricture was underestimated on CT. CT raised the possibility of lesions in 3 (3.1%) patients where the BE was negative. Ten (8.5%) patients had significant abnormalities identified outside the colon using CT. Seven (5.9%) barium enemas were abandoned or severely limited. Minimal preparation, minimal supervision CT is a practical alternative to BE in the frail elderly patient. Radiologists and referring clinicians should be aware that occasionally lesions will not be identified on CT but CT has the advantage that other significant pathology unrelated to the colon may be detected.

Clinical experiences with computed radiography

Computed radiography (CR) based on photostimulable phosphor is currently the only feasible way for a radiological department to digitize the bulk of radiological data: the lung and skeletal examinations. Regarding the quality of images for diagnostic purposes, CR imaging is never inferior to a screen/film system (SF) and for several clinical entities CR is superior. Of the many processing possibilities of the image plate (IP) image, the unsharp masking or edge enhancement should be used at a minimum. Dose reduction with CR ranges from 15% to 95%; at our institution it is 37%. Softcopy reading of CR images is advantageous due to the many postprocessing and improved display facilities. Currently there is little use for a 4000 x 4000 (4 K) pixel imaging and display. All images (including mammography) can be read in 2 K without any loss of clinically important information. To include CR in a picture archive and communication system (PACS) is demanding because of the load of data that each CR image represents. Networks for image distribution are essential if digital imaging is to have any impact on patient treatment and hospital organization.