The Pros And Cons Of CT Colonoscopy

Optical Colonoscopy was invented in 1969 and has been the gold standard for CRC screening ever since (Wolf, 1989). The gold standard is its 90% sensitivity for adenoma 5mm, and 97% sensitivity for advanced adenoma based on employing CTC as a standard. Colonoscopy is an invasive imaging procedure which visually examines the whole colon and permits the gastroenterologist to perform biopsies on suspicious polyps. A few additional disadvantages to this procedure besides the invasiveness are the prep procedures to cleanse the bowel, the mandatory use of sedatives, patients must have a companion to transport them home, time-consuming, expensive, perforation of the bowel, and bleeding. However, this test is repeated every ten years (Patel & Ahnen, 2015).
In contrast, CT Colonography (CTC) was developed in 1994 (Fajardo et al., 2006) and it is a non-invasive procedure which also observes the whole colon and other organs in the abdomen and pelvic region without the use of sedatives.
Its specificity is 86-95% and the test is repeated every five years. Disadvantages to using CTC is that it may not detect small polyps sizes such as
1 cm, the bowel cleansing process, and radiation exposure (Patel & Ahnen, 2015). The following two pictures compare the 2008 recommendation and the most recent review of the recommendations.
Most patients are unaware of the choice to undergo the CTC procedure thus do not ask for them. It should become common practice for physicians to offer this to their patients. They only offer CTC for screening CRC in frail patients. Providing educational materials and administering patient preference Likert questionnaire to patients will assess the state of mind of their patients. Although the June 2016 recommendation by the USPSTF does not have a snapshot of CTC as a screening method. It is still listed as evidence is not sufficient but it does not advertise that with a recommendation of I as seen in the 2008 snapshot. The USPSTF now believes that any CRC screening test that encourages patients to participate is worth it. (USPSTF,
2016a)

(USPSTF, 2015).

(USPSTF, 2016)

Both OC and CTC procedures have already been implemented. However, for Medicare reimbursement, it was discontinued in 2009. It was stated that not enough studies evaluating CTC were conducted with Medicare age patients (65-74 years) (CMS.gov, 2015). Reimbursement is still under review. More studies are being conducted to evaluate the benefit of reimbursing for this CTC procedure in Medicare-aged patients. However, in twenty-two states reimbursement is the law. It was not explicitly stated, but I believe this is for diagnostic purposes and not screening purposes. A few insurance companies who support this endeavor are Cigna, United Healthcare, UniCare and Blue cross Blue Shield (Bracco, n.d.d ). Moreover, if there was a failed optical colonoscopy, then a diagnostic CTC is reimbursable under Medicare in most states (Bracco, n.d.a). Reimbursements tend to occur if there was already an obstruction. It is not reimbursed for screening purposes which is the purpose of this study. It is the hope that if several Medicare-aged patients choose to undergo CTC screening without any symptoms for CRC then CMS will more likely reimburse for screening services rendered. Possible implementation strategies that the Community Preventive Services Task Forces recommend are employing clinician-patient reminder systems, brochures and videos, decreasing barriers such as establishing extended clinic hours and patients offering feedback to their clinicians about screening tests (USPSTF, 2016a).