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Moecke DP, Holyk T, Beckett M, Chopra S, Petlitsyna P, Girt M, Kirkham A, Kamurasi I, Turner J, Sneddon D, Friesen M, McDonald I, Denson-Camp N, Crosbie S, Camp PG. Scoping review of telehealth use by Indigenous populations from Australia, Canada, New Zealand, and the United States. J Telemed Telecare 2023:1357633X231158835. [PMID: 36911983 DOI: 10.1177/1357633x231158835] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Telehealth has the potential to address health disparities experienced by Indigenous people, especially in remote areas. This scoping review aims to map and characterize the existing evidence on telehealth use by Indigenous people and explore the key concepts for effective use, cultural safety, and building therapeutic relationships. METHODS A search for published and gray literature, written in English, and published between 2000 and 2022 was completed in 17 electronic databases. Two reviewers independently screened retrieved records for eligibility. For included articles, data were extracted, categorized, and analyzed. Synthesis of findings was performed narratively. RESULTS A total of 321 studies were included. The most popular type of telehealth used was mHealth (44%), and the most common health focuses of the telehealth interventions were mental health (26%) and diabetes/diabetic retinopathy (13%). Frequently described barriers to effective telehealth use included concerns about privacy/confidentiality and limited internet availability; meanwhile, telehealth-usage facilitators included cultural relevance and community engagement. Although working in collaboration with Indigenous communities was the most frequently reported way to achieve cultural safety, 40% of the studies did not report Indigenous involvement. Finally, difficulty to establish trusting therapeutic relationships was a major concern raised about telehealth, and evidence suggests that having the first visit-in-person is a potential way to address this issue. CONCLUSION This comprehensive review identified critical factors to guide the development of culturally-informed telehealth services to meet the needs of Indigenous people and to achieve equitable access and positive health outcomes.
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Affiliation(s)
- Débora Petry Moecke
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Travis Holyk
- Carrier Sekani Family Services, Prince George, Canada
| | - Madelaine Beckett
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Sunaina Chopra
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | | | - Mirha Girt
- 1974Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | - Ivan Kamurasi
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Justin Turner
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Donovan Sneddon
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | | | - Ian McDonald
- University of British Columbia (UBC), Vancouver, Canada
| | | | | | - Pat G Camp
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
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Gutnik L, Bleicher J, Davis A, McLeod MC, McCrum M, Scaife C. American Indian/Alaska native access to colorectal cancer screening: Does gastroenterologist density matter? Am J Surg 2022; 224:965-970. [PMID: 35513914 DOI: 10.1016/j.amjsurg.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND American Indians/Alaska Natives (AI/AN) receive less colorectal cancer (CRC) screening than other populations. Using gastroenterologist (GI) locations as a measure of colonoscopy access, we correlate GI density and AI/AN CRC screening rates. METHODS We identified GIs from the 2016 National Provider Identifier registry, and calculated GI density per 100,000 people. We identified screening, demographic, and socioeconomic variables from the 2016 Behavioral Risk Factor Surveillance System Survey. GI density and CRC screening rates were analyzed with Multivariable Poisson regression. RESULTS In states with GI Density greater than 3.98/100,000, odds of AI/AN CRC screening are 1.27-1.37 times higher than in states below this threshold (p < 0.036). CONCLUSIONS GI density has a limited association on CRC screening, with decrease impact beyond threshold of 3.98 GI/100,000. Minimal access to GIs is important in improving AI/AN CRC screening; however, further research is required to elucidate the most critical factors contributing to CRC screening.
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Affiliation(s)
- Lily Gutnik
- University of Alabama at Birmingham, Department of Surgery, 1807 Seventh Ave South, BDB 515, Birmingham, AL, 35233, USA; University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
| | - Josh Bleicher
- University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
| | - Andrea Davis
- University of Utah, Department of Geography, 260 Central Campus Dr #4625, Salt Lake City, UT, 84112, USA.
| | - M Chandler McLeod
- University of Alabama at Birmingham, Department of Surgery, 1807 Seventh Ave South, BDB 515, Birmingham, AL, 35233, USA.
| | - Marta McCrum
- University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
| | - Courtney Scaife
- University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA; Huntsman Cancer Institute at the University of Utah, Division of Surgical Oncology, 2000 Cir of Hope Dr #1950, Salt Lake City, UT, 84112, USA.
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O'Connor B, Boakye-Ansa NK, Brown CA, Flores EJ, Ross AB, Martin MD, Robbins JB, Narayan AK. Predictors of CT Colonography Use: Results From the 2019 National Health Interview Cross-Sectional Survey. J Am Coll Radiol 2022; 19:874-880. [PMID: 35490713 DOI: 10.1016/j.jacr.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE CT colonography (CTC) is a minimally invasive screening test with high sensitivity for colonic polyps (>1 cm). Prior studies suggest that CTC utilization remains low. However, there are few studies evaluating recent CTC utilization and predictors of CTC utilization. Our purpose was to estimate recent nationwide CTC utilization and evaluate predictors of CTC utilization using 2019 nationally representative cross-sectional survey data. METHODS Participants between ages 50 and 75 without colorectal cancer history in the 2019 National Health Interview Survey cross-sectional data were included. Proportion of participants reporting utilization of CTC was estimated, accounting for complex survey design elements. Multiple variable logistic regression analyses evaluated predictors of CTC utilization. Analyses were conducted accounting for complex survey design elements to obtain valid estimates for the civilian, noninstitutionalized US population. RESULTS In all, 13,709 respondents were included, and 1.4% reported undergoing CTC, of whom 39.9% underwent CTC within the last year, 18.5% within the last 2 years, 13.0% within the last 3 years, 7.8% within the last 5 years, 11.2% within the last 10 years, and 9.6% underwent CTC 10 years ago or more. Multiple variable logistic regression analyses revealed that Hispanic (odds ratio 2.67, 95% confidence interval 1.66-4.29, P < .001) and Black (odds ratio 2.47, 95% confidence interval 1.60-3.82, P < .001) participants were more likely than White participants to undergo CTC. CONCLUSION Survey results suggest that nationwide utilization of CTC remains low. Black and Hispanic participants were more likely than White participants to report undergoing CTC. Promotion of CTC may reduce racial and ethnic disparities in colorectal cancer screening.
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Affiliation(s)
- Brandon O'Connor
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas.
| | | | | | - Efren J Flores
- Massachusetts General Hospital, Boston, Massachusetts; and Associate Chair, Equity, Inclusion and Community Health, Massachusetts General Brigham Enterprise Radiology, Boston, Massachusetts
| | - Andrew B Ross
- Musculoskeletal Fellowship Program Director, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maria D Martin
- Director, Diversity and Inclusion, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jessica B Robbins
- Assistant Residency Program Director and Vice Chair of Faculty Development and Enrichment, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Anand K Narayan
- Vice Chair, Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; and Vice Chair of the ACR PFCC Outreach Committee
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PPV and Detection Rate of mt-sDNA Testing, FIT, and CT Colonography for Advanced Neoplasia: A Hierarchic Bayesian Meta-Analysis of the Noninvasive Colorectal Screening Tests. AJR Am J Roentgenol 2021; 217:817-830. [PMID: 33703913 DOI: 10.2214/ajr.20.25416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND. Noninvasive tests for colorectal cancer (CRC) screening and prevention limit the need for invasive colonoscopy to follow up positive test results. However, the relative performance characteristics of available noninvasive tests have not yet been adequately compared. OBJECTIVE. We performed a systematic review and meta-analysis to compare the diagnostic performance of the available noninvasive CRC screening tests, including multitarget stool DNA (mt-sDNA) testing, fecal immunochemical testing (FIT), and CT colonography (CTC), with an emphasis on comparison of PPV and detection rate (DR) for advanced neoplasia (AN; encompassing cases of advanced adenomas and CRC). EVIDENCE ACQUISITION. After systematic searches of MEDLINE and Google Scholar databases, 10 mt-sDNA, 27 CTC, and 88 FIT published screening studies involving 25,132, 33,493, and 2,355,958 asymptomatic adults, respectively, were included. Meta-analysis with hierarchic Bayesian modeling was conducted in accordance with Cochrane Collaboration and PRISMA guidelines to determine test positivity rates (TPRs) leading to optical colonoscopy, as well as PPVs and DRs for both AN and CRC. Different positivity thresholds were considered for FIT and CTC. EVIDENCE SYNTHESIS. Point estimates (with 95% credible intervals) from pooled Bayesian meta-analysis combining all thresholds for FIT and stratifying CTC results by a polyp size threshold of 6 mm or larger (CTC6) and 10 mm or larger (CTC10) were calculated. TPR was 13.5% (10.9-16.6%) for mt-sDNA testing, 6.4% (5.8-7.2%) for FIT, 13.4% (11.4-15.6%) for CTC6, and 6.6% (5.2-7.7%) for CTC10. AN PPV was 26.9% (95% credible interval, 21.8-33.2%) for mt-sDNA testing, 31.8% (29.3-34.5%) for FIT, 34.4% (27.2-41.0%) for CTC6, and 61.0% (54.0-70.0%) for CTC10. CRC PPV was 2.4% (1.5-3.9%) for mt-sDNA testing, 4.9% (4.3-5.3%) for FIT, 3.5% (2.5-4.8%) for CTC6, and 6.0% (4.3-8.0%) for CTC10. The DR for AN was 3.4% (95% credible interval, 2.5-4.8%) for mt-SDNA, 2.0% (1.8-2.3%) for FIT, 4.8% (4.0-6.5%) for CTC6, and 4.0% (3.0-4.6%) for CTC10. When FIT is restricted to a lower threshold (< 10 μg Hb/g feces), its performance profile is similar to that of mt-sDNA testing, although available data are limited. AN PPV odds ratios (relative to CTC10 as the reference) were 0.24 (95% credible interval, 0.17-0.33) for mt-sDNA testing, 0.30 (0.24-0.45) for FIT, and 0.33 (0.25-0.47) for CTC6. CONCLUSION. Among noninvasive CRC screening tests, CTC with a polyp size threshold of 10 mm or larger most effectively targets AN, preserving detection while also decreasing unnecessary colonoscopies compared with mt-sDNA testing and FIT. CLINICAL IMPACT. CTC performed with a polyp size threshold for colonoscopy referral set at 10 mm or larger represents the most effective and efficient noninvasive screening test for CRC prevention and detection.
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Choukou MA, Maddahi A, Polyvyana A, Monnin C. Digital health technology for Indigenous older adults: A scoping review. Int J Med Inform 2021; 148:104408. [PMID: 33609927 DOI: 10.1016/j.ijmedinf.2021.104408] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/15/2021] [Accepted: 02/01/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Telehealth implementation is a great solution for Indigenous older adults (OAs) due to the rise of chronic disease and other age-related health disorders. Telehealth is a promising option to increase quality of life, decrease healthcare costs, and offer more independent living. OBJECTIVES This scoping review investigated existing telehealth solutions that have been implemented to serve Indigenous OAs. METHODS A structured search strategy was performed on 6 electronic databases: Ovid Medline, Ovid PsycINFO, Ovid Embase, EBSCOhost, Scopus and Cochrane. Studies were included in the review if they contained information on telehealth technologies for Indigenous OAs (aged 65 years and older). Grey literature was also explored in ProQuest Theses and Dissertations, ERIC, Google Advanced and various government websites from Canada, Australia/New Zealand and the USA. RESULTS Twenty six articles were included and reviewed by two assessors. Analysis of the results from five countries revealed eight different types of telehealth solutions for Indigenous OAs. No documented telerehabilitation technologies were available to OAs in Indigenous Communities. Analysis of a broad range of Indigenous OAs with different chronic diseases revealed that they are seeking telehealth technologies for ease of access to health care, increased health equity and cost-effectiveness. Results revealed various advantages of telehealth for Indigenous OAs and barriers for implementing such technologies in Indigenous communities. CONCLUSION The use of telehealth technologies among OAs is expected to rise, but effective implementation will be successful only if the patient's acceptance and culture are kept at the forefront, and if healthcare services are provided by telehealth-trained healthcare professionals.
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Affiliation(s)
- Mohamed-Amine Choukou
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0T6, Canada; Centre on Aging, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada.
| | - Ali Maddahi
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0T6, Canada; Tactile Robotics Ltd., 100-135 Innovation Dr, Winnipeg, MB, R3T 6A8, Canada
| | - Anna Polyvyana
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Caroline Monnin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada
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CT Colonography Performance for the Detection of Polyps and Cancer in Adults ≥ 65 Years Old: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:40-51. [DOI: 10.2214/ajr.18.19515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Reassessing medicare trends in diagnostic CT colonography after achieving CPT code category I status. Abdom Radiol (NY) 2016; 41:1357-62. [PMID: 26880175 DOI: 10.1007/s00261-016-0636-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Compare national trends in utilization and coverage of diagnostic (non-screening) computed tomography colonography (CTC) in the Medicare population before and after achieving Current Procedural Terminology(®) (CPT) Category I code status in 2010. METHODS Claims by provider type and location for diagnostic CTC were identified between 2005 and 2013 using Medicare Physician Supplier Procedure Summary Master Files. Frequencies of billed and denied services were used to calculate denial rates for CTC and abdominal computed tomography (CT). PubMed search for articles with "CT colonography" in abstract or title during 1997-2013 was performed. Publications were recorded yearly and matched to CTC denial rates. RESULTS Annual Medicare claims for diagnostic CTC increased 212% during 2005-2009 in Category III status and increased 27.4% during 2009-2013 after implementation of Category I codes. Claims for abdominal CT rose 13.4% over the same overall period. Denial rates decreased from 70% to 32.8% between 2005 and 2009, and fluctuated between 24.7 and 30.6% thereafter. Denial rates for abdominal CT remained constant (4.1%-4.6%). From 2005 to 2013, services grew most in the private office (1678-7293) and hospital outpatient (1644-6449) settings with radiologists performing 93.3% of CTC. 1037 CTC publications were identified which increased 3567% between 1997 (3) and 2008 (107), plateaued until 2010 (114) and declined thereafter (75 in 2013). CONCLUSIONS Diagnostic CTC grew dramatically from 2005 to 2009, but slowed thereafter; even after achieving CPT Category I code status in 2010. Medicare denial rates declined during early years but later stabilized which paralleled a slowing in new peer-reviewed research. CTC continues to be performed predominately by radiologists in the outpatient setting.
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Noncathartic CT colonography: Image quality assessment and performance and in a screening cohort. AJR Am J Roentgenol 2013; 201:787-94. [PMID: 24059367 DOI: 10.2214/ajr.12.9225] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Cathartic bowel preparation is a major barrier for colorectal cancer screening. We examined noncathartic CT colonography (CTC) quality and performance using four similar bowel-tagging regimens in an asymptomatic screening cohort. SUBJECTS AND METHODS This prospective study included 564 asymptomatic subjects who underwent noncathartic CTC without dietary modification but with 21 g of barium with or without iodinated oral contrast material (four regimens). The quality of tagging with oral agents was evaluated. A gastrointestinal radiologist evaluated examinations using primary 2D search supplemented by electronic cleansing (EC) and 3D problem solving. Results were compared with complete colonoscopy findings after bowel purgation and with retrospective unblinded evaluation in 556 of the 564 (99%) subjects. RESULTS Of the 556 subjects, 7% (37/556) and 3% (16/556) of patients had 52 and 20 adenomatous polyps ≥ 6 and ≥ 10 mm, respectively. The addition of iodine significantly improved the percentage of labeled stool (p ≤ 0.0002) and specificity (80% vs 89-93%, respectively; p = 0.046). The overall sensitivity of noncathartic CTC for adenomatous polyps ≥ 6 mm was 76% (28/37; 95% CI, 59-88%), which is similar to the sensitivity of the iodinated regimens with most patients (sensitivity: 231 patients, 74% [14/19; 95% CI, 49-91%]; 229 patients, 80% [12/15; 95% CI, 52-96%]). The negative predictive value was 98% (481/490), and the lone cancer was detected (0.2%, 1/556). EC was thought to improve conspicuity of 10 of 21 visible polyps ≥ 10 mm. CONCLUSION In this prospective study of asymptomatic subjects, the per-patient sensitivity of noncathartic CTC for detecting adenomas ≥ 6 mm was approximately 76%. Inclusion of oral iodine contrast material improves examination specificity and the percentage of labeled stool. EC may improve polyp conspicuity.
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Cash BD, Stamps K, McFarland EG, Spiegel AR, Wade SW. Clinical use of CT colonography for colorectal cancer screening in military training facilities and potential impact on HEDIS measures. J Am Coll Radiol 2013; 10:30-6. [PMID: 23290671 DOI: 10.1016/j.jacr.2012.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 05/10/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE The National Committee for Quality Assurance developed the Healthcare Effectiveness Data and Information Set(®) (HEDIS(®)) to provide quality measures for the evaluation of standards of medical care across health plans. Screening for colorectal cancer (CRC) has been shown to increase the detection of early-stage disease and reduce mortality. Current HEDIS measures for CRC screening include fecal occult blood testing, flexible sigmoidoscopy, and colonoscopy. The aim of this analysis was to quantify the use of CT colonography (CTC) for CRC screening and demonstrate the potential impact of including CTC as a HEDIS-acceptable screening modality. METHODS Demographic and health care utilization data from the Military Health System Population Health Portal for January 1, 2005, through December 31, 2010, for individuals aged 50 to 75, were analyzed to determine the degree of overall utilization of CTC. Screening compliance for CRC per HEDIS was also estimated, and the incremental impact of adding HEDIS-eligible patients who had undergone CTC as their only CRC screening test was then evaluated for two similarly sized, regional Navy medical centers. RESULTS Across all sites (10 Army, 4 Navy, 3 Air Force), 17,187 CTC studies were performed, with increasing utilization during the 6-year study period. At the two Navy medical centers, screening compliance ranged from 33.8% to 67.9% without CTC and from 33.8% to 84.0% with CTC. CONCLUSIONS CTC is actively being used for CRC screening across military treatment facilities. The inclusion of CTC as a HEDIS-compliant CRC screening test has the potential to significantly increase health care system compliance for National Committee for Quality Assurance CRC screening measures.
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Affiliation(s)
- Brooks D Cash
- Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
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Robbins JB, Kim DH. Computed tomographic colonography: evidence and techniques for screening. Semin Roentgenol 2013; 48:264-72. [PMID: 23796377 DOI: 10.1053/j.ro.2013.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jessica B Robbins
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53729, USA.
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Evolving role of computed tomographic colonography in colon cancer screening and diagnosis. South Med J 2012; 105:551-7. [PMID: 23038488 DOI: 10.1097/smj.0b013e318268c602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Computed tomographic colonography (CTC) is a relatively new imaging modality for the examination of patients for colorectal polyps and cancer. It has been validated in its accuracy for the detection of colon cancer and larger polyps (more than likely premalignant). CTC, however, is not widely accepted as a primary screening modality in the United States at present by many third-party payers, including Medicare, and its exact role in screening is evolving. Moreover, there has been opposition to incorporating CTC as an accepted screening instrument, especially by gastroenterologists. Heretofore, optical colonoscopy has been the mainstay in this screening. We discuss these issues and the continuing controversies concerning CTC.
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Commentary on "Evolving role of computed tomographic colonography in colon cancer screening and diagnosis". South Med J 2012; 105:558-9. [PMID: 23038489 DOI: 10.1097/smj.0b013e318268c62a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bridging the Gap: Using CT Colonography to Improve Colorectal Cancer Screening Compliance. AJR Am J Roentgenol 2010; 195:1107-9. [DOI: 10.2214/ajr.10.5435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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