Computed tomographic colonography (CTC), often referred to as virtual colonoscopy, is gaining a foothold in US hospitals despite lack of Medicare coverage or national consensus on the role of CTC in colorectal cancer screening.
Data gathered from American Hospital Association annual surveys from 2005 through 2008 indicate that 17% of all general, nonfederal hospitals offered CTC in 2008, compared with 13% in 2005. (Number of completed surveys ranged from 3,895 to 4,021 per year.)
The analysts—led by Megan McHugh, PhD, of the Feinberg School of Medicine at Northwestern University in Chicago, Illinois—also conducted telephone interviews with radiology staff at nine hospitals in 2009. Six of the hospitals provided CTC; three did not. The six CTC providers listed several factors that motivated them to offer the service:
- a desire to provide alternative screening options for frail, elderly patients and for patients with failed optical colonoscopy
- long waits for optical colonoscopy
- promising evidence on CTC published in peer-reviewed literature.
The most commonly cited barrier to the use of CTC was lack of reimbursement. Nevertheless, “Growth of CT colonographic services at US hospitals occurred even in the absence of Medicare coverage or agreement among national guideline-setting organizations regarding CTC’s use in screening,” acknowledged Dr. McHugh and colleagues in their report, published in the Journal of the American College of Radiology (2011;8:169-174, http://download.journals.elsevierhealth.com/pdfs/journals/1546-1440/PIIS1546144010004448.pdf).
Dr. McHugh’s team also found that in 2008, 69% of the hospitals offering CTC offered optical colonoscopy services as well. “Almost one-third of hospitals that offer CTC do not offer optical colonoscopy and may not be prepared to provide adequate follow-up for patients with failed CTC,” cautioned the authors.