CT Colonography: A Cancer Screening We Can All Get Behind

kjchang_photo_This post was contributed by Kevin J. Chang, MD, FSAR, Director of CT and IT at Newton-Wellesley Hospital in Newton, Massachusetts and a member of the American College of Radiology (ACR) Colon Cancer Committee

Each year in March, for Colorectal Cancer Awareness Month, we pause to consider that more than 145,000 Americans are diagnosed with colorectal cancer each year, and over 50,000 die because of late detection. This is all the more tragic when you consider that colorectal cancer is largely preventable—and has a 90 percent cure rate when detected early through recommended screenings.

In 2018, the American Cancer Society published their updated guidelines for colorectal cancer screening, which concluded that adults aged 45 years and older with an average risk should undergo regular colorectal cancer screening every five years. The United States Preventative Task Force (USPSTF) has given colorectal cancer screening an “A” rating. CT Colonography (CTC), often known as “virtual colonoscopy,” is one of the available screening options.

There is widespread agreement among the medical community that the best colorectal screening test is the one that gets done. Virtual colonoscopy does not require sedation. It is over in minutes. You can go back to daily activities and you don’t need anyone to drive you home. These and other unique features of CTC make it an appealing test for many Americans.

The Patient Protection and Affordable Care Act requires private health insurers to provide, without patient cost-sharing, all preventive services that earn grades of A or B in USPSTF recommendations – so CTC is covered by insurers. That’s good news for many.

However, the Centers for Medicare and Medicaid Services has yet to grant reimbursement for Medicare beneficiaries who choose CTC for screening in lieu of conventional screening colonography despite the USPSTF’s previous positive recommendation. That leaves millions of Americans unable to choose CTC, a test that could save their lives. Many of these may forego any colorectal cancer screening at all.

The ACR’s Colon Cancer Committee, along with government relations staff, have been working to pass legislation that would mandate Medicare coverage of CTC. Last year’s bill had 86 co-sponsors, and we anticipate this session’s version of the legislation to be introduced in the next few days.

The ACR also recently submitted a comment letter to the USPSTF regarding the task force’s draft research plan for an upcoming five-year review of its recommendations for colorectal cancer screening.

The bottom line: CTC is life-saving, safe, cost-effective and could reduce the racial and ethnic disparities that plague colorectal cancer screening adoption.

For more information, please consult the ACR’s Colon Cancer Screening Resources and encourage your patients to learn more at RadiologyInfo.org.

  • How are you working to educate patients, primary care physicians and lawmakers about CTC?
  • Join the conversation all month long on social media using hashtags #VirtualCT, #CTColonography and #CRCAwareness, and by following @RadiologyACR on Twitter.

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

The Ethics of Artificial Intelligence

Dr.McGinty(updated)_andcroppedThis post was contributed by Geraldine McGinty, MD, MBA, FACR, chair of the ACR Board of Chancellors

Earlier this week, a consensus draft document dealing with the ethics of AI in medical imaging was posted on the ACR website. I would like to congratulate the authors, listed with their affiliations below, on a collaborative effort to address this important topic.

This was a multi-society effort including the American College of Radiology (ACR), American Association of Physicists in Medicine (AAPM), Canadian Association of Radiologists (CAR), European Society of Radiology (ESR), Radiological Society of North American (RSNA), Society for Imaging Informatics in Medicine (SIIM) and European Society of Medical Imaging Informatics (EuSoMII).

Importantly, the group included trainees, patients and other stakeholders such as an ethicist from MIT.

But despite the wide ranging backgrounds and expert input that created this draft, the writing group and our Societies’ leaders are very clear that this is just that: a draft.

That’s why, having kept the writing group fairly small to facilitate an accelerated turnaround, it’s now critical to get extensive comments from the broader imaging and healthcare ecosystem.

I hope you’ll take the time to read the document and add your expertise and perspective.

We also anticipate that, given the pace of change in this sphere, this document will be a living one.

There is much work to do to ensure that we meet the goal that we’ve set for our ACR Data Science Institute (DSI): to promote safe appropriate data science solutions that improve the care we provide to our patients.

I thank the writing group for their efforts to guide us on this journey.

Judy Birch, B.Ed
Pelvic Pain Support Network, Poole, UK

Consultant Radiologist, Mercy University Hospital, Cork, Ireland
Chair of ESR Quality, Safety & Standards Committee
Representing ECR

Andrea Borondy Kitts, MS, MPH
Patient Outreach & Research Specialist
Lahey Hospital & Medical Center, Burlington, MA
Patient Advocate

Tessa S. Cook, MD, PhD
Assistant Professor of Radiology
Fellowship Director, Imaging Informatics
Co-Director, Center for Practice Transformation
University of Pennsylvania, Philadelphia PA
Representing ACR

J. Raymond Geis, MD
Adjunct Associate Professor of Radiology, National Jewish Health, Denver, CO
Senior Scientist, American College of Radiology Data Science Institute, Reston, VA
Representing ACR

Robert van den Hoven van Genderen, Phd., Msc., LLM
Director, Center of Law and Internet, Vrije Universiteit Amsterdam
Managing Partner, Switchlegal international Lawyers
Chairman, Netherlands Association for AI and Robotlaw

Judy Wawira Gichoya, MBchB, MS
Department of Interventional Radiology, Oregon Health & Science University, Portland, OR
Representing ACR

Jacob L. Jaremko, MD, FRCPC, PhD
Associate Professor, Alberta Health Services
Chair of Diagnostic Imaging, Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
Representing ACR

Marc Kohli, MD
Medical Director of Imaging Informatics, UCSF Health
Associate Professor of Radiology and Biomedical Imaging, UCSF, San Francisco, CA
Representing SIIM

Elmar Kotter, MSc, MD, MBA
Deputy Director and Head of IT, Department of Radiology, University Medical Center, Freiburg, Germany
Associated Professor of Radiology, University of Freiburg, Freiburg, Germany
Chair, ESR eHealth and Informatics Subcommittee
Vice President, European Society of Medical Imaging Informatics
Representing ESR

Steve G. Langer, PhD
Chair, Enterprise Radiology Architecture and Standards, Co-Chair Radiology Informatics Laboratory
Professor of Diagnostic Imaging and Informatics, Radiology Department-Mayo Clinic, Rochester, MN
Representing AAPM

Matthew B. Morgan, MD, MS
Associate Professor
Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT

Erik Ranschaert, MD, PhD
Radiologist, ETZ Hospital, Tilburg, the Netherlands
President, European Society of Medical Imaging Informatics
Representing EuSoMII

Nabile M. Safdar, MD, MPH
Associate Chief Medical Information Officer, Emory Healthcare
Vice-Chair of Informatics, Dept. of Radiology and Imaging Sciences, Emory University, Atlanta, GA
Representing SIIM

William F. Shields, JD, L.LM
General Counsel
American College of Radiology

Jack Spencer, PhD
Associate Professor
MIT, Department of Linguistics and Philosophy, Cambridge, MA

An Tang, MD, MSc
Radiologist, Centre Hospitalier de l’Université de Montréal
Researcher, Centre de Recherche du Centre Hospitalier de L’Université de Montréal, Quebec, Canada
Representing CAR

Carol C. Wu, MD
Associate Professor
University of Texas MD Anderson Cancer Center, Houston, TX
Representing RSNA

All ACR volunteers are subject to the ACR’s Conflict of Interest Process.

All interested parties, including patients, radiologists and others in the radiology community who may be affected by AI technology, are encouraged to comment.

Comments submitted will help in preparing the final version, which is expected to be published in November 2019.

Please submit your comments  by April 15, 2019.