Quality Improvement

Radiologists must take an active role in monitoring and improving their individual practice. Regular assessment of the adequacy of patient preparation, distention and tagging should be performed. Further, a log of all cases that are referred to colonoscopy should be performed to assess true and false positives. A simple quality assessment form to be completed after each examination and collated by an assistant can be easily implemented without disruption of clinical workflow. Regular review of all data should be required. Sharing of problems and insights among colleagues can lead to improvements throughout the practice.

In summary, CTC is an exciting technique for the detection of colorectal neoplasia. Careful attention to the technical requirements of the examination (patient preparation, insufflation, data acquisition, reader training and interpretation methodology) is required for a high-quality examination. Performance data indicates that CTC has the potential to detect colorectal polyps with the same sensitivity and specificity as colonoscopy. The indications for the examination are growing, but patients with inflammatory bowel disease and active gastrointestinal hemorrhage should be examined with colonoscopy. Common pitfalls include the lack of attention to the technical aspects of the exam, adequate training and experience, and familiarity with the appearance of flat adenomas. CTC without laxative purgation will likely occur rapidly after the technical requirements of this examination are confirmed. Radiologists must commit themselves to a vigilant CTC quality assessment program to maintain high standards of care.

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