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Advancing Virtual Colonoscopy to Practice

Advancing Virtual Colonoscopy to Practice. Mark Wax MD, Arie Kaufman PhD, Jerome Liang PhD, and Kevin Kreeger MS. Advancing Virtual Colonoscopy to Practice. Introduction Cited Limitations Approach to Overcoming Obstacles Conclusions.

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Advancing Virtual Colonoscopy to Practice

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  1. Advancing Virtual Colonoscopy to Practice Mark Wax MD, Arie Kaufman PhD, Jerome Liang PhD, and Kevin Kreeger MS

  2. Advancing Virtual Colonoscopy to Practice • Introduction • Cited Limitations • Approach to Overcoming Obstacles • Conclusions

  3. Colorectal Cancer Screening Guidelines(Gastroenterology, 1997) • Screening Modality • Safe • Acceptable • Available • Cost Effective

  4. 3D Virtual Colonoscopy • An alternative endoscopic procedure for examining the inner surface of the human colon • Overcoming disadvantages of existing procedures

  5. Virtual Colonoscopy Procedure 40 sec CT scan of patient’s abdomen Reconstruction of 3D colon model Pre-processing of colon model Interactive navigation inside colon

  6. Advancing Virtual Colonoscopy to Practice • Introduction • Cited Limitations • Approach to Overcoming Obstacles • Conclusions

  7. New England Journal of Medicine(Nov 11, 1999) • “A Comparison of Virtual and Conventional Colonoscopy for the Detection of Colorectal Polyps” H. Fenlon et. al, Boston University • “Virtual Colonoscopy - Promising but Not Ready for Widespread Use” J. Bond, Minneapolis VA

  8. Cited Limitations • Patient Preparation • Bowel Cleansing • Technique • Gas distention of colon • Time to process data/images to determine whether optical colonoscopy is required

  9. Cited Limitations • Image Interpretation • Time consuming • Steep learning curve • Technically inadequate studies • Retained stool/fluid • Contracted segments • Sensitivity/specificity

  10. Cited Limitations • Cost • Expensive scanning hardware • Needs to be less than optical colonoscopy

  11. Advancing Virtual Colonoscopy to Practice • Introduction • Cited Limitations • Approach to Overcoming Obstacles • Conclusions

  12. Bowel Cleansing • Contrast Agents - Barium Sulfate, Gastrograffin • Low residue diet • Electronic Cleansing

  13. Inner View of the Colon

  14. Technique • Colon Distention • CO2 instead of room air • Fast reabsorbtion • Increased patient comfort • Collapsed colon segments • Glucagon • Supine and Prone Views

  15. Image Interpretation • Steep Learning Curve • Similar to any new technology or procedure • Virtual fly-through interface mimics optical colonoscopy

  16. User Interface

  17. Time to Process Data and Interpret Images • Volume rendering with SGI and PC platforms • Navigation • Guided using colon centerline • Interactive with the click of a mouse

  18. 2 1 3 4

  19. Sensitivity/Specificity • Stool/Fluid tagging • Electronic Cleansing • Electronic Biopsy

  20. Costs • Estimated cost - $200-$300 • Less than Medicare reimbursement for Abdominal and Pelvic CT ($410) • Less than Physician charges for optical colonoscopy ($700) • Only requires 10 minutes of CT scanning time • Increased utilization of CT scanners

  21. Advancing Virtual Colonoscopy to Practice • Introduction • Cited Limitations • Approach to Overcoming Obstacles • Conclusions

  22. Virtual Colonoscopy System • Technical Advances • Speed • Automation • Comfort • Cost effective • Future • System still evolving, not yet frozen • Large scale clinical trial

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