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Computed tomography colonography: Radiographer independent preliminary clinical evaluation for intraluminal pathology. Radiography (Lond) 2019; 25:359-364. [DOI: 10.1016/j.radi.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 01/22/2023]
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Henderson I, Mathers SA, McConnell J. Advanced and extended scope practice of diagnostic radiographers in Scotland: Exploring strategic imaging service imperatives. Radiography (Lond) 2017; 23:181-186. [PMID: 28687283 DOI: 10.1016/j.radi.2017.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/21/2017] [Accepted: 02/25/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The development of diagnostic imaging services manifests features specific to the Scottish environment, in particular development of the radiographic workforce through implementing skills mix and role developments to enhance outcomes for patients. A component of a College of Radiographers Industry Partnership Scheme (CoRIPS) supported study, this research investigates perspectives of strategic service managers with Health Board responsibility for service delivery. METHOD A questionnaire survey was administered to strategic service managers across Scotland (N = 14), followed up with telephone interviews. There was a return rate of 57% (n = 8) for the questionnaires and n = 4 agreed to be interviewed. Data collected related to radiographer roles across their Board area; awareness and understanding of service development issues and features as well as perspective on opportunities and barriers in the context of Scottish Government policy, workforce logistics, attitudes and inter-professional relationships. RESULTS The results indicate evidence of financial, logistical and political barriers to service evolution, offset by a sense of optimism that scope for beneficial change may be approaching. There are a range of significant initiatives in place and an appetite exists to pursue the development of radiographer roles and skill mix for the benefit of service users more generally. CONCLUSION The difficulties in achieving change are well understood and there are basic issues related to finance and industrial relations. There are also however, cultural elements to contend with in the form of attitudes demonstrated by some radiographers and significantly, the radiological community whose influence on the practice of independently regulated radiographers seems incongruent.
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Affiliation(s)
- I Henderson
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, UK.
| | - S A Mathers
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, UK; NHS Grampian Health Board, Aberdeen AB24 2ZN, UK
| | - J McConnell
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, UK; Department of Radiology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
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Henderson I, Mathers S, McConnell J, Minnoch D. Advanced and extended scope practice of radiographers: The Scottish perspective. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2015.12.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wan D, Bruni SG, Dufton JA, O'Brien P. Differential Diagnosis of Colonic Strictures: Pictorial Review with Illustrations from Computed Tomography Colonography. Can Assoc Radiol J 2015; 66:259-71. [DOI: 10.1016/j.carj.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 01/06/2015] [Accepted: 01/29/2015] [Indexed: 01/18/2023] Open
Abstract
Strictures of the colon can lead to significant morbidity requiring surgical management. The etiology of strictures is broad and generally categorized as benign, malignant, or pseudostrictures. Computed tomography (CT) is a crucial imaging modality in the assessment and characterization of colonic pathologies but colonoscopy remains the diagnostic gold standard. However, in the setting of incomplete colonoscopy due to strictures, the imaging features of CT will be relied on. This review will focus on the CT features of different colon pathologies leading to strictures and will be illustrated with images from 10 years of experience with CT colonography at our institutions from 2002-2012 (Hotel Dieu Hospital, Queen's University and Mount Sinai Hospital, University of Toronto).
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Affiliation(s)
- Daniel Wan
- Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada
| | - Silvio G. Bruni
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - John A. Dufton
- Department of Imaging, University Hospital of Northern British Columbia, Prince George, British Columbia, Canada
| | - Paul O'Brien
- Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada
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Shariff MK, Sheikh K, Carroll NR, Whitley S, Greenberg D, Parkes M, Cameron EAB. Colorectal cancer detection: time to abandon barium enema? Frontline Gastroenterol 2011; 2:105-109. [PMID: 28839591 PMCID: PMC5517211 DOI: 10.1136/fg.2010.003616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2010] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To assess the sensitivity of double contrast barium enema (DCBE) for diagnosing colorectal cancer (CRC). DESIGN Retrospective evaluation of DCBE performed in the 2 years prior to diagnosis of CRC. SETTING Teaching hospital in Cambridge, UK. PATIENTS 1310 consecutive cases of CRC identified from cancer registry data. INTERVENTIONS DCBE and colonoscopy. MAIN OUTCOME MEASURES Sensitivity of DCBE for diagnosing CRC. RESULTS 215 patients had undergone a DCBE within the 2 years prior to diagnosis with CRC. After excluding those reported as inadequate, 37 of these were reported as normal, giving a sensitivity of 83% (81-85%). CONCLUSIONS The performance of DCBE is inadequate for the exclusion of CRC. Expansion of colonoscopy and CT colonography capacity is urgently required nationally so that DCBE can finally be abandoned as a firstline test in patients at risk of CRC.
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Affiliation(s)
- M K Shariff
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K Sheikh
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N R Carroll
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Whitley
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Greenberg
- Eastern Cancer Registration and Information Centre, Unit C, Hinton Way, Cambridge, UK
| | - M Parkes
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E A B Cameron
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Odofin O, Alexander R, Bowers H, Chave H, Branagan G. Do patients require outpatient follow-up after rapid referral double contrast barium enema? Colorectal Dis 2009; 11:729-32. [PMID: 18624822 DOI: 10.1111/j.1463-1318.2008.01605.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION In our hospital, patients above the age of 40 years referred with a change in bowel habit without rectal bleeding undergo a double contrast barium enema (DCBE) ideally within 2 weeks. Results of benign studies are sent to a consultant colorectal surgeon and a routine clinic visit arranged. The aim of this study was to identify whether, following DCBE, patients (i) presented at a later date with colorectal cancer and (ii) needed assessment in clinic. METHOD This is a review looking at all patients who underwent DCBE prior to routine clinic visit between January 2004 and December 2005. Hospital databases were cross-referenced to identify any patients presenting with a new diagnosis of colorectal malignancy between DCBE and April 2007. Clinic letters were reviewed to identify the number of outpatient visits prior to discharge and reasons for continued follow-up. RESULTS During the study period, 521 patients (age range 31-93 years, 316 female) had DCBE prior to assessment in clinic. Diagnoses: cancer 48 (9.2%), polyps 13 (2.5%), colitis 3 (0.6%), no significant pathology 457 (87.7%). Of this latter cohort, 387 (84.7%) were discharged after one clinic visit; 54 (11.9%) attended twice and 11 (2.4%) were seen more than twice. Reasons for multiple attendances were management of haemorrhoids/anal fissure or investigations of unrelated symptoms. No new cancers were identified in this cohort between January 2004 and April 2007. CONCLUSION Double contrast barium enema is a safe screening tool following a '2-week rule' referral with CIBH. Following a report of no significant pathology, there is no need to arrange routine follow-up.
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Affiliation(s)
- O Odofin
- Department of General Surgery, Salisbury NHS Foundation Trust, Odstock, Salisbury, Wiltshire, UK
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Judson E, Nightingale J. An evaluation of radiographer performed and interpreted barium swallows and meals. Clin Radiol 2009; 64:807-14. [DOI: 10.1016/j.crad.2009.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 04/17/2009] [Accepted: 04/28/2009] [Indexed: 12/30/2022]
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Toma J, Paszat LF, Gunraj N, Rabeneck L. Rates of new or missed colorectal cancer after barium enema and their risk factors: a population-based study. Am J Gastroenterol 2008; 103:3142-8. [PMID: 18853981 DOI: 10.1111/j.1572-0241.2008.02199.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Double-contrast barium enema (DCBE) is widely used in clinical practice to detect colorectal cancer (CRC). Our objective was to evaluate the rate of new or missed CRC following DCBE and the associated risk factors in a population-based study. METHODS All patients (> or =20 yr old) with a new diagnosis of CRC between April 1, 1997, and March 31, 2004, in Ontario were identified. Data were extracted from the Ontario Health Insurance Program, the Canadian Institute for Health Information, the Registered Persons Database and the Ontario Cancer Registry. Patients who had a DCBE examination 36 months prior to the diagnosis of CRC were divided into two groups: detected cancers (DCBE within 6 months prior to diagnosis) and new or missed cancers (DCBE 6-36 months prior to diagnosis). Multivariate analysis was used to evaluate factors associated with new or missed CRC. RESULTS We identified 13,849 patients who had a DCBE 36 months prior to the diagnosis of CRC. The overall rate of new or missed cancers following DCBE was 22.4%. Independent risk factors for new or missed cancers were older age, female sex, previous abdominal or pelvic surgery, diverticular disease, right-sided CRC, and having the DCBE in an office setting. CONCLUSIONS Physicians who use DCBE to evaluate the colon must inform their patients that if a cancer is present, there is an approximately one in five chance that it will be missed. Given the recent endorsement of CT colonography by the U.S. Multi-Society Task Force on Colorectal Cancer as an option for CRC screening, it may be time to reconsider the use of DCBE to detect CRC.
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Affiliation(s)
- Jonathan Toma
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Law RL, Titcomb DR, Carter H, Longstaff AJ, Slack N, Dixon AR. Evaluation of a radiographer-provided barium enema service. Colorectal Dis 2008; 10:394-6. [PMID: 18412714 DOI: 10.1111/j.1463-1318.2007.01370.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Radiographers performed and reported 5516 double contrast barium enemas (RDCBEs) over 4 years to October 2001. This study was undertaken to assess the accuracy of RDCBE and the sensitivity for diagnosing colorectal cancer (CRC). METHOD A total of 224 consecutive outpatient RDCBEs were reported; normal (C1), diverticulosis (C2), diverticulosis with filling defect (C3), diverticulosis & other pathology (C4) and abnormal (C5). RDCBEs were then reported by a radiologist (AL, NS) and the two reports compared. Of 450 CRCs, 153 had undergone DCBE; 152 RDCBEs. Reports were analysed to establish concurrence between radiographer and radiologist and final CRC diagnosis. RESULTS By category: C1 - 37%, C2 - 31%, C3 - 21%, C4 - 11%, C5 - 0%. C4s included polyps (50%), cancer (12.5%), disrupted anastomosis (8%) and colitis (4%). There was no discrepancy between RDCBE and radiologist reports. Radiology and CRC diagnosis agreed in 145 of 152 DCBEs. There were three exclusions: DCBEs occurred outside the study period (2), one only with raised possibility of malignancy. Of eight remaining RDCBEs, seven were false negatives and one false positive. Sensitivity score for RDCBE was 94.5%. Double reporting by a radiologist did not improve sensitivity. CONCLUSION RDCBEs are as accurate as those performed by radiologists and have a very high sensitivity for CRC. In a time of ever increasing demands for complex staging investigations for CRC and interventional radiology, the ACPGBI needs to reconsider its guidelines on radiographers not only performing but also reporting DCBE.
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Affiliation(s)
- R L Law
- Department of Radiology, Frenchay Hospital, North Bristol NHS Trust, Bristol, UK
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Law R, Slack N, Harvey R. An evaluation of a radiographer-led barium enema service in the diagnosis of colorectal cancer. Radiography (Lond) 2008. [DOI: 10.1016/j.radi.2006.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Critical analysis of the performance of double-contrast barium enema for detecting colorectal polyps > or = 6 mm in the era of CT colonography. AJR Am J Roentgenol 2008; 190:374-85. [PMID: 18212223 DOI: 10.2214/ajr.07.2099] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of our study was to perform a meta-analysis comparing the performance of double-contrast barium enema (DCBE) with CT colonography (CTC) for the detection of colorectal polyps > or = 6 mm using endoscopy as the gold standard. MATERIALS AND METHODS Prospective DCBE and CTC studies were identified. Percentages of polyps and of patients with polyps > or = 10 mm and 6-9 mm were abstracted. The performance of DCBE versus CTC was determined by separately evaluating each technique's performance versus that of endoscopy, and contrasting the techniques. The I-squared statistic and Fisher's exact test were used for heterogeneity, the Cochran-Mantel-Haenszel and the Kruskal-Wallis tests for correlation, and the A(z) test for comparing pooled weighted estimates of performance. RESULTS Eleven studies of DCBE (5,995 patients, 1,548 polyps) and 30 studies of CTC (6,573 patients, 2,348 polyps) fulfilled inclusion criteria. For polyps > or = 10 mm, a 0.121-per-patient sensitivity difference favored CTC (p < 0.0001; DCBE, 0.702 [95% CI, 0.687-0.715]; CTC, 0.823 [0.809-0.836]). For polyps > or = 10 mm, a 0.031-per-polyp sensitivity difference favored CTC (p < 0.0001; DCBE, 0.715 [0.703-0.726]; CTC, 0.746 [0.735-0.757]). For polyps > or = 10 mm, a specificity difference of 0.104 favored CTC (p = 0.001; DCBE, 0.850 [0.847-0.855]; CTC, 0.954 [0.952-0.955]). DCBE was also significantly less sensitive for 6- to 9-mm polyps (p < 0.001). CONCLUSION DCBE has statistically lower sensitivity and specificity than CTC for detecting colorectal polyps > or = 6 mm.
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Burling D, Moore A, Marshall M, Weldon J, Gillen C, Baldwin R, Smith K, Pickhardt PJ, Pickhardt P, Honeyfield L, Taylor SA, Taylor S. Virtual colonoscopy: effect of computer-assisted detection (CAD) on radiographer performance. Clin Radiol 2008; 63:549-56. [PMID: 18374719 DOI: 10.1016/j.crad.2007.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 11/12/2007] [Accepted: 11/16/2007] [Indexed: 10/22/2022]
Abstract
AIM To investigate the effect of a virtual colonoscopy (VC) computed-assisted detection (CAD) system on polyp detection by trained radiographers. MATERIALS AND METHODS Four radiographers trained in VC interpretation and utilization of CAD systems read a total of 62 endoscopically validated VC examinations containing 150 polyps (size range 5-50mm) in four sessions, recording any polyps found and the examination interpretation time, first without and then with the addition of CAD as a "second reader". After a temporal separation of 6 weeks to reduce recall bias, VC examinations were re-read using "concurrent reader" CAD. Interpretation times, polyp detection, and number of false-positives were compared between the different reader paradigms using paired t and paired exact tests. RESULTS Overall, use of "second reader" CAD significantly improved polyp detection by 12% (p<0.001, CI 6%,17%)) from 48 to 60%. There was no significant improvement using CAD as a concurrent reader (p=0.20; difference of 7%, CI -3%, 16%) and no significant overall difference in recorded false-positives with second reader or concurrent CAD paradigms compared with unassisted reading (p=0.25 and 0.65, respectively). The mean interpretation time was 21.7 min for unassisted reading, 29.6 (p<0.001) min for second reader and 19.1 min (p=0.12) for concurrent reading paradigms. CONCLUSION CAD, when used as a second reader, can significantly improve radiographer reading performance with only a moderate increase in interpretation times.
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Affiliation(s)
- D Burling
- St Mark's Hospital, Harrow, Middlesex, UK.
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CT Colonography for Incomplete or Contraindicated Optical Colonoscopy in Older Patients. AJR Am J Roentgenol 2008; 190:145-50. [DOI: 10.2214/ajr.07.2633] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Effect of directed training on reader performance for CT colonography: multicenter study. Radiology 2007; 242:152-61. [PMID: 17185666 DOI: 10.1148/radiol.2421051000] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To define the interpretative performance of radiologists experienced in computed tomographic (CT) colonography and to compare it with that of novice observers who had undergone directed training, with colonoscopy as the reference standard. MATERIALS AND METHODS Physicians at each participating center received ethical committee approval and followed the committees' requests regarding informed consent. Nine experienced radiologists, nine trained radiologists, and 10 trained technologists from nine centers read 40 CT colonographic studies selected from a data set of 51 studies and modeled to simulate a population with positive fecal occult blood test results: Studies were obtained in eight patients with cancer, 12 patients with large polyp, four patients with medium polyp, and 27 patients without colonic lesions. Findings were verified with colonoscopy. An experienced radiologist used 50 endoscopically validated studies to train novice observers before they were allowed to participate. Observers used one software platform to read studies over 2 days. Responses were collated and compared with the known diagnostic category for each subject. The number of correctly classified subjects was determined for each observer, and differences between groups were examined with bootstrap analysis. RESULTS Overall, 28 observers read 1084 studies and detected 121 cancers, 134 large polyps, and 33 medium polyps; 448 healthy subjects were categorized correctly. Experienced radiologists detected 116 lesions; trained radiologists and technologists detected 85 and 87 lesions, respectively. Overall accuracy of experienced observers (74.2%) was significantly better than that of trained radiologists (66.6%) and technologists (63.2%). There was no significant difference (P=.33) between overall accuracy of trained radiologists and that of technologists; however, some trainees reached the mean performance achieved by experienced observers. CONCLUSION Experienced observers interpreted CT colonographic images significantly better than did novices trained with 50 studies. On average, no difference between trained radiologists and trained technologists was found; however, individual performance was variable and some trainees outperformed some experienced observers.
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Koo BC, Ng CS, U-King-Im J, Prevost AT, Freeman AH. Minimal preparation CT for the diagnosis of suspected colorectal cancer in the frail and elderly patient. Clin Radiol 2006; 61:127-39. [PMID: 16439217 DOI: 10.1016/j.crad.2005.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 06/29/2005] [Accepted: 07/07/2005] [Indexed: 12/30/2022]
Abstract
Colorectal cancer is a common malignancy with an increased incidence in the elderly population. Traditional methods of evaluating this disease have included double contrast barium enema and colonoscopy. Unfortunately, in the frail and elderly patient, these investigations can be difficult to perform and are often not tolerated. Minimal preparation computed tomography (MPCT) of the colon has been suggested as an alternative in this patient population. In this technique, no bowel preparation is used apart from the administration of oral contrast medium. The patient is imaged only in the supine position, without per rectal insufflation of gas or barium. This article reviews the experience to date of MPCT in detecting colonic tumours, and compares its efficacy to the traditional methods. A meta-analysis of the studies allowed estimation of the pooled sensitivity of MPCT to be 83% (95% confidence interval: 76-89%), and pooled specificity to be 90% (95% CI: 85-94%). An added advantage of MPCT is the ability to identify extra-colonic pathology, and this aspect is also reviewed. In addition, the common radiological features and pitfalls in identifying colonic tumours by MPCT are discussed.
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Affiliation(s)
- B C Koo
- Department of Radiology, Addenbrooke's NHS Trust, Cambridge, UK.
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Radiographer and radiologist perception error in reporting double contrast barium enemas: A pilot study. Radiography (Lond) 2005. [DOI: 10.1016/j.radi.2005.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bradley AJ, Rajashanker B, Atkinson SL, Kennedy JN, Purcell RS. Accuracy of reporting of intravenous urograms: a comparison of radiographers with radiology specialist registrars. Clin Radiol 2005; 60:807-11. [PMID: 15978892 DOI: 10.1016/j.crad.2004.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Revised: 11/10/2004] [Accepted: 11/12/2004] [Indexed: 11/19/2022]
Abstract
AIM To evaluate whether uroradiographers trained to do so can interpret intravenous urograms as accurately as radiology specialist registrars (SpRs). METHODS A total of 150 consecutive IVU examinations were prospectively assessed. The preliminary reporter (a uroradiographer, or an SpR in years 1 to 4) wrote a provisional report on each, and all the IVUs were subsequently assessed by an experienced uroradiologist blinded to the provisional report. The uroradiologist's report was taken as the standard. Comparisons between the provisional reports and the standard were made by Pearson chi-squared test (chi(2)). RESULTS Data were available for 149 IVUs. In comparison with the standard report, 1st year SpRs interpreted the IVU series with an accuracy of 76%; the combined group of 2nd, 3rd and 4th year SpRs achieved an accuracy of 88%, whereas the uroradiographers demonstrated an accuracy of 92%. Overall, the difference was to be statistically significant (p=0.021), with a linear trend for increased accuracy with increased experience being highly significant (p=0.006). CONCLUSION The uroradiographers significantly outperformed all the SpRs from years 1 to 4, achieving 92% accuracy in interpretation compared with an experienced consultant uroradiologist.
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Affiliation(s)
- A J Bradley
- Radiology Department, Wythenshawe Hospital, Manchester, UK.
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Jensch S, van Gelder RE, Florie J, Thomassen-de Graaf MA, Lobé JV, Bossuyt PMM, Bipat S, Nio CY, Stoker J. Nonradiologists as second readers for intraluminal findings at CT colonography. AJR Am J Roentgenol 2005; 188:W249-55. [PMID: 17312031 DOI: 10.2214/ajr.06.0451] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES Multiple trials have documented wide interobserver variability between radiologists interpreting computed tomography colonography (CTC) exams. We sought to determine if nonradiologists could learn to interpret intraluminal findings at CTC with a high degree of sensitivity to determine if they could play a role as second readers in interpreting CTC exams. MATERIALS AND METHODS Seven nonradiologists (five medical students, two radiologic technologists) undertook self-directed CTC training using a teaching file of 50 cases; thereafter, each reader blindly interpreted 50 cases with colonoscopic correlation (30 positive, 20 negative). Results were compared with a previously studied cohort of radiologists. The two technologists additionally repeated the exam after 6 weeks of clinical experience. RESULTS The sensitivity of nonradiologists for small (5-9 mm) polyps, large (>9 mm) lesions, and cancers was similar to that of radiologists (0.45 versus 0.63, 0.74 versus 0.71, and 0.80 versus 0.88, respectively). After 6 weeks of clinical experience as second readers, the accuracy of one technologist significantly improved (from 74% to 90%, P = .008), whereas accuracy of the other tended toward improvement (from 74% to 86%%, P = .25). Nonradiologists detected, on average, 6/36 additional polyps (17%) missed by any radiologist, and the sensitivity of 5/7 nonradiologists was significantly greater than at least one of the radiologists (P = .05). CONCLUSION Nonradiologists can perform similarly to radiologists in interpreting intraluminal findings at CTC, with nonradiologist performance improving even after experience with more than 100 cases. Skilled nonradiologists may play a vital role as a second reader of intraluminal findings or by performing quality control of examinations before patient dismissal.
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Affiliation(s)
- Sebastiaan Jensch
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Noord-Holland, The Netherlands.
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Taylor SA, Halligan S, Burling D, Bassett P, Bartram CI. Intra-individual comparison of patient acceptability of multidetector-row CT colonography and double-contrast barium enema. Clin Radiol 2005; 60:207-14. [PMID: 15664575 DOI: 10.1016/j.crad.2004.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 06/10/2004] [Accepted: 07/20/2004] [Indexed: 10/25/2022]
Abstract
AIMS To compare the subjective acceptability of CT colonography in comparison with barium enema in older symptomatic patients, and to ascertain preferences for future colonic investigation. MATERIALS AND METHODS The study population comprised 78 persons aged 60 years or over with symptoms suggestive of colorectal neoplasia, who underwent CT colonography followed the same day by barium enema. A 25-point questionnaire was administered after each procedure and an additional follow-up questionnaire a week later. Responses were compared using Wilcoxon matched pairs testing, Mann-Whitney test statistics and binomial exact testing. RESULTS Participants suffered less physical discomfort during CT colonography (p = 0.03) and overall satisfaction was greater compared with barium enema (p = 0.03). On follow-up, respondents reported significantly better tolerance of CT colonography (p = 0.002), and were less prepared to undergo barium enema again (p < 0.001). Of 52 subjects expressing an opinion, all preferred CT to barium enema. CONCLUSION Patient satisfaction was higher with CT colonography than barium enema. CT colonography caused significantly less physical discomfort and was overwhelmingly preferred by patients.
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Affiliation(s)
- S A Taylor
- Department of Intestinal Imaging, St Mark's and Northwick Park Hospitals, London, UK.
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Bodily KD, Fletcher JG, Engelby T, Percival M, Christensen JA, Young B, Krych AJ, Vander Kooi DC, Rodysill D, Fidler JL, Johnson CD. Nonradiologists as second readers for intraluminal findings at CT colonography. Acad Radiol 2005; 12:67-73. [PMID: 15691727 DOI: 10.1016/j.acra.2004.10.055] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Revised: 10/25/2004] [Accepted: 10/25/2004] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES Multiple trials have documented wide interobserver variability between radiologists interpreting computed tomography colonography (CTC) exams. We sought to determine if nonradiologists could learn to interpret intraluminal findings at CTC with a high degree of sensitivity to determine if they could play a role as second readers in interpreting CTC exams. MATERIALS AND METHODS Seven nonradiologists (five medical students, two radiologic technologists) undertook self-directed CTC training using a teaching file of 50 cases; thereafter, each reader blindly interpreted 50 cases with colonoscopic correlation (30 positive, 20 negative). Results were compared with a previously studied cohort of radiologists. The two technologists additionally repeated the exam after 6 weeks of clinical experience. RESULTS The sensitivity of nonradiologists for small (5-9 mm) polyps, large (>9 mm) lesions, and cancers was similar to that of radiologists (0.45 versus 0.63, 0.74 versus 0.71, and 0.80 versus 0.88, respectively). After 6 weeks of clinical experience as second readers, the accuracy of one technologist significantly improved (from 74% to 90%, P = .008), whereas accuracy of the other tended toward improvement (from 74% to 86%%, P = .25). Nonradiologists detected, on average, 6/36 additional polyps (17%) missed by any radiologist, and the sensitivity of 5/7 nonradiologists was significantly greater than at least one of the radiologists (P = .05). CONCLUSION Nonradiologists can perform similarly to radiologists in interpreting intraluminal findings at CTC, with nonradiologist performance improving even after experience with more than 100 cases. Skilled nonradiologists may play a vital role as a second reader of intraluminal findings or by performing quality control of examinations before patient dismissal.
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Affiliation(s)
- Kale D Bodily
- Mayo Clinic School of Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA
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Ajaj W, Lauenstein TC, Pelster G, Holtmann G, Ruehm SG, Debatin JF, Goehde SC. MR colonography in patients with incomplete conventional colonoscopy. Radiology 2004; 234:452-9. [PMID: 15591429 DOI: 10.1148/radiol.2342032001] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess dark-lumen magnetic resonance (MR) colonography for the evaluation of colonic segments in patients in whom conventional colonoscopy could not be completed. MATERIALS AND METHODS Institutional review board approval and written informed consent were obtained. Within 24 hours of incomplete conventional colonoscopy, 37 patients (22 women, 15 men; age range, 25-63 years) underwent MR colonography. Contrast material-enhanced T1-weighted three-dimensional images were collected after rectal administration of water for colonic distention. Data from MR colonography were evaluated by two radiologists. With a three-point scale, image quality was characterized in terms of colonic distention (1 = good; 2 = moderate, diagnostic; and 3 = poor, nondiagnostic) and presence of artifacts (1 = none; 2 = moderate, diagnostic; and 3 = extensive, nondiagnostic). Depiction of colorectal disease was assessed according to the following colonic segments: cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. RESULTS Four patients had history of colorectal cancer, and each had undergone partial colonic resection of two segments. Hence, 214 segments were evaluated. Conventional colonoscopy failed in assessment of 127 of 214 potentially visible colonic segments in the 37 patients. MR image quality was rated diagnostic in 35 patients and permitted assessment of 206 of 214 potentially visible segments. Nondiagnostic image quality in two patients was attributed to inadequate distention of prestenotic colonic segments owing to high-grade tumor stenosis. All inflammation- and tumor-induced stenoses and all five polyps identified at conventional colonoscopy in poststenotic segments were correctly detected at MR colonography. However, MR-based assessment of prestenotic segments revealed two lesions suspected of being carcinoma, five polyps, and four segments affected by colitis. CONCLUSION MR colonography proved reliable in evaluating the majority of colonic segments inaccessible with conventional colonoscopy. The identification of additional disease at MR colonography underscores the need for a second diagnostic step in the setting of incomplete conventional colonoscopy.
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Affiliation(s)
- Waleed Ajaj
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Vora P, Chapman A. Complications from radiographer-performed double contrast barium enemas. Clin Radiol 2004; 59:364-8. [PMID: 15041457 DOI: 10.1016/j.crad.2003.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2003] [Revised: 11/04/2003] [Accepted: 11/11/2003] [Indexed: 11/20/2022]
Abstract
AIM To determine the types and rates of complications encountered by radiographers when performing double contrast barium enemas (DCBE). MATERIALS AND METHODS Seven hundred and forty-one questionnaires were posted to radiographers who had in the last 5 years attended one of the biannual barium enema training courses. RESULTS Of 741 questionnaires posted 407 (54.9%) were returned completed. Approximately 348,000 barium enema examinations had been performed. Fifty-nine radiographers reported 89 complications, including 13 intra-peritoneal and 11 extra-peritoneal perforations. There were five deaths (mortality 1 in 70,000). Deaths resulted from two of 24 (10%) perforations, two of 45 (5%) cardiac events and one cerebrovascular accident that occurred during an examination. CONCLUSIONS Radiographers have been regularly performing DCBEs for almost a decade. The mortality for radiographer-performed DCBE is similar to that previously reported for radiologists, although a slightly higher rate of perforation is noted and so this is an area where radiographer training should be targeted.
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Affiliation(s)
- P Vora
- Department of Clinical Radiology, St James' University Hospital, Leeds, UK
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Taylor SA, Halligan S, Saunders BP, Morley S, Riesewyk C, Atkin W, Bartram CI. Use of multidetector-row CT colonography for detection of colorectal neoplasia in patients referred via the Department of Health "2-Week-wait" initiative. Clin Radiol 2003; 58:855-61. [PMID: 14581009 DOI: 10.1016/s0009-9260(03)00273-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM Patients referred under the Department of Health 2-week wait initiative with symptoms of colorectal cancer frequently undergo whole-colon examination. We investigated the use of computed tomography (CT) colonography as an alternative to colonoscopy in this scenario. MATERIALS AND METHODS Fifty-four consecutive patients, referred via the 2-week wait initiative and scheduled for colonoscopy, consented to undergo multidetector CT colonography immediately before endoscopy. The site and morphology of any polyp or cancer detected by CT was noted and comparison made with subsequent colonoscopy. RESULTS Colonoscopy detected polyps or cancer in 29 patients (53.7%). CT colonography prospectively detected 18 of 41 (44%) polyps of 1-5 mm, three of four (75%) polyps of 6-9 mm, four of four (100%) polyps 10 mm or larger, and five of six (83%) cancers. The missed cancer occurred early in the series and was a perceptive error. The overall sensitivity, specificity, positive predictive value and negative predictive value of CT colonography for cancer and polyps 10 mm or greater on a per patient basis were 90, 100, 100 and 98%, respectively. CT detected one renal cancer and one colonic cancer, initially missed due to incomplete colonoscopy. CONCLUSION CT colonography is a robust technique for investigation of symptomatic patients. The learning curve must be overcome for optimal performance.
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Affiliation(s)
- S A Taylor
- Department of Intestinal Imaging, St Mark's Hospital, Northwick Park, London, UK
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Halligan S, Marshall M, Taylor S, Bartram C, Bassett P, Cardwell C, Atkin W. Observer Variation in the Detection of Colorectal Neoplasia on Double-contrast Barium Enema: Implications for Colorectal Cancer Screening and Training. Clin Radiol 2003; 58:948-54; discussion 945-7. [PMID: 14654027 DOI: 10.1016/s0009-9260(03)00317-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To assess inter-observer error for the diagnosis of neoplasia on double contrast barium enema (DCBE) in the light of claims that no additional interpretative training would be needed for implementation in a national screening programme. MATERIALS AND METHODS 10 experts, 10 consultants, and 10 experienced trainees each reported 20 DCBE studies, of which two showed cancer, three showed large polyps, four showed small polyps, and 12 were normal. Inter-observer variation was compared using odds ratios with the trainee group as reference (baseline group). RESULTS Experts were significantly more likely to correctly identify neoplasia on DCBE than trainees. The odds of a correct diagnosis for experts were 2.79 (95% CI 2.04, 3.81) for cancer, 2.36 (1.88, 2.97) for large polyps, and 3.50 (1.98, 6.18) for small polyps. While consultants were more likely to correctly diagnose a large polyp than trainees, 1.45 (1.15, 1.84), there was no significant difference between these two groups for the correct diagnosis of either cancer, 1.24 (0.52, 2.96), or small polyps, 1.26 (0.83, 1.90). A cancer was missed by 6 (60%) experts, 9 (90%) consultants, and 8 (80%) trainees. Large polyps were missed by 4 (40%) experts, 5 (50%) consultants, and 6 (60%) trainees. There was no significant difference between any group when false positive diagnoses were considered. CONCLUSIONS There is considerable inter-observer perceptive error for the diagnosis of neoplasia on DCBE. Experts performed significantly better than other observers but the overall standard of performance was poor, even amongst experts.
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Affiliation(s)
- S Halligan
- Intestinal Imaging Centre, St. Mark's Hospital, Northwick Park, HA1 3UJ, London, UK.
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Commentary on: Observer Variation in the Detection of Colorectal Neoplasia on Double-contrast Barium Enema: Implications for Colorectal Cancer Screening and Training. Clin Radiol 2003. [DOI: 10.1016/s0009-9260(03)00318-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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The gastrointestinal advanced practitioner: an emerging role for the modern radiology service. Radiography (Lond) 2003. [DOI: 10.1016/s1078-8174(03)00038-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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N/A. N/A. Shijie Huaren Xiaohua Zazhi 2003; 11:97-98. [DOI: 10.11569/wcjd.v11.i1.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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