title: Automated insufflation of carbon dioxide for MDCT colonography: distension and patient experience compared with manual insufflation.
abstract: OBJECTIVE
  The purpose of our study was to compare the effects of automated and manual carbon dioxide insufflation before CT colonography on distention and patient acceptance.
  
  
  METHODS
  One hundred forty-one symptomatic subjects underwent CT colonography using either an automated device (n = 47) or a manual method (n = 94) for carbon dioxide insufflation. CT data sets were assessed retrospectively in consensus by two blinded observers who graded distention for six colonic segments using a 4-point scale. An additional assessment of the overall clinical adequacy of distention (yes/no) was also made, and any learning curve was sought. Each patient completed a validated 24-point patient questionnaire reflecting patient satisfaction and discomfort. Distention scores, clinical adequacy, and questionnaire responses were analyzed using ordered logistic regression, Fisher's exact test, and the Mann-Whitney test statistic, respectively.
  
  
  RESULTS
  Automated insufflation significantly improved distention overall (p = 0.001). For individual segments, distention was significantly improved in the sigmoid (p = 0.007) and descending (p < 0.001) colons when the patient was supine; and in the sigmoid (p = 0.02), descending (p = 0.001), and transverse (p = 0.02) colons when supine and prone positions were combined. No significant difference was seen in the clinical adequacy of distention, nor was there evidence of any learning curve for either insufflation method. Subjects were more weary after automated insufflation (p = 0.03), but no significant difference was seen for the remaining 23 questionnaire items or for feelings of bloating or discomfort.
  
  
  CONCLUSIONS
  Automated carbon dioxide insufflation significantly improves colonic distention compared with manual insufflation. Benefit is greatest in the left colon, particularly when the patient is supine. Patient acceptance is similar to that for manual insufflation.
authors.affiliation: Department of Intestinal Imaging, St. Mark's and Northwick Park Hospitals, Harrow HA1 3UJ, UJK.
authors.forename: David
authors.initials: D
authors.lastname: Burling
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Taylor
authors.forename: Steve
authors.initials: S
authors.lastname: Halligan
authors.forename: Louise
authors.initials: L
authors.lastname: Gartner
authors.forename: Mehjabeen
authors.initials: M
authors.lastname: Paliwalla
authors.forename: Chandani
authors.initials: C
authors.lastname: Peiris
authors.forename: Leanne
authors.initials: L
authors.lastname: Singh
authors.forename: Paul
authors.initials: P
authors.lastname: Bassett
authors.forename: Clive
authors.initials: C
authors.lastname: Bartram
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D002245:Carbon Dioxide; D023881:Colonography, Computed Tomographic / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007327:Insufflation / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D002245:Carbon Dioxide