title: Screening for colorectal neoplasia with CT colonography: initial experience from the 1st year of coverage by third-party payers.
abstract: OBJECTIVE
  To evaluate our experience in the 1st year of computed tomographic (CT) colonography screening since the initiation of local third-party payer coverage.
  
  
  METHODS
  This HIPAA-compliant study was approved by the institutional review board, and informed consent was waived. Over a 1-year period that ended on April 27, 2005, 1110 consecutive adults (585 women, 525 men; mean age, 58.1 years) underwent primary CT colonography screening. More than 99% were covered by managed care agreements. CT colonographic interpretation was performed with primary three-dimensional polyp detection, and the final results were issued within 2 hours. Patients with large (> or =10-mm) polyps were referred for same-day optical colonoscopy, and patients with medium-sized (6-9-mm) lesions had the option of immediate optical colonoscopy or short-term CT colonography surveillance.
  
  
  RESULTS
  Large colorectal polyps were identified at CT colonography in 43 (3.9%) of 1110 patients. Medium-sized lesions were identified in 77 (6.9%) patients, 31 (40%) of whom chose optical colonoscopy and 46 (60%) of whom chose CT colonography surveillance. Concordant lesions were identified in 65 of 71 patients who underwent subsequent optical colonoscopy (positive predictive value, 91.5%). Sixty-one (86%) of 71 optical colonoscopic procedures were performed on the same day as CT colonography, thereby avoiding the need for repeat bowel preparation. The actual endoscopic referral rate for positive findings at CT colonography was 6.4% (71 of 1110 patients). The demand for CT colonography screening from primary care physicians and their patients increased throughout the study period.
  
  
  CONCLUSIONS
  As a primary colorectal screening tool, CT colonography covered by third-party payers has an acceptably low endoscopic referral rate and a high concordance of positive findings at optical colonoscopy.
authors.affiliation: Department of Radiology and Section of Gastroenterology and Hepatology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA. pj.pickhardt@hosp.wisc.edu
authors.forename: Perry J
authors.initials: PJ
authors.lastname: Pickhardt
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Taylor
authors.forename: David H
authors.initials: DH
authors.lastname: Kim
authors.forename: Mark
authors.initials: M
authors.lastname: Reichelderfer
authors.forename: Deepak V
authors.initials: DV
authors.lastname: Gopal
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Pfau
mesh_terms: D016009:Chi-Square Distribution; D023881:Colonography, Computed Tomographic; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D012017:Referral and Consultation; D012189:Retrospective Studies